Botswana's first AIDS case was diagnosed more than ten years ago. The epidemic was initially concentrated in urban centres but quickly spread to rural villages. Botswana has good roads and a highly mobile population with between two and three dwelling places per household. Currently, the overall HIV rate is estimated at 17% of the population; it is even higher for those aged 15-49 years. AIDS has become a major threat to the country's production and economic development; the average retirement age has been cut in half due to ill health. HIV/AIDS is now at the top of the national policy agenda and the government's budgetary priorities. Government, nongovernmental and private sectors are working towards saving the country's population and economic growth. In this context, the Debswana Diamond Company has developed a comprehensive HIV/AIDS policy and strategy, backed by strong top management. Its Jwaneng Mine programme is a good example of the private sector's involvement in the fight against AIDS.

 Jwaneng Mine lies on the fringes of the Kgalagadi Desert, one and a half hour's drive Southwest of the capital Gaborone. The mine has been operational since 1982, employing over 2000 workers, predominantly men. Jwaneng town, 11 km from the mine, has almost 17,000 inhabitants. It serves nearby villages and is a stopover for travellers and truckers from Namibia and South Africa. Testing for HIV started in 1989, when the local hospital noticed a high number of clinically suspicious cases. The following year a team from the hospital invited their Town Council counterparts to form the Jwaneng AIDS Committee, whose main functions included community mobilisation and advocacy, AIDS awareness and education, and monitoring HIV prevalence rates through hospital statistics.

Jwaneng Mine AIDS programme

The Jwaneng Mine AIDS programme started in 1992. Its structure resembles a tree with roots and branches joined together by the stem. The supportive roots comprise a pro-active management committee that provides the necessary support for effective management of HIV/AIDS in the workplace. A policy document helps to situate HIV/AIDS as a strategic issue and provides guidelines for programme implementation. Support groups and services act as channels for implementation by reinforcing messages, providing new information and assistance to the target populations.

The stem represents the day-to-day running of the programme: the HIV/AIDS Programme Coordinator coordinates the activities of the various support structures and ensures they are equipped with the necessary knowledge and skills. The coordinator also links up with national AIDS management structures, including AIDS NGOs.

The programme has three main branches:

1. AIDS awareness includes daily or weekly activities addressing specific issues for employees and mine catchment area communities. Theatre, music and drama are channels for disseminating information on behaviour change and company policies on HIV/AIDS. Internal publications carry features on AIDS and are distributed among employees and non-mine departments in Jwaneng. Finally, electronic boards carrying HIV messages are strategically placed to catch the attention of large populations.
2. Education comprises peer education programmes driven by line management in their respective working areas. Reading materials and videos are placed in the workplace under the supervision of peer educators. The mine's HIV/AIDS education and counselling drop-in centre also has reading materials and videos. Individuals and families can come in for educational sessions during working hours and may arrange with staff for after-hours sessions. The mine runs seminars and workshops with themes addressing different target groups for employees' families and local communities. Jwaneng Mine also conducts in-house training for all internal support structures, as well as for its partners in care (local health staff and community-based groups). The sexual health communication workshops are a good example of opportunities where peer educators can discuss human sexuality with confidence. The course addresses personal attitudes towards men and women and the (dis)advantages of traditional gender roles. The sessions between peer educators and their work mates have yielded clear behaviour change messages.
3. Care involves voluntary counselling and HIV-testing services for employees, dependants, contractors and the general public. Home-based care services (e.g., treatment of opportunistic infections) are provided in partnership with the local district health team. Debswana Diamond Company is Botswana's first company to offer anti-retroviral drugs to employees and their wives/husbands through a company subsidy.

Areas of collaboration and support

Apart from Jwaneng Mine's own AIDS programme, the mine has been collaborating with and supporting several other initiatives:

• Youth involvement and community participation:
• Adolescent reproductive health and sexuality workshops for mine employees' dependants and children in the local communities.
• Resource materials and technical support for schools in the catchment area.
• Peer education and counselling activities, including a vegetable garden in the centre's premises, supplying home-based care clients with food support. A counsellor also facilitates a support group for people living with HIV/AIDS.
• Technical assistance and sponsorship: transport, human resources training, materials and office facilities for local youth and adult groups. Also, non-mine workplace peer educators and community volunteers attend company-run courses free of charge.
• Men, sex and AIDS: training and motivational support from the Men, Sex & AIDS team, an innovative government programme aimed at fighting AIDS by addressing male sexual behaviour.
• District Multi-sectoral AIDS Committee: collaboration and partnerships with important stakeholders. Jwaneng Mine's General Manager, Chief Medical Officer and AIDS Programme Coordinator have been members of the Jwaneng District Multi-sectoral AIDS Committee since its inception. Jwaneng Mine has sponsored and participated in many of the committee's activities.

Female condom study

Jwaneng Mine has recently embarked on a female condom acceptability study among men and women. Greater acceptability of the female condom could increase the options for HIV/STI education and behaviour change. Most significant is that, to date, more men than women are interested in knowing about the condom. In Botswana's local communities, men usually decide when to have sex, with whom and whether to use a condom. The study reveals that traditional attitudes on male and female sexuality need to change: in order to curb the HIV epidemic, men must learn to share responsibility with their female partners and replace their traditional "macho" behaviour. Care and love can only be expressed through responsible sexual behaviour.

Success and failure: lessons learned so far

High levels of HIV/AIDS knowledge alone cannot reduce HIV infection rates and the impact of AIDS. The underlying cultural practices and gender roles that act as barriers to changing attitudes and practices, need to be part of our communication and education strategies. As attitudes and behaviour change requires 100% involvement and interest of the people concerned, Jwaneng Mine sees its employees as key stakeholders. Jwaneng Mine's experiences so far have shown that departmental HIV plans are best left with the unit managers, as they understand better the operations and needs in their area. A key lesson learned is that in order to deal with HIV/AIDS effectively, company management and trade unions must decide to sit on the same side of the table and agree when dealing with HIV/AIDS issues. Both stand to lose if their disagreements are not solved quickly enough to save human lives and that of the company.