Mining giant fights workplace HIV/AIDS

"Recognition that the HIV/AIDS problem exists is half a mile towards overcoming it. The other half is the course people take as the affected and the infected," said Louis Nchindo, the managing director of the De Beers Botswana (Debswana) Diamond Mining Company, as he presented his company's financial results in July.

When most companies regard HIV/AIDS programmes as a fulfilment of their corporate public relations, Debswana a 50-50 partnership between South Africa's De Beer and the Botswana government, has vested its financial resources on the employee, the endangered species, and has been providing anti-retroviral drugs since 2001.

Being Botswana's largest employer with 11 mining and related operations and the highest contributor to the country's revenues through diamonds, Debswana has not escaped the effects of HIV/AIDS and was standing on the threshold of losing the cream of its staff. Instead of waiting for the unthinkable to happen, the company waged a multi-fronted fight against the scourge.

In a country of 1.6 million people, according to the 2001 Population Census, Debswana's 6000 plus labour force is the highest in the country. Diamonds account for 33 per cent of Botswana's Gross Domestic Product and account for 79 per cent of the country's total exports.

According to Debswana's corporate communication manager, Jacob Sesinyi, an HIV/AIDS infection survey conducted in early 2001 revealed that 35 per cent of its employees were infected with the virus.

All the company operations were experiencing an increase in the total number of sick leave days taken by employees. Between 1997 and 2001 all Debswana operations except at head office in Gaborone, Botswana's capital, experienced an increase in the number of sick leave days taken. HIV/AIDS continued to be the leading cause of death among employees followed by accidents, accounting for 51 per cent of all deaths.

"We took this matter as a crisis and hired an employee counsellor to help in dealing with the scourge," he says, adding that this resulted in the launch of a "total war" against the virus.

In May 2001, the company came up with a programme called Aid for AIDS. Through this programme Debswana trained 200 employees from the five mines as peer educators. While this seemed effective at its onset, the company still had to battle the influx of HIV related deaths.

"Peer educators are effective as many people tend to relate and communicate well with their own peers," says Sesinyi. "But the deaths made us change our approach to HIV/AIDS".

"Our strategy shifted to the fact that while HIV/AIDS is chronic, it is also manageable, and settled for antiretroviral drugs,"

Anti-retroviral drugs cost about P6000 or US$1200 per year per patient. To counter the costs Debswana formed a trust fund under which trustees are appointed from both employer and employee representatives to manage the provision of anti retroviral drugs and monitor the related costs. Three trustees representing the company and two representing employees were appointed in September 2001.

When the drugs became available for employees in Debswana's hospitals, a total of 162 employees came forward and registered for the programme. In the 12 months of 2002 the figure shot up to 314, according to Sesinyi.

He said currently there are 468 employees registered under the antiretroviral programme.

Sesinyi says 320 of the registered employees are receiving treatment while the rest are just being monitored .

"The disturbing observation is that over 50 per cent of employees receiving treatment came in when they were at Stage 4 of the disease, when their immune system had already been severely impaired," he notes. "Only 10 percent of the employees registered at Stage 1 when they had no symptoms and their immune system was minimally impaired."

He adds that 61 of the registered patients are spouses while the rest are employees. A total of 40 couples had registered on the programme together.

Sesinyi says 2003 is the first time in five years that there has been a general decline in sick leave and AIDS related deaths from 51 per cent to 42 per cent.

He attributed the decline in sick leave to better management of sick leave as a result of increased awareness of HIV/AIDS and partly to anti-retroviral therapy.

"The decline in the rate of AIDS related deaths is attributed mainly to the introduction of anti retroviral therapy," says Sesinyi.

He adds: "The registered employees represent 33 per cent of the estimated number of HIV positive employees as derived from a another survey we undertook in 2002. The current strategic objective is to register 50 per cent of the HIV positive employees by 2004."

However, at the current rate of registration the above objective seems distant in attaining according to Tlhotlhokoli Tladi, Debswana's HIV/AIDS co-ordinator.

She says few employees, especially those working in mines a distance from the head office, are not coming forward. "We still have to battle with denial emanating from having HIV/AIDS," she says. "Most employees with evident symptoms rather visit traditional doctors who tell that they have been bewitched."

Tladi cites Orapa Diamond Mine, which is 600 kilometres from Gaborone, which registered only one employee at the end of 2003.

Botswana is battling a threatening HIV/AIDS prevalence rate with latest statistics from its health ministry saying 39 per cent of the 16 to 49 years age group has the virus.

In February this year, with funding from the American government, Botswana became the first country in southern Africa to start providing free anti-retroviral drugs to the people.

Debswana has also taken advantage of the free drugs. In the first quarter of the year it initiated discussions with the health ministry to explore opportunities for collaboration over the roll out of the anti-retroviral programme at its hospitals.

A team of ministry of health officials visited its hospitals and feeder clinics to assess their readiness for the programme. The report that was submitted after the visit stated that in order for Debswana to add effective additional capacity to the Government programme, the existing human resources would require significant strengthening as well as alignment and harmonisation.

Despite these issues, on April 1 the government began rolling out the free anti-retroviral programme to the diamond mining company's hospitals.

"The major advantage to government is the increased access to anti-retroviral without the attendant infrastructural and staff costs. This collaboration is an excellent example of public-private partnership," says Lesego Motsumi, the country's health minister.