How to stop East Africa's truckers from driving the AIDS epidemic

NAIROBI, Sep 22, 2003 — Ali Athumani, a driver with one of Kenya's largest long-distance road haulage firms, is a man living in fear. A father of three, Athumani readily confesses that his travels across East Africa have been marked by many casual sexual encounters at various truck stops, putting him at risk of exposure to the killer disease, HIV/Aids.

Athumani has reason to worry. According to UNAids, it is people like him who were instrumental in driving the HIV/Aids epidemic along Africa's transport corridors, helping it percolate into the continent's rural interior. UNAids says people like Athumani are helping introduce new strains in new localities, complicating the nature of the epidemic.

"Mobility has been accepted by UNAids and the International Labour Organisation (ILO) as one of the biggest risk factors to infection with HIV," the International Transport Federation (ITF) says. "The longer people are away from home — often combined with a harsh working environment and personal insecurity — the greater the risk. Migrant workers, but most importantly transport workers, clearly fall into this category."

According to the federation, "throughout history, ports have been associated with prostitution and nowadays the same is true for truck stops." Transport industry workers are, in fact, considered to be at an extraordinarily high risk of contracting — and transmitting — the killer disease.

Ahmed Omar, the secretary-general of the Kenya Long Distance Truck Drivers Association, agrees with this assessment, saying that the nature of trucking has encouraged the spread of the disease across East Africa and sub-Saharan Africa in general.

"Drivers and their assistants are usually away from home for so long that many succumb to the temptation to engage in casual sexual contact during their journeys," Omar told The EastAfrican last week. "The fact that the companies that employ them do not bother to give them adequate leave, or to conduct HIV awareness programmes, complicates the situation."

According to Omar, whose organisation has about 10,000 registered members, a Mombasa-Kigali-Mombasa return trip takes about five weeks on a slow truck, with many stops along the way. Often, a driver has to make the trip several times before being granted time off to see his family.

Not surprisingly, he says, the incidence of HIV/Aids among Kenyan truck drivers is estimated to be beyond 40 per cent — far above the Kenyan national rate of 10 per cent.

The situation, the World Health Organisation (WHO) and UNAids say, is the same across the world.

"The findings of a demographic survey of truck drivers carried out in India revealed that 84 per cent of the interviewees were suffering from some kind of sexually transmitted disease (STD)," a report on a study conducted in India through UNAids says. "In analysing the sexual behaviour of truck drivers, it was also found that 94 per cent of those infected with STDs had visited sex workers during the past year."

In much of East Africa, Aids experts say, poverty and social disruption along transport corridors help to fuel the flesh trade servicing truckers, with local women along the stops seeing the truckers as ready sources of scarce income.

"Truck drivers and their assistants often have a higher disposable income than the communities through which they pass," says Omar. "This, coupled with the fact that many of the transporters themselves have little knowledge in HIV prevention, often leads to unprotected encounters that result in the transmission of HIV."

In a pioneering project, Omar's truckers' union recently partnered with the American non-governmental organisation, Africans United Against Aids Globally (AUAAG), to launch a programme to educate the long-distance drivers and their assistants on the risks of HIV on the highway.

Already, the partnership has opened four information centres along the Mombasa-Nairobi transport corridor, where HIV awareness materials are distributed free to crews of road haulage vehicles and other transporters. The centres, dubbed "Celebrate Life Resource Centres," are housed in 20 and 40-foot containers.

"The centre at Mlolongo, near Nairobi, distributed 6,000 condoms in August and counselled hundreds of drivers on HIV/Aids," Tiahmo Rauf, AUAAG's chief executive, said. "Such numbers show that our partnership with the truckers union can have immediate, tangible results."

The centre at Mlolongo is expected to be launched officially this week by Kenya's Minister for Transport and Communications, John Michuki. At least two other centres, sponsored by Nestle Foods, will be opened in Tanzania and Uganda next month in an effort to broaden the initiative across the region.

According to Omar, other than HIV/Aids awareness, the centres will also serve as focal points to address other welfare issues affecting the trucking sub-sector.

"A recent survey by our organisation showed that only 35 per cent of our members were fully insured despite being exposed to constant danger on the roads," Omar said. "Together with AUAAG, which has helped us open a permanent office, we intend to lobby against this situation, as well as on such issues as long working hours, the denial of leave, and poor wages as part of a comprehensive programme to alleviate the dismal living standards of truckers."

UNAids says that projects such as that undertaken by AUAAG and Kenya's truckers union can have an impact on awareness and behaviour change when the right interventions are made.

"Strategies which should be employed by such projects to maximise results include social marketing, mass media campaigns and the use of peer education among the target groups, including truck drivers and sex workers," the organisation says in a report published last year. "In West Africa, evaluations suggest that safer sexual practices have increased since the beginning of road-sector interventions in 1998."

According to the UN agency, in Burkina Faso, for example, a comparison of data from studies conducted in 2000 reported condom use among truck drivers to have increased from 69 per cent to 90 per cent following an awareness programme targeted at the transport sector. AUAAG and Kenya's truckers' union hope it is a model that can be replicated across East Africa.

"If we are able to halt the transmission of HIV along the region's highways, then we will be on our way to beating the killer virus across sub-Saharan Africa," AUAAG's Rauf says.

"The key intervention is the trucker, and the local girl he interacts with."