HIV/AIDS remains a source of concern for Anglo American, particularly for Group companies operating in Southern and Eastern Africa. Sub-Saharan countries in general are confronted by an advanced epidemic, which if not effectively managed, will have devastating socio-economic consequences. There is no room for complacency in our response to HIV/AIDS -this theme characterises our response to HIV/AIDS during 2003, a year in which Anglo American made great strides in the evolution of its HIV/AIDS policy and strategy.

The Group HIV/AIDS policy was extensively reviewed during the year and published in December 2003. The opening statement of this revised policy is reproduced in the box on this page. The full policy statement can be found on the Anglo American plc website at http://www.angloamerican.co.uk/hivaids/ourresponse/policy.asp

Anglo American Group HIV/AIDS Policy
Opening Statement

Anglo American plc recognises the human tragedy caused by the HIV/AIDS epidemic, particularly in sub-Saharan Africa. We are concerned about the gravity and implications of the epidemic for our operating companies, the Group as a whole, our employees and their families and the communities within which we operate. Our aim is to reduce the fear of HIV/AIDS and to make a contribution towards minimising the social, economic and developmental consequences of this epidemic.

The policy supports the key responses to the epidemic, namely: elimination of stigma and discrimination on the basis of real or perceived HIV status; prevention of new infections; care and support of employees infected and affected by HIV/AIDS; and management and mitigation of the impact of HIV/AIDS.

The Group will respond to the human needs of the epidemic in a supportive, positive and non-discriminatory manner, so that people living with HIV/AIDS are able to be open about their HIV status without fear of stigma or rejection.

The Group believes non-discrimination, as well as consultation, inclusivity and encouraging full participation of all stakeholders are key principles, which should underpin its HIV/AIDS responses.

The magnitude of the health challenge posed by HIV/AIDS is such that individual companies cannot adequately address it alone. A comprehensive and effective response to HIV/AIDS will require a partnership between all stakeholders. Anglo American and its operating companies will, therefore, seek to work with national and provincial governments and local authorities, international donors such as the Global Fund to fight AIDS, TB and Malaria, and appropriate NGOs and communities in order to build capacity for an effective response to the epidemic.

The Group will extend its efforts to publicise Anglo American’s responses to the HIVAIDS epidemic in highly affected countries and to demonstrate that the epidemic is manageable. We expect this to have a positive effect on sentiment towards investment in highly affected countries, particularly in Southern Africa. Such investment will help to tackle the root causes of the epidemic, which lie in poverty, poor health, social disruption, poor education and unemployment. We believe that Anglo American’s response to the AIDS epidemic is a significant contribution to sustainable development and will help to ensure the continued profitability of our businesses.

This policy statement forms the foundation of our HIV/AIDS strategy, which seeks to respond effectively in the workplace, extend the response into the communities associated with our operations and build partnerships with other stakeholders. The brunt of the HIV/AIDS problem for the Group is in Southern and Eastern Africa and the following report confines itself to activities in this region during 2003.

The workplace response

HIV Prevalence

The following table gives our best estimate, through a combination of prevalence surveys, actuarial projections and estimates, of HIV Prevalence amongst employees in Anglo American subsidiary companies in Southern and Eastern Africa as at the end of 2003.

Voluntary Counselling and Testing (VCT)

Whilst HIV prevalence surveys give us a good indication of the extent of HIV infection within the workforce, the greatest challenge for the future is to encourage employees to establish their individual HIV status through a process of voluntary counselling and testing (VCT). Knowledge of HIV status is well recognised as being a key intervention for mobilising individuals to take personal responsibility for containing the spread of HIV infection.

Uptake of VCT has been generally disappointing across Group companies, with fewer than 10% of employees in Gold and Platinum coming forward for testing in 2003. Elsewhere in the Group, there have been some notable exceptions to this rule and in some business units, upwards of 50% of employees have undergone VCT following education and awareness drives. VCT uptake has been identified as a key performance indicator with regard to effective management of HIV/AIDS and business units will be encouraged to set ambitious targets for improvement in 2004. In order to succeed with VCT we need to create a climate that is conducive to testing with special emphasis on confidentiality, non-discrimination, efficiency and caring,

Wellness Programmes for HIV positive employees

VCT feeds directly into wellness programmes for HIV positive employees. Ideally all employees who test HIV positive should enrol into a programme of care and support which includes:

• understanding the disease through counselling
  
• encouraging a healthy lifestyle
  
• offering nutritional supplements where necessary
  
• immune system monitoring through regular CD4 counts
  
• preventing and treating opportunistic infections, especially TB
  
• providing access to appropriate, affordable and sustainable anti retroviral therapy when clinically indicated
  

During 2003, approximately 3300 employees were enrolled in HIV wellness programmes across the Group. Business units have been asked to set management targets and create an environment that encourages greater uptake of VCT facilities in 2004.

Antiretroviral therapy (ART)

In August 2002, Anglo American announced an ambitious programme to provide ART to employees with AIDS at company expense. Implementation of this programme progressed very well during 2003, with technical support provided by Aurum Health Research (an AngloGold subsidiary). This ART initiative is widely recognised as the largest employer sponsored AIDS treatment programme in the world. The Global Business Coalition on HIV/AIDS has commended Anglo American for its leadership in providing workplace access to ART.

By 31st December 2003, 1048 employees were receiving ART across all Group companies. Approximately one third of these employees presented with advanced (WHO Stage IV) AIDS disease at the start of treatment and it is reasonable to presume that without treatment they would have died from their disease by the time of publication of this report. Instead, the vast majority are back at work and leading normal lives.

Preliminary Antiretroviral Therapy Outcomes

• 94% of employees on ART back at normal work
  
• 90% reported adherence to treatment regimen
  - Biological markers of adherence still being evaluated
  
• 28% minor side effects
  
• 2% serious adverse events
  
• 8% decline offer of treatment
  

Economic impact assessment

Aurum Health Research is carrying out a comprehensive assessment of the economic impact of HIV/AIDS across all Group companies, in collaboration with the London School of Tropical Medicine and Hygiene. This 3-year project, which is quite unique in the world, will seek to determine the extent to which health interventions, particularly antiretroviral therapy, can modify the economic impact of AIDS on business activities. It is our intention that this research should be carried out at the highest level of quality and integrity and that the information arising out of the research should be published in independent, peer-reviewed medical journals of international standing. It is also our intention that the outcomes of the research should be shared with other businesses and interested parties as part of our joint contribution to understanding and enhancing the business response to HIV/AIDS. This project is being supported by a research grant awarded by GlaxoSmithKline, who supply the drug Combivir, which is the backbone of our treatment regimen.

The community response

Our HIV/AIDS response will only be effective if our successful workplace programmes can be extended into the communities associated with our operations. It is extremely important that we ensure access to HIV education and awareness, VCT and ART to the dependants and/or partners of our employees. It is also important that we do not create islands of privilege within communities; we must ensure a broader penetration of effective HIV/AIDS interventions. No business can take on this burden alone – community outreach requires the building of partnerships with government, other employers, trade unions, NGO’s and other Community Based Organisations (CBO’s), Faith Based Organisations (FBO’s) and international donors.

The Anglo American Community HIV/AIDS partnership

In October 2003, Anglo American announced an ambitious community HIV/AIDS partnership designed to enhance and accelerate the provision of comprehensive HIV/AIDS services in government primary health care clinics. We chose the NGO loveLife as our first strategic partner in this initiative, based on our desire to extend the rollout of their successful National Adolescent Friendly Clinic Initiative (NAFCI) into communities associated with our operations. loveLife has an existing partnership with the National Department of Health in South Africa and is also supported by the Kaiser Family Foundation, the Nelson Mandela Foundation and the Global Fund to fight AIDS,TB and Malaria. The Anglo American Chairman’s Fund is donating R30 million ($4.5 million) to loveLife over a period 3 years. This co-investment with the Global Fund has enabled us to double the reach of the NAFCI initiative into our communities. We have identified seven communities across six provinces of South Africa - all of these are disadvantaged, in both peri-urban and rural settings. Within these communities we have selected 38 government primary health care clinics for the initial intervention.

Anglo American operations associated with the identified communities will commit considerable time and expertise to working with loveLife and other partners to help build capacity in these public sector primary health care clinics. The overall goal will be to enhance the health sector response to HIV/AIDS at community level. The essential elements of the programme are listed in the box below:

Enhancing the health sector response to HIV/AIDS at community level”

• Building capacity at primary health care clinics and improving efficiency
  
• Ensuring easy access to comprehensive HIV prevention services
  
• Providing Voluntary Counselling and Testing
  
• Enhancing care and support for those with HIV infection
  
• Preventing mother to child transmission of HIV
  
• Preparing the ground for early access to antiretroviral therapy for those with AIDS
  

The power of partnerships

At Anglo American we strongly believe that the collective effort is much bigger than the sum of all its parts. By working together in partnership, we hope to build on each other’s strengths and leverage the initial commitments of a small number of players to produce a significant multiplier effect. As private sector partners in the community HIV/AIDS initiative we hope to contribute business experience, innovation, efficiency and drive. Our public sector partners will provide the infrastructure to ensure long-term sustainability. Together with our other partners we hope to build a force in the fight against HIV/AIDS that will secure the future for communities far beyond our initial commitments.

Summary of Anglo American HIV/AIDS Strategy

• Pursue HIV prevention programs with vigour
  
• Conduct voluntary, anonymous, unlinked HIV prevalence surveys at all operations on an annual basis
  
• Vigorously promote VCT
  –set targets for annual VCT uptake
  
• Implement wellness programs for HIV +ve employees
  –set targets for wellness programme enrolment
  
• Provide access to antiretroviral therapy (ART) at company expense when clinically indicated
  
• Extend workplace programs into surrounding communities in partnership with government, unions, NGO’s and international donor agencies.
  
• Monitor and evaluate program outcomes