Sunday Times (Johannesburg) - June 2, 2008

The move follows growing concern over a "perfect storm" of disease caused by two dangerous epidemics - HIV/Aids and drug-resistant tuberculosis - that are crippling the health-care service.

Senior researchers this week said the situation at the country's mines reflected a national crisis that has alarmed international bodies, including the World Health Organisation. Latest statistics suggest South Africa may have as many as 40000 drug-resistant TB cases, more than elsewhere in the world.

"Everybody is concerned; we can't be complacent about this," said Dr Keertan Dheda, head of lung infection and immunity at the University of Cape Town medical department. "Drug-resistant TB is going to be a huge problem and it will be impossible to deal with," Dheda said.

Advocate Adila Hassim, head of litigation and legal services at the Wits Aids Law Project, said the state also needed a more urgent intervention to curb the countrywide disease explosion.

"This is a national problem, one that I think has already run away from us. The drug-resistant TB epidemic is already out of control. The two epidemics feed off each other because HIV positive people are much more susceptible to TB," Hassim said.

It is the first time a major South African company has moved on such a scale to save its workforce and their dependants from disease. It aims to provide free antiretroviral treatment for those who cannot afford medical aid. The roll-out plan coincides with a disturbing number of new infections among Anglo's workforce, about 14000 of whom are HIV positive.

There is also concern over an increasing incidence of multidrug-resistant (MDR) TB at the country's largest gold mining company, AngloGold Ashanti. Despite a workplace TB treatment programme, a new study due to be released this year shows increasing incidence of MDR TB.

The disease time-bomb is compounded by high levels of lung disease among mineworkers, particularly those with long service, whose condition makes them far more susceptible to infectious disease.

Anglo medical senior vice-president Dr Brian Brink said: "We want to make sure that every family member has access [to HIV/Aids treatment].

"Right now we can commit to funding and right now we say we can do it at our mine medical services. Our vision is to stop Aids and it requires a comprehensive plan. We can't just treat half the problem. That's a deficiency. It's one of the reasons why we're not succeeding. We're still seeing new infections," Brink added.

He said the plan involves setting up company clinics staffed with doctors and nurses who would hopefully partner with government health services.

Patients were likely to be eligible for drug treatment far sooner in the disease cycle than at state facilities, due to concerns about secondary TB infection, Brink said. "We know it's going to cost a lot but it has to be done," he said. "At the heart of this whole thing has really been our health systems, which have become overloaded and aren't coping."

In addition to the Anglo initiative Business Times has established that:

The Chamber of Mines, the National Union of Mineworkers (NUM) and the Department of Health this week signed a new agreement to expand the number of state health clinics to treat mineworkers and their families in rural districts

The Department of Health has introduced new regulations to reduce the level of silica dust in 95% of the country's mines before the end of the year. There are also plans to change regulations around workplace TB programmes

Mortality figures from AngloGold Ashanti remain high, despite a massive Aids and TB treatment programme. Last year 285 people died due to illness while in the service of the company, only slightly down from 306 in 2006, despite a huge uptake of antiretroviral treatment. The company spent R25.15-million on its HIV/Aids programme last year.

Recent studies show up to 25% of long-service mineworkers in the gold industry contract a lung condition called silicosis - caused by dust in the mines - that, in combination with HIV/Aids, causes a 12-fold increase in the chances of active tuberculosis of the lung.

"What we're seeing is three diseases coming together," said Dr Dave Clark, a senior health researcher for the Aurum Institute for Health Research. "The mines are certainly well aware of the problem."

The disease avalanche has also raised the spectre of civil claims for personal damages against the mining industry, with several infected mineworkers involved in two court cases. Although the law makes provision for workplace compensation for mineworkers who suffer from occupational disease, there is no provision for workers who become ill after they have left the mines, despite the fact that silicosis may lead to illness years after retirement.

NUM general secretary Frans Baleni welcomed Anglo's plan to extend treatment to mineworkers' dependants: "It's a positive step which is in line with what we have been campaigning for."

Chamber of Mines health adviser Dr Fazel Randera said the increasing burden of HIV/Aids co-infection seen in the mining industry and South African society generally should prompt changes to the Aids treatment protocol, including starting antiretroviral treatment earlier to reduce opportunistic infection.

He said private-public partnerships in the sector were vital to the future wellbeing of not only the mining health services and workforce but the entire country. "What is becoming increasingly apparent to everybody working in healthcare is a recognition of the importance of partnerships," Randera said.

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