The term "workplace interventions" often refers to established industries and companies with a genuine interest in building and maintaining their workforce. However, in developing countries informal industries also play an important role in the economy, but often the importance of these industries in preventing the spread of HIV is not sufficiently recognised. In Tanzania, more than 4000 registered artisanal and small-scale mining companies (SSM) employ a labour force of 550,000 workers. The past economic socialist policies and the geological environment favoured the development of this huge mining sector. A single mine might employ between 100 and 1000 or more workers, almost exclusively men. SSM requires low investments, based on informal operational organisation, and uses poor mining and processing technology. The marketing channels are partly recognised, partly underground.

Namungo Mine in Lindi region

Namungo is a recently established SSM area, with deposits of green gemstone (tsavorite). About 400 men and women are living in temporary settlements around the mine. The miners use a simple torch, hammer and chisel in the pits, which are up to 90 feet deep and have poor ventilation and lighting. The deeper the pit, the younger the miners, because only boys or small men called nyoka (snakes) are able to work in the deep and narrow spaces. Workers descend underground using ladders and ropes. The local people surrounding the mines serve the camp with services such as selling water, vegetables, firewood, running errands and laundry services. Some of the women living in the mines are involved in petty trading of stones, while others sell food, alcohol and sex. Alcohol and drug use is quite common, especially after a big find. The miners engage in multiple sexual relations with girls and women from the neighbouring village. Often, after a short period in one mine, the miners move to other sites in other regions of the country. For many of them, Namungo mine is the fifth or sixth mining site where they have worked.

An HIV/STI workplace intervention

At each mine site, the miners have elected leaders who negotiate their interests with the claim-holders, gemstone brokers and government officials. These leaders are responsible for maintaining order and peace in the camp. In August 2001, the leaders and claim-holders asked Tanzanian health officials to begin a workplace intervention on HIV and sexually transmitted infections (STIs). Acting upon this request, a team of regional and district health experts developed an intervention plan comprising:

• a baseline study on knowledge, attitudes and practices (KAP) with villagers and miners
• a survey on syphilis and HIV infection rates
• STI treatment
• an educational campaign
• plans for continuous collaboration between the mine and the health system.

The KAP study among 467 miners and volunteer villagers available on the day of the study showed that 81% of the respondents knew that sexual intercourse without a condom is the main mode of HIV transmission. Eighty percent correctly stated that an HIV-infected person may remain asymptomatic for a long period. Three-quarters mentioned sex with a stranger or sex worker as risky. Even so, half the respondents said they had paid sex with more than one partner during the last 12 months and 48% reported having used a condom in the past three months. Most said they were willing to have voluntary counselling and testing (VCT) to know their HIV status. Four hundred people came voluntarily for syphilis and HIV testing, confirming their willingness for counselling and testing.

Most of the 429 people who had come with STI symptoms were treated for discharge syndrome (40% males, 24% females) and genital ulcers (38% in males and females). Testing and counselling for syphilis and HIV was offered to STI clients and volunteers. Infection rates were high in both groups (see Table 1). Women were more affected at both the mine and village. The highest prevalence rate of 38% was in women aged 30-34 years.

The statistics in the table must be interpreted with caution because they pertain to a self-selected sample. Especially in the mine, the vast majority (estimated more than 80%) of people living in the camp participated either as a patient or as a volunteer. The only figures available for comparison with the "normal" population in the area are statistics for women attending antenatal clinics in Lindi Region, which showed rates of 8.9% for HIV and 7.8% for syphilis in 2000. The sexual behaviour in a small-scale mine seems to favour the easy spread of STIs and HIV and creates a highly-infected female population. These women serve the miners in the camp and in the neighbouring village. Namungo is a newly established mine. Higher infection rates are expected among the residential population in older mining areas because they accumulate infection.

The educational campaign in Namungo Mine included videos in Kiswahili on HIV/STIs and the socio-economic consequences of HIV/AIDS. Posters, leaflets and a set of six booklets answering frequently asked questions on sexual and reproductive health were distributed. Questions-and-answer sessions with groups and individual counselling were offered. Condom demonstrations and free distributions were repeatedly carried out. According to the plans established with the miners and claim-holders this start-up activity will be followed by:

• Regular outreach visits by a health team
• Creation of a health fund (by withholding a percentage from the sales of gemstones)
• Establishment of sales points for condoms
• Training of the drug hawker in the camp. The training of peer educators is still under discussion because the high mobility of miners makes this a difficult option.

Conclusions

The main conclusions that can be drawn so far include:

• Workplace intervention policies need to include informal industries, which should be inventoried, mapped and characterised according to their potential for spreading HIV. SSM will probably rank as a high-priority area for interventions.
• Workplaces must be addressed together with their "sexual environment" including the people with whom the workers have sex. This is especially important when male workers live without permanent partners.
• Districts need support in assessing workplaces in their area and in developing appropriate interventions.