AEGiS-WSJ: Mining Firm Anglo American Offers AIDS Drugs to Workers

JOHANNESBURG, South Africa -- Anglo American PLC, the London-based mining conglomerate with huge operations in Africa, says it is making plans to provide AIDS drugs to its African workers and their spouses. Potentially, Anglo could end up treating more than 50,000 people.

The group's plans aren't yet finalized, and Anglo Chief Executive Tony Trahar has asked for a careful cost analysis before embarking on the bold plan. The board is scheduled to formally consider the idea on May 14 at a meeting in London. But the company's executive committee gave its in-principle approval last November, and Anglo executives have been quoted in the South African press affirming that commitment.

"There's so much momentum on this now," says Clem Sunter, a director of the company's unit, Anglo American Corp. of South Africa. "I don't think anything could turn it around."

¹Mbeki's Doubts About Drugs Thwart Efforts to Fight AIDS in South Africa (April 26)

²AIDS Gaffes in Africa Come Back to Haunt Drug Industry in the U.S. (April 23)

If the plan proceeds, Anglo American would be the largest company to provide AIDS drugs to its workers in sub-Saharan Africa, where 25 million people are infected with HIV, the virus that causes AIDS. Like other companies in the region, Anglo American has been profoundly affected by the disease, which has killed many of its workers, caused others to be frequently absent, and driven up its medical costs for AIDS-related illnesses. Anglo executives say providing the drugs also would send a message to worried investors that Anglo is managing the epidemic.

Anglo American holds a unique place in South African history and culture, having influenced the nation more than probably any other single entity. It owns a 53% stake in the world's largest gold-mining company, AngloGold Ltd., as well as 32% of De Beers, the largest diamond mining company. (Anglo is trying to increase its stake in De Beers to 45%.)

Anglo American, which reported operating profit of more than $3 billion last year, employs about 160,000 workers in Africa and estimates about 20% of them are infected with HIV. Anglo has said it intends to treat spouses as well as employees.

Brian Brink, head of Anglo's medical program, says providing the drugs might cost as much as $4.5 million for the first year and eventually rise to several times that amount. Yet the savings -- from fewer death benefits, less absenteeism, and so forth -- could exceed that cost, as they have in other countries. Buying AIDS drugs, says Dr. Brink, "isn't a cost that's going to kill the company, it's a cost that's going to protect the company."

One potential sticking point to the plan: The National Union of Mineworkers, the support of which is considered essential, has been consulted but hasn't yet fully agreed.

Welcome Mboniso, a union official who deals with health and safety issues, has met with Anglo on this issue and says the union is "very skeptical" about HIV testing. The union fears the company might use test results to discriminate against workers, something Anglo insists it does not and will not do. Still, in recent demonstrations, the union has made providing AIDS drugs one of its demands.

Anglo's initiative has been made possible by large price cuts offered by major pharmaceuticals companies. In addition, 39 drug companies dropped their high-profile lawsuit against the South African government, opening the gates for generic-drug companies to compete in Africa against patented, brand-name AIDS medicines.

Following that court battle, Anglo met with the Indian generic-pharmaceuticals firm, Cipla Ltd. However, no company has yet applied for a compulsory license to import or manufacture the drugs in South Africa. Dr. Brink said that if no company does so, Anglo would consider applying for the license itself in order to assure the lowest price.

Anglo's effort is the largest of several private-sector initiatives here to provide AIDS drugs to employees. The South African Chamber of Business is working to create a managed-care type entity that would offer, as a commercial enterprise, AIDS treatment and related services to employers. Insurance companies, which already provide the drugs to many white-collar South Africans, also have been looking for ways to extend AIDS drugs to more people.

Anglo will offer the drugs through its own, in-house network of clinics and hospitals and track outcomes so other companies and governments can learn from its experience. Dr. Brink says the company is particularly determined to minimize the growth of drug-resistant strains by making sure workers take the drugs properly.

Dr. Peter Piot, director of the Joint United Nations Programme on AIDS, called Anglo's plans to provide antiretroviral drugs "highly symbolic and highly practical, because companies will be one of the fastest ways antiretrovirals will get to people in the developing world." Private sector health-care systems, he added, are "in better shape than public systems." He also said that if implemented, Anglo's plans could "break the taboo that antiretroviral drugs are impossible in Africa."

Some activists hope Anglo's actions will push the government, which has insisted the drugs are still unaffordable, to provide them. But South African Health Department spokeswoman Jo-Anne Collinge said, "The scale on which even the mining industry is moving is much smaller than what government would have to do." So, she said, it is "false" to think that "government must mirror what the private sector is doing."

Anglo's planning has been going on quietly for months and, in the Anglo tradition of highly autonomous divisions, differs greatly among various subsidiaries. Even the units that Anglo directly manages, such as Anglo Platinum, will devise their own treatment strategies.

AngloGold, which is independently managed, so far has committed only to having its medical-research arm run a clinical trial of 1,000 or more miners to determine the costs and feasibility of administering the drugs. AngloGold Health Services director Colin Eisenstein says the trial may not begin until next year. De Beers, which also is independently managed, is probably furthest along in both its planning and resolve to provide AIDS drugs. De Beers spokesman Kerwin Rana says the company will use an outside medical firm, rather than in-house clinics, to provide treatment, partly to avoid the issue of whether the company would use test results to discriminate against workers.

Mr. Rana said the company also has tackled one of the toughest ethical issues: whether to keep workers on lifelong therapy if they get laid off or resign. Mr. Rana said such employees will be treated the same as those with any other medical conditions and won't receive the AIDS drugs.

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