Maintaining privacy and ensuring non-discrimination in the context of HIV/AIDS

Working in hyper-endemic countries
A major mining presence in southern Africa
The De Beers Family of Companies (including De Beers sa and its owned and controlled subsidiaries and divisions, joint ventures and independently managed subsidiaries)
Primary countries of operation:
Southern Africa, including Botswana, Namibia and South Africa, as well as in Canada
Major Shareholders:
Anglo American Group (45%), Central Holdings Group (representing the Oppenheimer family, 40%) and the Government of the Republic of Botswana (15%)
No. of employees:
More than 15,000 - with more than 14,000 of these located in southern Africa


The De Beers Family of Companies produces and markets approximately 40% of world diamonds by value. It has a major and longstanding mining presence in southern Africa, including mines in Botswana, Namibia and South Africa. In Botswana and Namibia the mines are owned in equal share by De Beers and the governments of those countries through the Debswana and Namdeb joint ventures. De Beers recently opened two new mines in Canada, both of which are wholly owned. Sorting and sales take place primarily in these countries, as well as in the United Kingdom.

Further information:

Dilemma: Working in hyper-endemic countries

De Beers employees in Africa live and work in countries classified as hyper-endemic for HIV. These are countries with prevalence rates in excess of 15% in the general population. The rate of infection amongst adults in Botswana is estimated at 23.9%. Prevalence rates in Namibia and South Africa are estimated at 15.4% and 18.1% respectively. Managing HIV and AIDS in these countries is a central part of the Family of Companies ongoing operational risk management process.

The De Beers Family of Companies has established a leadership position with respect to HIV/AIDS management. Debswana, a joint venture with the Government of the Republic of Botswana, was the first company in the world to provide an HIV/AIDS management programme outside of medical insurance. Similarly, De Beers was one of the first companies to provide ART for all of its employees and their spouse/life partners.

Achieving a 'vision of zeros'

The Family of Companies is working to achieve a 'vision of zeros'. This means: zero new HIV infections in employees or partners; zero babies born with HIV/AIDS from mothers registered on its treatment programmes; and zero deaths from HIV/AIDS as employees and partners access its treatment programmes.

The HIV/AIDS management programme initially focused on prevention, treatment, care and support of employees and their lifetime partners. This approach has evolved to include the communities in which De Beers companies operate, and from which employees, contractors and their families are drawn. The extension of risk management activities into local communities now forms a key part of the company's comprehensive HIV/ AIDS strategy. De Beers also works closely with public health authorities in each of its operating countries.

The Family of Companies places great emphasis on the inclusion of other stakeholders in the development and implementation of its risk management strategy. This includes government, expert NGOs, trade unions and other organisations. The Family of Companies operates a strict policy of non-discrimination and confidentiality with respect to HIV/AIDS. This helps ensure those infected do not suffer any further disadvantage with respect to their employment, working environment, career prospects or otherwise. It also creates a culture of trust and cooperation that is central to company efforts to combat the disease.

Challenges: Balance, boundaries and sustainability

When developing its disease management programme De Beers sought to address the following challenges:

Challenge 1: Balancing the role of the state as a provider of essential public services and that of the state as a shareholder

  • Controlling company costs whilst supporting public health services through company treatment programmes
  • Avoiding perceptions of discrimination when providing different HIV/AIDS programmes to citizens and employees
  • Ensuring strong alignment between national interest and company interest in the fight against HIV/AIDS

Challenge 2: Balancing business needs with the needs of those that are HIV positive

  • Minimising the cost of absenteeism and other impacts of HIV/AIDS without discriminating against HIV positive employees
  • Ensuring efficient long-term talent management without discriminating against HIV positive employees
  • Offering a conducive workplace for those infected whilst minimising impacts on operational efficiency
  • Ensuring revenues and other economic benefits are not compromised by over-extension of HIV/AIDS responsibility

Challenge 3: Setting appropriate boundaries in terms of who is included in HIV/AIDS management

  • Cost (i.e. what can the company afford?)
  • Discrimination (i.e. how to decide who is included and who is not?)
  • Responsibility (i.e. which group can the company be considered responsible for?)
  • Business needs (i.e. who does the company need to include?)
  • Reputation (i.e. will non-inclusion of groups result in reputational damage?)

Challenge 4: Providing disease management and ART in a responsible and sustainable manner

  • Retrenchment (i.e. potential loss of treatment where retrenched employees are not at fault)
  • Dismissal (i.e. potential loss of treatment where dismissed employees are at fault )
  • Retirement (i.e. addressing whether treatment should continue after productive employment)
  • Contract period (i.e. mitigating potential avoidance of responsibility through short contracts)
  • Voluntary departure (i.e. ensuring terms of treatment provision do not act as an undue barrier to departure)
  • Treatment transition (i.e. enabling smooth transition from company-run treatment to state provision)
  • Contractors (i.e. changing boundaries of responsibility with respect to long-serving contractors)

Challenge 5: Balancing the requirements of strong HIV/AIDS management against individual rights

  • Motivating employees to understand the disease and protect themselves even outside the workplace
  • Promoting a stigma-free work environment whilst challenging culturally-entrenched values
  • Targeting vulnerable groups whilst advocating non-discrimination
  • Maintaining confidentiality about HIV status in safety-critical environments
  • Obliging employees to work with colleagues that may be HIV positive despite individual concerns, beliefs or attitudes

Challenge 6: Developing and maintaining positive relations with relevant public authorities

  • Fighting HIV/AIDS without removing or undermining the responsibility of public authorities
  • Establishing responsibility for post-employment treatment and care
  • Providing ART to specific groups within wider populations that are not guaranteed access
  • Promoting non-discrimination in countries where it is not clearly advocated
  • Raising awareness on prevention and treatment when not necessarily in line with official views

Good practice: Prevention, treatment, care and community

Implementing a comprehensive HIV/AIDS management system

De Beers is currently implementing the new South African National Standard (SANS 16001: 2007) for HIV/AIDS Management Systems (HAMS) at its operations in South Africa. SANS 16001 differs from the AIDS Management System (AMS 16001:2003) standard, which was pioneered and developed jointly by Debswana and the National Occupational Safety Association. SANS 16001: 2007 goes beyond workplace programmes focused on HIV/AIDS to cover prevention of infection in the community, and as such requires a more wide-ranging approach to risk management. The Orapa and Jwaneng mines in Botswana are already certified to AMS 16001 and are evaluating a transition to the South African standard.

Despite having won numerous awards for its HIV/AIDS activities, the baseline reviews of De Beers South African mines against SANS 16001 found a number of gaps in performance. This related to the lack of a “systems approach” in the management of prevention, community response and treatment initiatives. Some aspects that De Beers is planning to rectify in 2009 include a lack of individual risk assessment or management data, a lack of rigour in checking service provider compliance with standards, as well as a lack of comprehensive outcome and impact indicators. Many of these gaps exist because HIV coordinators tend to be untrained in systems management and thus focus on their areas of competence e.g. nursing, social work, psychology and human resources. Since completing the benchmark reviews, all De Beers South African mines have participated in training programmes to build the skills required to achieve the SANS 16001: 2007 standard.

Awareness-raising and prevention

Knowledge, Attitude and Practice (KAP) surveys, poster campaigns and art competitions. These events and campaigns also help address stigma by approaching the issue in an open, constructive and non-judgemental manner.

VCT forms a key element of the De Beers HIV/AIDS programmes. It allows the company to help those found to be negative to stay negative, and to offer those who are infected access to relevant health programmes. Testing is available to employees, spouses, life partners and contractors. It has also been extended into local communities through private-public partnerships. By the end of 2008, around 70% of employees in South Africa had participated in workplace testing. This high rate of participation is partly due to:

  • Cultivation of a stigma-free culture in which testing is 'normal'
  • Guaranteed confidentiality High-profile, annual testing campaigns
  • The offer of routine testing during medical consultations at mine clinics

Other prevention initiatives include the provision of free male and female condoms at medical centres and restrooms, medical actions to prevent mother-to-child transmission and post-exposure prophylaxis.

Treatment and adherence rates

Employees at Family of Company operations in Botswana, Namibia and South Africa are given free access to ART. ART is also provided to spouses and life partners without payment. The Debswana joint venture also provides ART to the children of employees. The company works closely with public health authorities to ensure treatment is continued through government programmes if and when employment ends.

De Beers ART programmes are externally coordinated by a disease management service provider, Aid for AIDS. Key indicators enable De Beers to understand more clearly how well its service providers perform in getting employees to adhere to disease management programmes.

Care and support

The Family of Companies takes a holistic approach to HIV/AIDS, with a concentration on maintaining both the physical and psycho-emotional wellbeing of those who have been infected. These efforts are aimed at helping those infected live a longer, healthier life and extending the duration of their productive employment. Programmes include wellness advice, medical consultations, pathology, counselling and support, prophylactic medication to prevent opportunistic infections such as tuberculosis, as well as nutritional supplements.


Investment in community HIV/AIDS programmes is primarily carried out in partnership with government, international donor agencies, NGOs and community based organisations. Activities include support for education and awareness building initiatives, outreach and training support, and home-based care support. In South Africa, the De Beers Community HIV/AIDS Partnership Programme (DBCHAPP) has invested a total of US$3.9 million in community projects over the last three years. In some countries community care also includes access to doctors, pathology testing, nutritional supplements and access to medication through company hospitals.