HIV and AIDS

HIV AND AIDS WORKPLACE PROGRAMME

HIV and AIDS have been managed as an integrated response along a continuum of care (from prevention through to care and support), founded on the larger socio-economic circumstances that are a co-factor in the pandemic and closely linked to strategies for prevention.

THE PEER EDUCATION HIV/AIDS PROJECT


Anglo Platinum, together with its HIV/AIDS partner, CareWorks, is responsible for the largest peer education project in South Africa. At the project's inception in 2007, the plan was to have one peer educator for every 50 employees – meaning that 2,200 peer educators would have been required for the total workforce. Today there are 945 peer educators, but the number is growing.

Prevention is more effective than cure

Eighty per cent of the Company's e orts is targeted at prevention, and only 20% at treatment. This philosophy and approach were part of the reason why Anglo Platinum chose to partner with CareWorks.

Overcoming illiteracy

The storytelling methodology employed by peer educators is designed to overcome the challenge of illiteracy. The approach is characterised by a two-way process in which trainers learn relevant stories from peer educators, who in turn learn how to integrate information about HIV into their stories.

Evolving communication to make the message 'stick'

Internal research findings indicate that peer education is most effective when educators are able to communicate in a way that makes it easy for others to understand and embrace messages.

Information must therefore be accessible, and should relate to day-to-day life. One peer educator came to this conclusion: “I realise now that present, simple, basic issues move from the known to the unknown. Information must not be hard stu but what people live with from day to day. Not too much information! Quality information, not quantity.”

Communication skills first, content second

Initial peer education training takes 40 hours, which are typically divided up over five days. The training is followed by a regular monthly facilitators' meeting, which provides backup and support.

Only 20% of the content mix focuses on HIV and AIDS. Most of it focuses on communication skills: on how to educate, how to present, and how to be a leader and a role model. The logic behind this is that HIV/AIDS material is readily available; what is lacking is the ability to get people to listen, and to come to understand how to shoulder the burden of disclosure.

Behavioural change

A core principle of Anglo Platinum's HIV/AIDS management approach is that one cannot make choices for people. This, naturally, is not without its challenges. Among them are low levels of literacy, beliefs around gender, the fact that operations are usually located in very rural environments in remote areas, and the dynamics typical of the mining industry, which is traditionally class conscious and autocratic.

A key focus for Anglo Platinum has therefore been informed choice. Every day, members of the HIV/AIDS programme team are required to ask themselves three questions: 'Have we informed?', 'Have we educated?' and 'Have we facilitated access to services?'

Gauging the success of peer education

At Anglo Platinum, peer educators are expected to assist in achieving the following objectives:

  • Promoting better HIV/AIDS knowledge and understanding.
  • Promoting better knowledge and understanding of TB and sexually transmitted infections.
  • Creating an environment where people feel comfortable about knowing their HIV status and are empowered to seek the appropriate treatment when needed.
  • Having one-on-one conversations about issues that fuel the HIV pandemic, such as social and economic circumstances and pressures.
  • Referring colleagues to the available resources for assistance with HIV/AIDS.

The programme is also accredited by the Sector Education and Training Authority, which means that it is written around specific unit standards.

The key aspects of the approaches have been:

  • a targeted, and culturally appropriate, information, education and communications strategy (primarily through peer education and support media);
  • increased access to and uptake of all workplace prevention interventions (especially VCT, PMTCT, PEP, STI and TB screening and treatment);
  • strengthened capacity of the health system, NGOs and organisational structures to maximise the effectiveness of programme implementation;
  • improved the care and support of the infected, including access to good nutrition, psychosocial support and treatment, to promote a better quality of life and limit the need for hospital care;
  • programmes aimed at reducing stigma and discrimination by providing information that builds confidence in individuals' ability to protect themselves against infection and the impact of AIDS;
  • a monitoring and evaluation framework that outlines process, outcomes and impact indicators, and also the mechanisms for measuring and reporting on these;
  • the provision of adequate, sustainable and predictable financial resources to maximise efficiencies for better outcomes;
  • continued stakeholder engagement, both internal (unions and associations, management and employees) and external (government, NGOs, traditional leaders); and
  • continued support for community projects (eg home-based care NGOs and traditional health practitioners).

PROMOTIVE CARE

Unions

The revised HIV and AIDS Partnership Agreement was signed off by the unions and Anglo Platinum after a review process.

Total medically boarded employees versus HIV+

Training and education

In 2007, in response to the demand for workplace peer education and informed by the low literacy and numeracy levels of an enormous number of employees, Anglo Platinum initiated the largest peer-education project known in any workplace. We concluded 2008 with the recruitment and selection of over 945 peer educators, who were trained to SETA standards, and implemented a system of reporting, supervision, mentoring and coaching. These peer educators will also be utilised to spread the message about the efficacy and effectiveness of ART, a message that has not yet filtered through to employees.

PREVENTIVE CARE

Voluntary Counselling and Training (VCT) and screening on-site

In conjunction with information and education, VCT was again made available to all employees during their annual medical examinations, significantly contributing to every person being aware of the risk of HIV, TB and STIs and the need for annual testing. The 2008 target of 75% of the total workforce was achieved, with a total of 45,008 full-time employees testing voluntarily. From these tests we deduce that the number of HIV+ employees as a percentage of the total number of full-time employees is 17% for the 2008 reporting period. It should be noted that Anglo Platinum also provides free VCT for all contractors. In the period under review, 36,924 contractors volunteered for testing.

STI testing

A total of 4,037 STI tests were conducted in 2008, with the highest numbers at Amandelbult (1,522) and Rustenburg (1,250), but these figures ought to be far higher. The low numbers at Union, BRPM, LPM and Mogalakwena are also to be addressed. Workers who tested positive were referred for treatment.

Complementing the challenge to positive behaviour change is the ongoing provision and promotion of male and female condoms; advisory and treatment services for sexually transmitted infections (STIs) and TB; post-test support; and follow-up psychological support. In addition to the professional code of ethics, medical staff signed a public pledge guaranteeing confidentiality, which was greatly appreciated by potential patients. All patient records are subject to strict medical confidentiality.

TB screening

Active TB screening is part of the annual medical examinations and is covered under 'Occupational health'.

The wellness programme

By the end of December 2008, 5,043 employees were enrolled in the wellness programme. The programme's objectives are to keep employees healthy and free from opportunistic infections such as TB and pneumonia and to delay ART as long as possible.

PMTCT (prevention of mother-to-child transmission) and PEP (post-exposure prophylaxis)

PMTCT for women giving birth and PEP for health workers and rape survivors have been policy since 2003. However, both were actively promoted for improved uptake in 2008, with updated PMTCT guidelines implemented. A total of 43 women were enrolled into the PMTCT programme and all babies born to these mothers are HIV negative. Testing was voluntary.

CURATIVE CARE

Total employees on ART

Antiretroviral therapy (ART)

At the end of December 2008, 2,314 employees were on ART, of whom 134 are women. Compared with international norms, the programme outcome is good, but we remain concerned with the number of people who have withdrawn from treatment. This will continue to be a high-focus area for the programme.

Unfortunately, and despite the education and information provided some employees are still entering the programme at an advanced stage of HIV infection. Juxtaposed with this is the noticeable health improvement in those who are on treatment, based on increased CD4 counts and lower viral loads.

As part of the agreement with organised labour, the Company agreed to extend ART to spouses in 2006. In the period under review, 86 spouses enrolled, either through the medical scheme or through the HMO; 35 minor dependants enrolled through the medical scheme.

REHABILITATIVE AND PALLIATIVE CARE

Medical board committees are in place at all operations and have resulted in a significant number of medically affected employees being placed in alternative jobs. The number of HIV-related terminations has decreased significantly owing to the roll-out of ART, as reflected above under 'Medical incapacity'.

SKILLS ATTRACTION AND RETENTION

Skills attraction and retention is a material issue for our business and has therefore been included in the 'Our Material Issues' section of this report on page 58.