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We have seen the light
Jo-Ann Du Plessis, HIVAN Sectoral Networking Team. November 2003.
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The Lesedi-Lechabile project, based in and around the mining towns of Virginia and Welkom, is a beacon for HIV prevention in the mining industry. This community intervention has proven to be successful in the prevention of sexually transmitted infections (STIs) and, although it cannot be directly attributed to decreasing the transmission of HIV among miners, evaluation of the project has strongly suggested that it has an impact on the spread of HIV among these men. It has also changed the lives of the vulnerable women residing and working in ?“hotspots?” near the mines.
I visited Lesedi-Lechabile in July this year, and was struck by the dedication and commitment shown by the staff running the programme. Every day five teams (each consisting of one nurse and her assistant) head out in fully equipped mobile clinics to various rural or peri-urban areas around the mines. Their aim is to bring services ?– that is, the provision of antibiotics, free STI diagnosis and treatment, family planning advice and STI and HIV/AIDS education ?– directly to women living in these areas. Peer educators attached to the programme also promote condom use to women at risk. While visiting the project, I learnt more about how an idea sparked seven years ago has grown into the successful HIV intervention it is today.
The Lesedi programme (meaning ?“we have seen the light?”) started as a small pilot project in Virginia in 1996. At this time, Family Health International?’s AIDS Control and Prevention Project, Harmony Gold Mining Company and the Sexually Transmitted Disease Reference Centre at the South Africa Institute for Medical Research collaborated closely to design an HIV intervention that would benefit the mining industry. A situation analysis revealed that miners had access to information, condoms, preventive and curative STI care, but that they underestimated the risk of HIV infection. It also showed that STI treatment was not easily available to women living around the mines, and, coupled with previous ethnographic research findings that commercial sex work was common in these areas, it suggested that control of STI and HIV transmission in the mining communities would depend on extending effective services to these women.
Meeting places for risky sexual activity (or ?“hotspots?”) were mapped out around Virginia to determine where STI services could be situated to best serve the clients that needed them. A caravan was equipped with the necessary medical utilities needed to provide STI treatment and, manned by a nurse and her assistant, this ?“mobile clinic?” was despatched to a different hotspot each week-day. The approach adopted in terms of STI treatment was essentially a presumptive one: given that many STI?’s among women are asymptomatic (baseline data from this project showed that over half the women had one or more curable STIs on their first visit), it was decided that regular treatment of STI?’s based on the likelihood of infection should be provided in addition to syndromic management of STIs. Apart from periodic presumptive treatment (PPT) ?– a single dose of the antibiotic Azithromycin ?– the clinic also provided condoms and information about HIV and STIs. Outreach workers and peer educators promoted community trust and involvement in the project by explaining the services that the clinic offered and encouraging women to use its services. Notably, clinic staff were non-judgemental about how their clients earned their money, and this contributed to the positive attitude that the women soon developed towards the project.
Nine months after the intervention was implemented, STI rates were documented among women coming for services at the clinic, among miners located near the clinic, and among miners situated at varying distances from the clinic. The results were significant. Among women using the service, the prevalence of the most common curable STIs dropped by up to 85%; among miners in mine hostels near the intervention, prevalence rates of gonorrhoea and/or chlamydia declined by 43% and the prevalence of genital ulcers decreased by 77.5%. As the distance from the intervention increased, STI attendance rates at mine clinics increased proportionately. The AVERT model was used to determine impact that STI treatment and peer education for women around the mines was estimated to have on HIV transmission. The finding: 40 HIV infections among women and 195 infections among miners were estimated to have been averted.
These results impressed other mining houses, the national and provincial Departments of Health and local health authorities. Harmony, together with the health authorities, Gold Fields, Joel Mine, the South African Institute for Medical Research and USAID, and with the support of the community and the trade unions, began expanding the project to more mobile clinics in 1998. Anglogold, Harmony, Gold Fields and African Rainbow Minerals replicated the project in the area around Welkom, and called it Lechabile, meaning ?“the sun has risen?”. A similar programme, the Mothusimpilo Project, has also been set up in the Carletonville mining area.
In 2002 it was decided to merge the Welkom and Virginia programmes and register them as a Section 21 company called Lesedi-Lechabile Primary Care. Currently, five mobile units and two fixed clinics service fourteen different areas in the Virginia, Odendaalsrus, Theunissen, and Welkom surrounds. In June alone, these units treated over 3 500 women and in the last financial year (from July 2002 to June 2003) 20 031 visits were recorded, that is, women who received PPT or had STI examinations at the units. In the same period of time, a total of 26 871 women were reached through health education talks at the units and through peer education in their communities. Sadly, a few days after I returned from my visit to Welkom, I received news that one of the mobile units had been hijacked with a nurse and her assistant inside. It is fortunate that no-one was hurt during the event, but the terrible experience for the staff involved in losing a fully-equipped clinic, complete with medications and patient records, is a tragedy. The incident highlights one of the challenges that this and similar practitioners face when carrying out their daily work.
Improved STI care, the promotion of condom use through peer education and the provision of accurate information about STIs and HIV/AIDS has made a remarkable difference to vulnerable women who live in the areas around the mines, and consequently it impacts positively on the lives of the miners with whom they interact. Lesedi-Lechabile is an extremely successful programme, not least because the nurses and assistants who dedicate themselves to the project do so from their hearts.
For more information, please contact:
Stori Ralepeli or Tony de Coito, Lesedi-Lechabile Primary Health Care, Ernest Oppenheimer Hospital, PO Box 87, Welkom 9460.Tel:(057)9009111. |
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A health education lesson on HIV/AIDS, STI?’s or condom use. Afterward, condoms are distributed.
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