Silicosis, Tuberculosis (tb) And Hiv/aids: The Triple Epidemic Among Gold Mineworkers In South Africa (literature Review And Policy Analysis)

The scourge of the triple epidemic of silicosis, tuberculosis (TB) and HIV/AIDS has plagued the South African gold mineworkers, with black mineworkers in particular, for over two decades now. Factors such as oscillating migration patterns, hazardous working conditions, and crowded living arrangements allow for the perfect conditions needed to sustain and amplify the epidemic within this population. The objective of this thesis is to provide a detailed review of the epidemiological literature regarding the different aspects of the silicosis, TB and HIV epidemic in South Africa, followed by an in-depth analysis of the current policy response, and its implications for directing the next phase of response to this epidemic. Review of the epidemiological literature provides strong and cogent evidence for the rapid and concomitant increase in the incidence and prevalence of silicosis and TB among gold mineworkers in South Africa over the last two decades, and shows that silica dust exposure is an independent risk factor for TB even among gold mineworkers without silicosis, thereby putting miners at increased risk of TB even after the exposure to silica dust has ceased. The policy analysis shows that there are serious gaps in research, policy and implementation regarding the approach and strategy to address the epidemic so far, especially with the steady decline in research expenditure on mining-related occupational health and safety research over the last few years. There has also been a wide-ranging failure to reduce silica dust exposure levels in gold mines, resulting in the failure to prevent new cases of silicosis among mineworkers