1

HIV and AIDS

• The management of HIV and AIDS is an ongoing challenge for Anglo companies operating in countries with a high burden of HIV disease

• Strategy remains unchanged:– Strong line management leadership– Prevention through education, reproductive health,

condoms – Voluntary counselling and testing (VCT)

• the entry point for both prevention and treatment

– Care, support and treatment for HIV +ve employees– Results focus– Community partnerships

2

HIV and AIDS data 2005 and 2006Southern Africa

2005 2006

Number of employees 121,113 115,878

Best estimate of HIV prevalence 23% 21%

Estimated number of HIV positive employees 28,291 24,211

Number of employees who received VCT for HIV 37,982 73,570

Percentage VCT uptake 31% 63%

Number of HIV positive employees enrolled in HIV disease management programmes

8,315 11,403

Number of employees taking ART 3,034 4,598

% of estimated HIV positive employees taking ART 10.7% 19.0%

Includes AngloGold Ashanti, excludes De Beers

3

Voluntary Counselling and Testing

Uptake of HIV testing

2003 <10%

2004 21%

2005 31%

2006 63%

Target for 2007 = 70%

Our main strategic thrust is getting all employees to know their HIV status through VCT

4

Antiretroviral Therapy (ART)

• 4598 employees on ART at end December 2006

• Although this is approx 20% of estimated HIV +ve population, we believe that about 30% are in need of treatment now

• Further successful VCT drives will help us close the treatment gap

• Those who start treatment before they get sick have much better treatment outcomes– Treatment started late (Advanced AIDS) Mortality 20%– Treatment started before the onset of AIDS Mortality 5%

• Over 94% of employees on treatment carry out their normal work and live healthy productive lives

• Ensuring meticulous adherence to the treatment regimens is the most important long-term issue

5

Economic impact

• HIV/AIDS cost to companies would be 5% of payroll without access to ART

• The estimated average cost to the Anglo Group of not having a worker on treatment is:– R 235, 500 (Range R65,000 – R300,000) (constant 2006 Rand)– US $31,824 (Range $8,783 - $40,540)

• Cost of providing ART in the first year is R1,650 ($223) per patient per month– Costs reduce over time due to economies of scale and declining drug prices

• The cost of ART is more than covered by reduction in absenteeism and reduced health care costs– Savings from reduction in absenteeism cover 20 – 60% of ART costs– Savings from reduced hospitalisation cover 45 – 70% of ART costs

Work carried out by the Health Economics Unit, Aurum Institute for Health Research

Conversion to US $ at spot rate as on 8 March 2007

6

Cost of HIV

Cost components of impact - Anglo Group wide

12%

2%1%

49%

33%

3%

Employee benefit costs

Recruitment and training

Management costs

Medical care costs

Productivity costs

HIV programme costs

Cost of HIV to the business (without ART) in 2006 would amount to just over 5% of payroll (Range = 0.1% - 6.7%)Without ART this is predicted to continue to increase through 2015

7

Trends in cost of ART provision

Anglo Group Wide ART cost trends per patient month on treatment

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

12 mths 18 mths 24 mths 30 mths 36 mths

Ra

nd

pe

r p

ati

en

t p

er m

on

th o

n t

re

atm

en

t

Other medicalsupplies

Direct patient contacttime

Laboratory (Inc fees)

Drugs (inc fees)

Site prog admin andmgmt

Site basedinfrastructure

Companymanagement

Central programmesupport

8

Absenteeism patterns by CD4 count before and after commencement of ART

Absence pre/post ART initiation by starting CD4 category

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2.00

4.00

6.00

8.00

10.00

12.00

14.00

Months pre post treatment start

Sic

k d

ays p

er

mo

nth

< 50

50 - 100

100-250

250-350

ART start

9

Cost per patient per month on treatment

Health care savings Absenteeism

savings

Net cost / savings per patient per month on treatment

Per month over 12 months

R 1670$226

R 610$82

R 875$115

Cost R 185$25

Per month over 18 months

R 1403$190

R 670$91

R 947$128

Saving R 214$29

Per month over 24 months

R 1256$170

R 740$100

R 979$132

Saving R 463$63

Table of average net cost / savings over 24 months on treatment

Note that these figures change as new patients reach these periods on treatment and this table therefore represents a snap shot of trendsto the end of 2005

Conversion to US $ at spot rate as on 20 March 2007

Source: Economic impact assessment carried out by Ms D Muirhead, Aurum Institute for Health Research

Shows the importance of patient retention as savings start to accrue between 12 and 18 months period on treatment

10

HIV and AIDS Community Partnerships

• Community programmes are designed to build capacity for comprehensive HIV and AIDS services in communities associated with our operations

– In partnership with local government, NGO’s, trade unions andprivate health service providers

• Business in the Community international award recognised Anglo American’s leading HIV/AIDS responses in the workplace and in the community

• Anglo Community HIV and AIDS Partnership programme$4.7 million over 3 years – started in 2003

– Presence across eight regions of South Africa– Focus on youth education, awareness and leadership– New initiatives being developed in rural health care delivery

• Business training on HIV and AIDS in China

• Community education and awareness in Brazil

• Seeking to extend community based initiatives to cover all our global operations

– Focus on youth andthe vulnerability of young women and girls to HIV infection

11

Stop AIDS Now!

For any given workplace community,measured over one year

Target three zeroes:

• ZERO new HIV infections• ZERO people get sick or die from AIDS• ZERO babies born HIV positive

on a foundation of

• ZERO tolerance of discrimination; stigmatisation or any breach of the human rights framework