Sex talk a setback for Aids
Alfred Mthombeni has no qualms about talking about sex with his three children. ‘If you as a parent are free to talk about sex, your children will be free,” he said, adding that he even takes condoms home from work, where they are distributed freely, and gives them to his children.
He knows his status because he tests for HIV regularly at work. ‘You should just go and test so you know where you stand.”
Mthombeni, who has worked at Anglo Coal’s Greenside Colliery near Witbank for 24 years, benefits from one of the largest HIV/Aids workplace programmes in the world. It has been lauded internationally for its hands-on approach to the virus.
‘We’re not afraid to talk about sex,” said John Standish-White, who heads Anglo Coal’s Aids programme. ‘It’s not a problem. This is a subject that’s been broken over the last five years.” It’s clear that this approach to sex and health is working.
Among its 9 000 employees, the mining house has managed to cut HIV infections by 50% in the past five years, a target government hopes to achieve nationally by the end of 2011. When it comes to testing, it is also ahead of the curve.
Since the beginning of this year 76% of workers have tested for HIV and 94% of staff have had a test at least once in their career. So how do they do it?
When the programme first started in the 1980s, it was mainly concerned with education. But as the epidemic spiralled out of control in the 1990s, the workforce began to feel the impact. T
here were no guarantees that miners hired today would be around to fill more senior posts in 10 years. Those with low CD4 counts were losing up to 15 workdays a month. When they left work or died, the mine paid sickness benefits or pensions to their families much earlier than would have been the case for someone without HIV.
‘Investors were looking at businesses in sub-Saharan Africa and saying, this is a business that’s not going to survive; should we be looking elsewhere?” said Brian Brink, Anglo American’s chief medical officer.
In 2002 the mining house went on the offensive and adopted a holistic approach to the disease. Interventions were scaled up and the company began to offer antiretroviral treatment (ART) to staff.
Today the mines run weekly HIV campaigns, offer free counselling and testing to staff and have nurses provide follow-up visits. In addition, ART has been extended to include workers’ dependants.
Peer educators at each mine encourage others to know their status and door-to-door campaigns are run to improve awareness in nearby communities. Peer educators are aware that HIV must be fought one person at a time.
Sonto Mahaye, a wellness coordinator at Anglo Coal since 1999 and now the regional HIV/Aids coordinator, said convincing people to take an HIV test takes time and patience.
‘Sometimes you feel like you’re explaining and explaining and this person doesn’t want to listen and you want to give up. By the time you give up, the person comes around,” she said.
‘You have to build a one-on-one relationship because the person must trust you. It can take years before they’re willing to be tested.” The company has invested in technology to improve the programme.
Standish-White believes many people talk themselves out of getting tested; they may have a fear of needles, or change their minds before getting their results. A third of people tested in the public health system never return. ‘You’ve got to keep taking the excuses away to make it easier to test,” he said.
Keeping needles out of the process and making sure people get their results quickly helps. Instead of doing blood tests, the company uses the OraQuick Rapid HIV test, which tests for HIV antibodies in the saliva with 99% accuracy.
Taking the test is no more difficult than brushing your teeth—subjects swab the inside of their mouth with a plastic spatula, in similar fashion to a pregnancy test. The spatula is placed in a vial of developer solution and within a few minutes the results appear in the test window, one line for negative, two for positive.
A few kilometres away, at Anglo Coal’s 134-bed Highveld Hospital, the chief medical officer, Jan Pienaar, has deployed The Health Source, an in-house information management system that he helped design.
Pienaar calls The Health Source ‘the most important tool we have right now — because of this unique information system, we’ve been able to track HIV incidence for the past five years.” The system uses biometrics and keeps track of patients’ entire medical histories at the hospital and at mine clinics.
When a patient steps into a doctor’s office, a fingerprint scan brings his history—every visit, diagnosis, X-ray, lab result and prescription—to the doctor’s computer screen.
It aggregates data about the health of mine workers, allowing Pienaar to track changing HIV prevalence and incidence rates across the mine by age, gender or other variables. By understanding where the vulnerable groups are—in this case women and men in their mid-50s—the company can adjust its intervention strategies.
Brink believes that the strengthening of the health system is essential, as it prevents errors and duplication of records and guides health practice. ‘We can’t afford not to get more health for our money. Already more than 50% of our medicine bill goes to ARVs,” he said.
Brink and Pienaar hope to pilot the use of The Health Source in nearby state clinics. Brink said the programme showed that HIV, once a huge threat for the company, can be confronted.
‘If we can do this within the microcosm of our own business, we can easily extend it into the communities around us,” he said. ‘Just as a business should invest in the environment, I believe businesses should also invest in health.”