In total, 727 potential participants were intercepted, 709 (98 %) of whom were eligible for the survey. Of all eligible potential participants, 430 (61 %) agreed to participate and completed the survey questionnaire (enrollment continued after reaching the target of 400 due to a higher than anticipated percent of refusal for DBS). Among those who agreed to participate, 323 consented to preparation of DBS (75 % who completed the survey). Among those who did not consent to preparation of DBS, most did not provide a specific reason for not doing so (n = 35), another 31 said they did not want or feared a finger prick, 17 had recently given blood for other purposes, 13 had no time and 11 gave some other reason.
Demographic Characteristics of Mineworkers
The general characteristics of mineworkers are shown in Table 1. Age ranged from 23 to 68 with an average of 43 years; the majority was older than 30 years of age. The main language spoken at home by mineworkers was Xichangana/Xironga (54.0 %), followed by Xitswa (19.5 %). About half of mineworkers were Protestant or Evangelical (49.5 %). Miners reported their residence for both Mozambique and South Africa. The largest percentage of mineworkers reported their main residence in Mozambique to be in the province of Gaza (42.3 %), followed by Maputo (35.8 %) and Inhambane (19.3 %). In South Africa, the main provinces of residence were North West (57.7 %) and Gauteng (19.3 %) (Table 1).
More than three quarters (79.3 %) of mineworkers had attended some primary school or some literacy classes, and 14.9 % had attended some secondary school or higher. Most (38.6 %) were primarily working in the mines as engine drivers, pump operators, crane operators, or mechanics. Approximately 81 % of participants had 10 or more years of experience working in the mines. Mineworkers mostly lived in hostels (41.2 %); another 19.5 % resided with relatives and nearly one third lived alone (29.3 %).
Marital Status, Sexual History and Risk Behavior
The majority of mineworkers (96.3 %) were married or cohabitating. Among married mineworkers, 99 % had at least one wife in Mozambique and 9.2 % had at least one wife in South Africa; 8.2 % had at least one wife in each country (Table 2).
Two or more partners in the past 12 months were reported by 51.3 % of participants. Most (93.4 %) reported that they did not pay for sex in the last 12 months. No mineworkers reported having ever engaged in sexual intercourse with a man.
In the 12 months preceding the survey, 18.5 % of mineworkers used a condom the last time they had sex (Table 3). Among those who had at least one occasional or transactional sexual partner in the last 12 months, 51.8 % used condoms at last sex with all occasional or transactional partners in the same period, and among those with a spouse or main partner in the last 12 months, 13.6 % used condoms at last sex with all spouses or main partners in the 12 months preceding the survey.
Access to and Use of Healthcare Services and Prevention Programs
In the last mine where they worked, 94.0 % of the mineworkers had access to free condoms (Table 3). In the 12 months preceding the survey, 79.5 % of the mineworkers participated in educational sessions about HIV. Within the same period, 70.0 % of the mineworkers received condoms, lubricants or HIV prevention pamphlets.
In the 12 months preceding the survey, 8.1 % of the mineworkers reported having had symptoms or having been informed that they might have an STI. Among them, 31.6 % did not seek medical advice or treatment (not shown in table).
Reported HIV Testing History and HIV Risk Perception
Mineworkers were asked to report prior HIV testing history and perceived risk. Approximately nine out of every 10 mineworkers (88.8 %) reported ever having tested for HIV (Table 3). Among those who had ever tested, 85.6 % tested within the 12 months preceding the survey, of which 92.5 % tested negative and 7.2 % reported that they tested positive at their most recent HIV test. Participants were asked to provide the principal reasons (multiple response question) for having had their last HIV test. The majority (74.0 %) reported testing because of their desire to know their status, 13.1 % tested at the request of the employer and 11.5 % were advised to test by a healthcare worker (not shown).
Among those who had never tested positive for HIV, 35.8 % believed that their risk of HIV infection was moderate and 27.1 % believed they were at a high risk of HIV infection. Nearly all (99.7 %) believed their HIV status at the time of the survey was negative.
HIV Prevalence in Mineworkers
HIV prevalence was estimated among 318 (74.0 %) men who provided DBS specimens. Overall HIV prevalence was 22.3 % (95 % CI 17.8–26.9). The 23–30 age group had an HIV prevalence of 13.6 % (95 % CI 0.0–28.0); the 31–40 age group had the highest HIV prevalence of 26.7 % (95 % CI 18.2–35.1); the 41–50 age group had an HIV prevalence of 20.6 % (95 % CI 12.6–28.7); and the 51 and older age group had an HIV prevalence of 21.3 % (95 % CI 13.0–29.6) (Table 4).
HIV prevalence was higher among mineworkers with province of residence in Maputo (27.4 %; 95 % CI 16.3–38.5), and Gaza (26.1 %, 95 % CI 18.7–33.6), followed by Inhambane (14.7 %, 95 % CI 8.2–21.1), however this difference was not statistically significant. No differences were found in HIV prevalence by education level, religion, province of residence in South Africa, years of work in South Africa, or number of annual trips back to Mozambique.
Nearly three quarters (74.6 %) of HIV-positive mineworkers were not aware of their status. Among mineworkers who reported a negative HIV test in the 12 months preceding the survey, 14.5 % tested positive for HIV in the survey (Table 5). Of the 27 participants who self-reported being HIV-positive, 21 (77.8 %) were on antiretroviral therapy.
Two thirds of mineworkers (66.7 %) were circumcised. HIV prevalence among uncircumcised mineworkers (31.2 %) was significantly higher than among circumcised mineworkers (18.5 %) (Table 4). The percentage of mineworkers that were circumcised was highest in Inhambane province 96.1 % (95 % CI 93.0–99.1) (not shown), where the prevalence of HIV among mineworkers was the lowest at 14.7 % (95 % CI 8.2–21.1).