Introduction: 'dying for gold': the effects of mineral miningon HIV, tuberculosis, silicosis, and occupational diseases in southern Africa.

Mineral mining is among the world's most hazardous occupations. It is especially dangerous in southern Africa, where mining activity is a leading cause of HIV and tuberculosis epidemics. Inside mines, silica dust exposure causes long-term pulmonary damage. Living conditions are often substandard; poorly ventilated living quarters facilitate tuberculosis and airborne disease spread, and high rates of alcohol and tobacco use compromise immune responses. Family segregation, a legacy of apartheid's migrational labor system, increases the likelihood of risky sexual activity. Sex trafficking in women increases risks of HIV and other sexually transmitted diseases, and labor trafficking in men through poorly regulated labor brokering impedes access to health care. Labor migration spreads mining hazards to rural, labor-supplying communities. Cross-border care is often inadequate or nonexistent, contributing to significantly greater rates of extensive and multi-drug resistance in miners, ex-miners, their families, and communities. Miners in high-income countries, working for the same transnational companies, do not experience elevated rates of death and disability. Cost-effective interventions can reduce HIV incidence through social housing, curb trafficking of high-risk groups, stop tuberculosis spread through screening and detection, and reduce drug resistance by standardizing cross-border care. Urgent action is needed to respond to mining's staggering, yet avoidable disease toll in sub-Saharan Africa.