M.A. / This dissertation examines the fear that surrounds death as a consequence of AIDS. It focuses on the relationship that exists between two kinds of deaths, namely the ‘good death’ and the ‘wild death’. The aim of this dissertation is two-fold. It specifically investigates the existence of a ‘good death’, posing the question whether dying ‘wildly’ is necessarily inhumane or unnatural. Secondly, it seeks to emphasise the fact that the stigma surrounding AIDS increases the fears of dying and death. In this dissertation, investigation is confined to workers on the Impala Platinum Mines on the western limb of the bushveld complex, near the towns of Phokeng and Rustenburg in South Africa’s North West Province. The dissertation focuses on mineworkers, among whom – as a consequence of an excessive use of prostitution, single sex hostels, strenuous working conditions, and a lack of knowledge – there is a high level of HIV infection. The dissertation consists of two critical parts. The first aims at understanding the ideas of the fears of dying and death, with a specific focus on the theory of good and wild death, while the second analyses these fears in relation to HIV-positive miners. My methods of data collection, analysis and interpretation were ethnographic, providing a description of death and AIDS in concrete circumstances, rather than an abstract and hypothetical analysis of the phenomenon of dying and death. Information was acquired from 25 selected HIV-positive mine respondents during the period November 2002 to March 2003. This dissertation deals with a topic on which little has been written in relation to AIDS sufferers in South Africa. Its objectives are to clarify the meaning of a ‘good death’ by drawing on the South African approach of a ‘good death’ and to also examine what would be required in trying to help people living with HIV/AIDS (PLWHAs) to achieve this ‘good death’. / Prof. P. Alexander Dr. Ria Smit

Introduction Pulmonary tuberculosis (TB) is a disease which is both curable and preventable, with recognised complications such loss of lung function and progressive massive fibrosis (PMF). It is a major cause of pulmonary disability and mortality in the South Africa mining industry. Tuberculosis has a high social and economic cost, both for the individual concerned and for the industry as a whole. However, notwithstanding the extensive literature on TB in the mining industry, given the size and economic importance of coal mining in South Africa, there is surprisingly scanty information available on TB and other occupational lung diseases in coal mines. A strong correlation was reported in Canada, the USA and China between coal usage and TB. This highlights the possibility of the direct impact of coal usage on TB. Although black miners have historically done jobs with the highest exposure in the coal mining industry, there have been remarkably few studies reporting the prevalence of TB and the exposure response relationship in black coal miners in South Africa. Dust exposure in coal mines is a risk factor for occupational lung diseases such as coal workers' pneumoconiosis (CWP), chronic obstructive airways disease (COAD) and lung function deficiency. However, there are still doubts and debates about the risk in such work of tuberculosis. The aim of this study was to fill the gap in the literature by determining the prevalence and exposure response relationship of TB to coal dust exposure. Objective To determine, within a sample of coal miners: . Prevalence of tuberculosis (TB) . Prevalence of coal workers' pneumoconiosis and past TB . Association of outcome variables with exposure variables and underground coalmine workers' exposure as compared to that of surface workers . Association of TB with coal workers' pneumoconiosis and past TB . Exposure response relationship of TB, coal workers' pneumoconiosis and past TB to respirable coal dust. Method A cross-sectional study of 344 employed black male coal miners at a coal mining complex with fourteen mine shafts at Secunda in Mpumalanga, was done. The records from 1 January 2000 to 31 December 2005 were reviewed. The main outcome measure was the prevalence of current TB in coal miners. The sample consisted of 220 underground and 124 surtace coal miners. The exposure variables considered were lifetime mean exposure level (LMEL) (mgim3), cumulative dust exposure (CDE) in mg-years/m3, and coal mining years. Information was collected from multiple sources including hospital files, surveillance records and medical records, and crossvalidated with the information from the human resources department. Information was collected on the demographic profile, exposure, underground or surface work, area of work, smoking history, HIV status from medical records, dust exposure intensity, length of service, TB diagnosis and the methods of diagnosis and outcome of the treatment, and previous TB and CWP. Participants with current TB were either sputum culture positive or sputum culture negative TB. Results The mean age of the sample was 45.2 years, (range 2844 years; SD = 8.2).The mean duration of service was 16.1 years (range 4.1-27.7 years; SD 5.9). There were 34 (9.9%) cases of current TB in total, of which 31 were underground coal miners and three were surface coal miners. The prevalence of current TB reported by this study was 9.97o, with a mean age of 46J years and length of service of 16.2 years. The prevalence of current TB among the underground and surface workers was 14.1o/o and 2.4o/o rcspectively. The prevalence of CWP was 3.8o/o, with a mean age of 51.3 years and a mean length of service of 2Q.l years. The prevalence of past TB was also 3.8o/o, with a mean age and length of service of 44.9 and 1 6. 1 years respectively. Underground coal mines workers' exposure to coal dust was high, with a lifetime mean exposure level (LMEL) and cumulative dust exposure (CDE) of 2.4 mg/m3 and 33.4 mgyears/ m3 respectively. The difference in LMEL and CDE among underground vs. surface workers was significant, with underground exposure being higher than surface exposure, namely p<0.001 and p<0.001 respectively. The difference in length of service between underground and surface participants was not significant. The difference in exposure to coal dust (LMEL and CDE) among participants with current and previous TB, compared to those without current and previous TB, was statistically significant, p<0.008 and p<0.04. The difference between the coal dust exposure indices (LMEL, CDE exposure duration) for participants with and without CWP was significant. However, the difference between participants with current TB and previous TB compared to those with non-current TB and without previous TB in age and length of service years was not significant. This also applied to HIV status and smoking: the difference between participants with and without current TB was not significant. There was a strong significant association of underground mine work with current TB, with a prevalence odds ratio (POR) of 6.62 (p<0.001).This showed that the association of exposure to coal dust with current TB was strong and significant as underground mine workers were exposed to higher coal dust concentrations than surface workers. Workers with current TB were more likely to have co-existing CWP, with a POR of 1.7 (95Vo Cl:0.f7.1). The exposure-response relationship of LMEL and CDE in participants with current TB and CWP was significant. A significant trend was observed of increasing of LMEL and CDE with an increase in the prevalence of current TB, CWP and past TB. Conclusions There was a possible dose response relationship between coal dust exposure and the risk of development of pulmonary TB. The study showed that coal dust exposure was associated with pulmonary TB, and a dose response relationship with the trend of increasing coal dust exposure. lt has been shown that there is a more significant and stronger association of underground coal mine work with current TB than there is in surface work. This study has shown a significant exposure response relationship in the exposure indices (CDE and LMEL), age and length of service for CWP. This study found a high prevalence of pulmonary TB of 9.9% in black migrant coal mine workers who historically held jobs in the dustiest areas in the mining industry. The limitations of the study include the use of cumulative exposure calculated from current exposure, and the secondary healthy worker effect or survivor workforce. Dust control and HIV/AIDS programmes should be an integral part of a TB and occupational lung disease control strategy in the mining industry. / Thesis ( M.Med. )-University of KwaZulu-Natal, Durban, 2009.

A THESIS SUBMITTED TO THE FACULTY OF ARTS, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY. / In its chronic form silicosis had always been been taken for granted as one of the occupational hazards of mining. But both during and shortly after the Anglo-Boer War it manifested itself in a new accelerated form amongst former Witwatersrand rock drillers. Despite the appointment in the Transvaal of a commission of enquiry in 1902 and the promulgation of dust precaution measures, by 1912 the prevalence of and mortality from the disease amongst the Witwatersrand miners had not diminished. This finding suggests two of the purposes of the study: first, the reasons for the continued prevalence of the disease; and second, the extent of the mortality from silicosis amongst the miners. Because of the apparently low prevalence of and mortality from the disease amongst African mineworkers, the disease was ironically nick-named the "white death". Therefore another aim of the study is to examine the validity of the medical claim that the short contracts of African migrant workers safeguarded them from contracting accelerated si licosis. As the subject is complex, the study uses a thematic approach. Chapters two to nine deal with significant themes: first, the growing medical knowledge concerning silicosis, the mining and medical precautions against the disease and the age-old disregard for the occupational illness in its chronic form; second, the industrialists* need to reduce working costs, the development of mass-production technologies and the resort by management to "speeding up"; and third, the miners' needs for job and wage security, the encroachment of African competitors in semi-skilled and skilled spheres of mining and the introduction and the extension of the colour bar. Chapter nine deals with underground health conditions. Chapter ten explores the awareness of the new form of the disease, accelerated silicosis, and the establishment in 1902 of the first Transvaal commission on silicosis. Chapter eleven discusses the failure to implement remedies. Finally, chapter twelve explores the prevalence of and mortality from silicosis and the impact of the disease on the workforce of the mines. In chapters ten, eleven and twelve a synthesis is offered of the themes and findings of the previous chapters. The project is based almost entirely on contemporary primary and published sources. Apart from silicosis, a unifying theme throughout the discrete sections is the perceptions of miners of their vocation in general, and of this occupational disease in particular. The study requires periodization. As silicosis is a slow-developing disease the starting point of the investigation is 1886, when gold was discovered on the Rand. The study ends in 1910 because the establishment of Union in 1910 and the legal award of compensation in 1911 heralded a new era in the history of silicosis on the South African gold mines. The following are the conclusions. First, almost an entire generation of overseas miners, most of whom remained migrants and whose skills pioneered the South African gold mining industry, died from silicosis. Second, for reasons of self-interest, some of which they shared with one another, both the Transvaal state and the Randlords did virtually nothing to remedy the occurrence of the disease. Both parties were culpable for the neglect of the health of the industry's workforce: using only perfunctory dust safeguards, management intensified production through the deployment of both modern technology and labour intensive practices, peculiar to the Witwatersrand; and most of the state's interventionist initiatives were the result of pressure from the British House of Commons. Third, the fear and anger of miners at being the victims of a preventable occupational disease, provided the catalyst for their militancy during the period. Fourth, the industry's power was partly responsible for causing both the press and medical profession to be silent about the problem until 1910. Finally, the mineowners both seized and promoted the unsubstantiated medical orthodoxy, namely that the short contracts of African mineworkers protected them from accelerated silicosis, as an important rationale for perpetuating the migrant labour system / Andrew Chakane 2018