Risk behaviour, sexually transmitted infections and HIV among long-distance truck drivers: A cross-sectional survey along national highways in India

National Institute of Medical Statistics, Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
AIDS (London, England) (Impact Factor: 5.55). 01/2009; 22 Suppl 5(Suppl 5):S81-90. DOI: 10.1097/01.aids.0000343766.00573.15
Source: PubMed


To report HIV and sexually transmitted infection (STI) prevalence and sexual behaviour of long-distance truckers on four national highway routes from a large, cross-sectional, national-level trucker survey in India.
Seven trans-shipment locations covering the bulk of India's transport volume along four routes, north-west (NW), north-south (NS), north-east (NE) and south-east (SE) were identified as survey sites. A total of 2066 long-distance truckers were selected using a two-stage, time-location cluster sampling approach and, after consent, interviewed about their sexual behaviour. Urine and blood sample were tested for selected STIs.
Overall, HIV prevalence among truckers was found to be 4.6%, with prevalence highest on the SE route (6.8%) and lowest on the NS (2.4%). Positive HSV-2 serology, which was tested in a 10% subsample, was low along three routes, 10.0%, 12.8% and 6.7% for the NE, NS and NW, respectively, but 38.7% in the SE. The truckers from the SE were found to be more likely to have sex with paid partners than the NE route. Moreover, truckers who owned their trucks were more likely than those who did not use condoms consistently with paid partners, and truckers who drive trucks owned by their relatives/friends are more likely than others to have any STI.
Low self-risk perception for HIV (9.9%), low consistent condom use with non-paid partners (18.6%) and wives (3%), low reported exposure to any interventions (25.6%) and low levels of ever having taken an HIV test (16.5%) make truckers an important bridge population requiring strengthened interventions.

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Available from: Arvind Pandey, May 25, 2015
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    • "Over the last decade, the HIV epidemic in India has been spreading from high-to low-risk populations, and from urban to rural areas, mainly through the bridge populations (Becker et al., 2007; Solomon, Chakraborty & Yepthomi , 2004; Solomon, Kumarasamy, Ganesh, & Amalraj, 1998). The most important bridge population appears to be long-distance truckers (''truckers'') and men who migrate between states for seasonal work in construction and other industries (Pandey et al., 2008). India has approximately 3.5 million truckers. "
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    ABSTRACT: It is important to know about patterns of sexual behaviors among married couples in order to develop effective HIV prevention strategies for them. Herein we describe the sexual behaviors, estimate prevalence of anal intercourse (AI) among truck drivers ("truckers") and their wives, and determine partner-specific demographic and behavioral correlates of AI. We carried out a cluster-sampled cross-sectional survey among 18-49 year-old wives and their trucker husbands in a south Indian district. Data were collected by same-gender research team members with color-coded computer-assisted interviews. We used random intercept logistic regression to identify the independent correlates of AI. Thirteen percent of 475 wives and 467 truckers reported ever having AI with their spouse. Of those who responded, 55 % of 40 wives and 47 % of 36 truckers never used condoms during AI. Of those who responded, 22 of 32 wives and 24 of 32 husbands felt that condoms were unnecessary during AI. Reporting ever having AI was associated with younger age and higher education of both husband and wife. AI reported by wives was associated with having sexual partner(s) other than husband (adjusted OR 8.8 [95 % CI 3.2-24.0]), correctly answering all HIV knowledge items (adjusted OR 4.9 [95 % CI 1.9-12.5]), husband's sexual debut occurring before marriage (adjusted OR 1.9 [95 % CI 1.0-3.5]), and husband's high HIV risk perception (adjusted OR 2.5 [95 % CI 1.2-5.4]). AI reported by truckers was associated with having sex with a male or transgender (adjusted OR 4.0 [95 % CI 1.2-13.3]). Reported prevalence of AI was high considering that in India anal sex is non-normative, heavily stigmatized and, criminal. Indian heterosexual mobile populations need to be informed about the greater risk of HIV infection consequent to unprotected AI.
    Archives of Sexual Behavior 09/2014; 44(2). DOI:10.1007/s10508-014-0358-3 · 3.53 Impact Factor
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    • "The size of both the FSW population and their client group, and the rate of unprotected sexual contacts between them are important determinants of the rate of HIV transmission [19]. High levels of sexual risk behaviours have been reported among male sub-populations like attendees of sexually transmitted disease (STD) clinics [20], homeless men [21], contract migrant workers [22] and truckers [23]. Using nationally representative behavioural surveillance data from 2006, Gaffey et al [24] estimate that 8.5 million Indian men had sex with a female sex worker in the last year. "
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    ABSTRACT: It seems generally accepted that targeted interventions in India have been successful in raising condom use between female sex workers (FSWs) and their clients. Data from clients of FSWs have been under-utilised to analyse the risk environments and vulnerability of both partners. The 2009 Integrated Biological and Behavioural Assessment survey sampled clients of FSWs at hotspots in Andhra Pradesh, Maharashtra and Tamil Nadu (n=5040). The risk profile of clients in terms of sexual networking and condom use are compared across usual pick-up place. We used propensity score matching (PSM) to estimate the average treatment effect on treated (ATT) of intervention messages on clients' consistent condom use with FSW. Clients of the more hidden sex workers who solicit from home or via phone or agents had more extensive sexual networks, reporting casual female partners as well as anal intercourse with male partners and FSW. Clients of brothel-based sex workers, who were the least educated, reported the fewest number/categories of partners, least anal sex, and lowest condom use (41%). Consistent condom use varied widely by state: 65% in Andhra Pradesh, 36% in Maharashtra and 29% in Tamil Nadu. Exposure to intervention messages on sexually transmitted infections was lowest among men frequenting brothels (58%), and highest among men soliciting less visible sex workers (70%). Exposure had significant impact on consistent condom use, including among clients of home-based sex workers (ATT 21%; p=0.001) and among men soliciting other more hidden FSW (ATT 17%; p=0.001). In Tamil Nadu no impact could be demonstrated. Commercial sex happens between two partners and both need to be, and can be, reached by intervention messages. Commercial sex is still largely unprotected and as the sex industry gets more diffuse a greater focus on reaching clients of sex workers seems important given their extensive sexual networks.
    PLoS ONE 09/2013; 8(9):e73470. DOI:10.1371/journal.pone.0073470 · 3.23 Impact Factor
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    • "In India, evidence suggests that jobs with high mobility are likely to be associated with high risk sexual behavior. Long distance truck drivers and their assistants, apart from being at higher risk, are also found to have important roles in the transmission of STIs.[3] Results of a study involving workers of various private sectors in Karnataka did show that workers engaged in mining, garment/textile, sugar, construction/infrastructure and fishing industries had a higher risk of acquisition of HIV and other STIs.[4] A study on the sexual behavior of garment/textile workers in the southern Indian state of Tamil Nadu had documented an occupational pattern in their risky sexual behavior[4] In a study conducted among 995 men workers, aged 15-24 years from a knit city in south India, the results indicated that higher income and having more girl friends were associated with a greater likelihood for engaging in risky sexual behaviors.[5] "
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    ABSTRACT: Sexually transmitted diseases are now gradually affecting the general population groups increasingly. Our earlier observations from qualitative research called for an effort to understand the sexual exposure, activity and behavior of the workers in these software professionals in Bengaluru, India. The current study is explored to understand the association of the sexual behaviors with Job. The study design employed was a cross-sectional study using a mixed sampling method. A total of 1071 subjects from software sector in Bengaluru, the capital city of Karnataka completed the self-administered questionnaire. The source population comprised all information technology/information technology enabled services (IT/ITES) professionals aged 20-59 years working in "technical functions" in 21 selected worksites (units) of the software industry. The exposure of interest was job stressors and the outcome measures were sexual behaviors in the form of having multiple sexual partners, paid sex in last 3 months and frequency of intercourse with irregular sexual partners and condom use with regular partners during last sexual act. Among the study population, 74.3% reported not using a condom during their last vaginal intercourse with their regular partner. Regression estimates indicated that workers with high physical stressors had 6 times odds of having paid for sex in last 3 months and those with a moderate level of income related stress had 2.4 times likelihood of not using a condom during the last sexual intercourse with their regular partner. There is scope for starting prevention programs among young professionals in the IT/ITES sector to mitigate their possible risk behaviors.
    Indian journal of occupational and environmental medicine 05/2013; 17(2):58-65. DOI:10.4103/0019-5278.123165
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