The risk of sexually transmitted infections in a Tanzanian mining town

Mining communities' transient populations can be high risk environments for sexually transmitted infections. Are there particular groups in these communities that are most at risk? If so, how can these groups' sexual behaviour change and how can the population as a whole be protected from infection?

TheNational Institute for Medical Research, Tanzania, together with the MedicalResearch Council, UK, looked at sexual behaviour in a small gold mining town innorth-western Tanzania to discover who was most at risk of contracting HIV andother sexually transmitted infections. Miners and sex workers are commonly identifiedas two potentially high risk groups. Miners come for short-term jobs withouttheir wives and families, whilst sex workers visit the town to look forbusiness. Sex workers are often blamed for the spread disease within andbetween communities.

Insuch communities it can be difficult to distinguish between sex workers andwomen receive payment for sex.  A thirdof the women surveyed who work in the recreation industry, such as bars,hotels, restaurants and dance halls, said they had been paid for sex in the weekbefore the survey. Almost half of all women surveyed in the recreation industrywere HIV positive.

Payingfor sex and having more than one partner is normal behaviour amongst many menin the mining community. To exacerbate the problem, the majority of men do notuse condoms for paid sex. Subsequently, women who are faithful to theirhusbands are still at risk of HIV if they have an unfaithful husband.

Thestudy found that:

• It is difficult to distinguish between people who are at high risk andthose at low risk. However certain places are linked with higher levels of sexualactivity, for example, bars, discos and video evenings.
• ‘Modern’ values were important in the town surveyed. The townspeoplevalued brand-name clothes and looked down on rural traders who were poor anduneducated.
• The town is seen as a place of opportunity and wealth. Sex workers areattracted to the town as a source of income, while men were attracted to the greaterfreedom the town has to offer.

Gold miningtowns are high sexual health risk environments for all residents and visitors. Theirrelative wealth attracts large flows of people. This can make prevention andmanagement more difficult. The study recommends that:

• Health education should be presented in ways that are considered modernand popular, such as through video shows, music and theatre.
• Miners should be prioritised for health education, for example, on theneed for condoms. These men are held in high esteem by the town and are likelyto be opinion leaders.
• In addition, health programmes should target certain groups, for example,the technical advisors at the mine, unemployed girls who live together and are morelikely to sell sex, and young people at discos and video shows.
• Low cost housing schemes could be set up so miners can bring theirfamilies with them.
• The income inequalities between the town and the surrounding areasshould be lessened by creating jobs in rural areas.