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One town begins to confront sexual mores that contribute to Africaleading the world in HIV cases. November 24, Flanked by scrub-stubbled hills southwest of Johannesburg, the shantytowns that surround this South African gold-mining community are unlikely places for an AIDS success story. Some 70, African men here have left their families to work a dirty, dangerous job. They live in hostels, 18 to a room - far from home. And paid-for sex is rampant. Until recently, experts say, the prospect for stemming the AIDS epidemic in Carletonville was no better - perhaps worse - than for other places on this continent, where an estimated 23 million have HIV, the virus that said to cause AIDS.
An estimated 1 in 4 miners in this town has AIDS - compared with 1 in 10 in South Africa's mining industry as a whole. Of the 5. But here in the squatter camps that stretch out in the shadow of Carletonville's gold mines, attitudes and practices are beginning to change.
Progress is incremental. But it's a start. Four years ago, Professor Williams hosted a conference of international AIDS experts and drew on the best of their experiences to come up with a fresh HIV-fighting strategy for this mining community. As a result, scientists have joined forces here with mine managers, prostitutes, local doctors, health officials, and even high school students and local bar owners. But now we see people at high risk starting to communicate and mobilize themselves.
So far, the greatest success lies in the about-face change in the attitudes of female sex workers toward using condoms - a feat that is all the more remarkable because it required a direct confrontation with African taboos and mining culture. There is a debate about how much of this is due to "the culture" and how much comes from "the living conditions" so many Africans experience. But clearly, danger and loneliness contribute to promiscuity among mine workers.
Many of the men working in some South African mines live in cramped, bleak dormitories. Some get home only once or twice a year. And 1 in 40 mine workers is killed on the job. Mine workers construct macho identities to cope with the risks of their work, according to Catherine Campbell, a social psychologist who has published studies on the Carletonville HIV epidemic.