From left to right - Dr Sahu Suvanand, Stop TB Partnership - Martin Caton MP, Rt Hon Peter Hain MP and Jonathan Smith Epidemiologist, researcher and film-maker

On Tuesday 22nd May 2012, the APPG’s on Global TB, HIV/AIDS and Earth and Environmental Sciences hosted a parliamentary event to pay particular attention to TB in the gold mining industry in South Africa.

This meeting offered the opportunity for debate and discussion on this issue as well as extracts  of  ‘They Go to Die’ a short film that investigates the life of four former migrant gold mineworkers from South Africa and Swaziland who have contracted HIV and drug-resistant TB while working in South African gold mines. After being diagnosed with TB, mine workers are deemed too sick to work and their employment is terminated. Migrant workers generally return to their communities without treatment, both sealing their fate and leaving their friends and families exposed to a high risk of contracting TB and HIV. The process of returning home has been referred to as ‘being sent home to die’. The film raises concerns of disease and human rights violations uniquely though the context of life, love, and family; unlike traditional health films, it focuses on relationships and bonding, not death and disease.  It is a film of uniting across cultures and paints a portrait of common humanity.

TB is the largest killer of people infected with HIV and South Africa is at the centre of this dual epidemic with data showing that TB and HIV in the region are further exacerbated by gold mining. Both the conditions in which miners live and work in and the specific mineral content of the rocks (silica) from which the gold is mined; provide conditions that increase the risk of contracting and the ease of transmission of both TB and HIV.  Mining and HIV are the largest drivers of TB in the sub-Saharan African region and responsible for over three quarters of a million TB cases each year in the general population. With or without silica, someone with HIV is more likely to contract TB as the risk factors are multiplied. HIV+ increases the affected person’s risk of contracting TB x4; Silicosis increases the affected person’s risk of contracting TB X4; Silicosis and HIV have a multiplicative effect increasing risk by x16.

Chaired by Martin Caton MP (Chair of the APPG on Earth and Environmental Sciences) and Peter Hain MP (participant of the RESULTS UK Delegation to South Africa, February 2012), the meeting welcomed guest speakers Jonathan Smith, TB-HIV epidemiologist and director of the documentary, ‘They Go To Die’ as well as Dr. Sahu Suvanand, Team Leader of TB REACH, from the Stop TB Partnership, Geneva.

Following on from his participation in the RESULTS UK delegation to South Africa in February 2012 with fellow MP Alun Michael, Peter Hain spoke about the shock of learning about the impact of TB and TB/HIV in South Africa and in particular, the injustices surrounding the health of goldmine workers in South Africa. TB is of particular concern in the gold mining industry. Gold miners have the highest rates of TB in the world, most with HIV and many with silicosis. Migrant workers come from all over South Africa as well as from neighbouring countries, which means the spread of TB from this key population reaches out not just into local communities but is now a regional problem across southern and eastern Africa.

An estimated 760,000 cases of TB in the general population of sub-Saharan Africa is directly attributable to the mining industry annually and as many of us know, TB kills with alarming efficiency. Without treatment HIV+ patients that contract TB have an 83% fatality rate within 6 months. However, with treatment it’s a completely different story.

Despite hundreds of years of neglect of this particular issue, there is sign of recognition of this problem. Led by the South African Government, the Ministers of Health for South Africa, Lesotho and Swaziland resolved to address this issue with the help of the Secretary of the Southern African Development Community (SADC) assisted by the World Bank and Stop TB Partnership. One meeting in March 2012, in Johannesburg and in April 2012 in Angola with NTP Mangers, have initiated the process of drafting a declaration on TB and mining, to address the unmet health needs of gold mine workers in the region. In August 2012, it is hoped that this declaration will be signed by the 15 heads of state within SADC.

In additional to SADC there is an additional component to the solution to tackling this problem through active and innovative case finding, TB REACH. TB REACH is an initiative that started in 2010, to reach and care for more people with TB using innovative approaches – especially in poor, underserved & vulnerable populations.  It provides fast-track short term funding – up to 1 million USD per project for one year – a competitive selection of projects for funding, open to public and private organizations and implemented by Stop TB Partnership; supported by Canadian International Development Agency (CIDA).