In August 2002, the mining company Anglo American announced plans to provide free AIDS drugs to workers who needed them, saying this was less expensive than the costs associated with not offering treatment. The company estimated that 24 percent of its 140,000 employees in eastern and southern Africa were HIV-positive, said Dr. Brian Brink, its chief medical officer.

Yet despite encouraging results from workers who have accessed the drugs, the overall response to the program remains disappointing. While about 8,500 workers were at the stage where they needed the drugs, only 2,100 were enrolled in the program at the end of 2004. "I wish I knew why," said Brink, who noted that 94 percent of Anglo employees on the AIDS drugs are well and working.

"People talk about fear, denial, and stigma, but I don't think they're the main reasons. I think it's simply that people don't know they are HIV-positive," Brink said.

As a result, many workers access the program only after becoming ill and may experience an increased risk of adverse reactions and reduced drug effectiveness. "If you start late, even though you get the patient's viral load down, the immune system is often too impoverished to recover," Brink said.

Of patients who have joined the program, 5 percent have died. Four hundred began treatment but stopped, chiefly because of drug side effects or difficulties in adhering to drug regimens.

Anglo also provides workers with the drugs for three months after leaving the company and helps them find other assistance programs, Brinks said. The drugs are provided only to workers, not their dependents. Since Jan. 1, AIDS drugs have been classed as "prescribed minimum benefits," the package of health care services that governments says medical plans must provide for all members, regardless of what they pay for membership.

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