One of the key focus areas of AngloGold Ashanti’s HIV and AIDS programmes in South Africa in 2009 was to improve enrolment in wellness programmes for HIV and AIDS affected employees. Wellness clinics set up by AngloGold Ashanti in its two main operating hubs in South Africa – West Wits and Vaal River – receive HIV and AIDS patients referred from voluntary counselling and testing (VCT) programmes, peer educators, primary health care clinics, occupational health centres, and regional hospitals. During the course of the year new enrolments improved as did the number of employees starting anti-retroviral therapy (ART). However, a key lesson learned was that although new patients were starting on the programme, others were defaulting from clinic appointments and hence the net increase in total numbers treated was marginal. Our focus in 2010 and 2011 is therefore not only to improve enrolment of new patients, but also to improve retention.

For many years sub-Saharan Africa has borne the brunt of the HIV and AIDS epidemic and consequently prevalence rates in the region are high. The HIV prevalence rate among the 37,500 employees and contractors working at AngloGold Ashanti’s operations in South Africa is estimated to be some 30%. In recent years there has been significant success in raising awareness around HIV and AIDS and in the numbers of employees who undertake voluntary HIV testing. Once employees know their status, those who are HIV positive are encouraged to enroll at wellness clinics. AngloGold Ashanti has offered ART free of charge to employees since 2002 and this treatment is now administered through our wellness clinics with appropriate support and counselling.

Despite the maturity of our HIV and AIDS programmes, we experienced a decline during 2007 and 2008 in the number of new patients enrolling in wellness programmes. Some who tested positive did not enroll into the clinics as they felt they were still well and healthy and did not require medical attention.

The company’s health service therefore set itself the objective of improving referral rates into wellness clinics, so that employees could benefit from appropriate treatment, care and support. In addition it also wanted to trace those who had defaulted from their clinic appointments in the past and re-enroll them into the clinic for continuous care.

Programmes were set up in both the West Wits and Vaal River regions to improve referrals. In the West Wits region the West Wits 50 project was set up with targets and various initiatives in five key areas:

• Improving VCT programmes through awareness, access, and accountability.
• Increasing referrals from health care clinics by tracing new patients, defaulting patients, and giving waiting room talks to raise awareness.
• Use of peer educators at business units to undertake group talks, one-on-one interviews or role plays
• Occupational health centre reviews for those who have defaulted previously from the clinic or those with new symptoms.
• Improving referral rates from hospital wards and out-patient clinics and using a central system to trace patients who booked for clinics but did not attend.

Similar programmes and initiatives were set up in the Vaal River region.

These projects were co-ordinated by AngloGold Ashanti’s health services and required an integrated approach across all business units, working collaboratively with primary health care clinics at our operations, central hospitals and clinic services. In order to be successful, HIV programmes also require sound working relationships between mine management, organised labour and local health services.

During 2009, we saw encouraging progress with an increase in enrolments from an average of 69 per month in 2008 to a sustained level of over 140 new patients per month during the second, third and fourth quarters of 2009. Unfortunately these improvements were not matched by improved retention and therefore the numbers enrolled at wellness clinics rose only marginally, from 3,984 at the end of 2008 to some 4,300 at the end of 2009.

In 2010, therefore, we will focus efforts on improving retention and also understanding the reasons why patients are lost to follow up, with the objective of improving the health of our employees living with HIV and AIDS.