Select Committee on International Development Minutes of Evidence

Examination of Witnesses (Questions 264 - 279)




  264. Can I begin by thanking you all for your written evidence to us which we have been working our way through and which we have distilled into a number of questions we would like to ask. I think we had better plunge straight into questions because there are a lot of them. We have divided this morning's session into general impact in the private sector and then into a second series of questions, which I hope Mr Cochrane will remain with us for, and also Mr Saul Walker, to help us through the questions specifically on drugs. We will have to be a bit disciplined both on this side and your side if we are going to get through this number of questions which are vitally important, to our understanding anyway, of what we are facing in the private sector in dealing with HIV/AIDS. First of all, we would like to ask a series of questions on the impact of HIV/AIDS on the private sector. What is the estimated prevalence of HIV/AIDS in your various workforces? How does that compare with the workforce in general and with the overall prevalence in each country? Does prevalence vary according to the skill of the worker or their country of origin? Do you have a sense of the extent to which workers are contracting HIV whilst in your employment and the extent to which they are already HIV-positive when joining the company? I wonder who would like to start us off on that. We visited one of the companies in South Africa, an Anglo American company, so could I invite Dr Brian Brink to lead us off.

  (Dr Brink) Thank you very much, Chairman. It is a very difficult question to answer, as I am sure you anticipated.

  265. We have not got any clear answers, that is why we are asking the question, yes.
  (Dr Brink) When asking the question one must clearly understand what one means by prevalence—and that is the pool of infected people. What perhaps is more important to us is the rate at which new people are being added to that pool and the rate at which people are leaving the pool through death, and clearly those are much smaller numbers. When one first hears prevalence figures the reaction often is one of alarm but, in fact, the situation despite what might appear to be high numbers can still be very manageable. So I would preface my remarks with that. Secondly, with regard to prevalence figures, one must understand that they vary enormously between countries and within countries. The next big thing to remember is that very often the information is missing and you have to ask how do you arrive at that figure and essentially there are three different ways you can do it. One can rely on surveys that have been carried out at a national level. The most beneficial surveys that we have in South Africa, for example, are the surveys amongst ante-natal clinic attenders and I think the latest prevalence figure from these was 22.4 per cent. For the extrapolation of that figure to the wider community one must understand who you are looking at. For example, the level of infection in women may be very different to the level of infection in men so to say we will take that ante-natal figure and extrapolate that to the whole population may not in fact be valid, so one has to be very careful in using these figures. However, they do give an indication of the prevalence within the adult pool. One can get further down the road and employ statistical modelling techniques to get more accurate prevalence figures which take into account variable factors for the particular location you are looking at, the particular company, the make-up of the pool of people you are looking at, the demographics, and so on. Then the last method would be to go to what we would call a sero-prevalence survey where specifically you conduct an epidemiologically controlled survey of a particular population, take a sample, do it on an anonymous basis (completely unlinked, nobody can find out who is HIV-positive and who is not) and that will probably give you the best and most accurate figures.

  266. Do you do that?
  (Dr Brink) We carry out those surveys. I would say that increasingly we are doing that because we are finding that they are very useful things to do, for two reasons. One, when you embark on such a survey first of all you have to get everybody to agree. That means getting management and unions and employees all together to recognise and to understand the problem. It is that heightened awareness when you face up to how you are going to do this. That in itself has a profound effect upon people in terms of raising their awareness and raising their understanding of the issues. It is good to do it from that point of view and then you end up with a figure which quantifies the size of the problem. Once you have measured the size of the problem you can then say, "What are we going to do about it?" and put in place a whole lot of plans to manage around what you have discovered and come back later to re-measure to see whether what you have done has had the required effect. So that is the importance of such surveys. In a way I have been skirting around the original question which is what are the numbers. I am doing that deliberately because to just come out with the numbers is the wrong thing. It creates the wrong impression. I think they are different in different countries and different in different circumstances. They can range between 10 per cent, 15, 20, 25, sometimes even higher. You must understand what the figure that you arrive at means and you must be able to do something with that figure in terms of managing the epidemic.

  267. In South Africa we have been given evidence that there are different rates of prevalence of HIV/AIDS in different parts of South Africa, as you have just stated and the Kwa-Zulu Natal figure is the highest, we have been told, and the Western Cape the lowest. Do you operate in each of the states of South Africa and can you give us some idea of how you behave as a result of different prevalence rates?
  (Dr Brink) Our big operations in South Africa are primarily based in Free State Province, Guateng and North West Province. They are provinces which are pretty much middle of the road when it comes to prevalence figures. Even so, again within our workforces our emphasis is not so much on what is the exact prevalence in that workforce, it is far rather getting an understanding of what HIV/AIDS is all about with a very focused management effort so as to prevent new infections. Whatever those prevalence figures are, one must always remember that the greater majority of people are not infected and we have a huge opportunity to try to stop new infections, and that is a far more important message than saying how many people are infected. I think for those that are infected what is more important is how are we going to look after and care for those people. They may be HIV-positive but they are perfectly well and perfectly able to work and we like to find ways and means of keeping them that way as long as possible.

  268. We are going to come to how you do that in a series of questions we have later. Mr Christopher Wheeler, would you like to make some comments about the prevalence of HIV/AIDS and how you see it from your point of view?
  (Mr Wheeler) As you know, the Bank has operations in 12 countries across Africa. If I can give a little bit of context. Approximately three years ago we started to notice a higher incidence of sickness, of death in service, and so forth, and it was at that point in time that we decided that we had to look further at causes. We are obviously very aware of an increasing prevalence of HIV and we decided the statistics that we were able to obtain publicly were not completely reliable and from our own point of view we thought what we needed to do was to look internally at our own workforce initially and then see from within, if you like, some of the issues that would need to be managed. I think the caution that has been expressed in terms of the data is probably one that has been expressed to you before. I think what it is fair to say is there are broad areas of prevalence of 20 to 40 per cent, depending on which country you talk to and which region of which country you are looking at. Within the bank's organisation we are not able to determine whether or not there are distinguishing characteristics between skilled and non-skilled. Looking at our own incidence, for example, data from medical suppliers in Zambia, for example, suggests that perhaps up to 30 per cent of the workforce that we have could be infected. The data is "could be infected" because we cannot insist that individuals have testing and we would not suggest that they do so, but we would encourage people who are unwell to go to our medical suppliers and they provide broad, generic data on the nature of the illness. It is from that basis that we have developed our own policies to learn more about our own workforce and the incidence within each country.

  269. Do you do a similar thing in bringing about the workforce and management agreement to test a sample of your employees?
  (Mr Wheeler) We are talking with the unions and the labour force on voluntary testing and we are encouraging staff to undertake voluntary testing on a no-names basis such that we are able to get the data back. It is from those sources, Zambia, Ghana, Kenya, South Africa, that we have started to collect the data we have referred to in our written submission.

  Chairman: Shall we go on to other questions or are there other points that other witnesses would like to add on prevalence? Then can I ask Mr Robathan to lead.

Mr Robathan

  270. When you are doing these anonymous tests do you do a 100 per cent survey, Dr Brink?
  (Dr Brink) We like to get as many people involved as possible. It is a very big company. You do not have to—

  271. Take a mine like Carletonville, have you ever done a survey of the complete workforce of the mine?
  (Dr Brink) Not on that magnitude at all. Jenny has experience.
  (Ms Crisp) Carletonville is a particularly big mine and gold mines are very much larger than the coal mines. The areas in which we have carried out these anonymous sero-prevalence surveys have been predominantly in our coalmines where the numbers were about 1,000 per mine and around about 80 per cent of the workforce has come forward. Initially we suggested to the unions that we would just do a ten per cent sample but they were much more comfortable to ask all the workers to come forward so that there was absolutely no question of anybody being pinpointed at the end of the day. Simply because the union has been on board and has agreed up front there has been that kind of level of participation.

  272. If you take this coal mine and test 800 people you would find a prevalence rate of 20 per cent?
  (Ms Crisp) Slightly lower than that, just under 20.

  273. This presumably is a matter of great concern to employees. What has been their reaction? Do they then go out and get another test?
  (Ms Crisp) It has not been totally unexpected to them because prior to doing this testing we have had huge education programmes in place for four, five or six years prior to doing any testing so they are aware of the situation. I think throughout Africa what we have seen is a lot of denial about the epidemic. I think it is like all of us. We do not want to think that anything like this is going to affect us. So even when the results are made known (and that is always done on a joint basis to management and unions at the same time and testing is carried out by external agencies) yes, there is shock, but there is still unfortunately in our experience some kind of denial.

  274. "Not me"?
  (Ms Crisp) Not me.
  (Dr Brink) I could reinforce that because alongside all of these surveys at the same time we offer quite independently voluntary, specific, individual AIDS testing at a completely separate site free of charge. If you want to find out your own HIV status that is where you go and do it.

  275. Confidentially?
  (Dr Brink) Yes, confidentially. The take-up of that offer has been extremely low. In the Carletonville survey they surveyed 1,500 employees in that survey and not one, I am told, went for the voluntary individual testing.

  276. That is very interesting. I notice that Anglo American do not have compulsory testing. Do any others? Is it possible to have compulsory testing? Is it against the law?
  (Ms Crisp) It is certainly against the law in South Africa. We have an Employment Equity Bill which specifically prohibits compulsory HIV tests.


  277. So it has to be voluntary?
  (Ms Crisp) It has to be voluntary.

Mr Robathan

  278. I am not quite sure about employment practices in South Africa but here a good employer might give every employee a health check each year and almost certainly they will give a blood test. If there was a high prevalence of disease such as HIV that would be tested. Does that happen at all?
  (Mr Wheeler) There is testing on a voluntary basis, no names basis. We will collect data generically, not specifically.

  279. Would you as an employee, Mr Wheeler, have an annual health check? How far down the company does that go?
  (Mr Wheeler) Not very far.

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