Social and structural factors related to HIV risk among truck drivers passing through the Iringa region of Tanzania

ABSTRACT

Truck drivers and their assistants have been identified as groups at higher risk for HIV infection. We sought to identify and describe the social and structural factors that may contribute to HIV risk among truck drivers who visit rest stops in Iringa, Tanzania, a region characterized by high levels of migration and mobility. This analysis was part of a comprehensive strategic assessment to examine HIV risk factors in Iringa. This analysis focuses on 11 in-depth interviews with truck drivers and a transport owner. A semi-structured interview guide was developed to elicit open-ended responses and enable probing. Interviews were conducted in Swahili, transcribed, and translated into English. Data analysis followed thematic analysis procedures that included initial reading of transcripts, development of a codebook and identification of themes through in-depth reading of transcripts. Drivers described structural risk factors for HIV including work conditions, the power imbalance between male drivers and their sexual partners and minimal perceived HIV risk with certain partners (e.g., regular partners and women selling sex). Multiple and inter-related social norms associated with truck stop environments influenced HIV risk, including peer influence and expectations, presence of sex workers, ability to purchase sex throughout their travel and alcohol consumption. These distinct social norms in truck stops and other rest points facilitated behavior that many participants said they would not engage in elsewhere. HIV prevention strategies with truck drivers should address individual, social and structural barriers to HIV prevention through partnerships with the health and transportation sectors, local government and local communities. HIV prevention services should be adapted to drivers’ times and places of availability, for example, condom provision where/when drivers make decisions about or have sex. A focus on positive messaging and addressing specific challenges including the continual challenge of re-choosing and reinforcing decisions to engage in safer sexual behaviors is important.

KEYWORDS:

• Truck drivers
• Tanzania
• structural risk factors
• social risk factors
• HIV
• prevention

Acknowledgements

We are grateful to the participants in this study for sharing their personal experiences with our research team. We would like to thank the ethnographers who conducted interviews and all the individuals who contributed to this study in different ways through the Research to Prevention (R2P) project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by USAID Project SEARCH, Task Order No. 2, funded by United States Agency for International Development [Contract No. GHH-I-00-07-00032-00], beginning 30 September 2008, and supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR). The analysis presented here was funded by the Research to Prevention (R2P) Johns Hopkins University Doctoral Student Publication Initiative.