Archie Msiza is slumped on a wooden chair at the Highveld hospital, which sits in the middle of a flat, prairie-landscape pock-marked only by colliery shafts, 100km east of Johannesburg.
In his dark sports top with a tear on the front, Msiza looks too small to grapple with the heavy machinery needed to wash coal destined for foreign power stations.
He leans for reassurance into his medical adviser -- Sister Rose Masemola -- and speaks in a whisper, but this is not because of the HIV that runs round his veins. The youthful 42-year-old mineworker has agreed to talk but is still nervous his name might be disclosed in the newspaper. He has not admitted even to his friends or colleagues he has the sexually transmitted disease because he fears discrimination.
ILLUSTRATION: YU SHA
A huge stigma is still attached to the illness in South Africa.
"The only person I could tell was my wife," he says
"That was very hard. I had to tell her I had too many girlfriends. I was drinking a lot," he adds.
Msiza (not his real name) is in fact one of the lucky ones out of the millions estimated to be suffering in the country of his birth.
He was admitted to the hospital run by his employer, Anglo Coal, nearly 12 months ago, suffering from tuberculosis as a result of an HIV-depressed immune system.
He agreed to an AIDS test, was diagnosed as having the potential killer virus, and became one of the first to be put on a free cocktail of anti-retroviral drugs provided by the London-listed Anglo American group that controls Anglo Coal.
A year on, Msiza insists he feels "great," and boasts that his life has pretty much returned to normal. He is working back at his old job, is playing for a local football team and has an active sex life.
There are more girlfriends, but this time he insists he uses the free condoms handed out by Anglo Coal.
Msiza can spot the other coal miners around him who are suffering. He would like to help, but argues that he could not do that without revealing his own status.
"I am afraid to do that," he says bluntly.
More worrying is the position of his wife. While Msiza is happy that she has shown no outward sign of the AIDS virus, he knows she has been infected and yet has no access to the treatment she needs.
Anglo is trying to safeguard the future of its 124,300 local employees, but has so far balked at the cost of extending the treatment to wife and family. The corporation, that controls coal, gold and aluminum mines, believes a quarter of its South African work force is infected: that means 30,000 people.
It insists it has no firm statistics yet of the financial impact of this catastrophic epidemic but knows productivity must be hit by increased absenteeism and loss of trained staff.
A recent study by the World Bank on the impact of AIDS warned that if nothing was done South Africa could face "complete economic collapse" within four generations.
The situation has not been helped by a government that has moved only slowly from complete denial to indecisive dithering. In the meantime Anglo last year became one of the first, and certainly the biggest, employer to embark on groundbreaking plans to provide anti-retroviral drugs to all its infected workers. Since then other firms such as British drinks group Diageo have promised to do the same.
The strategy, whether for compassionate or commercial reasons, sounds simple, but Brian Brink -- the architect of the moves at Anglo -- says it's actually hugely complicated. Now, 12 months after the executive board gave the go-ahead to distribute AZT and other drugs, it still has only 700 staff receiving treatment.
The biggest problem is trying to find out exactly who is HIV positive. The 30,000 staff infected figure is extrapolated from voluntary and anonymous testing of a relatively small number of employees -- 10 percent -- who have been willing to turn up and give their blood.
"There is still a huge amount of ignorance in the country and the lack of leadership from government has caused confusion. It has been inexcusable, really. We are moving ahead now but we all need to do a whole lot more," says Brink, the chief medical officer at Anglo.
It is not just the mine workers themselves that must be cajoled into action -- the managers, too, show varying degrees of commitment to tackling the issue.
One of Brink's big mine bosses is John Standish-White, the straight-talking head of the Goedehoop colliery, which mines 8 million tonnes of coal a year.
He claims to have "shocked the shit" out of his own line managers by his tireless work to convince the men and women who work both above and below ground that they must become AIDS aware.
One of his recent initiatives at Goedehoop brought 171 staff over a month for a pinprick test, but Standish-White still does not know exactly how many of his 1,229 employees are HIV-positive.
Employees fear they will be discriminated against by their bosses, their colleagues and society at large, although Standish-White has tried to convince them otherwise. He has held workshops, brought in tribal leaders and developed a confidentiality pledge signed by himself and all senior managers.
"I have told them that the sooner they know their status, the sooner the company can be looking after them. But breaking the silence is a huge issue. Just talking about sex is not easy here. But we have come a long way with our AIDS awareness issue," he says.
Not the least of the company's problems is that the powerful National Union of Mineworkers (NUM) remains to be convinced it should be entirely supportive.
Labor leaders say they are keener than anyone to tackle the problem, given it is their members who are suffering the most. They can feel the scale of the problem by the fact they provide a R2,500 (US$360) funeral assistance program to families affected by the death of their wage earner. This scheme is already costing the union R5 million to R6 million (US$716,000 to US$860,000) a year, and the figure is growing fast.
"We are pleased that companies are beginning to tackle the problem, but we need to have proper HIV agreements at national level signed by the union general secretary and the company chief executive. There have been no such deals, only companies going off on their own implementing local programs," argues Welcome Mboniso, the health and safety officer at the NUM.
Not only that, mining companies are appealing for cooperation to a workforce that has been downtrodden by them for years, especially during the apartheid years, argues Mboniso.
"The mining industry has been very brutal and you can't expect confidence and trust that workers will not face dismissal if they test positive with HIV to appear overnight," he explains.
In addition, Anglo and other firms have added to, if not created, some of the triggers for the HIV and AIDS epidemic.
The heavy reliance on migrant workers and their accommodation in hostels where four or five male workers share a room and only see their families a few times a year has encouraged the spread of AIDS.
Sex workers are as much part of the hostel environment as alcohol sellers.
The union also criticizes Anglo, which has profits of more than ?1 billion (US$1.7 billion) a year, for only providing proper health care insurance for a relatively small percentage of its workforce.
The NUM says the mining industry has presided over an annual death rate from rock falls and other accidents averaging 200.
"It's already a killer industry," argues Mboniso, who says many NUM members will require convincing that the distribution of drugs is more than a PR exercise. They are particularly frustrated that Anglo is treating its staff but not their dependants.
All of these arguments depress Brink, a trained doctor who comes over as someone with a passionate desire to solve a humanitarian problem rather than win semantic battles on behalf of his corporation.
He understands many of the NUM's arguments and admits that while Anglo is worried about the potential spiralling costs -- initially worked out at R29,294 (US$4,200) per patient including all the administrative back-up -- that could come from treating staff and their families, his own company's position is ultimately "untenable."
Brink points out that diamond miner and distributor De Beers, which is part-owned by Anglo, is already offering anti-retroviral drugs to both its staff and dependants. His hope is that the South African government will accept the recommendations of its own taskforce that it should help financially with treatments for all citizens, as has happened in Botswana.
Even if this takes place Anglo will continue with its work, he says, given the experience and knowledge that has been gained about treatments.
Brink knows more than anyone in corporate life about this disease. He started working for Anglo 22 years ago and first encountered HIV in 1985.
A study he initiated the following year using anonymous and random testing on 18,450 staff found an infection rate of 0.2 percent, compared with today's 24 percent overall and 28 percent in its goldmining business.
By Christmas Brink hopes to have 1,000 staff "on treatment" and their life expectancy rate will be improved dramatically, but he believes business cannot conquer the problem alone and wants unions and local authorities working together more.
Earlier this month Anglo promised to commit US$4,3 million over three years to a LoveLife community programme aimed at youth awareness, prevention and treatment of the disease in six provinces where it has operations.
This will be done in partnership with government health clinics, but Anglo knows it is running to keep up with a disease that is threatening to destroy its workforce, if not a country.
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