One Man's Drive... One Company's Courage

The most important day in Dr. Brian Brink's medical career came last August 1, more than 15 years after he put down his stethoscope and started climbing the ladder at Anglo American, the mining conglomerate that is the most powerful company in South Africa. It had taken Brink years of meetings and memos to get Anglo to that day. He had had moments of optimism and months of discouragement as three earlier plans were each announced, only to be sidelined. Then, quickly, in a morning meeting, it was decided. CEO Tony Trahar said simply, "Let's do it."

That Thursday, Brink got approval from Trahar and Anglo's executive committee to buy anti-AIDS medicine for any of Anglo's 130,000 employees in South Africa who needed it. Between 25% and 30% of the company's employees are HIV positive; the decision to provide the drugs made Anglo one of the largest customers for AIDS medicine in the world. It may also be the pivot of a terrible 10 years for South Africa.

Tall and slight, with a lean face and alert eyes, Brink seems unlikely to have the muscle to reset the course of a company with 177,000 employees in 61 countries. A South African, he speaks with an amused drawl that sounds cultivated and charming to an American ear. At 50, he has the confidence of an experienced doctor. He is soft-spoken, even when insistent.

That Thursday in August, after the decision was made, Brink went back to his desk and dialed the office of South Africa's minister of health. He was calling with good news. But the phone call was a reminder that the war wasn't yet won, by any stretch. "I need to speak with the minister rather urgently," Brink said. "I'd like an appointment."

"The minister is out," her assistant said, "and the soonest you could expect an appointment is October."

"I was actually thinking about Monday," Brink replied. He eventually wrangled the cell-phone number of the director general of health. "I called," says Brink. "I got his voice mail."

That Monday, Anglo officials faxed details of its AIDS treatment plan to the minister of health and to the office of the president of South Africa, along with private numbers for a range of Anglo officials, including CEO Trahar. No response. "What were we going to do?" says Brink. "Wait and ask for permission? I said, Let's just do it."

On Tuesday, August 6, Anglo announced that it would be providing its miners with the same "triple cocktail" antiretrovirals that have helped arrest AIDS in the developed world. The decision was front-page news in South Africa. It also made the front page of the Financial Times in London and the New York Times. But the South African government was silent for a week. The minister of health, Dr. Manto Tshabalala-Msimang, is known in the country as "Dr. No" for her refusal to provide antiretroviral therapy (ART) to government clinics in a nation that has more AIDS cases than any country in the world. The ministry had to be sued last year to force it to provide poor pregnant women with the antiretroviral drugs, which dramatically cut the rate of transmission of HIV to fetuses.

More than a week after Anglo's announcement, Tshabalala-Msimang did have something to say. She denounced Anglo for providing the drugs, failing to consult her in advance, and putting the government in the awkward position of refusing to provide medicine that a mining company would be giving away. In a meeting with Brink, she was scorching. "Oh, she was pissed off. She said, 'You're squeezing me.' For that," says Brink, a twinkle in his eyes, "I don't apologize."

A Nation Lost: A Thousand Dead per Day

How bad is AIDS in South Africa? Average life expectancy around the world is now 66.5 years. In the United States, it's 77 years. In South Africa, it's 48 years -- down from 54 in 1997, largely as a result of AIDS. Life expectancy hasn't been 48 years in the United States since 1901.

Here's how debilitating an HIV infection rate of 30% is. Earlier this year, I went to a managers' safety meeting at Anglo's Mponeng gold mine, an hour west of Johannesburg. This group of 150 fresh-scrubbed men and women in khakis and golf shirts manage a mine that produced 29,125 pounds of gold last year. How do you run a mine while planning for the possibility that 40 of your 150 frontline managers will die from a single disease before 2010? The mine employs 5,616 people in all. Imagine losing 1,400 of them.

In the United States, providing medicine in this situation would seem obvious. But South Africa is such a complicated place that it took Anglo years to talk itself into providing ART. CEO Trahar says that his thinking changed "180 degrees" on whether Anglo should provide AIDS drugs. "I was pretty opposed when we first started considering this," says Trahar. "I really thought, Treatment is a problem for other organizations. Now I think it's absolutely the right thing for us to do."