CATHERINE MUROMBEDZI
HEALTH CORRESPONDENT

This week, we take a look at the risks of highly mobile workers, the artisanal miners, known as makorokoza in Zimbabwe.
The word kukorokoza means scrounging the earth. It shows the hard work and difficulty that it entails.
Makorokoza face a heightened risk of HIV infection due to their occupation.
These independent miners travel to various locations in search of gold, diamonds, or any mineral to make a living.
This often leads to prolonged periods away from home and separation from their families and support networks.
This isolation, combined with the unpredictable nature of their work, can lead to reckless behaviour and an increased risk of HIV infection.
For sexual pleasure, transactional sex is the norm with sex workers. When they run out of condoms, sexual activities don’t stop, further exposing everyone involved at risk of sexually transmitted infections and HIV. Zimbabwe has been reporting condom stock outs in some areas.
Condom programming is one of the pillars in prevention pillars. The country has attained the 95-95-9 HIV targets ahead of schedule. However, the targets are off track for children. We shall look into that in the future..
The economic instability and poverty that often accompany artisanal mining can also contribute to risky behaviour. When miners finally strike gold, they may engage in extravagant spending and showing off to their peers and taking the most wanted girl or sex worker. The competitions can lead to multiple sexual partners and alcohol abuse. Furthermore, artisanal miners often work in remote areas with limited access to healthcare services, including HIV testing and treatment. This perfect storm of factors makes artisanal miners a vulnerable population that requires targeted interventions to address their unique needs and reduce their risk of HIV infection.
MSF Belgium is mitigating these risks in mining communities in Gwanda District in Matabeleland South in Zimbabwe.
Dr Perseverance Chikide, working for Doctors Without Borders, MSF Belgium, serves right in the communities in Gwanda, where HIV prevalence is higher than the national.
Matabeleland South new HIV infections stand at 0.18 while the national incidence is at 0.14 in the 15-49 years.
Dr Chikide speaks of the measures that his organisation is taking.
“At first, I was hesitant as I had heard wild stories of artisanal miners. As a professional, I took the steps to find out and not rely on hearsay.
The artisanal miners aren’t what they are painted to be. One needs to take time to listen to them and understand where they are coming from. Environments shape behaviour, after working and engaging with them, we get to respect each other. They are actually, very normal like everyone else, they have their strengths and weaknesses too. Small scale miners work far away from their homes. The nature of their job places them at risk. Actually the figures for HIV incidence in Matabeleland South Province is higher than the national one, I cannot remember the actual figures right now. The general thoughts among public health personnel is that the mining activities in the community could be driving this statistic up,” said Dr Chikide.
“Working for MSF Belgium, our project has seen us testing a number of clients during our outreach clinics. In fact, HIV Testing Services are one of the main activities miners are coming for. We are starting treatment for those whom we diagnose of HIV and link them with care and follow-up with their local clinics,” said Dr Chikide.
With Zimbabwe now using the new guidelines where one testing HIV positive is initiated on treatment, severe disease is reduced.
“Test and Treat” concept is a strategy in the current HIV cascade where immediate initiation of antiretroviral therapy (ART) for those who test positive, regardless of CD4 cell count or viral load. This approach aims to increase early diagnosis and treatment, reduce viral load and transmission risk and improve treatment outcomes and quality of life before one gets ill,” said the doctor.
With some miners in the Midlands Province getting admitted in hospital for silicosis, Dr Chikide said it was not high in Gwanda district.
“We have seen Silica TB, not a lot though, maybe just a couple of cases. Those whom we diagnose with Silicosis, we already put them on TB preventative therapy, so their risk of catching TB is lowered,” said Dr Chikide.
The Gwanda Small-Scale Artisanal Mining Community, welcomes the MSF Belgium interventions. Trust Njube, one of the beneficiaries of the health interventions said he no longer defaults on treatment.
“I am originally from Plumtree, I came here in search of work in January. I could not find any formal work in the mines. I had no choice but to be an independent miner. Being on anti-retroviral therapy, I ran out of medication. I failed to travel back home to get a resupply. I missed treatment for two days. I was so happy when the village health worker informed us that the MSF Belgium team were visiting. I was open to say that I had defaulted for two days. I showed them my empty containers. I was counseled on the risks of skipping medication. I was given three months supply with a referral for resupply at the local clinic here,” said Njube.
The mobile team travels to mining and hotspot communities around Gwanda District.
Working in conjunction with Village Health Workers, communities are urged to attend outreach clinics. The mobile clinics offer HIV counseling, testing and treatment.
“The mobile clinics bring the services to the people thereby cutting out the catastrophic costs of traveling to facilities. MSF Belgium facilitate linkages to care and support,” said Dr Chikide.
Surveillance is an important aspect of monitoring. Who else is better placed to carry this important role than the Village Health Workers? Collaborative efforts mitigate on case management, community sensitisation, and tracing of patients. The MSF Belgium team conducts patient and community feedback assessments and reports on findings after implementing activities for health education, awareness. There are monitoring and evaluation experts who write reports on the impact of activities.
As the mobile clinics go out they offer psychosocial support activities, identifying and enhancing capacity for peer education and support. They initiate surveys, operational research, and assessments to give campaigns or community mobilisation activities with the Ministry of Health and Child Care (MoHCC) and other partners.
Collaboration and community engagement of MSF Belgium working with Village Health Workers to reach the marginalised is paying off as a testimony from Njube.
The surveys, research, and feedback improve the health services.
The mobile clinic is a beacon of hope for artisanal miners bringing a lifeline right to their work places.
By addressing the artisanal miners unique needs, MSF Belgium is reducing HIV transmission and improving lives in Zimbabwe’s mining communities.
“Zimbabwe adopted the Differentiated Service Delivery (DSD) health model that tailors services to meet the specific needs of different populations or individuals. It involves assessing the unique characteristics, needs, and preferences of each individual or group and designing services that respond to their needs,” said Dr Chikide.
DSD improves health outcomes, enhanced patient satisfaction, increased efficiency and as implemented in Gwanda District, in the coming years, new HIV infections can be reduced.
The DSD model is a patient-centered approach that seeks to address the unique needs and preferences of each individual or group, improving health outcomes and quality of life.
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