Solly Matjeke spends much of his free time answering questions about HIV/AIDS. A committed member of the National Union of Mineworkers (NUM) and a nurse at Kloof Mine 7 Shaft, Matjeke decided to become a “peer educator” to try to prevent his colleagues from contracting the disease.
“People have got difficulty in accepting HIV. They need educating,” says Matjeke.
“They come to me, maybe three in a day, to ask about this disease. Some ask me privately for an HIV test, but those are still very few. People are still afraid of the test.”
Kloof’s owner, Gold Fields, has given the peer educators a number of offices on the Carletonville mine. This morning, three emaciated men wait to speak to one of the educators.
Gold Fields has implemented a vigorous prevention programme driven largely by peer educators ‘ ordinary workers who have been trained to explain how HIV/AIDS is transmitted and how it can be prevented. Many of the volunteers are active union members. Most believe that workers believe information more when it comes from their friends and colleagues.
Despite the severity of the HIV/AIDS pandemic, not a single mining house has signed a company-wide general HIV/AIDS policy with its trade unions. However, Gold Fields aims to be the first to do so within the next week.
Gold Fields’ HIV/AIDS manager Stella Ntimbane is passionate about her job. “I eat, drink and sleep AIDS,” says the former nurse. “What we are saying is that there must be Gold Fields after HIV/AIDS. AIDS must not kill Gold Fields.”
But AIDS is killing Gold Fields workers, sometimes at a rate of 10 a month, says Ntimbane.
“There was an accident at a mine in the Free State a few months ago and five workers died. That was on the news and the workers wanted to arrange buses to go there. I said to them, ‘what about the workers who die of AIDS every month? What are you saying about them?’” says Ntimbane.
While the exact cost of HIV/AIDS to the mining industry is difficult to determine, Gold Fields has pegged the figure at around $10 per ounce of gold. Harmony’s Dr Tony de Coito says a terminally ill mineworker has probably cost the company R60 000, taking into account absenteeism, health care benefits loss of production, death benefits and training costs.
Anglo American’s Dr Brian Brink says that while actuaries do modelling for his group, he has little faith in the figures as there are so many variables.
Chief amongst the problems is the lack of accurate information about exactly how many mineworkers are HIV positive. Figures range from 0.6% (Namaqualand-based mines) to around 33% of the workforce.
But without widespread testing, accurate figures are impossible to compile. Without accurate figures, future planning is difficult.
The National Union of Mineworkers’ (NUM) publicity officer, Moferefere Lekorotsoana, says that employers test their workers for HIV whenever they go to mine health facilities, “even if they’ve got the ‘flu”. However, even if this is so such testing will not yield accurate figures as the sample will not be representative of the entire workforce.
The major mining groups all have HIV/AIDS campaigns based largely on prevention and a wellness programme for HIV positive employees.
The prevention programme is standard at most mining houses, based largely on HIV/AIDS education and condom distribution. However, Brink stresses that voluntary HIV counselling and testing (VCT) needs to become a more prominent part of the prevention strategy.
For the past seven months, AngloGold has been running a VCT programme staffed by 20 counsellors. Some 754 workers from the company’s three regions volunteered for the test during the first three months.
“There has to be behaviour change. For this to happen, people need to take personal responsibility for their health by going for an HIV test,” says Brink.
Two flagship mine prevention programmes ‘ Lesedi in Virginia, Free State, and Mothusimpilo in Carletonville ‘ were the first to recognise that the HIV campaign had to extend to communities around the mines.
Both Lesedi, administered by Harmony, and Mothusimpilo, administered by Gold Fields, targeted both mineworkers and the communities around the mines, particularly sex workers.
“Sexually transmitted diseases dramatically increase the spread of HIV,” says Dr Tony de Coito, Harmony’s manager of health services. “So we put together an intervention in Virginia that dramatically reduced sexually transmitted diseases both in our workforce and the women surrounding the mines. Ulcers reduced by about 90% and discharge diseases by 60-70%.”
One of the key components of both Lesedi and Mothusimpilo is Periodic Presumptive Treatment (PPT) in which “high risk” people are treated monthly with antibiotics for sexually transmitted infections, whether they show symptoms or not.
In 1996, 15% of Harmony’s Free State workers used condoms. Today surveys show condom use is at 70%, says De Coito.
“Our workers are changing their behaviour, but not fast enough,” says De Coito. “We need 90% plus condom use.”
Such has been the success of the two projects that other “clones” have been set up in Welkom (Lechabile project), Westonaria-Randfontein (WRAP project) and Evander (the Powerbelt project).
Wellness programmes for HIV positive employees involves treatment for opportunistic infections at mine clinics and hospitals as well as encouraging them to live healthily.
“Once a mineworker has been diagnosed with HIV, he is enrolled in a wellness management programme,” says Ntimbane. “He must see a doctor every three months so we can pick up any opportunistic infections very early. We also give them a concoction of vitamins including Moducare.”
However, anti-retroviral treatment remains out of reach for most mineworkers as companies grapple with the question of cost. However, Anglo American intends running pilot studies to see whether such treatment is feasible.
“The subject of anti-retroviral drugs is very complex and difficult,” said Brink. “We have to acknowledge that the drugs work. [But] once a person starts on the drugs, we have to be committed to seeing them through as long as they live.
“When you start adding up the lifetime cost of these drugs, this adds up to an intervention that is extremely costly.”
A fairly new addition to mine HIV/AIDS campaigns is a home-based care component for mineworkers who opt to die at home. The Employment Bureau of Africa (TEBA), the old recruiting arm of the mines, has recently been transformed into a development agency headed by former NUM head James Motlatsi. One of TEBA’s functions will be to follow up on mineworkers at their homes in rural areas to ensure they are getting some care.
The Bambisanani project in the Eastern Cape, which co-ordinates care for HIV positive mineworkers and their families, is one of the leading mine-linked home-based care programmes.
According to a recent agreement negotiated between the unions and the Chamber of Mines, workers who are incapacitated (including those with AIDS) get death benefits if they die within a year of leaving the mine. Their termination package amounts to three years’ salary minus their provident fund contribution.
Ntimbane says Gold Fields is still discussing whether to give terminally ill workers all their benefits when they decide to go home as this could mean that their families get nothing when they die.
HIV/AIDS has clearly been identified by mine management as a major threat. However, the flagship projects need to become standard practice and factors that make mineworkers so vulnerable to unsafe sex ‘ most notably single sex hostels ‘ need to be addressed more vigorously.