Diamond boom towns ignore threat of AIDS

In rough hewn pits, knee-deep in water, miners pan for diamonds in Koidu, eastern Sierra Leone, searching for the elusive gems that could transform their lives. The open-cast diggings stretch as far as the eye can see. Villages have mushroomed precariously on the margins, and petty traders flock to the mine sites each day to scrounge for business. In mineral-rich Sierra Leone, mining provides livelihoods for almost one-fifth of the population. The industry attracts men from across the country, but also migrants from neighbouring Guinea, Liberia, Senegal and the Gambia. It's a tough life, and one tailor-made for the spread of HIV/AIDS. "The endemic areas where there are high numbers of those infected with the virus are always areas where mining is booming," said Sylvester Samba, the head of Voluntary Confidential Counseling and Testing (VCCT) at Koidu government hospital. "There's also an extremely high incidence of STI's in these areas and, as yet, I can't see anyone intervening to target this high risk group." The relative wealth of miners in a poverty-stricken area has created a thriving commercial sex industry. Low levels of education and high levels of illiteracy, a hangover from a decade of civil war, all combine to create conditions for a rapid spread of HIV. Added to that is a highly macho culture, where suffering from a sexually transmitted infection - or "man sick" as it is commonly called - is a sign of virility; a barrier to both condom use and medical treatment. No comprehensive survey has been done to assess the infection rate among the mining communities in the country. A national survey in 2005 estimated HIV prevalence as 1 percent in Kono district and 1.9 percent in neighbouring Kenema - the two major mining districts. But Abdul Rahman Sessay, deputy head of the National AIDS Secretariat (NAS), said the figures were questionable - especially in relation to the mining areas. "I suspect the prevalence rate to be higher than the national average. If you look at the general population, people are poor and the miners have the money and the resources to play around and engage in unsafe sex," he said. A dilapidated Koidu hospital, with its crumbling walls and primitive facilities, provides one of four VCCT centres in Kono district. Two outside hand pumps provide water for the hospital, many patients lie on mattresses in the open air. Of the 1,229 HIV tests carried out in 2005, 84 people - or 6.8 percent - were found to be HIV-positive. Just over 30 percent of those who tested positive were between the ages of 12 and 24 years. "These figures are really alarming and I think demonstrate just how serious the problem is among the youth in this area," said Samba. The 2006-2010 Sierra Leone National HIV/AIDS Strategic Plan highlights the fact that two-thirds of the population still live in rural areas and most of these work in agriculture and mining. The report goes on to say "the corollary of this gloomy picture is pervasive and endemic poverty, which in turn can lead to transient sex, multiple sexual partners for economic gains and early sexual relationships". Sessay of the NAS explains that the mining communities epitomise the problem. "We are targeting the miners, but the miners have clients and they are the commercial sex workers, so we need a programme that targets both," he said. A decade of civil war, which led to widespread sexual violence and rape, triggered the displacement of over half a million people. Thousands were left homeless or orphaned, with commercial sex work one of the few avenues to make money in a culture where women have little power to negotiate condom use. Millicent Suaray, a nurse and social worker in Kono, said many of the sex workers she meets are ex-combatants, or other victims of the conflict. "So many of the girls were sexually abused during the war, but the only option for them to survive is to go out on the streets at night." The problem "isn't lack of health centres, its educating the communities to access our services and to understand the link between multiple partners, STI's and HIV/AIDS," said Dr Yvonne Harding, director of the Marie Stopes family planning centre in Kono district, which opened just over a year ago. "Culturally woman in Sierra Leone have no powers to negotiate sex or whether to use a condom, let alone whether they want a tenth or eleventh child," she added.