A radical new approach to prevent the spread of HIV and sexually transmitted diseases is now being used successfully in South African mining communities.
The programme, which has not been used anywhere else in the world, not only saves lives, but translates into a saving of almost R4 million per annum to the mining companies.
The Lesedi project has introduced an approach to HIV prevention that involves the eradication of other sexually transmitted diseases (STDs) The approach, called periodic presumptive treatment (PTT), is based on the assumption that proper STD care can reduce the rate of HIV infection by 40%. The presence of other STDs makes it twice as easy for the HI virus to move from one person to another during sexual intercourse.
The Lesedi project targets women who have a high risk of contracting an STD and offers them a single monthly dose of an antibiotic called azithromycin, regardless of whether they have symptoms of an STD or not.
Dr Tony de Coito, manager of health services at Harmony Gold Mining Company, says that in a high risk population such as a mining community the conventional approach to treating STDs, which relies on patients noticing their symptoms and coming in for treatment, is simply not enough to eradicate STDs.
One of the reasons for this is that people often do not know that they have an STD and should get treatment. Instead, they unknowingly continue to transmit the disease to others.
Another reason for introducing PPT is that the antibiotic azithromycin not only cures STD infections, but prevents them for a limited period of time.
“It stays in the blood for ten days so you can’t get bacterial STDs for ten days. So the number of organisms in circulation goes down and the risk of re-infection goes down,” says De Coito.
Previously, STD services provided by mining companies were hamstrung by the fact that they were only treating their employees, and not their employees’ sexual partners, including commercial sex workers. As a result, mine employees simply become re-infected.
“Where you have a large number of men having sex with a small group of women, it makes sense to treat the women with PPT,” says de Coito. “That way, you impact on the women as well as on all the men.”
Treating people for STDs without accessing their sexual partners is like washing one hand but not the other. Soon, both hands will be dirty again.
The Lesedi project began in a residential community in the Free State that grew up around three hostels housing about 4 000 miners.
STD rates are particularly high whenever a migrant labour system, such as that on the South African gold mines, separates men from their wives and families.
Given the limited economic opportunities, many women in the area have become involved in regular commercial sex work or they develop casual relationships with migrant labourers for money or material support. Inevitably, they are at high risk of STD and HIV infection.
“PPT is an emergency measure for high-risk groups until you have high levels of condom-usage, says De Coito. If everybody uses condoms, PPT isn’t necessary. “
De Coito points out that achieving the levels of condom-use required to break the cycle of STD and HIV transmission within any community takes time.
After a concerted four-year sexual health promotion campaign, condom-use in the mining community targeted by the Lesedi Project has now reached between 40% and 50%.
The commercial sex workers are keen to use condoms, but the men are the ones with the power, says De Coito.
In the meantime, PPT has already reduced STD rates among women by 85% in nine months. STD rates among miners have also dropped dramatically. There are 78% fewer genital ulcers and 43% less gonorrhoea and chlamydia among miners.
“And the only time you see chancroid in a miner any more is when he comes back from home,” says De Coito. “Now, at least we can be sure that miners are no longer taking what we call ‘unwanted packages’ home.”
Estimates indicate that the provision of PPT prevented HIV infection in 40 of the 400 women treated. This would have already prevented another 195 HIV infections among the larger group of miners.
Apart from the 235 lives saved, this also translates into an estimated saving of R3 824 450 for the mining companies involved in the project, says De Coito.
According to De Coito, the antibiotic used for the periodic presumptive treatment of STD’s has no major side effects.
“10 to 15% of people will experience nausea for a day or two after taking their monthly dose,” says De Coito.
To date, continuous monitoring has shown up no signs of any drug resistance developing.
“The probable reason is that there is total compliance with the medication. What protects us from resistance is that it’s a one-off dose, so 100% compliance is easy to achieve,” says De Coito.
“It has worked so perfectly that results can be seen by all,” says Sethoke Mahemu, chairperson of the Harmony branch of the National Union of Mineworkers.
The main partners in the Lesedi project are Gold Fields, Anglogold, and Harmony goldmines.
According to De Coito, PPT is only applicable in groups such as commercial sex workers who are at very high risk of STD and HIV infection because “you need to be sure that the treatment benefits outweigh the risks.” – Health-e News Service.