Carletonville shows HIV epidemic can be managed

Loud kwaito is pumped into the semi-darkness as thousands of mineworkers blow their cash on the liquor that makes them forget about their dangerous jobs; their cramped hostels, and the demands of their faraway families.

This is the Civic Beer Hall, the best entertainment Carletonville has to offer mineworkers in the country’€™s top gold producing town.

A bartender candidly admits that plenty of sex takes place in the darkened corners of the two massive joined halls, as over 2 000 mineworkers cram into the Civic on a Friday night.

Sex is for sale for as little as R20 around Carletonville. Women have set up shacks outside hostels, and either entertain their “clients” in these shacks or under nearby thorn trees and bushes.

Transactions are usually fast and plentiful, oiled by the beer the sex workers sell as a pretext for hanging around the hostels.

It makes sense, then, that the Carletonville AIDS project, Mothusimpilo (“working together for health”) depends heavily on sex workers to fight the spread of HIV.

Since the project started almost two years ago, 90 sex workers have been trained as “peer educators”. They, together with youth and mineworker peer educators, then go out and educate the greater community about the dangers of sexually transmitted diseases (STDs) and HIV/AIDS.

The project, initiated by the CSIR and the community-based Carletonville AIDS Committee, is a three-year pilot funded mainly by the British and US governments.

The challenge is daunting. A recent survey shows 47 percent of women and 40 percent of men from both the township and the shacks are HIV positive, while 28 percent of mineworkers are infected.

Yodwa Mzaidume trains the sex workers

and others to be peer educators

“Our starting point is the STDs,” says Yodwa Mzaidume, the dynamic nursing sister who heads Mothusimpilo’€™s peer education programme.

“People identify with STDs because many have had them. They don’€™t identify with HIV because it takes a long time to show itself. It is very important to prevent STDs as these make the spread of HIV easier,” says Mzaidume, who was Anglo American’€™s community nurse before joining the project.

So the peer educators, armed with hideous pictures of oozing penises and inflamed vaginas, set about warning people to wear condoms if they want to avoid the pain and discomfort of STDs.

Their success has been phenomenal. In a recent survey, eight out of 10 sex workers reported using a condom every time they had sex. Last year, only two out of 10 of the women were using condoms.

Sophie (not her real name), leader of a sex worker settlement on the doorstep of a Western Deep Levels shaft, says it is easy to check whether a woman has been using a condom.”We can ask the client,” she says. “But we can also smell if she hasn’€™t been using a condom.”

“No one can operate here [as a sex worker] without meeting the peer educators,” says Sophie, adding that if a woman violates the “no condom, no sex” rule, she gets chased away.

Becoming peer educators has meant a great deal to the women, says Sophie, as they now have respect. The sex workers, 70 percent of whom are HIV positive, are using part of their R200 monthly peer-educator stipend to set up a burial fund.

Mzaidume, who is clearly a cornerstone of the project, says it was difficult for her to work with the sex workers to begin with. “I was intimidated by their behaviour at first, seeing a person wearing a short nightie, with a bottle of beer and a cigarette at 9am. But I was being judgmental. I had to adjust to their norms.”

Remarkably, Mzaidume has only had to “fire” three peer educators in the past two years ‘€“ mainly for drinking.

Alcohol has emerged as a serious threat to the project, as sex workers confess that sometimes they are too drunk to make sure that a condom is used. And at the Civic, there are too many condoms still in the box, to the consternation of Mothusimpilo’€™s manager, Solly Moema.

A neat, energetic man, Moema worked as a social worker for Anglo for 16 years. There is not much that goes on at their mines that gets past him. He is in charge of training mineworkers as peer educators.

Moema says the project distributes 200 000 condoms a month in Khutsong, Carletonville’€™s township. Last year, it distributed 1,5-million condoms, which are supplied free by the health department.

But Mothusimpilo is not just a gigantic condom-distributing jamboree. It is underpinned by sound scientific principles. This is where the third kingpin in the project, Dr Brian Williams, comes in.

Dr Brian Williams, who handles the  

medical research side of the project

Williams is an epidemiologist (a person who researches the spread of diseases) who works with the CSIR’€™s Miningtek division. He is adamant that “HIV/AIDS can be managed” and says the Carletonville project is the country’€™s “only serious large-scale attempt” to do so.

The bedrock of the project is something called “syndromic management”. This is the management of STDs by treating people on the spot on the basis of their symptoms, rather than the slow route of sending blood or urine samples to laboratories for tests.

In comparison to malaria or smallpox, HIV transmission is relatively slow, says Williams. “But if a person also has syphilis or gonorrhoea, the chances of them getting or transmitting HIV increases about 10 times. Between 10 and 20 percent of all South African adults have syphilis or gonorrhoea. So if we did nothing else but got rid of these two STDs we could turn the epidemic around.

Young men in the marketplace in Khutsong,

where the HIV rate amongst adult men in the

township is around 40 percent

“If we could also eradicate other STDs and get sex workers and young people to wear condoms, we could manage the HIV epidemic.”

The snag with “syndromic management” is that 40 percent of women show no symptoms in the early stages of STD infection. Thus, health workers have now resorted to giving all sex workers a monthly dose of a broad spectrum antibiotic. This approach will be used for a short time, says Williams, “to knock STD rates right down”. But it is too expensive to maintain.

Mothusimpilo staff have also trained 65 private doctors and 141 nurses in syndromic management to ensure all local healthworkers share a common approach.

The project also monitors its impact through an annual survey involving 2 000 people from the mines, informal and formal townships. This is a massive undertaking, says evaluation manager Dirk Taljaard, as each questionnaire takes 30 minutes to complete, and blood and urine samples of all participants are taken.

Although this year’€™s survey results are still being process, so far it looks encouraging. There is not much difference between last year’€™s HIV prevalence, and people far more people say they are now using condoms.

Carletonville offers a glimmer of hope amongst the doomsday AIDS predictions. With solid yet simple foundation — local people as peer educators, proper STD management, millions of condoms and annual evaluations ‘€“ it seems to prove Williams right. The HIV/AIDS epidemic can be managed. But do communities, businesses and government have the commitment to do it? ‘€“ Health-e news service.


Free to Share

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Stay in the loop

We love that you love visiting our site. Our content is free, but to continue reading, please register.

Newsletter Subscription

Enable Notifications OK No thanks