HCT in the mining industry Chamber of Mines Khanyile Baloyi 12 October 2011

Contents Introduction TB and HIV Stats Health Management Model Challenges 5. Conclusion

Introduction Food for thought “If TB and HIV are a snake in the SADC Region, the head of the snake is here in South Africa in the mines. People come from all over the SADC Region to work in our mines and export TB and HIV, along with their earnings. If we want to kill a snake, we need to hit it on its head”. Dr Aaron Motsoaledi, South African Health Minister, June 2010 Paula Akugizibwe of the Aids and Rights Alliance for Southern Africa (ARASA) stressed that the mining sector, which she referred to as a ‘TB factory’, was over a century behind schedule in its response to TB.

Perception out there: Highest TB and HIV rates We export TB/HIV to the SADC Region Referred to as the TB factory We are over a century behind schedule in our response to TB /HIV.

WHO Global Report 2010 India 2,000,000 167 China 1,300,000 97 Country All cases Per 100,000 population India 2,000,000 167 China 1,300,000 97 South Africa 490,000 978 Nigeria 460,000 297 Indonesia 430,000 187 Pakistan 420,000 232 Bangladesh 360,000 222 Ethiopia 300,000 362 Philippines 260,000 283 DR Congo 250,000 379 Myanmar 200,000 400 Viet Nam 180,000 204 Russian Fed. 150,000 106 Kenya 120,000 301 Uganda 96,000 293 Mozambique 94,000 411 Zimbabwe 93,000 743 Thailand 137 Brazil 87,000 45 Tanzania 80,000 183 Cambodia 65,000 439 Afghanistan 53,000 188 Global total 9,400,000 138 WHO Global Report 2010

Per 100,000 population 978 743 439 411 400 379 362 Countries All cases South Africa 490000 Zimbabwe 93000 Cambodia 65000 Mozambique 94000 Myanmar 200000 DR Congo 250000 Ethiopia 300000

Mining industry 500 000 COM Members 450 000 (90%) COM Members that submitted 349 562 (78%) Number of test done 262 048 (75%)

Factors determining the incidence of TB in a mining community

(Provider initiated CT) Disease Management Legal obligation Voluntary Legal /Voluntary TB and HIV Programmes Wellness Campaigns Awareness, education, nutrition, Testing Medical Surveillance (Provider initiated CT) Disease Management PHC, Secondary & Tertiary Referral Systems Fitness to work assessments Disclosure & clinical assessment Monitor effectiveness of controls TB & HIV Disease Prevention, treatment, care & support Disease Management provided by treating doctors Treatment protocol Determine severity and prognosis of the condition with proper referral systems Prevention Education(induction, posters etc.) Condom distribution

Health Policy Committee Decisions HPC Meeting May 2010 Support the National HCT Campaign Strengthening of company HCT campaigns Integration of TB and HIV Care Test 100% workforce Promote access to HIV/AIDS prevention and treatment services for employees, their spouses, family members and the surrounding communities. Submit data to Nerve centres and SABCOHA Annual Industry surveys on HCT contribution.

HIV/AIDS Intervention Strategy – Business Review – Impact Analysis Not intervening will cost the companies more Intervening too late has opportunity costs that cannot be recovered Savings only happen ‘at scale’ (because of overhead costs) Externalized benefits accrue with high levels of uptake & if ‘done properly’ Sustainability depends on the design and approach (a human development process!)

Other ‘externalized’ benefits Corporate image (e.g. GBC awards) Transformed workplace culture & highly motivated employees on treatment Improved relationships in workplace Safe working environment Mining Charter obligations fulfilled Public-private partnership with Government

Roadmap Towards a “Blue-chip” Response to HIV/AIDS

Take Home message Given the challenges we have with respect to data, we appreciate the initiative by SABCOHA for establishing the web based date tool. Business need to be organized to ensure a coordinated response to the epidemics. Today’s workshop acknowledges the important role of engaging in such a multi-sectoral approach. The availability of data enable the sector to do effective advocacy and beyond.

Two hands clap and there is a sound Two hands clap and there is a sound. What is the sound of one hand clapping?