Changing patterns of knowledge, reported behaviour and sexually transmitted infections in a South African gold mining community

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Abstract
Background: In 1998, a major HIV intervention project was started in a mining community in Carletonville, South Africa. This included community-based peer education, condom distribution, syndromic management of sexually transmitted infections (STI), and presumptive STI treatment for sex workers. Objectives: To investigate changes in sexual behaviour and the prevalence of STI before and 2 years after the start of the HIV prevention programme. Methods: Cross-sectional surveys were carried out in 1998 and 2000 among mineworkers, sex workers and adults in the community. Demographic and behavioural factors were recorded and participants were tested for syphilis, gonorrhoea and chlamydial infection and, at the start of the intervention, for HIV. Results: In 1998, the prevalence of HIV among men and women in the general population, mineworkers, and sex workers, was 20%, 37%, 29% and 69%, respectively. In 2000, syphilis, gonorrhoea and chlamydial infection had increased among mineworkers; chlamydial infection had increased among men and women, and syphilis had increased among women. There was evidence of positive behaviour change but this was not substantial or universal. Knowledge of HIV/AIDS and awareness of the epidemic were high but condom use remained low. Conclusion: There was little evidence of significant behaviour change and the prevalence of curable STI increased. The prevention programme had had less impact than expected. Reasons for the reduced impact, and the lessons for future intervention projects are discussed. There is a need for further monitoring of the HIV epidemic especially as its impact increases.