Friday, July 20, 2007

Workers in mining companies are coming down with AIDS

South Africa's mining industry is worth $60bn - BBC 2002

Workers in mining companies are coming down with AIDS
By Anna Stablum
Wednesday, July 11, 2007

LONDON: From Africa to Russia, from Peru to China, mining companies face a problem: The workers who haul up the earth's riches are coming down with AIDS, and it is hampering operations at a time of booming demand for minerals.
"The epidemic is extremely severe, it's worse than any of us admit to, there are a lot of undiagnosed cases that don't get reported," Brian Brink, medical senior vice president at Anglo American's South Africa operations, said.
He said Anglo, the world's fourth-largest mining group, realized it had a problem at its mines 21 years ago when four of its 18,450 South African workers tested positive for the virus.
Over two decades later, with up to one in three infected and South Africa the center of a global pandemic, the firm says its own prevention efforts failed.
"We didn't stop this epidemic. In fact if I was to look back and score ourselves, I think we get zero," Brink said.
In May this year health experts from seven mining giants met for the first time in London, forming a group to come up with an improved strategy on how to halt the spread of AIDS.
"It is a major challenge this industry is rising to meet," said the Britain-based head of operations and safety for Rio Tinto, Richard Gaunt.
Worldwide the disease has killed about 30 million people, double the amount of casualties in World War I. Miners are anxious to build on lessons learned in South Africa to try to stem the tide elsewhere.
The world's fourth-biggest gold producer, Gold Fields, has estimated the total cost from HIV at around $5 per ounce of gold produced in South Africa, and even with gold trading at around $650 per ounce the cost is significant.
AIDS is growing fastest in eastern Europe and Central Asia, where the number of people living with HIV has grown twentyfold in less than a decade, according to the United Nations.
In Russia, the infection rate has more than doubled in two years to 1.2 million in 2005 and in the country's fifth-largest gold mining area, Irkutsk, the rate is more than three times the Russian average, UN data showed.
In India, there are many areas where the population's infection rate is above 1 percent.
"In the early 1990s that is where we were and then it is very difficult to stop," Brink said of South Africa.
The HIV infection rate among South African miners is now nearly double that of the general working population.
In China, the United Nations estimated that 650,000 people were infected in 2005, up by 23 percent in two years. If that spread continues, about 1.9 million Chinese will be infected by 2015.
Other countries "must not fall into the same trap as South Africa," said Lennox Mekuto, health and safety officer for the National Union of Mineworkers in South Africa.
Miners - many of them migrant workers - risk their lives to make money daily, so unprotected sex seems a minor hazard.
Remote mine sites attract sex workers. In the mining province Yunnan in China, sex workers from Myanmar and Vietnam are a high-risk group likely to spread the disease as illegal migrants fear the threat of deportation if they contact public health services.
"This is the nature of our business, it attracts sex workers; whether we like it or not we cannot wish it away," said Stella Ntimbane, group HIV/AIDS coordinator for Gold Fields in South Africa.
Clients of sex workers are a major bridge of HIV transmission to the general population. In 2005 the International Labor Organization estimated that 1.4 million sex workers were forced laborers, without access to treatment.
Russia, China and India and most of Africa face a huge urban-rural divide, limiting rural access to HIV clinics. In often inhospitable mining areas workers and their communities depend on services provided by the mining company.
Poverty adds to the risk of infection and the virus creates a vicious circle, with an estimated cost of 0.5 to 2 percent of the GDP growth in the worst-hit countries.
In India, an influx of multinational corporate investment gives business a great opportunity to play a significant role in the fight to halt the epidemic, said Neeraj Mistry of the Global Business Coalition in New York, a group of 200 companies dedicated to fighting AIDS.
Governments must also act, he said: "In Russia and eastern Europe we are seeing that the governments are a bit slow."
In Russia and neighboring countries, HIV is concentrated within the prison population, sex workers and intravenous drug users - Russia is a main transit route for Afghanistan's opium.
"When I was working in Ukraine, it was well known that on payday miners would spend a lot on drugs and alcohol, and HIV was spreading quite rapidly," the Human Rights Watch director for HIV/AIDS, Joseph Amon, said.
Mistry said China's government was proving more responsive, having learned from its failure to deal with the deadly severe acute respiratory syndrome, or SARS.
"Companies that are now investing in China and working there are working hand-in-hand with the government to get a more comprehensive response in its strategies," he said.
Tina Meng, Beijing business development manager for Anglo American, said: "We do it because we know that if this disease takes root it is really terrible, of course for individuals and the community, but also for a company's operations."
South Africa has brought all stakeholders together and the government, civil society and business have set up a five-year plan to tackle HIV.
Firms are enticing miners to take HIV/AIDS tests by offering prizes, sending mobile treatment units to the bush where sex workers operate and blanketing the region with condoms.
For instance, Gold Fields gives each miner who takes an HIV/AIDS test a lottery ticket, offering monthly prizes of cellphones, televisions and cash, plus a final sweepstake where one worker wins a new pickup truck.
If more governments addressed the pandemic it would secure the sustainability of HIV programs, especially when a mine closes and the company leaves, say South African executives.
"It is certainly one of the biggest concerns for us, again that really points to the importance of a collaborative approach with other partners," said Rob Barbour, medical coordinator in Tanzania for gold producer Barrick Gold.
BHP Billiton, the world's largest mining company, said for every dollar it invests in HIV training, education and medical programs the return is four-fold in terms of benefits such as re-training, absenteeism and productivity.
"There is an overwhelming business case," said Billiton's regional health adviser for southern Africa, Andre van der Bergh. "When we started our HIV program we didn't wait for any government to say yes or no, if there is a risk for an organization we take appropriate action."
Additional reporting by Eric Onstad in Johannesburg, Lucy Hornby in Beijing, Maria Luisa Palomino in Lima and Robin Paxton in Moscow.

AIDS in Africa: Rising above the partisan babble
By Abigail Zuger, M.D.
Wednesday, July 4, 2007

It is hard to remember when AIDS was just a simple epidemic disease. Long ago it exploded into a global rallying cry for ideologues of every stripe, politicizing the science and the social science alike. A small army of academics and consultants now stake careers — and millions of international aid dollars — on specific and often conflicting theories of how to reduce behavioral risks for acquiring and transmitting HIV
Amid the partisan babble, Helen Epstein has for years generated some of the most sensible commentary around, posting dispatches from AIDS-afflicted countries in Africa to The New York Review of Books and other publications. As a scientist morphed into a journalist, Dr. Epstein combines an understanding of the biology of AIDS with a coolly impartial view of the political and social landscape of Africa. She has now assembled more than a decade's worth of reporting into an enlightening and troubling book.
It is a testament to the book's strength that the one scientific goof she makes actually matters relatively little. AIDS drugs, Dr. Epstein says, will never prove the salvation of infected Africans, as they have Westerners, because "HIV mutates and soon becomes resistant to one or all of the cocktail drugs. Therefore, patients must eventually switch to a new cocktail" — and the second-line drugs for this purpose are likely to be unavailable in Africa for years.
Her statement about drug resistance is incorrect. Although resistance does occur and may turn out to be a particular problem in Africa, it is by no means an inevitable outcome of treatment. Studies indicate that antiretroviral drug combinations, used correctly, work about as well in Africa as anywhere else and are just as likely to induce a permanent remission.
That said, however, Dr. Epstein's basic point is quite true: the drugs alone will never save Africa. Prevalence and transmission rates are too high, the health care infrastructure is too weak, there are too many other threatening diseases, and the costs are impossible. Instead, experts agree that hope lies in a still-distant vaccine, and in the "invisible cure" of Epstein's title: dramatic behavioral changes to prevent new infections.
But the problem lies in achieving those changes in cities where almost half the adult population is infected, where rampant poverty turns sex into a form of currency, and children orphaned by AIDS grow up in a chaos that may render them particularly vulnerable to becoming infected as adults.
Interrupting this perfect storm requires a clear understanding of its origins, and we still cannot fully explain why heterosexually transmitted HIV exploded in Africa while remaining confined to very specific communities in the West. Theories abound, and Dr. Epstein does a nice job of reviewing them.
The fiction that Africans are more "promiscuous" than Westerners has been disproved; studies have found that Africans often have fewer sexual partners during their lifetime than Westerners do.
But accepted patterns of sexual activity seem to have ignited the tinderbox in Africa. Sex there crosses social boundaries more often than in the West, and the habit of having concurrent partners — simultaneous long-term relationships in which friendship and trust may thwart routine condom use — means a single person's infection may spread rapidly through a group.
Unfortunately, understanding these patterns makes it no easier to interrupt them. Enter the ideologies: should the catchword of anti-HIV campaigns be "abstinence" or "condoms"? If both, should they be invoked in parallel or in sequence? How vigorously should Western AIDS experts exert their wisdom and dollars to change indigenous African values? And what about religion, fertility, and the fact that, for the destitute, today's food and shelter are invariably more important than tomorrow's health?
Something of a natural experiment addressing these questions took place in the AIDS-devastated countries of East and Southern Africa in the epidemic's early years, as each country embarked on its own independent anti-AIDS campaign.
In the end, there was one clear winner: Uganda. From 1992 to 2003, the HIV rate there fell by two-thirds, Dr. Epstein writes, "a success that saved perhaps a million lives."
Needless to say, scholars now vehemently dispute the cause of Uganda's success. Some credit various religious or bureaucratic initiatives, while others cite the country's relatively stable political scene, relative economic health and relatively strong women's movement.
Dr. Epstein makes a good case for the efficacy of a pervasive grass-roots effort, with ordinary people talking openly about AIDS and caring for the sick and orphaned in hundreds of small community initiatives in a "spirit of collective action and mutual aid." Radio spots on AIDS were accompanied by the beating of a traditional warning drum: "When I was young, I'd lie awake all night if I heard a drum beating that way," a Ugandan man tells Dr. Epstein.
In stark contrast stands the disaster of present-day South Africa. AIDS was a taboo topic there for years. When it could no longer be ignored, the country's president decided to question all basic assumptions about the disease, undermining progress and delaying treatment and prevention programs for still longer. Even now, South Africa's prevention programs seem to Dr. Epstein to lack the simplicity and practicality of the Ugandan efforts, favoring a far less direct, heavily Westernized approach instead.
Throughout the book, Dr. Epstein paints an unforgettably nuanced portrait of Western efforts in Africa: well-meaning, vitally necessary and yet often so misguided. Well-financed Western research projects seduce health care workers from other important work. Western bureaucracy lurches and stalls. And Western money sometimes bypasses the people who need it most, nourishing consultants and middlemen rather than patients.
To describe a rather lackadaisical group of American researchers whose projects in Kampala go nowhere, Dr. Epstein borrows pseudonyms from the children's Babar books. There they are — Celeste, Arthur and Cornelius — pleasant, ineffectual, two-dimensional cutouts pasted into a complex and dangerous landscape they will never quite fathom. It is a sadly inspired touch.

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