South Africa has the highest number of HIV-infected people in the world - 11%-12% of a population of 44m. That's just less than 5m infected people. Botswana has a higher prevalence rate, but as its population is only 1,6m, it translates into fewer infected people.
In SA the more important group to look at is the 15-49-year-old sexually active population because that is the nidus of the epidemic, where the infection rate is 24,8%.
The problem with Aids statistics is that information is often scanty. What exists is poorly interpreted and often leads to alarmist scenarios of gloom and doom.
For example, Zimbabwe has a mature epidemic. The Anglo American operations there have been tracking ill health, early retirement and deaths in employment over the past 10 years. In 1991 the withdrawal rate was 1,5%. In 2002 it was 3,3%. In 10 years, though there's been a doubling in the number of people leaving prematurely, the total number of affected employees remains relatively small. At present , Anglo believes about 60% of those withdrawals are due to Aids.
In Zimbabwe the HIV-prevalence rate in adults is about 24%. If it takes eight years from the time of infection to the onset of Aids, that's 3%/year who are falling ill with Aids, which is manageable. But people think: "Twenty-four percent? A quarter of the workforce is sick and dying." That is not true. Most of the 15 000-strong workforce - 97% - are perfectly well and able to work.
The rationale behind our response to Aids is crucial. The milestone for myself was in 1986. The HIV test had just come out, though people didn't understand all the implications of HIV testing. We started our education and awareness methods then. At that time the Chamber of Mines did an HIV-prevalence survey among mineworkers. They took 18 450 specimens of blood, randomly and anonymously, from SA mineworkers. Just four of them were HIV-positive.
At the same time they tested 3 165 Malawian mineworkers and the prevalence rate was 3,76%.
What we've seen over the years is the progression of HIV infection. In every graph I've seen of Aids, the figures increase. In antenatal clinic surveys, the HIV-prevalence rate in the early 1990s was well below 1%. In 2001 it was 24,8%, and our experience has tracked an almost identical rate.
Over the past 15 years, this epidemic has spread unabated. Whatever we've been doing in terms of education, prevention and awareness; we still haven't found the solution.
To be harsh, I would say SA has failed to contain the HIV epidemic and, of course, the Aids epidemic lags behind the HIV epidemic. You don't know when HIV infection is going to progress to Aids; with some people it's after two years, with others it may be eight or more. Eight years is the average. Some people may be HIV-positive, but do not appear to fall ill. But most will progress to Aids.
In the past 15 years of intervention we have not succeeded in slowing down the rate of new infections, though in terms of education and awareness we know we have got the message across. People know about HIV and that it causes Aids.
But despite all the information, they have not changed their behaviour. And the way to fight the epidemic is through changing behaviour. For Anglo, the critical question is how?
In our analysis, the most crucial intervention to get people to change their behaviour is HIV testing, for individuals to establish their HIV status. This is being done at Anglo American through voluntary, confidential counselling and testing. We don't think mandatory testing would be a sustainable solution; voluntary testing is about individuals becoming mobilised themselves.
The effect of the individual becoming aware of his HIV status will be a change in behaviour. For people who are HIV-negative, the knowledge will motivate them to stay negative. For those who are HIV-positive, you can say to them: "This is not a death sentence. You can go to the following places for the care and support you need to help you through this. You haven't got Aids yet, we don't know when you will get it. Let's try to keep it away for as long as possible."
There are things they can do: healthy living; proper nutrition; and some immune therapies. And lastly, we will provide drugs to stop the virus. There are two approaches to treatment: protecting the immune system and attacking the virus that destroys the immune system.
The science behind understanding the immune system and how to protect it is still in its infancy. But it's developing fast and I'm sure we will see new treatments that will be effective.
That's what lies behind our announcement to provide antiretroviral therapy to our workforce. To date, being HIV-positive has meant stigma, discrimination and death. That's why people don't want to go for a test. They don't want to know their HIV status; they're in a state of denial. We're trying to turn that around and tackle denial and the stigma.
And the most powerful force in challenging denial and the stigma is providing treatment, care and support for people who are HIV-positive.
Let's show everyone that people don't have to die from Aids. We know the drugs work. Side effects are manageable; dosage regimens are becoming easier. We're fairly confident we know which drug combinations work effectively.
Drugs are going to be critical. There's a school of thought that says: "Let's treat all the opportunistic diseases: TB; pneumonia; fungal infections; and so on." But the problem is when you're treating those in the face of immune system collapse, no sooner have you made a dent, then they come back.
There's a lot of evidence now that the immune system of people on antiretroviral therapy is reconstituted and the incidence of these opportunistic diseases drops dramatically - by more than 80%. So my way of dealing with these diseases is to fix the immune system and prevent the virus from ever taking hold.
We've announced this antiretroviral therapy intervention for our employees through our existing clinics and facilities. We have not been able to extend the undertaking to dependants unless they are members of medical schemes with an Aids drug benefit.
But this intervention must be extended to all dependants in due course. We would like to form a partnership with government and international donor agencies to say: "Let's each take our share of the load." We're taking our share of the load in the workplace. If government and donor agencies can take the share of the load outside the workplace, the combined effort will make a difference to the way this epidemic unfolds.
Will government provide the same antiretroviral therapy? We would say to government and other organisations: "Let's make a start."
The size of this epidemic is beyond the capacity of any one organisation. We're going to have to form partnerships. And I find it encouraging that many businesses are now on the same track. And they're doing it for good sound reasons; it's a socio-economic issue.
It is important to talk to government. Let's not waste words arguing about Aids, let's start dealing with the problem. Too many of our resources have been directed at arguing and debate and far too little at getting on with the job. I'm always reluctant to point fingers at anybody; I know how hard it is to get it right. I have enormous respect for anyone who's doing anything about HIV/Aids, no matter how small.
No-one can ignore this pandemic. This is the worst health crisis to affect humankind, certainly since the Black Death 600 years ago. Aids will probably eclipse that. Yet we haven't become mobilised. It is time to act.
- Dr Brian Brink, Anglo American medical senior vice-president, is responsible for Anglo American's HIV/Aids programme and its implementation.
