South Africa is shifting its lines in the battle against tuberculosis to mines, where lung-attacking dust, crowded working conditions and a pan-African workforce make the industry a focal point for spreading the disease.
Drug resistant TB strains, associated with cramped urban conditions, are spreading among miners, who have infection rates about three times higher than the general population, according to South African officials.
The disease is further spread when foreign-born miners – tens of thousands from Lesotho, Swaziland, and other neighbouring countries work in South Africa's mines – return to their homes.
South Africa has tied TB treatment and prevention with anti-HIV/Aids campaigns and brought new equipment and medicine to clinics and hospitals.
Tip of the spear
"Mine-associated TB is the tip of the spear. Addressing this issue could transform the continental response to TB," said Joel Spicer, a senior strategist at the Stop TB Partnership.
The group includes UN agencies, nongovernmental organisations, medical experts and the private sector.
The Aurum Institute and London School of Hygiene and Tropical Medicine are also testing in South Africa vaccine-type medicines known as Isoniazid Preventive Therapy (IPT) on miners to prevent infection.
Initial results have shown that providing IPT to miners and their families can reduce the risk of infection by about 60%. The Stop TB Partnership estimates IPT costs about R157 a year per person.
Call to workers to be screened
South Africa is a major gold and platinum producer and has called on mining firms to screen workers for both TB and HIV in the next 12 months.
It will also set up more clinics near mines, bolster existing facilities and get more screening kits to mining areas as quickly as possible, the health ministry said recently.
Complicating the situation is a high incidence of HIV/Aids among workers in the sector. Because the human immunodeficiency virus that causes Aids weakens the immune system, people with it are much more likely to be infected with TB.
HIV infections among miners spread quickly through brothels. The government of former President Thabo Mbeki made the situation worse by denying for years there was a link between HIV and Aids, while prescribing meaningless treatments such as beetroot instead of internationally proven medicines.
TB spreads through the air
Tuberculosis spreads through the air. If it is not effectively treated, each person with active TB can infect on average 10 to 15 people a year.
Death rates among HIV patients are high, particularly in poorer countries. Over two million people will contract a form of TB resistant to standard drugs by 2015, the World Health Organization said last month.
East and Southern Africa are the area’s most heavily affected by the HIV epidemic. Out of the total number of people worldwide in 2009 living with HIV, 34% were in 10 countries of Southern Africa, according to the UN Programme on HIV/Aids.
The number of HIV-positive people globally screened for TB rose from nearly 200,000 in 2005 to more than 2.3 million in 2010, the World Health Organization has said.
"Our intention is to encourage all miners to be screened and tested for TB more frequently," David Mametja, chief director of the South African health ministry's TB Control and Management department, told Reuters.
(Cosmas Butunyi, Reuters Health, April 2012)
HIV/Aids and TB