Long Distance Truck Drivers and HIV/AIDS in Uganda: Synthesis of Information and Evidence to Inform the Response

This 60-page report discusses findings from a study by the HIV/AIDS Knowledge Management and Communication Capacity (KMCC) initiative to synthesise information and better understand the situation of HIV/AIDS among long-distance truck drivers as a key most-at-risk population (MARP), in order to inform responses. Based on a literature review, interviews with practitioners, and discussion with drivers, the study concluded that there is a need to upscale HIV prevention efforts designed specifically for long-distance truck drivers, their assistants, and sexual partners.

The report outlines the high overall risk of long-distance drivers for HIV/AIDS and other sexually transmitted infections (STIs). The constant movements, extended periods away from home, easy and available access to partners, and high rates of alcohol abuse among this group all contribute to risky behaviours. As well, the strenuous working conditions - for example, long hours, lack of access to healthy food, and infrequent breaks - can make living healthy with HIV very difficult. The report notes that illnesses and deaths in this sector not only affect the individual and their family, but, in the long term, could reduce transport sector productivity and, in turn, result in negative economic impacts from loss of goods transported.

The report provides information about different organisations and services currently working to address HIV/AIDS among long-distance truck drivers. These activities generally focus on increasing knowledge and expanding access to care among truck drivers, their assistants, partners, sex workers, and other members of the community. This is usually through peer education and infrastructure projects, such as mobile and roadside clinics.

According to the findings, knowledge about how to prevent HIV and risks is high but does not always result in behaviour changes. For example, while 98% of drivers were aware of the high risks of multiple sexual partners and unprotected sex, "behaviours among truck drivers operating along major transport corridors in Uganda include high rates of multiple sexual partnerships, low consistent condom use, and delayed STI treatment-seeking behaviours." Truck drivers also regularly engage in different kinds of transactional sexual relationships.

Similarly, while the overwhelming majority indicated that they knew and agreed that condom use was the only way to prevent HIV transmission during sex, "one-third of long distance truck drivers and 28% of sex workers agreed with the statement, 'Condoms kill the mood for sex'". As well, 18.4% of drivers indicated that they do not like to use condoms for themselves, often citing that the exhaustion from the long journey left them wanting pleasure and companionship, and that condoms detracted from the experience.

The report also notes that mobility makes it a challenge for drivers to access health services, as facilities are often far away and not open when they stop for the day. However, there is also a lack of awareness among drivers about where health facilities are and their rights to access them when travelling in a country not their own, as well as the feeling that they are not welcome in these facilities. "Perceptions of exclusion, discrimination, communication barriers, exploitation and poor physical protection impede access to healthcare services and, thus, exacerbate vulnerability."

Overall, the research found that there is insufficient programming to address HIV/AIDS prevention and care among long-distance drivers. Behaviour change communication (BCC) strategies in the locations drivers frequent are not specifically designed for their needs, and the messages that combine abstinence, being faithful, and condom use do not appeal to them. "Given long distance truck drivers’ vulnerability to HIV infection, the need for MARP-specific sexual behaviour-change strategies cannot be over emphasised. There must be an examination of how and where information is disseminated. Information is usually provided through television spots, radio jingles, leaflets, brochures, billboards and sensitisation campaigns targeting the general public. Innovative IEC [information, education, communication]/BCC interventions can target populations engaging in HIV-risk behaviour in transport-corridor hot spots."

The report states that programmes and behaviour change messaging should encourage long-distance truck drivers to:

• Use condoms correctly and consistently;
• Limit the number of sexual partners they engage with;
• Limit the intake of alcohol; and
• Seek healthcare for sexually transmitted infections and HIV.

The report offers a number of recommendations, which focus on the need for much larger and more coordinated efforts by various stakeholders. Some of these related to communication include the following:

Implementation level:

• "Document programme activities in a format that allows comparison with other programmes."
• "Adopt a community-led approach – help hot spots, trading hubs and local governments to create context-specific programmes to cater for their particular needs."
• "Mobilise communities of mobile people to take action on matters that affect them directly; given the necessary tools and resources, members of sex work groups, or long distance truck drivers, or any other key population can provide peer education and support behaviour change in a community."
• "Acknowledge language barriers when producing information, education and communication (IEC)/BCC) materials by using infographics in place of text."

Programme level:

• "Target specific risk behaviours among long distance truck drivers."
• "Promote consistent condom use with casual and regular partners and treatment-seeking behaviour including completing STI treatment regimens."
• "Tackle fatalism by promoting a positive attitude to life, improving health and discouraging HIV-risk behaviours."
• "Provide and encourage entertainment options other than drinking alcohol."
• "Set up 'sex worker-friendly' and 'long distance truck driver-friendly' integrated health services providing access to integrated services, paying particular attention to location and operating hours, and the preferences of sex workers and long distance truck drivers regarding service packages."

Click here to download the abridged report in PDF format.