PEPFAR project reports reduction in the number of partners among Zambian truck drivers

Prevention work among truck drivers in Africa appear to be leading to reductions in sexual risk taking behaviour according to one presentation at the 2006 HIV/AIDS Implementers Meeting of the President’s Emergency Plan for AIDS Relief held from June 12-15 in Durban, South Africa.

Travel away from home for work (such as the migrant labour population working in the mines of South Africa, or long-distance truck drivers carting goods from across east Africa) dramatically increases the risk of HIV because when people are separated from their family, the likelihood of their engaging in risky sexual practices tends to increase.

In Zambia, the Corridors of Hope (CoH) project targets commercial sex workers (CSWs) and their male clients (primarily truck drivers) with a variety of prevention interventions. CoH’s educational campaign (conducted one-on-one or through group discussion) reaches about 17,000 men each month, and the project treats 250 men per month for sexually transmitted diseases (most of whom are truck drivers).

To monitor and evaluate the impact that CoH and other groups' prevention efforts are having upon truck drivers, CoH has performed cross-sectional surveys at border sites and popular stops for the men in 2000, 2003 and 2006 to investigate whether there have been changes in behaviour.

In 2006, the number of truck drivers interviewed (1002) for the survey was almost double the number in 2000. In 2006, the proportion of men reporting sex with CSWs was 21% compared to 32% in 2000. Condom use during the last sex act with a CSW was reportedly pretty high (91% in 2000 increasing slightly to 94% in 2006). The proportion reporting transactional sex with non-regular partners fell from 27% in 2000 to 6% in 2006, while there was an increase in men reporting being faithful to their wives from 83% to 90%. The percentage who reported having no girlfriend (besides their regular partner) while travelling also increased substantially from 0.3% in 2000 to vs. 64% in 2006.

While CoH is likely a highly effective prevention programme, it will be important for these data to undergo critical peer-review, because the profound changes reported by the later survey may not be entirely due to the effectiveness of the intervention.

For example, the researchers were not interviewing exactly the same core population in the later survey. A substantial proportion of the truck drivers who were practising unsafe behaviours in 2000 may no longer be truck drivers (because of contracting HIV infection, becoming ill and dying), so the survey could simply be capturing more truck drivers who have always been more safe. Plus, the much larger sample size could mean that they are capturing a somewhat different population (e.g., of less experienced truck drivers) which could dilute the findings somewhat.

Also, as with many such repeated surveys, over time participants could simply begin telling the researchers what they think they want to hear (although to some extent, even that may be a measure of success since it indicates that their perceptions of the acceptable behavioural norm has changed).

Finally, CoH still needs to show whether these changes in reported behaviour actually correlate with reduced STIs and HIV infections.