2007
A 2nd Generation Prevalence Survey This involved linking prevalence to behaviour thereby attempting to correlate (high) prevalence to certain behaviour
and attitude patterns to allow further intervention targeting.
21% of permanent employees and 22.6% of contract employees were found to be
HIV positive. The results, although still high, seem to suggest a stabilisation of the prevalence within the Company, a factor that could be attributed to the success
of the Disease Management Programme and the provision of ART and to certain extent
prevention initiatives. However there are pockets of real increase in prevalence
compared to the 2003 within some employee groups/operations, indicative of the need
to sustain efforts to mitigate and minimise the impact of HIV/AIDS on employees,
their families and the Company at large.
2006
Strategic Focus Areas
- Continued prevention, care and support of employees and defined dependents infected with HIV
- Greater involvement of people (employees) living with HIV/AIDS (GIPA) as advocates of the programme and to diffuse perceived stigma and discrimination
- Community Partnerships (Corporate Social Investment): a way of extending the Company’s response strategy to surrounding communities through partnerships
- Integration into a Wellness programme as a way of de-stigmatising HIV/AIDS
2005/6
HIV/AIDS strategy Review – the review process included an Employee Perception
Survey to solicit views and opinions about the current HIV/AIDS programme from Debswana employees as the main beneficiaries of the programme.
2005
- Awarded 5 ribbons on the AMS by NOSA at Orapa & Letlhakane - first company to receive 5 ribbons
- External Review of the HIV/AIDS Strategy
- Conducted first Employee Perception survey regarding the Company’s HIV/AIDS programme.
2004
- Preliminary review of the Strategy
- Trial audits on the AMS by NOSA
2003
Prevalence Survey –A third prevalence survey was conducted in June 2003 using
both saliva and blood.The introduction of blood sampling was done to determine the
incidence rate and to get more information on the stages of infection in order to enable
better planning.The results showed a high correlation between the saliva and blood
tests at 19.9% prevalence for saliva and 20.1% for blood.
The rate of new infections stood at 3% among Debswana employees while for contractors it was 5.4%.
Private Public Partnership - In April 2003, the Company entered into a partnership with the Ministry of Health to make the Company healthcare facilities and professionals at the Jwaneng and Orapa Mine hospitals, available to the public for the Masa programme (Government Antiretroviral Therapy Programme).
This partnership meant that HIV positive children (then) and relatives of employees
could access ART Company hospitals under the Masa programme. This partnership has
enabled Government to increase ARV access to citizens in communities surrounding the
Company operations without incurring the infrastructural and staff costs.
Debswana constructed a new, purpose-designed facility within the Jwaneng mine hospital, referred to as the infectious disease care centre (IDCC) to cater for the public patients.
2002
KAP Study–The results still showed extensive HIV/AIDS knowledge base among
employees. However using that knowledge to manage risky bevahiour and change into desired and appropriate behaviour remained a challenge.
Debswana’s HIV/AIDS Strategy Beyond 2000
Whereas the HIV/AIDS activities in Debswana were previously derived and driven by the strategic issue on Health and Safety, the Company’s strategic plan review of 2000 identified HIV/AIDS as an area of strategic importance, which requires separate attention.
The new HIV/AIDS strategy, which includes a mission and vision for HIV/AIDS focused on the following areas, which are strategic to the management of HIV and AIDS: Epidemic Containment, Living with AIDS, Cost Containment, Stakeholder Engagement, Evaluation and Monitoring as well as Communication.
Stakeholders Engagement Policy to Ensure Compliance by All
In keeping with the strategy of engaging stakeholders in the fight against HIV/AIDS,
Debswana has developed a policy which compels companies providing goods and services to Debswana to support Debswana’s initiatives and to have a workplace policy and programme which will be audited on a regular basis.
This policy forms part of tender committee procedures and requirements.
2000
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Conducted actuarial studies on detailed costs of providing ART and appropriate funding vehicle
-
Conducted an Institutional Audit
Developed an HIV/AIDS Strategy
Developed and issued a Policy on Stakeholder Engagement
-
Conducted the 2nd KAP study
-
Registered an ART Trust Fund to manage the provision of ART and related costs including monitoring costs
-
Developed an AIDS Management System (AMS) in partnership with NOSA
-
Debswana case study published in the UNAIDS Best Practise series
Pre-Investment Testing - Following the results of the prevalence study in 1999,
the Company adopted a policy of testing all scholarship and apprenticeship candidates
effective from 2000.
This policy was adopted in view of the high prevalence levels in the Company and the
fact that the apprenticeship and scholarship schemes are the main sources of skilled
manpower for the Company. Apart from safe guarding the Company’s investment, the policy is seen as an incentive for young people to remain HIV negative.
The exercise meets all the requirements of informed consent as well as pre and post test counselling.
Evaluation of HIV/AIDS Policies and Programmes - A Company wide evaluation of current HIV policies and programmes was undertaken at all Debswana operations. The evaluation, which included a Knowledge, Attitude and Practice (KAP) study, was done in order to provide input into future prevention and education strategies.
The KAP study- showed that knowledge among employees was quite high at 94% but a significant percentage (26 – 46%) of both men and women respondents still maintained multiple partners and practised unsafe sex as determined by condom use. Development of appropriate programmes to address behaviour change was clearly the direction to take going forward.
HIV/AIDS Institutional Audit - to obtain a measure of the Company liabilities and future costs, by examining the implications of the increase in morbidity and mortality to the Company.
One of the key outcomes of the audit was the development of guidelines for the
identification and analysis of critical posts, i.e. those jobs core to the diamond mining
and processing business. These critical posts were to be targeted for specific risk reduction strategies including training and replacement strategies.
An Actuarial study - to determine the feasibility of providing ART. Although major
findings showed that the financial cost of providing ART exceeded the cost saving to the Company, and that taking such a move could not be justified on financial grounds, Debswana believed that provision of ART was a business imperative because it would result in extended productive lives of employees
1999
- Conducted the first HIV/AIDS Prevalence Study
- HIV Prevalence Survey – a voluntary anonymous study using saliva tests was conducted to establish prevalence levels by grade and age at all Debswana operations, Head Office and BDVC in response to the then experienced impact of increased morbidity and mortality among the workforce and to assist in planning for future risk reduction strategies.
- The results showed that 28.8% of the 5,261 employees were infected with the virus with prevalence at every level of the organisation and the age group 30 – 34 the hardest hit with a prevalence rate of 36.9%.
1996
- Issued an AIDS Management Workplace Policy which was revised in 2000 to provide for pre investment testing and in 2001 to include Anti- Retroviral Treatment (ART)
1995
Development of an HIV/AIDS Management Policy as a basis for the education programme and related activities and also to articulate the Company’s position and practices regarding employees who were infected with the virus.
1991/92
Appointment of Full-time AIDS Programme Co-ordinators as full time resource persons at Jwaneng and Orapa and Letlhakane mines to formalise the education programme and to take responsibility for the dissemination of information on the national education and preventative initiatives and to integrate these into Company activities in addition to coordinating the activitiesof the various support structures such as peer educators, counsellors and various AIDS committees.
1991
- Launched a major HIV/AIDS campaign that embraced accepted Information, Education and Communication strategies
- Launch of a major campaign which embraced the accepted IEC strategies. This was following a small-scale KAP at Jwaneng in 1990 which highlighted the need to extend the
education to the rest of the workforce.
1988/89
- AIDS Education and Awareness in response to the first AIDS cases seen at the Jwaneng Mine hospital in 1987 and Orapa Mine hospital in 1989.
- Started an HIV/AIDS Workplace Programme
Successes and Achievements
The past years have witnessed continued positive impact on the related morbidity and
mortality. To date, a majority of the AIDS related indicators tracked and monitored
(deaths, ill-health retirements and productive time lost to illness (sick leave days taken) continue to register downward trends and negative growth.
Present Challenges
Our programme success is not without challenges. The following are some but a few of the immediate challenges we are facing
- The strides made in mitigating the HIV/AIDS risk may breed complacency and a false sense of security. Recreating the HIV/AIDS burning platform in this environment
of ‘success’ becomes a serious challenge to contend with
- Balancing time for HIV/AIDS interventions in the workplace and production demands
- Sustaining prevention initiatives in the ART era and keeping HIV negative
people negative
- High HIV/AIDS knowledge with minimal translation into visible behaviour change, de-stigmatization and normalization of HIV/AIDS
- Scaling up VCT/partner disclosure and registration on the ART programme
- Possible onset of long term complications of ART? ‘Pill’ fatigue? The fact that ART only prolongs life but does not cure AIDS?
- Late registration on the disease management programme for care and support
- Ensuring adherence to treatment
- Forging value –adding partnerships and collaborations with the community in prevention strategies/programmes without the sense of being paternalistic ‘fathering’
In line with the philosophy of extending productive lives of its employees, Debswana will continue to enhance its HIV/AIDS programme.
Learning Points
In the time that we have been involved in this fight, we have learned that
- HIV/AIDS is a business issue because it impacts on the performance of
individual employees, which in turn impacts productivity of the Company.
It therefore requires:
-Active involvement and visible support from top management with real commitment not compliance.
-Managers who are AIDS competent. No serious organisation entrusts their finances to a financially incompetent management team.
-Adequate systems to measure and monitor AIDS impact on the business both before and after interventions.
-Adequate resources at appropriate levels to manage its impact and support those who are infected (budget and people)
-Continuing education for support staff and benchmarking opportunities.
- The impact of HIV/AIDS on the business can be minimised through structured workplace programmes.
- Collaboration is key - companies do not exist in isolation, they must join
hands with others.
- It is not enough to monitor costs alone and it is equally important to
identify critical posts in order to target them for specific risk reduction strategies.
- Engagement of the Unions must be on a joint problem solving approach.
- Confidentiality can be a disabling concept, which needs to be defined in context and managed consistently across the Company.
- For sustainability purposes, it is critical to put equal focus on prevention efforts.
- Change of behaviour requires more targeted and individualised communication.
Support structures and prevention programmes must address the various interest groups i.e. they must be age and gender sensitive (not neutral).
