Impact of AIDS on African Development

¶ … AIDS on South African Development

Today, the chromium, platinum, gold and diamond mining sectors provide the largest percentage of export revenues for South Africa. One of the inevitable consequences of these natural resource extraction industries is the proliferation of mining camps that house the migrant domestic and foreign workers from neighboring countries that support the industry. Although conditions vary, most mining camps are squalid affairs that lack running water, electricity or the other basic amenities of modern life that most people take for granted. These harsh living conditions, combined with the loneliness that results from being forced to spend long periods of time away from family and friends, create an ideal environment for the spread of communicable diseases, especially human immunodeficiency virus / acquired immunodeficiency syndrome (HIV / AIDS). This paper provides a review of the related primary and secondary literature concerning mining camps and their role in the spread of HIV / AIDS in general and in South Africa in particular, followed by a discussion concerning potential interventions and recommendations for action. Finally, a summary of the research and important findings concerning mining camps and the transmission of HIV / AIDS in South Africa are presented in the conclusion.

Review and Analysis

Background and Overview

The presence of the HIV / AIDS virus on the African continent was first documented when a confirmed case of HIV / AIDS was identified in Cameroon in 1959 (Barz and Cohen 6). Although slowly at first, the virus spread eastwardly for the next 2 decades in an increasingly rapid fashion that was facilitated by social and trucking routes (Barz and Cohen 6). The spread of the disease went unnoticed initially, and it has only been relatively recently that this public healthcare problem has come to light. In this regard, Barz and Cohen (2011) emphasize that, "At first, isolated to small populations and rural areas, HIV remained unknown during the 1960s and into the 1970s" (6).

In reality, advances in the medical understanding of the disease and improved diagnostic procedures, together with civil strife, were required to reveal the true extent of the problem with HIV / AIDS in Africa in general and South Africa in particular. For instance, Barz and Cohen note that, "Only during the late 1970s, as political conflicts, increased population motility, and forced urbanization displaced large populations within Africa, did AIDS receive significant attention and documentation on the continent" (6).

What has been learned for certain in recent years is that the conditions for the spread of the HIV / AIDS virus were ideal in many parts of the African continent due to longstanding traditional sexual practices, a high degree of mobility among workers, a paucity of healthcare facilities and the isolated regions in which significant percentages of the population live. Given the hundreds of thousands of mining jobs where workers live in squalid mining camps, it is not surprising that there is a virtual HIV / AIDS pandemic in some parts of Africa today (Alegi 354). According to West (2000), in many regions of Africa, "Men have abandoned their families to work in gold and diamond mines. The major recreations in the mining camps involve alcohol and prostitution. Traditional cultures had strict rules governing sexual relationships. But, with the coming of a modern economy, those codes have broken down, with nothing to replace them" (18). Likewise, Barz and Cohen (2011) emphasize that, "The [AIDS] virus found ideal conditions for a rapid spread thanks to long-term, concurrent sexual partnerships frequently practiced in Eastern and Southern African populations, exacerbated by a concentration of labor in remote mining camps" (6).

In areas where geographic proximity to roads and other infrastructure exist, there may also be male and female prostitutes that specialize in working mining camps. In this regard, Lewis and Bamber (1999) report that around the world, "The sex industry has continued to grow in areas of high economic activity where large numbers of people are concentrated. It has expanded in the towns and cities, along railways and roads, at truck stops, and near military bases and timber and mining camps" (215). These trends are more threatening than they first appear because of the high degree of mobility of these workers who may return to their homes and spread the infection without even knowing it (Hlaing, Taylor and Than 127).

The platinum, diamond, gold and chromium mining sector in South Africa is the country's largest source of export revenues (South African economy 3) and this sector is responsible for employing a large, highly mobile labor force drawn from across many countries and regions (Hlaing et al. 127). For instance, the South African gold mining industry employs migrant mine workers from South Africa, Botswana, Mozambique, Lesotho and Swaziland (Boe & Crush 15). When workers from these countries are placed in isolated mining camps together, there are inevitable consequences. According to Hlaing and his associates (2005), "Separated in many instances from family members for long periods of time and employed in remote areas with little access to other forms of entertainment, these men -- and in some instances, women -- turn to locally available sources of comfort including drugs and commercial sex" (127). Indeed, although it is not restricted to mining camps, intravenous drug use is strongly associated with mining regions (Hlaing et al. 127). According to Hlaing and his associates, "These areas, in turn, become epicentres of HIV infection as shared needles and sexual partners effectively transmit the virus throughout the mining camps and eventually back to the sending communities from which these workers originated" (127).

Although the sex industry in many African countries is responsible for a significant percentage of new HIV / AIDS cases, the term "sex industry" does not adequately connote all that is involved in these services in South African mining camps. For instance, Patton (1999) advises that, "In South Africa where mining has resulted in massive and cyclical migration of men from the countryside, women (and sometimes men) who live near mining camps sell home-cooked meals and wash clothes, supplementing these cottage industries through trading sex with favorite customers" (55).

According to Parker and Aggleton (1999), the paucity of timely and relevant seroprevalence studies of black males by work groups confounds the identification of actual HIV / AIDS acquisition patterns in mining camps. In response to this gap in the body of knowledge, some researchers have speculated that "truck drivers, not miners, and heterosexual behaviour, not male-male relationships, account for the movement of HIV. Infected miners brought HIV infections from home but did not acquire them in South African mining camps" (395). The accuracy of this assertion is difficult to gauge because of the dearth of timely and relevant studies concerning the prevalence of HIV / AIDS among migrant mine workers as well as the fact that the South African mining sector has experienced significant changes in recent years, including a reduction in activity at some mining sites on the one hand and an increase in subcontracting on the other (Boe and Crush 15). According to Boe and Crush, as bad as things are in some mining camps, workers for subcontractors may experience even worse conditions in their camps. In this regard, Boe and Crush emphasize that, "Miners working for sub-contractors have experienced a marked decline in wages, working conditions and job security" (15).

There have been some other changes in the South African infrastructure that have affected the transmission patterns of the HIV / AIDS virus in recent years that complicate formulating effective interventions for this population. Researchers have shown that in many South African mining camps, young miners assume the role of "mine wives," a role that includes the provision of sexual services (Parker and Aggleton 396). Some miners have become sufficiently accustomed and enamored of the lifestyle that they retain it once they return to their own townships (Parker and Aggleton 396).

Likewise, improvements in the South African transportation industry as well as the elimination of influx control barriers have facilitated the movement of migrant mine workers throughout South Africa. According to Boe and Crush, "For example, 60 per cent of the Basotho migrant miners now return home at least once a month. On the one hand, this could lessen the pressures for migrants and their spouses to engage in extra-marital relationships. On the other, it means that the rural areas are far less 'insulated' from HIV than before" (15).

A number of initiatives have been launched in an effort to identify human migration patterns with the spread and prevalence of HIV / AIDS in Africa in general as well as in South Africa in particular (Boe and Crush 15). By and large, the research to date has identified the transmission routes of HIV / AIDS as corresponding to major transport arteries and migration routes, but there are other ways that the mobility can affect the manner in which the disease can be transmitted (Boe and Crush 15). For example, there are a minimum of four main ways in which mobility is associated with the spread of HIV / AIDS:

1. Mobility per se can encourage or make people vulnerable to high-risk sexual behaviour;

2. Mobility makes people more difficult to reach, whether for prevention education, condom provision, HIV testing, or post-infection treatment and care;

3. Migrants' multi-local social networks create opportunities for sexual networking; and,

4. There is a higher rate of HIV infection in "communities of the mobile," which often include socially, economically and politically marginalized people (Boe and Crush 22).

Taken together, it is clear that the high degree of mobility of South African mining workers combined with a modern transportation infrastructure combine to create a number of obstacles to combating the spread of this disease. Indeed, Boe and Crush emphasize that, "The current geography of the HIV epidemic is also the clue to its link with mobility. The highest incidence is not in Africa's poorest countries, but in Southern African countries such as South Africa and Botswana which have a good transport infrastructure, relatively high levels of economic development, and considerable internal and cross-border migration" (23).

Meeting the Challenge of HIV / AIDS in African Mining Camps

To date, the South African government has taken some steps to address the national HIV / AIDS problem.

1. By March 2012, more than 20.2 million people had received HIV testing pursuant to the HIV Counselling and Testing campaign which started in April 2010 (Update on progress and achievements 2).

2. The South African departments of science and technology, trade and industry, health, and economic development announced a joint initiative in the fight against HIV / AIDS known as Ketlaphela ("I will be fine" in Setswana) with Swiss-based pharmaceutical company, Lonza. South Africa plans on building multi-million dollar pharmaceutical facility to manufacture antiretroviral medications which is expected to begin operations in 2016 (Update on progress and achievements 2).

3. The South African National Development Plan 2030 published in August 2012 proposes expanding coverage of antiretroviral treatment to all HIV-positive South Africans (Update on progress and achievements 4).

4. The South African Cabinet resolved on November 23, 2011 that all government departments that are signatories to the Negotiated Service Delivery Agreement 2010-2014 continue to work together to address cross-cutting issues such as combating HIV and AIDS (Update on progress and achievement 8).