How much longer can S. Africa production remain at current levels?
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Migrant labour system perpetuates HIV/Aids in the gold mining industry
The Wall Street Journal - June 27 2001
Gold miner Patrick Jikazi spent the day more than 3km underground in the world's deepest mine, TauTona, which is owned by the world's largest gold mining company, AngloGold. Finally off duty, he couldn't relax with his wife and children because they live a 10-hour bus trip away.
So before he retired to his quarters - shared with 15 other men, also separated from their families - he ambled to the open air bar, a cement plaza surrounded by walls topped with barbed wire. As women passed, Jikazi called out to them, sometimes standing up to get their attention.
"When I feel the need for a woman, I just go and get one," Jikazi says. He boasts that he's slept with more than 10 women in the past year, never with a condom. But he also admits he afraid of Aids.
In a world where the policies of a huge mining conglomerate encourage workers to separate from their families for months at a time, prostitution and casual sex have always been a problem. But in the age of Aids, the combination of lonely men in migrant camps and available women is downright toxic.
Almost 20 percent of all South African adults under 50 are infected with HIV. But the toll is particularly brutal in the suffocating mine shafts, the crowded barracks and, increasingly, in the far-flung villages of the families of workers who toil in one of the country's most lucrative industries. AngloGold estimates nearly one-third of its 44 000 mine workers are infected with HIV.
Its majority owner, London-based Anglo American, is one of the first major corporations to disclose measures aimed at treating Aids cases among its overwhelmingly black rank and file workers in Africa.
Last month Anglo American declared that it would conduct a trial offering free drugs to an unspecified number of employees, and possibly their spouses, with an eye to expanding the programme if it succeeded.
Separately, AngloGold committed itself to running its own clinical trial of 1 000 miners and their wives.
But in a sign of how South Africa's history and AngloGold's labour system have made the Aids scourge particularly intractable, the company's plans are already being scaled back. AngloGold now says its clinical trial will include as few as 200 miners and no more than 800.
One hurdle is that several pharmaceutical companies told AngloGold they would not provide free drugs for the trial. The company also wants an outside agency to foot most of the bill, estimated at between R24 million and R46 million.
"We are making up rules as we go along," says AngloGold's chief executive, Bobby Godsell. He won't specify how much money the company has committed to the trial, and it remains unclear when the trial will begin. He says if the trial proves cost effective, the treatment will be extended to all employees.
At least two other multinationals operating in South Africa have recently announced new Aids programmes. Just over a week ago, DaimlerChrysler said it would cover the cost of Aids drugs for its 4 445 South African employees and their families. Soon after, Coca-Cola, which at present pays for Aids drugs for its 1 500 South African employees and their families, said it would put its distribution and marketing system to work fighting the disease.
But neither of these companies faces the challenges that Anglo American does, with its harsh working conditions and its masses of migrant workers.
After all, Anglo American isn't just contending with a virus, but also with more than a century of economic and social policies that have fuelled the spread of disease and made treatment more difficult.
There is also a breathtaking irony: Anglo American itself helped extend these policies.
Beginning more than a century ago, black South Africans were herded into "homelands". Unable to live off the land, they were forced to seek employment, but laws supported by mining interests required men seeking work to leave their families behind.
As the biggest and richest mining conglomerate, Anglo American reaped the benefits of this system, which helped lay the very foundations of apartheid.
While it is no longer a legal requirement that migrant workers live apart from their families, the custom endures. Today more than four-fifths of AngloGold's low-skilled mineworkers, including Jikazi, live in crowded, company-owned hostels, often hundreds of kilometres from their families.
Mark Lurie, who is an Aids researcher with the Medical Research Council, a government agency, recently calculated that migrant workers are almost two-and-a-half times more likely to be HIV-positive than non-migrant workers. Other researchers have come up with similar results.
Lurie puts it this way: "If you wanted to spread a sexually transmitted disease, you'd take thousands of young men away from their families, isolate them in single-sex hostels and give them easy access to alcohol and commercial sex.
"Then, to spread the disease around the country, you'd send them home every once in a while to their wives and girlfriends.
"That is basically the system we have."
AngloGold has taken only incremental steps to pare back the migrant labour system, such as converting a few hostels into married-worker housing. That has led some public health experts to charge that AngloGold's proposal to provide Aids drugs won't solve the underlying health crisis.
"It's a Band-Aid," says Robert Cowie, a professor of medicine at the University of Calgary, who in the 1970s was a pioneer in pushing Anglo to treat miners with tuberculosis, rather than simply to send them home.
"Until you do away with migrant labour, you will continue to fight these problems."
Godsell disagrees. He says it hasn't been proved that the migrant labour system contributes to the spread of Aids. "Whether migrant miners are more at risk than other miners is an interesting proposition that requires some evidence," he says.
The consequences of admitting that migrant labour has worsened the Aids crisis could be costly. The government requires companies to compensate workers for occupational diseases. Already, the mining industry must pay miners whose lungs are damaged by tuberculosis or silicosis - diseases partly caused by mine conditions.
If Aids was to be classified as an occupational disease, on the theory that the migrant labour system contributes to its spread, then the company could be on the hook for additional compensation. AngloGold's biggest union, the National Union of Mineworkers, has considered pushing for this, though it has no plans to do so at present.
Godsell denies that this concern has influenced his thinking.
In any event, the harshness of the miners' lives is likely to make them uniquely hard to treat. At the TauTona mine, workers toil in humid heat that can exceed 45¼C. The stope - the part of the shaft where miners break rocks - is often only a metre high. Through it all, the deafening roar of the hydraulic drill reverberates. Latrine facilities are far away.
This is hardly an ideal setting in which to administer or monitor a complex Aids drug regimen that often requires swallowing two or more pills twice a day, and can cause vomiting, diarrhoea, dizziness and other side effects.
"If it causes diarrhoea, I wouldn't be able to cope," says miner Mavuso Xesebe, who says he has never been tested for Aids.
Colin Eisenstein, the head of AngloGold's health services, acknowledges the obstacles. He says a miner may have to walk 5km just to get to his work site.
Underground "it's noisy, dusty, frightening", says Eisenstein, whose father was a mine official. "Now, if you had been down there, what would you want when you came up? Beer, food, women and sleep. You wouldn't want pills."
Furthermore, some officials worry that the prospect of treatment may spur more unsafe behaviour. "They'll say, 'We've got the cure, now we can go all the way'," says David Magagula, the senior human resources officer at TauTona mine.
Several of AngloGold's staff of 73 mine doctors say they are also concerned about a study that suggested the efficacy of Aids drugs plummeted in patients who missed more than five of every 100 doses. The study, which appeared last year in the Annals of Internal Medicine, has doctors worried about creating drug-resistant strains of HIV.
Gavin Churchyard, who runs AngloGold's medical research team, says a 1997 AngloGold study of tuberculosis-drug compliance found that medical supervisors in company clinics sometimes overestimated the diligence of their patients.
In the study, the supervisors reported that nearly all their infected workers took their medication, but urine tests showed that only about 85 percent had actually done so.
Eisenstein says: "I don't want people to say in a few years, 'Hey, you stupid fools, you've created a huge pool of resistant virus'.
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