28 November 2008
Conakry — With an HIV infection rate of 5.2 per cent, the lucrative mining sector in Guinea is particularly at risk from the epidemic. Some mining companies have begun setting up their own programmes to make up for the lack of HIV/AIDS services on offer. But they say a public-private partnership is essential if local residents are not to be excluded.
Guinea has immense resources in bauxite, iron, gold, diamonds and other minerals which, the government says, make it "potentially one of the richest countries in West Africa". Yet according to the UN Guinea is one of the poorest countries in the world; over 53 per cent of its nine million inhabitants live on less than a dollar a day.
Mine employees are generally better paid than those working in other sectors and are often envied, particularly by local people who are living in poverty. "Mining areas are little islands of prosperity where a lot of risky behaviour goes on [regarding HIV]," said Cheikhou Yaya Diallo, president of the HIV/AIDS Steering Committee of the Guinea Chamber of Mines (CMG).
"In mining areas people aren't careful, especially young people," confirmed Piantoni *, who is HIV-positive and works at the mine in Fria, 160km north of the capital Conakry. "With the high cost of living, boys and girls give themselves easily." "Prostitution is high; the area is known for it."
Mine employees often come from other parts of the country and are far from their families for months at a time. They are what could be called "geographically single" and so enter into "short marriages" - temporary unions which last the length of their work contracts. The practice is known to be high-risk in the spread of HIV.
Needs and response
HIV services are still mostly concentrated in Conakry and where they do exist elsewhere, they do not meet existing needs.
The regional hospital of Boke, a mining area about 300km from Conakry, started to treat HIV in July 2007. Patients who used to be sent to Conakry are now referred to Boke.
"The hospital is supposed to cover the whole region, but only one doctor has been trained. He is looking after 129 patients on ARVs [antiretroviral drugs]," said Nathalie Daries, head of Therapeutic Solidarity and Initiatives Against AIDS (SOLTHIS), operating in Guinea since the beginning of 2008. One of SOLTHIS's objectives is to train professionals in the fight against AIDS.
Mining companies were hesitant to take on the fight against AIDS at first, the CMG's Diallo claimed. "The firms were cautious because they already had very high health costs and AIDS is such a bottomless hole [financially]."
Beginning to appreciate the impact of the epidemic on the mining sector, several companies within the CMG - which comprises 66 members - started to look at the problem in 2000.
"We saw how much it [HIV] was costing the company," Diallo said. The cost of medicines for opportunist infections, the cost of absenteeism, the cost of deaths and funerals, not to mention the atmosphere it created and the feeling of being abandoned."
Some companies launched their own programmes. "We started by testing, but we didn't go as far as ARVs", he said.
"Employees didn't understand why, if we treated illnesses which were more serious or more expensive [than HIV] on site - illnesses like cancer, diabetes or hypertension - for HIV why did they always have to go to Conakry? The testing saw some success, but to offer this service with no follow up was the best way to ruin our own plans, so we approached potential partners."
Some partners, like the World Bank, USAID and Partners Against AIDS - an initiative launched in 2006 by two international business networks - agreed to help. In 2003, representatives of the CMG visited South Africa, one of the countries most affected by HIV and with an important mining sector, as well as Cameroon, to study the mining sector's response to the epidemic
The SAG (Guinea Goldmining Company) has a programme in place, Abdoulaye Balde, the company's chief doctor, told IRIN. The company's site is at Siguiri, about 800km northeast of Conakry.
"Around 120 peer educators have been trained to encourage people to get tested," Balde explained. "The testing programme, which is open to employees, their dependents and the local community, attracted 1,300 people in 2007."
This result was possible only after months of outreach, in particular to reassure employees. "An employee who tests positive does not lose any of his/her benefits," Balde said. The company's recruitment process does not include an HIV test.
For the moment, without a doctor to prescribe ARVs, patients at SAG are referred to Conakry to start treatment, but repeat prescriptions and treatment of opportunist infections are handled on-site.
Today, 35 SAG employees receive ARVs at the company's health centre. Balde said: "Guinea has had some problems in ARV supply this year, so to try to overcome the breaks in supply, the company has built up a six-month stockpile of drugs."
Public-private cooperation
In addition to employees, companies are aiming to look after their dependents and the local community. To do this, they are campaigning for a partnership between the public and private sectors which can offer HIV-AIDS services to the wider community and to ensure that the impact lasts.
"It doesn't make sense to provide [services] just for employees," the CMG's Diallo noted. "HIV is a life-long illness. Today, the employee [who is HIV-positive] can be taken care of by his/her company, but what about tomorrow? Who will look after them when they are no longer [an employee of that company] - if there's no partnership?"
The authorities are all for such a partnership, according to doctor Mouctar Diallo, coordinator of the National Programme for the Prevention and Treatment of Sexually Transmitted Infections and HIV/AIDS. "The government had already suggested that solution some years ago, at a time when mining companies were still reluctant to invest in the fight [against HIV/AIDS]," he said.
The question of a partnership was discussed again during a joint visit to the area in October organised by the Partners Against AIDS initiative and the multinational mining company Alcan/RioTinto. The visit brought together all the parties involved in the fight against AIDS in Guinea's mining sector, in order to set out a framework for action and to determine the role of each party.
"[The government] can provide ARVs, and in return we can care for its patients. Our companies are prepared to install the necessary materials and to share with other people, we do it already. We're citizens too," said Yaya Diallo, whose company, the Guinea Bauxite Company (CBG), is one of the largest financiers of Kamsar Hospital in the Boke region.
For this to happen, the healthcare needs of mining communities and surrounding populations would need to be established. But, without an efficient health record system, this information is lacking.
All parties involved in the fight against AIDS in Guinea believe that the state needs to be more involved.
"Mining companies are ready, they're waiting for the signal", said CMG's Diallo. "We are the main contributors to the economy of this country. What will happen if we don't care for our many workers?"
*Not his real name
[ This report does not necessarily reflect the views of the United Nations ]
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