Digging deep - new dimensions of HIV prevention in southern Africa's mines

Labour migration plays an important role in HIV transmission, particularly in the mining industry in eastern and southern Africa. HIV prevalence is around 30 percent amongst South African gold miners. Improved strategies for HIV prevention are obviously needed - is it time for a new approach?

Researchers from the London School of Economics and the Johannesburg Council for Scientific and Industrial Research analysed the responses of mining management, unions and government to the HIV epidemic. The focus on biomedical and behavioural prevention programmes and human rights issues has obscured the social and psychological dimensions of HIV transmission. A more integrated approach is needed.

Prevention programmes in the region's mines have had disappointing results. Knowledge of HIV/AIDS has increased, but there has been little related behaviour change. HIV interventions are most likely to succeed when government, unions and management work together and share a common vision.

Through interviews with government, mining and union representatives and miners themselves, the study showed that:

• Mine managers provide HIV prevention programmes and have developed labour policies in response to HIV. However, they view the disease as the responsibility of individuals.
• Unions have negotiated human rights agreements concerning HIV/AIDS, but their response is generally reactive rather than proactive.
• There is little evidence that union or management activities have significantly altered the course of the epidemic.
• Governments often do not often provide leadership or vision in support of HIV/AIDS interventions at mines.
• Many of the contextual factors leading to HIV/AIDS lie outside the province of health departments and beyond the reach of biomedical or behavioural interventions.
• The social contexts of HIV include economic factors such as rural poverty, working conditions where illness, injury and death are a routine part of everyday life, and gender dynamics leading to commercial sex work.
• Psychosocial processes that increase risk include low self-efficacy, knowledge and beliefs that compete with health education messages, and masculine self-identities which encourage frequent sex and militate against condom use.

Policy-makers and health planners confronting the HIV epidemic in the region's mines should:

• involve a range of government departments in multi-sectoral strategies
• focus on broader social and environmental issues that facilitate unsafe sexual behaviour such as migration, housing, economic dependence of women, rural poverty, development and occupational safety legislation
• learn from the experiences of other countries
• recognise that the fight against HIV transmission must involve the whole community
• maximise networking between local, provincial and national HIV prevention initiatives.

These principles are applied in a new HIV-prevention programme at Carletonville in the Johannesburg region. As well as providing health education, condoms and syndromic management of sexually transmitted infections for mine workers, this programme will also:

• target members of the communities surrounding the mines
• involve representatives from the management, trade unions, grassroots community organisations and provincial and national health services
• incorporate traditional and biomedical practitioners
• use community-based outreach and peer education strategies
• encourage participation of target audiences in the design and implementation.

Source(s):
'Beyond the biomedical and behavioural: towards an integrated approach to HIV prevention in the Southern African mining industry' by C. Campbell and B. Williams, Social Science and Medicine 48 (1999)

Funded by: European Union

id21 Research Highlight: 24 July 2001

Further Information:
Catherine Campbell
Social Psychology
London School of Economics and Political Science
Houghton Street
London WC2A 2AE
UK

Tel: +44 (0)20 7955 7701
Fax: +44 (0)20 7955 7565
Contact the contributor: c.campbell@lse.ac.uk

London School of Economics

Brian Williams
Office L42, Communicable Diseases
World Health Organisation
P.O. Box PA/OMS/CDS
20 Avenue Appia
Geneva 27
Switzerland, CH 1211

Tel: +41 22 791 4680
Fax: +41 22 791 4268
Contact the contributor: williamsbg@bigfoot.com

World Health Organisation

Other related links:
The AIDS Foundation of South Africa provides general information on HIV/AIDS in a South African context.

The Health Economics and HIV/AIDS Research Division (HEARD) at the University of Natal has resources covering the economic and social impact of HIV/AIDS.

The Medical Research Council of South Africa provides a portal for information relevant to HIV in the region.

This South African site has details of research, services and other information.