Pulmonary mycobacterial disease is common in miners. Risk factors for nontuberculous pulmonary mycobacterial (NTM) disease and tuberculosis (TB) in gold miners were identified in a retrospective case-control study that included 206 NTM patients and 381 TB patients of known human immunodeficiency virus (HIV) status diagnosed between 1993 and 1996. A total of 180 HIV-tested trauma/surgical inpatients were selected as control patients. Both HIV infection (odds ratio [OR] 3.6 for NTM and 4.5 for TB patients) and higher grades of silicosis (OR 5.0 for NTM and 4.9 for TB patients) were significantly more common in NTM and TB patients than in control patients. HIV prevalence rose in the control and both case groups during the study period. The overall HIV prevalence was 13.1% in NTM patients, 14.2% in TB patients, and 5.6% in control patients. Previous TB (OR 9.6), premorbid focal radiological scarring (OR 7.4) and a dusty job at diagnosis (OR 2.4) were additional significant risk factors for NTM disease. These findings suggest that the historically high incidence of NTM disease in miners is largely attributable to chronic chest disease from silica dust inhalation and prior TB. HIV infection has recently become an additional risk factor for mycobacterial disease in miners and is likely to become increasingly important as the HIV epidemic progresses.