Mothusimpilo Intervention Project (MIP)

In planning the intervention, the organisers assumed that focusing on the risky sexual contacts between mine workers and SWs would have an impact on men and women in the larger community. Mine workers and SWs had high transmission rates of both HIV and STIs, and this was likely having an impact on the larger community through extensive sexual networks.

The first component of the project focused on a behaviour change intervention for SWs and mine workers.The key messages that were emphasised were the importance of condom use, the importance of seeking treatment for STIs at health facilities, and the availability of PPT services at mobile clinics.


Peer educators were chosen by the project coordinator from a list of women nominated by the SWs themselves. These women were trained in the following areas: community work, personal health and hygiene, the signs and symptoms of STIs, referral procedures for STI treatment and care, and promotion and distribution of condoms. The peer educator training methodology for SWs was participatory in nature; both drama and role-plays were used. The MIP trained over 150 SWs as peer educators since the inception of the project. Peer educators received a gratuity of R200 per month (approximately US$30). The outreach coordinator visited peer educators weekly to provide support to their ongoing activities. Peer educators filled in progress sheets recording the number of meetings organised and condoms distributed.

The second component of the project was condom distribution. The condoms were free of charge to those who wanted them. The mine companies collected government-supplied condoms from the MIP and distributed them through peer educators or appointed individuals in mining hostels.

The third component of the project was to strengthen the delivery of quality services for STIs at
private and public sector health facilities in Carletonville. Service providers from public and private facilities were trained in syndromic management. The training was initially aimed at nurses at local council clinics, private practitioners, and mine health facilities.

HIV/AIDS, Health, Women, Gender.

Data collected in 1996 indicated that 4.6 percent of mine workers were infected with syphilis, 6.7 percent were infected with chlamydia, and 8.1 percent were infected with gonorrhea (Ballard 1996). A literature review conducted by the International Organisation for Migration in 2003 suggested that migrant workers, many of whom work in mines, and sex workers (SWs) are particularly vulnerable to HIV infection as a result of their high-risk sexual behaviour (International Organization for Migration 2003). We hypothesized that focusing interventions on these two groups would reduce the transmission of HIV and have an impact on HIV incidence in the wider community. Thus, the MIP aimed to reduce HIV incidence in the entire community by targeting mine workers and SWs.

Challenges identified in the implementation of peer education activities for SWs included sustaining interest and motivation over a four-year period. Campbell (2003) remarks on the drop in the number of SWs attending activities due to the tendency for peer educators to use didactic teaching methods rather than participatory methods, the need for fresh material, and the gradual withdrawal of the ‘champion’ (the outreach coordinator) of the programme.


Furthermore, efforts to integrate economic empowerment activities into the program were not successful, which also hampered the effectiveness of the behavior change messages. As the project matured, an increasing number of peer educators fell ill and died of HIV/AIDS complications, which meant that the MIP had to recruit and train new peer educators.


A behaviour change intervention was also planned for mine workers. The mining companies were to identify mine workers who were interested in being peer educators. This intervention was planned to complement the sex worker intervention. Peer educators were to attend monthly trainings and planning and review meetings organised by the MIP, get time off to conduct activities, and receive a small allowance for providing these services. In the early years of the project, the mining companies tended to pursue their own independent programme with little or no connection to the intervention initiated by the MIP. The MIP trained very few peer educators, and those who were trained received little ongoing support, with no follow up after training or monitoring of their activities.

In addition, peer educators were not given paid time off to conduct outreach activities, which resulted in activities being conducted in an unsystematic fashion. Trade unions did not make any contribution to or support peer educators beyond identifying initial participants. In the third year of the project, one mine employed a full-time staff member to run its HIV/AIDS activities, but activities continued to be conducted separately from the MIP. This was of concern to the MIP, which had envisaged a more coordinated and synergistic peer education approach for mine workers. Despite setbacks, 185 mine workers from two mining houses were trained as peer educators by the end of the research period.