1st International AIDS Society Conference on HIV Pathogenesis and Treatment Buenos Aires, Argentina - July 8-11, 2001

[ABSTRACT:] Background: The Government of Botswana and De Beers Centenary AG own Debswana Diamond Company in equal shares. The Company mine diamonds at three locations in Botswana namely Orapa, Letlhakane and Jwaneng. In addition the Botswana Diamond Valuing Company which sorts and values diamonds, the Teemane Manufacturing Company which cuts and polishes diamonds and Morupule Colliery are wholly owned subsidiaries of Debswana. The Company head office is in Gaborone.The Company contributes 33% of GDP, up to 65% of government revenue and over 80% of foreign exchange from diamonds. It is one of the major employers and provides a substantial portion of the technical training in the country. The Company operates in a high HIV prevalence country and region. At the end of 1999, the adult prevalence rate was estimated at 35.8% and in 2000 it was at 38.5%.

Issues: Between 1996 and 1999 the Company experienced high morbidity and mortality which was HIV related. A significant percentage of ill-health retirements over this period, 40% in 1996 and 75% in 1999 were due to AIDS related conditions. The percentage of AIDS related deaths in 1996 were 37.5%, in 1997 it was 48.3% and in 1999 it was 59.1%.

The issue for the Company was how to make antiretroviral therapy affordable to employees who are infected particularly those who were not covered by medical aid schemes.

Description: The Company sought to establish the level of HIV prevalence among the workforce in order to assess the feasibility of making anti-retroviral drugs available to employees who are infected and what cost contribution to make.

A voluntary and anonymous prevalence survey using saliva tests was conducted to establish prevalence by grade and age at the three diamond mines, BDVC and Head Office.75% of the workforce participated. The results showed that 28.8% of the 5261 employees were infected with the virus. There was prevalence at every level of the organisation and the hardest hit age group was 30 - 34.

Conclusions: The Company Board of Directors approved:

a. The strategy of extending productive lives through the intervention of anti retroviral therapy. The provision of drugs is done through a comprehensive disease management programme which ensures that anti retroviral drugs are used in correct combinations at the correct stage of the disease and with appropriate monitoring and follow up.

b. The policy is to subsidise the cost of prophylactics, antiretroviral and monitoring for an infected employee and spouse on a co-payment basis to ensure commitment. The subsidy by the Company is 90%.

c. The creation of a trust fund for the costs of providing ART and related costs of monitoring under which trustees are appointed from both employer and employee representatives manage the disbursement of funds.

The Company not only had the capability and responsibility, they also had the mandate and resources to respond to the epidemic.

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