Targeting HIV-prevention efforts on truck drivers and sex workers:
implications for a decline in the spread of HIV in Southern Africa
HIV Prevention and
Vaccine Research, Medical Research Council,
296 Umbilo Road
Durban 4013 South
Tel: +27 (0) 31 202 0777, fax: +27 (0) 31 202 0950, e-mail:
The role of mobile
populations in the spread of the human immunodeficiency virus (HIV) has
been documented in several countries worldwide.1-4 The role of truck
drivers and sex workers in the spread of HIV has been studied in
Africa,5 India,6 and the USA.7 Due to the migratory nature of their
occupation, truck drivers tend to have multiple sexual partners.
The potential roles
of truck drivers and sex workers in the spread of HIV in southern Africa
are being explored through a combination of qualitative and quantitative
studies among these population groups in South Africa. Ten sex workers
from five truck stops (Van Reenen, Reids, Tugela, Newcastle and Warden)
in the KwaZulu-Natal Midlands were recruited as field workers. They were
trained to obtain informed consent, administer a questionnaire to obtain
socio-demographic data and collect a saliva sample for an HIV test from
men they have sex with.
HIV prevalence and
demo-graphic data for 194 women sex workers operating from these truck
stops were obtained from an ongoing vaginal microbicide trial among sex
contained in this MRC Policy Brief were drawn from the findings
of these studies.
Sociodemographics and migration patterns
workers interviewed a total of 320 men. The mean age of the truck
drivers was 37 years and they had been in this occupation for an average
of 8 years. Of the recruited men, 297 were black, 7 were coloured, 9
were Indian and 7 were white. Sixty per cent of the men reported having
had a sexually transmitted disease (STD) in the previous 6 months.
Thirty four per cent reported always stopping for sex during journeys.
Twenty nine per cent
never used condoms with sex workers. Seventy per cent reported having
wives/girlfriends, and only 13% had ever used condoms with these regular
Anal sex was
practised by 42% of the men. Only 23% reported ever using condoms during
All the truck
drivers travel-led to three or more provinces in South Africa and 65%
travelled to neighbouring countries such as Zimbabwe, Malawi,
Mozambique, Zambia, Botswana, Namibia, Swaziland and Angola.
The mean age of the
194 sex workers was 25 years and the average education six years. The
mean number of years working as sex workers was 2,5 years.
HIV prevalence among sex workers and truck drivers
overall prevalence among truck drivers was 56% (95% CI: 51-62%). One
hundred and sixty eight (57%) black drivers were HIV positive. Five
(71%) of the coloured men, 5 Indian (56%) and 2 (29%) of the white men,
respectively, tested positive for HIV. Grouping men who were not black
showed no significant association between race and HIV status. The
prevalence at each truck stop was: Van Reenen 57%, Reids 52%, Tugela
50%, Warden 52% and Newcastle 95%. HIV prevalence at Newcastle was
significantly higher compared to other stops.
prevalence for women at each of the truck stops was: Van Reenen 44%,
Reids 42%, Tugela 62%, Warden 74% and Newcastle 64%. The overall HIV
prevalence among sex workers was 56% (95% CI: 49-63%).
HIV prevalence by age for sex workers and truck drivers
prevalence among men increased significantly with age to a high of 69%
among men aged 55 to 59 years. For the sex workers, HIV prevalence
peaked at a much younger age at 20-24 years.4
The men in the study
were on average about 12 years older than the women (37 vs. 25 years)
and the age prevalence curves were quite different for men and women.
These data suggest that older men have younger women as sexual partners
at the truck stops.
The high HIV
prevalence and low condom use among truck drivers and sex workers, as
well as the complex web of travel and sexual mixing, create a milieu
that is conducive to the spread of HIV and other STDs. The study
highlights the urgent need to deal with the HIV epidemic across
political boundaries in the southern African region. Further studies of
the pattern of movement of the truck drivers could help to throw light
on the temporal and geographic spread of HIV in the region.
Given that 70% of
the men had wives and girlfriends in rural areas may have important
implications for the spread of the virus to other communities.
transmission of HIV and STDs, and about effectiveness of condom use with
all partners needs to be targeted at truck stops, toll plazas, border
posts and at the work places of truck drivers. Misconceptions about
condom use need to be eliminated and the seriousness of untreated STDs
needs to be emphasised.
is recommended at truck stops, toll plazas, work places and border
posts. A partnership needs to be formed between the Department of
Health, the road freight agency, workforce unions and the trucking
industry as a whole in order to impact on the reduction of HIV incidence
in this high risk group.
Provision of syndromic treatment and HIV counselling
recommended at strategic points along major trucking routes to allow
easy access to care and counselling. Mobile clinics are urgently
required along trucking routes to provide STD treatment and counselling
to truck drivers and sex workers. Since the truck stops are easy to
identify, effective interventions at these places could have a dramatic
Mobile clinics are urgently required along trucking routes to
provide STD treatment and counselling to truck drivers and sex
workers. Truck stops are an ideal spot for HIV prevention
activities, targeting both truck drivers and sex workers.
truck drivers and sex workers to spread positive messages.
Peer education programmes targeted at truck drivers and sex workers can
be used as a bridge in the spread of positive attitudes regarding condom
use and HIV education. A concerted effort is needed to target high-risk
populations in a non-discriminatory manner, and to use their occupation
to spread HIV-prevention messages and promote condom use throughout the
rural and urban areas of southern Africa.
Southern African initiative.
an urgent need for southern African countries to work as a whole.
Migrations of individuals from these countries occur on a regular basis.
HIV-prevention programmes in southern African countries should work
together to reiterate common prevention messages and target appropriate
interventions. In this way, for example, South African drivers could be
given access to STD treatment and counselling in any of the southern
African countries that are part of this initiative. Further, import and
export companies need to provide condoms and effective treatment for
drivers from different regions to minimise erosion of their workforce.
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