The SA mining industry has done what much of the country, NGOs and the government cannot — persuade men to test for HIV and get treatment if they test positive.
This has dropped HIV fatalities in 2019 at Anglo’s mines in SA to zero and substantially reduced TB cases.
What makes Anglo’s achievements unusual is that SA men generally do not access antiretroviral (ARV) medication even after they test positive.
From 2012 until earlier this year, former health minister Aaron Motsoaledi repeatedly begged men to test for HIV. “We have a problem with males when it comes to testing,” he said.
The reluctance of men to be tested and get care shows in SA’s life expectancy figures. SA’s biggest killer remains TB, of which about 75% is HIV related. Men’s life expectancy is 60 years and women’s is 67.
The effect of men undergoing ARV treatment is significant. Someone who is on treatment stops being infectious. This fact drives the UN goals of 90-90-90. The world body wants 90% of the human population worldwide to know their status, 90% of HIV-positive individuals to be taking ARVs and 90% of patients being non-infectious.
Anglo also has the 90-90-90 goals as part of business units performance targets and are linked to CEO Mark Cutifani’s performance assessment, says Tracey Kerr, group head of sustainability at Anglo.
In 2018, 88% of Anglo employees in Southern Africa tested for HIV. The TB incidence last year was 242 per 100,000 of its workers, below the South African rate of 781 per 100,000.
Anglo American has achieved high testing and treatment rates through a “captive audience” of workers and making testing normal. Leaders from Cutifani to Amplats CEO Chris Griffith often publicly undergo tests. This is to keep the message that regular testing just as much part of working life as a compulsory annual fitness test, explains Kerr.
Workers know a positive test does not mean dismissal or ill health, says Dr Tshepo Sedibe, head of health at De Beers.
Anglo American, under former chief medical officer Brian Brink, has always been a step ahead of the government in its response to HIV. It rolled out free ARVs before the government did in 2002 and allowed people to get treatment immediately after testing before the government enacted this policy.
“It’s about making it easy,” says Kerr.
In SA, efforts to get men taking ARVs have often failed.
A four-year trial by the KwaZulu-based Africa Health Research Institute and the French National Research Agency tried to get men to access ARVs. Researchers took HIV tests into people’s homes. From 2012 to 2016, they provided mobile clinics across Hlabisa to make accessing ARVs easier. Only 30% of the men who tested positive accessed ARVs within six months.
Anglo’s HIV response is not perfect, says Charles Mbekeni, head of health at Anglo Platinum. “There are challenges. We still get new HIV cases.”