Original research article
HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey
International Journal of STD & AIDS 2014, Vol. 25(6) 428–438 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462413512803 std.sagepub.com
Sinead Delany-Moretlwe1, Braimoh Bello1, Peter Kinross1,2, Monique Oliff1,2, Matthew Chersich3,4, Immo Kleinschmidt1,2 and Helen Rees1
Abstract We estimated the prevalence of HIV and assessed correlates of HIV infection in long-distance truck drivers in South Africa. Between October 2003 and July 2004, 1900 long-distance truck drivers aged 18 years consented to interview and for testing for HIV. Participants were selected from a 10% stratified random sample of registered truck depots. A proximate-determinants framework was used to assess the hierarchical relationship between risk factors and HIV infection using logistic regression. HIV prevalence was 26% (95% confidence interval 24% to 28%). In multivariate analyses, HIV infection was associated with spending 2–4 weeks on the road (adjusted odds ratio 1.4; 95% confidence interval 1.1 to 1.9). There was modest evidence of a dose-response relationship between time on the road and HIV risk. Mobility increased risk by creating conditions for unsafe sex and reducing access to health services. Targeted HIV interventions for long-distance truck drivers are needed.
Keywords HIV, human immunodeficiency virus, AIDS, Africa, location, epidemiology, high-risk behavior, viral disease, men, truck drivers Date received: 8 April 2013; accepted: 12 September 2013
Introduction High rates of sexually transmitted infections (STIs), including HIV, have been documented in long-distance truck drivers in Africa,1–3 Asia,4–6 and the Americas,7–9 and their sexual behaviour is thought to place them at high risk for infection. While on the road, truck drivers may be absent from their regular partners for long periods of time, less subject to social constraints, more likely to select commercial sex partners, and be exposed to high-risk sexual networks.10–12 Truck drivers may have limited access to health services and commodities, including prompt and effective treatment of STI, condoms, and other prevention interventions, while on the road.13–15 Truck drivers in South Africa are an important group for targeted HIV interventions. The spread of HIV in South Africa has been attributed in part to efficient transport networks which have linked areas and populations of high prevalence to those of lower prevalence,
leading to subsequent dissemination of HIV within the general population.16,17 Most of the 3000 registered road freight companies in South Africa are private and are estimated to operate over 200,000 vehicles.13 Despite the size of this industry, only one study involving 100 truck drivers has been published. In this study, low levels of condom use (29%), high levels of casual sex (37%), and high levels of self-reported STIs (66%) and HIV (56%) 1 Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa 2 London School of Hygiene & Tropical Medicine, London, UK 3 Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa 4 International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
Corresponding author: Sinead Delany-Moretlwe, Wits Reproductive Health & HIV Institute, University of Witwatersrand, P O Box 18512, Hillbrow, Johannesburg 2038, South Africa. Email: [email protected]
Downloaded from std.sagepub.com at University of Otago Library on March 15, 2015
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were observed.18 In 2003, the Department of Health and the National Bargaining Council and the Road Freight Association (NBCRFI), which represents the vast majority of small (1 to 10 drivers), medium (11 to 99 drivers), and large (100 or more drivers) companies within the road-freight industry in South Africa, piloted a programme to provide STI services at six clinics established on major truck routes around the country.19 Given the paucity of nationally representative data, we conducted a survey to determine the prevalence of HIV, STIs, and associated risk behaviour in long-distance truck drivers in South Africa to inform the development and expansion of HIV prevention and treatment interventions for truck drivers. Specifically, we examined the effects of time on the road on sexual risk behaviour and access to health services.
Methods Study design and population A nationally representative cross-sectional survey of 1900 truck drivers was conducted between October 2003 and July 2004. The study enrolled those who were 18 years or more, employed full-time as a longdistance trucker, co-driver or assistant in NBCRFIaffiliated organisations, and consented to be interviewed and provide urine and saliva samples for testing.
Sampling strategy A two-stage stratified sampling design was employed. The sampling frame for the first stage included the 1988 depots of all companies affiliated with the NBCRFI. The NBCRFI provided the complete list of depots with 67% classified as small (
HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey
International Journal of STD & AIDS 2014, Vol. 25(6) 428–438 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462413512803 std.sagepub.com
Sinead Delany-Moretlwe1, Braimoh Bello1, Peter Kinross1,2, Monique Oliff1,2, Matthew Chersich3,4, Immo Kleinschmidt1,2 and Helen Rees1
Abstract We estimated the prevalence of HIV and assessed correlates of HIV infection in long-distance truck drivers in South Africa. Between October 2003 and July 2004, 1900 long-distance truck drivers aged 18 years consented to interview and for testing for HIV. Participants were selected from a 10% stratified random sample of registered truck depots. A proximate-determinants framework was used to assess the hierarchical relationship between risk factors and HIV infection using logistic regression. HIV prevalence was 26% (95% confidence interval 24% to 28%). In multivariate analyses, HIV infection was associated with spending 2–4 weeks on the road (adjusted odds ratio 1.4; 95% confidence interval 1.1 to 1.9). There was modest evidence of a dose-response relationship between time on the road and HIV risk. Mobility increased risk by creating conditions for unsafe sex and reducing access to health services. Targeted HIV interventions for long-distance truck drivers are needed.
Keywords HIV, human immunodeficiency virus, AIDS, Africa, location, epidemiology, high-risk behavior, viral disease, men, truck drivers Date received: 8 April 2013; accepted: 12 September 2013
Introduction High rates of sexually transmitted infections (STIs), including HIV, have been documented in long-distance truck drivers in Africa,1–3 Asia,4–6 and the Americas,7–9 and their sexual behaviour is thought to place them at high risk for infection. While on the road, truck drivers may be absent from their regular partners for long periods of time, less subject to social constraints, more likely to select commercial sex partners, and be exposed to high-risk sexual networks.10–12 Truck drivers may have limited access to health services and commodities, including prompt and effective treatment of STI, condoms, and other prevention interventions, while on the road.13–15 Truck drivers in South Africa are an important group for targeted HIV interventions. The spread of HIV in South Africa has been attributed in part to efficient transport networks which have linked areas and populations of high prevalence to those of lower prevalence,
leading to subsequent dissemination of HIV within the general population.16,17 Most of the 3000 registered road freight companies in South Africa are private and are estimated to operate over 200,000 vehicles.13 Despite the size of this industry, only one study involving 100 truck drivers has been published. In this study, low levels of condom use (29%), high levels of casual sex (37%), and high levels of self-reported STIs (66%) and HIV (56%) 1 Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa 2 London School of Hygiene & Tropical Medicine, London, UK 3 Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa 4 International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
Corresponding author: Sinead Delany-Moretlwe, Wits Reproductive Health & HIV Institute, University of Witwatersrand, P O Box 18512, Hillbrow, Johannesburg 2038, South Africa. Email: [email protected]
Downloaded from std.sagepub.com at University of Otago Library on March 15, 2015
Delany-Moretlwe et al.
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were observed.18 In 2003, the Department of Health and the National Bargaining Council and the Road Freight Association (NBCRFI), which represents the vast majority of small (1 to 10 drivers), medium (11 to 99 drivers), and large (100 or more drivers) companies within the road-freight industry in South Africa, piloted a programme to provide STI services at six clinics established on major truck routes around the country.19 Given the paucity of nationally representative data, we conducted a survey to determine the prevalence of HIV, STIs, and associated risk behaviour in long-distance truck drivers in South Africa to inform the development and expansion of HIV prevention and treatment interventions for truck drivers. Specifically, we examined the effects of time on the road on sexual risk behaviour and access to health services.
Methods Study design and population A nationally representative cross-sectional survey of 1900 truck drivers was conducted between October 2003 and July 2004. The study enrolled those who were 18 years or more, employed full-time as a longdistance trucker, co-driver or assistant in NBCRFIaffiliated organisations, and consented to be interviewed and provide urine and saliva samples for testing.
Sampling strategy A two-stage stratified sampling design was employed. The sampling frame for the first stage included the 1988 depots of all companies affiliated with the NBCRFI. The NBCRFI provided the complete list of depots with 67% classified as small (
