HIV/AIDS Programme Milestones

A second 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.

A 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.

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

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.

• 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.

• Preliminary review of the Strategy
• Trial audits on the AMS by NOSA

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 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.

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 Communicatio.

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.

• Conducted a Knowledge Attitude and Practices (KAP) study
• 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

The 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

• 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%.

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)

Development of an HIV/AIDS Management Policy

Developed 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.

Appointment of Full-time AIDS Programme Co-ordinators

Appointed 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.

• 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.

• 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