Miners in South Africa are subject to a process colloquially referred to as being “sent home to die” after they contract TB while working underground. Harsh conditions underground and the presence of silica dust make the transmission of tuberculosis all too easy, and the introduction of HIV has increased the vulnerability of miners multiplicatively. It has been shown that one in three mineworkers will become infected with HIV within 18 months of working on the mine.
In the South African mineshafts, silica exposure and high rates of HIV create the highest incidence of TB infections in the world – 28 times a declared emergency by the World Health Organization and 1,800 times the TB incidence rate in Europe and the United States.
The prospect of employment and the remaining effect of apartheid laws have created an extensive system of circular migration throughout the whole of southern Africa. Aside from HIV, this oscillating movement of highly ill, highly infectious men is the largest driver of TB in the region, responsible for three-quarters of a million cases of TB each year in the general population.