From Africa to Russia, from Peru to China, mining companies face a problem: the workers who haul up the earth's riches are getting Aids, and it is hampering operations at a time of booming demand for minerals.
"The epidemic is extremely severe, it's worse than any of us admit to, there are a lot of undiagnosed cases that don't get reported," Brian Brink, medical senior vice-president at Anglo American's South Africa operations, told Reuters.
He said Anglo, the world's fourth largest mining group, realised it had a problem at its mines 21 years ago when four of its 18 450 South African workers tested positive for the virus.
Prevention efforts failed
Over two decades later, with up to one in three infected and South Africa the centre of a global pandemic, the firm says its own prevention efforts failed.
"We didn't stop this epidemic. In fact if I was to look back and score ourselves, I think we get zero," Brink said.
Worldwide the disease has killed some 30 million people, double the amount of casualties in World War One. Miners are anxious to build on lessons learned in South Africa to try to stem the tide elsewhere.
The world's fourth biggest gold producer, Gold Fields, has estimated the total cost from HIV at around R35 per ounce of gold produced in South Africa, and even with gold trading at around $650 per ounce the cost is significant.
Numbers rising steeply
Aids is growing fastest in Eastern Europe and Central Asia where the number of people living with HIV has grown 20-fold in less than a decade, according to the United Nations.
In Russia, the infection rate has more than doubled in two years to 1.2 million in 2005 and in the country's fifth largest gold mining area, Irkutsk, the rate is more than three times the Russian average, UNDP data showed.
In India, there are many patches where the population's infection rate is above 1 percent.
"In the early 1990s that (one percent) is where we were and then it is very difficult to stop," Brink said.
The HIV infection rate among South African miners is now nearly double that of the general working population.
In China, the UN estimated 650 000 people were infected in 2005, up by 23 percent in two years. If that spread continues, some 1.9 million people will be infected in China by 2015.
SA set bad example
"They (other countries) must not fall into the same trap as South Africa," said Lennox Mekuto, Health and Safety Officer for the National Union of Mineworkers in South Africa.
In May this year health experts from seven mining giants met for the first time in London, forming a group to come up with an improved strategy on how to halt the spread of Aids.
"It is a major challenge this industry is rising to meet," said the UK-based head of operations and safety at Rio Tinto, Richard Gaunt.
The impact of prostitution
Miners - many migrant workers - risk their lives to make money daily, so unprotected sex seems a minor hazard.
Remote mine sites attract sex workers. In the mining province Yunnan in China, sex workers from Myanmar and Vietnam are a high-risk group likely to spread the disease as illegal migrants fear the threat of deportation if they contact public health services.
"This is the nature of our business, it attracts sex workers, whether we like it or not we cannot wish it away," said Stella Ntimbane, group HIV/Aids coordinator for Gold Fields in South Africa.
Clients of sex workers are a major bridge of HIV transmission to the general population. In 2005 the ILO estimated that 1.4 million sex workers were forced labour, without access to treatment.
Russia, China and India and the broader continent of Africa face a huge urban-rural divide, limiting rural access to HIV clinics. In often inhospitable mining areas workers and their communities depend on services provided by the mining firm.
Poverty adds to the risk of infection and the virus creates a vicious circle, with an estimated cost of 0.5 to 2 percent of the GDP growth in the worst-hit countries.
Governments are slow
In India, an influx of multinational corporate investment gives business a great opportunity to play a significant role in the fight to halt the epidemic, said Neeraj Mistry of the Global Business Coalition (GBC) in New York, which consists of 200 companies dedicated to fighting Aids.
Governments must also act, he said: "In Russia and Eastern Europe we are seeing that the governments are a bit slow."
In Russia and neighbouring countries, HIV is concentrated within the prison population, sex workers and intravenous drug users - Russia is a main transit route for Afghanistan's opium.
"When I was working in Ukraine, it was well known that on pay day miners would spend a lot on drugs and alcohol and HIV was spreading quite rapidly," Human Rights Watch's director for HIV/AIDS, Joseph Amon, said.
Mistry said China's government was proving more responsive, having learned from its failure to deal with the deadly severe acute respiratory syndrome (Sars).
"Companies that are now investing in China and working there are working hand-in-hand with the government to get a more comprehensive response in its strategies," he said.
Tina Meng, business development manager for Anglo American in Beijing said: "We do it because we know that if this disease takes root it is really terrible, of course for individuals and the community, but also for a company's operations."
Win a truck
After initial confusion and political obfuscation, South Africa has brought all stake holders together and the government; civil society and business have set up a five-year plan to tackle HIV.
Firms are enticing miners to take HIV/Aids tests by offering prizes, sending mobile treatment units to the bush where sex workers operate and blanketing the region with condoms.
For instance, Gold Fields gives each miner who takes an HIV/Aids test a lottery ticket, offering monthly prizes of cell phones, televisions and cash, plus a final sweepstakes where one worker wins a new pick-up truck.
If more governments addressed the pandemic it would secure the sustainability of HIV programmes, especially when a mine closes and the firm leaves, say South African executives.
"It is certainly one of the biggest concerns for us, again that really points to the importance of a collaborative approach with other partners," said Rob Barbour, medical coordinator in Tanzania for gold producer Barrick Gold.
BHP Billiton - the world's largest mining company - said for every dollar it invests in HIV training, education and medical programs the return is four-fold in terms of benefits such as re-training, absenteeism and productivity.
An overwhelming business case
"There is an overwhelming business case," said BHP Billiton's regional health adviser for Southern Africa, Andre van der Bergh.
"When we started our HIV programme we didn't wait for any government to say yes or no, if there is a risk for an organisation we take appropriate action." – (ReutersHealth)