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Indian Journal of Community Medicine

Sexual Behaviour Among Long Distance Truck Drivers

Author(s): S Chaturvedi, Z Singh, A Banerjee, A Khera, R K Joshi, D Dhrubajyoti

Vol. 31, No. 3 (2006-07 - 2006-09)

S Chaturvedi1, Z Singh1, A Banerjee1 A Khera1, R K Joshi1, D Dhrubajyoti2

Abstract

Objectives: To study the knowledge of long distance truck drivers about HIV/AIDS and to study the sexual behavior of these drivers with reference to HIV/AIDS. Material & Methods: Cross sectional study was conducted on Pune Ahmednagar highway. Age, educational status, sexual behaviour and knowledge were studied among long distance truck drivers. Chi square, mean and SD were calculated. Results: 283 truck drivers participated in the study. Of these 275 (97.2%) were aware of HIV/ AIDS. Though 268 (94.69%) had knowledge of transmission by heterosexual route, knowledge of other routes of transmission was lower. Misconceptions about HIV transmission such as spread of the disease by sharing meals, mosquito bite and using same toilet were high. 128 (45.23%) truck drivers had more than 5 sexual partners. 162 (57.24%) had exposure to Commercial Sex Workers (CSW) out of which only 11(6.8%) had used condom every time while visiting CSW. There was significant association of alcohol intake and visit to CSW. Conclusion: High-risk behaviour was established in the study sample. Safe sex and use of condom have to be energetically promoted among long distance truck drivers.

Keywords: HIV/AIDS; Sexual Behaviour; Truck Drivers.

Introduction

In India, HIV/AIDS epidemic has emerged as the most serious public health problem since independence. The truck drivers, due to the migratory nature of their occupation and being far away from their families for a long time tend to have multiple sexual partners and visit commercial sex workers. The truck drivers thus constitute a well-known high risk group of population in the spread of HIV/AIDS. Earlier studies in India have documented a gradual increase in knowledge about HIV infection, safe sexual behaviour among truck drivers, CSW’s etc1,2,3,4.

The present study was carried out to study the knowledge and practices regarding HIV/ AIDS among truck drivers, the prevalence of unsafe sexual behaviour and condom use so as to formulate an Information, Education and Communication (IEC) package regarding HIV/AIDS, other Sexually Transmitted Infections (STI), safe sex and condom use.

Material and Methods

Long distance truck drivers plying on national highways passing through Pune-Ahmednagar State Highway No. 27, who halted at road side group of “Dhabas” (road side hotels) at Shirur in Pune district, Maharashtra (India) were enrolled in a cross-sectional study conducted for 5 days in March 2004 between 1800 hrs – 2300 hrs. A total of 338 truck drivers could be approached over a period of 5 days. Out of these 315 consented for the study. The adequacy of sample size was established using “Stat Cal” menu of WHO- CDC Statistical software Epi Info.

The study was conducted at Rural Health Training Centre, Shirur, District Pune, Maharashtra. All interviewers were properly trained and briefed for administering the questionnaire. A group of dhabas was identified on the Pune – Ahmednagar State Highway number 27. All the truck drivers who stopped at the dhabas were invited to participate and those who consented for the interview were taken to a separate enclosure in order to maintain privacy and confidentiality. On the first day, a pilot study of 32 truck drivers was carried out with the help of the questionnaire adopted from UNAIDS5. It included questions on knowledge and behaviour on HIV, STI and condom usage. The questionnaire was administered using personal face-to-face interview techniques. The questionnaire was suitably modified after the pilot study. The data of this pilot study has not been included in the final analysis.

In order to avoid interviewing the same driver twice, from second day of the study, the drivers were first asked whether they had been similarly interviewed in the preceding days at this group of dhabas. After the completion of interview, the truck drivers were educated about mode of transmission and prevention of HIV/ AIDS, STI and usage of condoms by using flip charts.

Results

Total of 283 truck drivers were included in the final analysis.

Socio-demographic profile: Mean age of truck drivers was 28.97 years. 30 (10.61%) truck drivers were less than or equal to 20 years of age, 134 (47.35%) were between 21-30 years and 119 (42.04%) were more than 30 years of age. 153 (54.06%) of truck drivers were from Maharashtra, 41 (14.49%) were from Karnataka and rest of them were from other states. 185 (65.37%) were married. 69 (24.39%) drivers had studied less than 6th class, 183 (64.66%) between 6th and 10th class and rest had studied beyond 10th class. Knowledge about HIV/AIDS: 275 (97.2%) truck drivers were aware of HIV/AIDS. Out of these, 185 (67.28%) got information from Mass media, 68 (24.72%) from their peer group, 16 (5.28%) from NGOs or doctors and only 6 (2.18%) were told about HIV/ AIDS in their schools.

For comparing the awareness level about HIV transmission, truck drivers were divided according to their education level into three groups – educated less than 6th class, from 6th to 10th class and more than l0th class. Overall 268 (94.6%) of the drivers were aware that HIV can be transmitted by heterosexual route, 244 (86.2%) were aware about transmission by contaminated needle and 239 (84.4%) were aware about transmission by blood transfusion. However knowledge about transmission from pregnant mother to her unborn child, through breast-milk and homosexual route was less being 198 (69.9%), 160 (56.6%) and 131 (46.29%) respectively. On analysis of data on the basis of educational status, it was found that there was statistically significant difference in knowledge of transmission of HIV/AIDS by different modes of transmission except for transmission by heterosexual route and breast feeding. (Table I)

Table I – Awareness About HIV Transmission and Education Status

  <6th 6-10th >10th p Value
Yes No Yes No Yes No
Hetrosexual route 63 (91.3%) 6 (8.7%) 175 (95.62%) 8 (4.38%) 30 (96.77%) 1 (3.23%) p > 0.05
Contaminated Needles 47 (68.11%) 22 (31.89%) 168 (91.8%) 15 (8.2%) 29 (93.5%) 2 (6.5%) p<0.005
Blood Transfusion 50 (72.46%) 19 (27.54%) 160 (87.4%) 23 (12.6%) 29 (93.5%) 2 (6.5%) p<0.005
Vertical Transmission 43 (62.3%) 26 (37.7%) 128 (69.9%) 55 (30.1%) 27 (87.1%) 4 (12.9%) p < 0.05
Breast Feeding 37 (53.6%) 32 (46.4%) 102 (55.7%) 81 (44.3%) 21 (67.7%) 10 (32.3%) p >0.1
Homosexual Route 22 (31.88%) 47 (68.12%) 89 (48.6%) 94 (51.4%) 20 (64.5%) 11 (35.5%) p < 0.01

It was observed that misconceptions about HIV transmission are quite prevalent among truck drivers. About 75 (26.5%) felt that AIDS can be transmitted by sharing meals, 150 (53%) stated that it can be spread by mosquito bite and 145 (51.24%) were of the opinion that AIDS can spread by using same toilet. Misconceptions of HIV spread by sharing meals status. (Table II)

Table II – Misconceptions About HIV Transmission and Education Status

  <6th 6-10th >10th p Value
Yes No Yes No Yes No
Sharing Meal 26 (37.6%) 43 (62.4 %) 45 (24.6%) 138 (75.4%) 4 (12.9%) 27 (87.1%) p<0.05
Mosquito Bite 32 (46.4%) 37 (53.6%) 106 (57.9%) 77 (42.1%) 12 (38.7%) 19 (61.3%) p>0.05
Sharing Toilet 41 (59.4%) 28 (40.6%) 100 (54.6%) 83 (45.4%) 4 (12.9%) 27 (87.1%) p<0.005

When asked about use of condom for preventing transmission of HIV, 47 (68.1%) truck drivers who have studied less than 6th class, 159 (86.8%) educated between 6th and l0th class and 26 (83.9%) who had studied beyond l0th class agreed that use of condoms does prevent spread of AIDS. Difference between three groups was statistically highly significant. (p<0.005)

Sexual behaviour of Truck drivers: 45 (16%) of the drivers had never experienced sexual intercourse. 73 (25.79%) said that they had only one sexual partner, 37 (13%) had 2- 5 sexual partners and 128 (45.23%) had more than 5 sexual partners in their lifetime.

9 (30%) of truck drivers in the age group of 20 years and below, 76 (56.75%) in 21 – 30 years age group and 77 (64.7%) in the age group > 30 years gave history of exposure to CSW. Overall 162 (57.24%) of truck drivers had exposure to CSW’s anytime during their life time. Of these 162 truck drivers, 108 (66.7%) were married and 54 were unmarried. There was no significant association between marital status and exposure to CSW’s (p > 0.05). On analysing the data according to educational status of 162 truck drivers who had exposure to CSW’s, 37(22.8%) had studied less than class 6, while 23(14.2%) had studied more than class 10th (Table III). On analysis there was no significant association between educational status and exposure to CSW’s.

Out of 162 (57.24%) truck drivers who gave history of CSW exposure only 11(6.79%) had used condom every time they visited CSW while 98(60.49%) drivers had never used condoms while visiting CSW. These 11 cases who always used a condom 7 (63.6%) had studied more than class 10 and 3 (27.8%) had studied between class 6th and 10th. Of the 98 cases who had never used a condom 24 (24.5%) had studied less than class 6th, 68 (69.4%) between class 6th and 10th and 6 (6.1%) had studied more than class 10th. On analyzing the data education status was found to be significantly associated with condom use.

Table III-Educational Status with Exposure to CSW & Condom Usage

Educational
Status
Exposure to CSW Total
Present Absent Total
< 6th 37 (53.6) 32 (46.4) 69 (100.0)
6th -10th 102 (55.7) 81 (44.3) 183 (100.0)
> 10th 23 (74.2) 8 (25.8) 31 (100.0)
Total 162 (57.2) 121 (42.8) 283 (100.0)
χ2 = 4.18 df =2 ; p >0.05

Relation between Alcohol Consumption and CSW Exposure: 154 (55.48%) truck drivers gave history of alcohol consumption out of which 105 (68.2%) gave history of exposure to CSW as compared to 57 (44.2%) of those who did not consume alcohol. Difference was found to be statistically highly significant.

Relation between the Days Stayed away from Home per Month and CSW Exposure: Eight out of 37 (21.6%) truck drivers who stayed away from home for less than 10 days per month gave history exposure to CSW. Of the 148 truck drivers who stayed away from home between 10 – 20 days per month, 75 (50.7%) gave history of CSW exposure. 79 out of 98 (80.6 %) truck drivers who stayed away from home for more than 20 days gave history of CSW exposure. The association between length of stay away from home and exposure to CSW was found to be statistically significant (p< 0.0001).

Awareness of STI: Awareness about diseases other than AIDS, which can be transmitted by sexual route, was poor among truck drivers. Only 51 (18%) were aware about STI’s and 232 (82%) had not heard of any disease, other than AIDS, which can be transmitted by sexual route. Of the 51 who were aware about STI’s 42 (82.4%) gave history of exposure to CSW as compared to only 120 (51.2%) out of 232 truck drivers who were not aware of other STI’s. On analysis data the association was found to be highly significant. Of the 42 truck drivers who were aware of STI’s as well as had exposure to CSW’s 9 (21.4%) always used a condom, 12 (28.6%) sometimes and 21 (50%) never used a condom (Table IV). On analysis of condom usage with awareness of STI’s among 162 who had exposure to CSW’s the association was found to be statistically significant (p < 0.01).

Table IV- Awareness of STI’s with Exposure to CSW & Condom Usage

Awareness
of STI’s
Condom usage
Always Sometimes Never Total
Present 9 (21.4) 12 (28.6) 21 (50.0) 42 (100.0)
Absent 2 (1.7 ) 41 (34.1) 77 (64.2) 120 (100.0)
Total 11 (6.8) 53 (32.7) 98 (60.5) 162 (100.0)

Discussion

In order to understand the nature and the magnitude of HIV/ AIDS problem, behavioral surveillance plays a very important role. Secondly, one of the main objectives of the National AIDS Control Policy II (1999) is to provide interventions to change behaviour, especially among high-risk groups6.

Awareness about HIV / AIDS

The overall knowledge about the modes of transmission of HIV/AIDS was generally good. Almost all of the truck drivers were aware about the transmission of HIV by heterosexual route.

But the knowledge about other modes of transmission that is from pregnant mother to her unborn foetus through breastfeeding and through a homosexual route was inadequate.

This could be due to the fact that the main thrust of HIV/AIDS education of truck drivers is limited to bring about change in their high-risk behaviour, that is unsafe sex with commercial sex workers and rightly so, of the respondents are aware that condom use during sex with commercial sex workers could prevent AIDS.

Misconceptions as regards to transmission of HIV/AIDS by sharing needles mosquito bite and using public toilet were present among truck drivers. These misconceptions can lead to increased discrimination against patients of HIV/AIDS. In our study we found that 57% of the truck drivers had visited commercial sex workers out of which 60% had never used a condom. Singh et al7 have reported that though 62% of truck drivers had sexual intercourse with CSW’s only 25% used condom regularly. In a survey carried out by Ahmed SI in 1992, 82% of truck drivers reported CSW exposure and none of them had used condoms9. Bansal RK in 1995 reported that 88.6% had visited CSW’s. Mishra et al in their study in 1998 found 80% of truck drivers visited commercial sex workers and of these 75% had either never used a condom or had used it very irregularly10. Manjunath JV et al in their study in 2000 found that 66% of truck drivers had visited commercial sex workers and 60.5% had never used a condom11. Marital status and educational status of truck drivers was not associated with exposure to CSW’s though educational status was significantly associated with condom use. Most of the truck drivers who gave history of exposure to commercial sex workers had picked up their women from roadside dhabas along the highways.

We found a very highly significant relationship between alcohol intake and commercial sex worker exposure. Those who consumed alcohol were 2.71 times more likely to visit a commercial sex worker than those who did not. High alcohol consumption (87%) amongst truck drivers has also been reported by Singh et al, 60% by Manjunath and 47% by Kootikuppala7,8,11.

We found the highly significant relationship between the number of days spent outside home and exposure with commercial sex workers. Truck drivers who stayed away for more than 20 days from their homes were 15 times more likely to have exposure to commercial sex workers.

Mass media has played an important role in spreading the message about HIV/AIDS. In our study it was observed that 67% truck drivers had gained the knowledge about HIV/AIDS from TV, radio and newspapers. Though they were aware of HIV/AIDS, the overall awareness regarding STI’s was aware very poor.

Recommendations

Long distance truck drivers, due to nature of their profession, have to stay away from home for long periods of time as well as traverse the length and breadth of the country. Being in the sexually active age group exposure to commercial sex workers becomes a frequent sexual practice. These factors make them an epidemiologically important risk group as far as transmission of HIV infection is concerned. Thus changing their sexual behaviour is of paramount importance to protect these drivers as well as have a major impact on spread of HIV infection. Though they have been targeted by IEC campaigns there still exist major lacunae in their sexual behaviour as brought out by this study. To overcome these lacunae the following actions are recommended:

  1. Information regarding all modes of transmission HIV/AIDS and other STI’s should be given due importance.
  2. Promotion of condom usage by truck drivers by involving transport company owners, truck drivers unions, NGOs etc.
  3. Ensuring easy availability of condom.

References

  1. Bansal, RK. Truck drivers and risk of STDs including HIV. Indian Journal of Community Medicine. 1995 Jul-Dec; 20(1-4): 28-0.
  2. Asian Marketing And Social Research, Report On Baseline Wave — 1996: HIV Risk Behaviour Sentinal Surveillance Survey In Tamil Nadu. APAC Project, Voluntary Health Service — India 1996.
  3. Asian Marketing And Social Research, Report On Second Wave — 1997: HIV Risk Behaviour Sentinal Surveillance Survey In Tamil Nadu. APAC Project, Voluntary Health Service — India 1997.
  4. Asian Marketing And Social Research, Report On Third Wave — 1998: HIV Risk Behaviour Sentinal Surveillance Survey In Tamil Nadu. APAC Project, Voluntary Health Service — India 1998.
  5. Evaluation of a National AIDS programme. A methods package. UNAIDS : UNAIDS/WHO.Geneva; 1999; Sec 3, Annex 1: 1 – 16.
  6. National Baseline General Population Behavioural Surveillance Survey -2001: National AIDS Control Organisation (NACO), Ministry of Health and Family Welfare, Government Of India, 2001: 3.
  7. Bansal RK. Sexual behaviour and substance use pattern amongst Adolescent truck cleaners and risk of HIV/AIDS, Indian Journal of Maternal and child Health, 1992; 3(4) : 108 – 10.
  8. Rao O2 Pilli RD, Rao AS, Chalam PS. British Medical Journal, 1999; 318: 162 – 163.
  9. Ahmed SI. Truck drivers as a vulnerable group in North East India. In: Aggarwal OP, Sharma AK and Indrayan. A HIV/AIDS Research in India, NACO, Ministry of Health & Family Welfare, Govt. of India, 1997, 497.
  10. Mishra R. STD and HIV/AIDS: A KAP Study Among Truck Operators, Health Millions, 1998, 224(5); 11-3.
  11. Manjunath J, Thappa D, Jaishankar T. Sexually Transmitted Disease and Sexual Lifestyle Of Long-Distance Lorry Drivers — A Clinical-Epidemiological Study In South India, International Journal of STD AIDS, 2002, 13; 612-617.

1 Deptt. of PSM, AFMC, Pune 411040

2 Deptt. of PSM, BJMC, Pune.

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