Carletonville-Mothusimpilo project: limiting transmission of HIV through community-based interventions

Abstract

For all of the last century, the economy of South Africa, and so also of its neighbouring countries, has depended on migrant labour from rural areas. This is particularly so for the mining industry, especially hard-rock mining, and this has led to a system of oscillating migration whereby men from rural areas come to live and work on the mines without their wives or families, but return home regularly. This pattern of oscillating migration is an important determination of health and especially at the start of the epidemic, contributed to the spread of HIV in Carletonville, the largest gold-mining complex in the world. We first consider the political and economic context within which earlier attempts to develop HIV intervention programmes were made and then show how the Carletonville project was based on a set of assumptions. First, that HIV should not be treated as another biomedical problem to be dealt with by changing individual behaviour but rather that it must be understood within the social, cultural and normative conditions that pertain in particular communities. Secondly, that in the short to medium term the most effective interventions would involve the treatment of sexually transmitted diseases and the use of community-based peer educators to promote safer sexual practices and the use of condoms. Thirdly, that for the intervention to sustainable for long term, it would require the full commitment of the local stakeholders including the state, the private sector, the trade unions and local community-based organisation. Fourthly, that in order to understand the nature and patterns of the epidemic, to focus our intervention efforts so that they have the maximum effect, to make sensible predictions as to the likely future course of the likely future course of the epidemic, and finally, to carry out detailed monitoring and evaluation of the epidemic using both biomedical and behavioural markers of infection and behaviour. The background and the current status of the project are described in detail. The surveys have shown that the situation is even worse that envisaged young women from infection. Valuable lessons have been learnt concerning the reasons for the continued spread of the epidemic and some success has been achieved especially in the empowerment of women at high risk and the mobilization of people from all sectors of the community to join the flight against HIV/AIDS. It is still too early to show significant changes in STI or HIV rates but it is hoped that this will become apparent over the course of the next one or two years.