Each October, hundreds of young migrants arrive at the farms around Hoedspruit, South Africa, carrying with them the weight of a province — Mpumalanga — where HIV prevalence is the highest in the nation. At Hlokomela Clinic, staff who once celebrated a decade of hard-won progress now watch that progress quietly unravel, finding roughly 15 new HIV-positive cases among every few hundred seasonal workers screened. The story of this farming community is, in miniature, the story of how epidemics do not end so much as shift — retreating in one place, finding new footholds in the young, the mobile, a
HIV resurgence among young seasonal workers threatens Hoedspruit farm progress
Young seasonal workers, particularly from economically disadvantaged regions, face elevated HIV infection risk due to unemployment, substance abuse, and limited access to treatment.
It feels like we are going back to what was happening 20 years ago
Mark
So the clinic was actually winning against HIV in this region. What changed?
Mimi
The seasonal hiring pattern exposed a gap. Young people arriving from Mpumalanga for farm work carry higher infection rates than the local population. The clinic screens them, finds the positives, but then what? They're temporary workers.
Luke
How confident are we in that 15-per-week figure? Is that consistent across seasons, or is Ngwenya describing a particularly bad week?
Mimi
She said it happens "by the end of the week" during screening season, when farms are bringing in hundreds. It's described as a pattern, not a one-time observation.
Mark
And Mpumalanga's numbers are that much worse?
Mimi
Seventeen-point-four percent prevalence overall, highest in the country. Young men there show 9.8 percent infection, which is unusual—normally young women are more vulnerable.
Luke
That's worth flagging. The survey found that pattern but didn't explain it. We don't know why young men in Mpumalanga are more infected than young women.
Mark
What about treatment? If the clinic finds these workers, can't they just start them on medication?
Mimi
That's where it breaks down. Some refuse treatment entirely. Others cite religious or cultural beliefs. And younger people in Mpumalanga overall have much lower treatment uptake—56 percent versus 84 percent for older adults.
Luke
So the clinic's success depended on people staying put and building trust over time. Seasonal workers don't stay put.
Mimi
Exactly. The clinic went from 29 percent prevalence to 6.3 percent by doing sustained work. Now they're seeing young transient workers with higher infection rates and less willingness to engage with treatment.
Mark
Is this a Hoedspruit problem or a sign of something bigger?
Luke
The reporting doesn't tell us. We know Mpumalanga has high prevalence and young people there have low treatment coverage. But we don't know if this seasonal worker pattern is unique to Hoedspruit or happening on farms across the region.
El Pulso
- A clinic that reduced HIV prevalence among farm workers from 29% to 6.3% over a decade is now detecting approximately 15 new infections per week during seasonal hiring — a reversal that staff describe as stepping back twenty years.
- Young migrants aged 20–35 are arriving from Mpumalanga, South Africa's hardest-hit province, where HIV prevalence sits at 17.4% and treatment uptake among those under 25 is a troubling 56.4%.
- Unemployment and substance abuse are stripping away the protective conditions that allowed earlier prevention efforts to succeed, leaving young workers with few economic alternatives and heightened exposure to risk.
- Some migrant workers — including those from Zimbabwe and Zambia — are refusing antiretroviral treatment outright, citing religious or cultural beliefs, with one case escalating to the threat of legal action before medication was accepted.
- Hlokomela's model of sustained trust-building faces a structural mismatch: seasonal workers are temporary by nature, and the clinic's tools were built for communities that stay.
Each October, hundreds of young migrants arrive at the farms around Hoedspruit, South Africa, carrying with them the weight of a province — Mpumalanga — where HIV prevalence is the highest in the nation. At Hlokomela Clinic, staff who once celebrated a decade of hard-won progress now watch that progress quietly unravel, finding roughly 15 new HIV-positive cases among every few hundred seasonal workers screened. The story of this farming community is, in miniature, the story of how epidemics do not end so much as shift — retreating in one place, finding new footholds in the young, the mobile, and the economically precarious.
Every October, the farms around Hoedspruit fill with young workers — most between 20 and 35, many traveling from neighboring Mpumalanga province. At Hlokomela Clinic, which has served this farming community since 2005, the arrival season now brings a familiar dread. Screening a few hundred new recruits in a single week, staff find roughly 15 testing positive for HIV. For a clinic that once celebrated a genuine turning of the tide, it feels like a retreat.
The progress had been real. HIV prevalence among local farm workers fell from 29% in 2008 to 6.3% by 2018. Hlokomela grew from four staff and fifty patients to a facility conducting 1,700 tests monthly and treating around 2,000 people. Education, testing, and prevention programs changed behavior. Supervisors stopped leveraging employment for sex. The epidemic, in this corner of the country, had been pushed back.
But the workers arriving now come from different circumstances. Mpumalanga carries South Africa's heaviest HIV burden — a prevalence rate of 17.4%, affecting an estimated 890,000 people. Among young adults there aged 15 to 24, the rate stands at 7.8%, with young men infected at higher rates than young women. These are the workers Hlokomela is now screening each spring.
Operations manager Antoinette Ngwenya points to unemployment, alcohol, and substance abuse as the forces driving vulnerability. Without stable income or prospects, young people face compounding risks. And once a diagnosis is made, the clinic encounters new resistance — migrant workers from Zimbabwe, Zambia, and elsewhere sometimes refuse antiretroviral treatment on religious or cultural grounds. Treatment uptake among South Africans aged 15 to 24 stands at only 56.4%, compared with 83.9% among those aged 25 to 49. Youth, it turns out, is its own barrier to adherence.
South Africa carries the world's largest HIV burden — 7.8 million people living with the virus in 2024 — yet has achieved a meaningful national decline in prevalence. The epidemic persists, however, precisely among the young and the mobile. Seasonal workers in Hoedspruit embody that persistence: they arrive poor, move between provinces, and leave before the slow work of trust and treatment can take hold. Hlokomela's past success was built on sustained presence. The question now is whether that model can be reimagined for people who are only ever passing through.
Every October, the farms around Hoedspruit begin their seasonal hiring. Hundreds of young people arrive looking for work—most between 20 and 35 years old, many traveling from Mpumalanga province next door. At Hlokomela Clinic, which has served the farming community since 2005, staff now dread this time of year. When they screen 200 or 300 new recruits in a single week, they find roughly 15 testing positive for HIV. It feels, one manager said, like stepping backward two decades.
This reversal is jarring because Hoedspruit had made real progress. In 2008, researchers found HIV prevalence among farm workers at 29 percent. By 2018, that figure had fallen to 6.3 percent. Hlokomela, which opened with four staff members and fifty patients, now conducts 1,700 HIV tests monthly and provides treatment to about 2,000 people living with HIV. The clinic introduced education, testing, prevention, and treatment programs that worked. Farm workers learned their status. Supervisors stopped using sex as currency for employment. The epidemic, in this corner of South Africa, had been pushed back.
But the young people arriving now tell a different story. Antoinette Ngwenya, Hlokomela's operations manager, has watched the pattern emerge season after season. Many come from Mpumalanga, a province carrying the heaviest HIV burden in the country. In 2022, Mpumalanga had a prevalence rate of 17.4 percent—the highest in South Africa, affecting an estimated 890,000 people. Among young adults aged 15 to 24 there, the rate stood at 7.8 percent, with young men showing higher infection than young women: 9.8 percent versus 6.3 percent. These are the workers now arriving in Hoedspruit looking for seasonal employment.
Ngwenya and her team believe unemployment, alcohol, and substance abuse are driving the vulnerability. Young people without stable income or prospects become more exposed to risk. The clinic also encounters resistance once diagnoses are made. Some migrant workers—including people from Zimbabwe and Zambia—refuse treatment altogether. Religious and cultural beliefs sometimes become barriers. One manager described workers who would rather face legal action than take antiretroviral medication. In Mpumalanga itself, treatment coverage among young people aged 15 to 24 stands at only 56.4 percent, compared with 83.9 percent among those aged 25 to 49. The younger you are, the less likely you are to stay on medication.
The national context makes this local crisis more visible. South Africa carries the world's largest HIV burden, with an estimated 7.8 million people living with HIV in 2024, though about 6 million receive treatment. The country has achieved something remarkable: HIV prevalence across all ages declined from 14 percent in 2017 to 12.7 percent in 2022. Yet 232,400 people still acquired HIV that year. The epidemic persists, particularly among the young and the mobile.
Hoedspruit's seasonal workers represent a specific vulnerability: they are young, often poor, moving between provinces in search of income, and arriving in a region where health infrastructure exists but cannot reach everyone. The clinic's success in the past two decades came from sustained presence and trust-building. But seasonal workers are temporary by definition. They arrive, work, and leave. Building the kind of relationship that leads to treatment adherence takes time the clinic may not have. Ngwenya's observation—that screening feels like returning to conditions from twenty years ago—carries weight not because the numbers are catastrophic, but because they represent a reversal of hard-won gains. The question now is whether Hlokomela can adapt its approach to reach workers who are here for a season, not a lifetime.
Citas Notables
During the farming season, with pre-employment screening of 200 or 300 people, by the end of the week you find that 15 are HIV-positive. So it feels like we are going back to what was happening 20 years ago.— Antoinette Ngwenya, Hlokomela operations manager
Some migrant workers will tell you to go open a case against them, but they won't take any HIV treatment. Religious and cultural beliefs can also become barriers to treatment.— Kgopotso Manamela, Hlokomela manager
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