HIV/AIDS

Impala Medical Services, RustenburgImpala, Rustenburg
Highlights Disappointments Opportunities
  • Greater co-operation between management and unions allowed better implementation of the programmes.
  • Kaelo VCT programme at Impala Rustenburg was highly successful.
  • A 74% increase in the number of people participating in VCT and Wellness Programme, including ART.
  • Prevalence levels still rising, and high-risk behaviour continued among certain employees.
  • Focus on reducing new infections and improving enrolment in and adherence to Wellness programmes (including ART).
  • Improving compliance with ART regimen.

Management approach

The management of HIV & AIDS remains a major focus area for the group’s health services and line management alike, as the spread of the disease and its impact continues at both the South African and Zimbabwean operations. Importantly, it is seen to be part of a broad health care management strategy that includes other chronic lifethreatening illnesses. While HIV & AIDS is not an occupational illness, its management is catered for within the occupational health care provision services of the company.

Medical care

All employees and their dependants have access to medical care through company facilities or contracted service providers. It is known that, in respect of HIV & AIDS, some employees prefer to make use of alternate private or state-owned facilities. The statistics reported reflect only those that are gathered for employees who make use of company facilities and the number of employees and dependants who receive HIV & AIDS treatment from outside facilities is therefore not known.

Cost to the company

The cost of HIV & AIDS to the company is not simple to quantify. There is a direct cost to the company in terms of medical treatment and prevention programmes, and also an impact on productivity in the workplace and on the replacement of skills in an industry where skills are in short supply. There is also a close relationship between pulmonary TB and HIV & AIDS. The presence of both infections among the workforce places a significant burden to both the health and well-being of employees and also on health care services.

Union involvement

As with other elements of health and safety, the involvement and support of the group’s unions is an important feature of the HIV & AIDS management programmes. Agreements are in place with unions regarding the management of HIV & AIDS, and these make provision for joint management committees. Through intensive effort, a better understanding and agreement was reached during the year on common objectives and strategies, and the functioning of these committees, particularly at Impala in Rustenburg, has improved.

All employees and their dependants have access to medical care through company facilities or contracted service providers

Programme

There are three broad areas within the company’s programme:

  • through awareness and education programmes, and, in particular, the use of peer educators, efforts are made to prevent the further spread of the disease to employees, their families and members of the community. A key component of this initiative is to encourage employees to know and understand their HIV status through the Voluntary Counselling and Testing (VCT) programmes.
  • through medical care, to increase registration on and compliance with the company’s wellness programme of those who have been diagnosed HIV positive through the VCT programme. The provision of antiretroviral treatment (ART) to employees is a vital component of this programme.
  • to extend the HIV & AIDS programmes into the communities in the areas in which the group operates and where employees live by funding and partnering with NGOs who provide HIV-related services.

Performance in FY2009

Based on estimates, independent analysis and limited testing, it is estimated that the prevalence levels among the company’s workforce is in the region of 23%. There is little scope for undertaking a broad, anonymous, compulsory prevalence testing programme as unions are opposed to this. The results of a VCT campaign undertaken in December 2008 at Impala Rustenburg provided some cause for concern.

The total cost of the HIV & AIDS education and medical programme for employees in Rustenburg was approximately R18.5 million in FY2009. This was R16.1 million in FY2008.

Education and training

Education and training initiatives continued both in planned, formal programmes (such as induction training) and through the peer educators programme. Peer educators have been appointed and trained at all operations.

Condoms and femidoms are provided by the company to employees and community members.

Testing and care

VCT is available at all of the company’s operations. VCT performance in FY2009 was boosted by a successful VCT campaign undertaken at Impala Rustenburg in December 2008. A total of 6 263 employees underwent testing during the year (FY2008: 3 609 tests).

Total number of people on VCT at Implats
OperationFY2009FY2008
Impala Rustenburg5 5952 808
Impala Springs3474
Marula119291
Mimosa11492
Zimplats401344
Group6 2633 609

* Includes dependants and contractors

VCT at Impala Rustenburg

The Kaelo VCT programme undertaken at Impala Rustenburg in December 2008 was intended to boost and popularise VCT. It was deliberately sub-contracted to a third party in order to cover any employees who may have been reluctant to undergo testing at our in-house facilities.

The campaign was considered to be highly successful, with 2 425 tests done, and 354 new cases diagnosed. Of significant concern, however, were the results of the behavioural study that was undertaken at the same time as the VCT campaign that indicated:

  • Continued casual sexual encounters reported by some employees, despite the massive public and private education campaigns on the epidemic; and
  • The relatively large number of people (20%) reporting having had multiple sexual partners in the past year.

The findings of this survey are being incorporated into future education campaigns.

Employees who are HIV-positive are strongly encouraged and advised to participate in wellness programmes so as to delay the progression of HIV. These programmes are available at all operations through the company or through the various medical aid schemes. The number of employees currently receiving treatment through external medical schemes and the Department of Health facilities is not known. The group also provides wellness and ART directly to employees through its own facilities. During the year, 1 196 new patients were enrolled in the group’s wellness programmes, with a cumulative total of 3 390 patients on the programme at year-end (FY2008: 2 734 patients). This increase is a consequence of the focus to have all HIV positive patients diagnosed and onto treatment programmes.

Number of people on VCT at Implats
Wellness programme at Implats
 Total number of people
on Wellness programme
OperationFY2009FY2008
Impala Rustenburg2 9332 336
Impala Springs2712
Marula329277
Mimosa2324
Zimplats7885
Group3 3902 734

ART programme at Implats
Total number of
people on ART
Total number of
new patients on ART
OperationFY2009FY2008FY2009FY2008
Impala Rustenburg1 122631518272
Impala Springs10640
Marula191271
Mimosa54253715
Zimplats51342619
Group1 256708592307

The provision of ART to all employees and their dependents through the group’s medical schemes remains a vital component of the Wellness Programme. In FY2009, 592 new patients started on the ART programme, with a total of 1 256 employees and dependants on ART through the group’s medical facilities at year-end (FY2008: 307 new patients and 708 on the ART programme). Note again the potential for under-reporting, as those receiving ART through external medical aids are not known.

Individual patients’ adherence to the ART regimens continues to be a challenge that needs to be closely monitored and managed, and greater effort was placed on this aspect of the programme during the year. Patients often find it difficult to comply with the multi-drug, multi-dosage regimes, as well as the fact that treatment must be taken without interruption for life. Certain patients also experience unpleasant side effects from these drugs. At Impala Rustenburg, HIV-positive peer educators who are on ART themselves, assist the doctor and nursing teams to encourage compliance among individual patients.

In FY2009, 122 patients died in service as a result of known AIDS-related illnesses and a further 116 people left the company’s employ as a result of HIV-related medical issues (FY2008: 105 deaths and 165 medical separations).

Care for former employees and communities

Implats is involved in a number of initiatives providing education and care to employees and others around its operations and to the communities where employees live. See the socio-economic development section for further details.

Objectives for FY2010

HIV & AIDS is expected to remain a focus area in the year ahead. In particular, the company aims to:

  • Continue to build on the positive relations with unions, to develop and implement a programme that achieves a reduction in new infections and the appropriate and early treatment of those who are infected.
  • To encourage VCT, and to ensure that those who test positive participate in the Wellness programme.
  • To continue to promote the ART programme, and to encourage compliance.
  • To continue to extend programmes into communities, both around operations and in labour-sending areas.
Total number of wellness programme people
ART programme at Implats
Implats Sustainable Development Report 2009