Heading towards the Safer Highways: an assessment of the Avahan prevention programme among long distance truck drivers in India

Abstract

BackgroundUsing data from two rounds of a cross-sectional, national-level survey of long-distance truck drivers, this paper examines the extent and trend of sexual risk behavior, prevalence of STI/HIV, and the linkage between exposure to HIV prevention programs and safe sex behavior.MethodsFollowing the time location cluster sampling approach, major transshipment locations covering the bulk of India’s transport volume along four routes, North-East (NE), North-South (NS), North-West (NW) and South-East (SE) were surveyed. First round of the survey was conducted in 2007 (sample size 2066) whereas the second round was undertaken in 2009-2010 (sample size 2085). Long distance truck drivers were interviewed about their sexual behaviors, condom use practices, exposure to different HIV prevention interventions, and tested for HIV, reactive syphilis serology, Neiserria gonorrhoeae and Chlamydia trachomatis. The key variable of this evaluation study - exposure to HIV prevention interventions was divided into three categories - no exposure, less intensive exposure and intensive exposure. Data were analyzed using multiple logistic regression methods to understand the relationship between risk behavior and exposure to intervention and between program exposure and condom use.ResultsThe proportion of truckers exposed to HIV prevention interventions has increased over time with much significant increase in the intensive exposure across all the four routes (NE: from 14.9% to 28%, P < 0.01; NS: from 20.9% to 38.1%; NW: 11.5% to 39.5%, P < 0.01; SE: 4.7% to 9.7%, P <0.05). Overall, the consistent condom use in sex with non-regular female partners too has increased over the time (paid female partners: from 67.1% to 73.2%, P <0.05; non-paid female partners: from 17.9% to 37.1%, P <0.05). At the aggregate level, the proportion tested HIV positive has declined from 3.2% to 2.5% in (p<0.10) and proportion tested positive for Syphilis too has reduced from 3.2% to 1.7% (p<0.05). Truckers who had sex with paid female partners (men at risk) were significantly more likely to get exposed to intensive program (aOR: 2.6, 95%CI 1.9-3.4) as compared to those who did not have sex with paid partners. Truckers who had sex with paid partners and exposed to intervention program were more likely to use condoms consistently (aOR: 2.1, 95% CI 1.2-3.7). The consistent condom use among respondents who travel through states with targeted interventions towards female sex workers was higher than those who travel through states with less intensive program among FSWs.ConclusionsThese evaluation study results highlight the ability of intensive program to reach truckers who have sex outside marriage with HIV prevention interventions and promote safe sex behaviors among them. Truckers who practice safe sex behaviors with an exposure to intensive program are less likely to suffer from STIs and HIV, which has implications for HIV prevention program with truckers’ population in India and elsewhere. The simultaneous targeted interventions among female sex workers app...

Impact of an HIV Prevention Intervention on Condom Use among Long Distance Truckers in India

“…In India, recent evidence shows that around one-fourth of truckers have sex with female sex workers (FSWs) [15] and less than three-fourth use condoms consistently in sex with these partners [14–16]. Substantial proportions of truckers also have sexual relations with non-paid female partners [14–16] and only about one-third use condoms consistently in such sexual encounters [15, 16].…”

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

“…Prior studies on condom use and other sexual behaviors of FSWs and truckers have been largely quantitative in nature [10][11][12][13][14] and conducted outside sub-Saharan Africa [16][17] , with limited qualitative assessments of the knowledge, attitudes and barriers to condom use in sub-Saharan African settings. At the moment, there is hardly any study that provides detailed qualitative information on the knowledge, attitudes and barriers to condom use among FSWs and truckers in Uganda despite evidence showing that FSWs contribute 11% of new HIV infections 18 and truckers form a greater proportion of their clientele 19 .…”

An Appraisal of Sexual Behaviors, STI/HIV Prevalence, and HIV Prevention Programs among Truckers in India: A Critical Literature Review

“…Although there is dearth of studies focusing on rigorous evaluation of large-scale HIV prevention interventions among truckers in India, results from few such efforts are suggestive of success of different programs including the national response to the HIV epidemic among truckers [76], Kavach intervention [17] and Operation Lighthouse program [68]. These studies attempted to evaluate the overall effect of HIV prevention programs on truckers' safe sex practices and prevalence of STI/HIV among them.…”

“…Only recent studies conducted after 2005 collected information on sexual behaviors with non-paid female partners who are defined as females whom truckers were not married and did not pay in cash for sex [16] [17] [36] [37]. These studies report that about one-fifth of the truckers have sexual relationships with non-paid female partners [16] [36].…”