Tackling HIV on the road

All over Africa, the truck routes are believed to have acted as a vector for HIV. Transport drivers are almost 100% men who spend long periods away from home. It is not difficult to come to the conclusion that at least some of these men will engage in casual sex somewhere on the road.

Back in 1998, when President Thabo Mbeki made his "Appeal to the Nation" to tackle HIV/AIDS, the Road Transport Industry responded immediately. The Road Freight Association, representing employers, and the National Bargaining Council for the Road Freight Industry, representing employees, have been working together in a fine example of management/labour co-operation. Together they put out a tender for a national HIV/AIDS programme. In 1999, the tender was awarded to The Learning Clinic.

"Ever since we started work on the project, that's just about all we've been doing," says Paul Matthew, managing director of The Learning Clinic. "It's been a steep learning curve for us. Our first project was called Trucking Against AIDS and was focused on educating management about the facts and how to tackle HIV/AIDS, as well as training peer educators. But it soon became apparent that we needed to take it out on the road - to go where the industry was, instead of waiting for it to come to us.

"We started in Harrismith, with Operation Hotspot. We provided a facility at Highway Junction, where all the trucks stop, for peer education. It was a great success. We saw more than 300 drivers and gave them training, not only about HIV, but also about STDs (sexually transmitted diseases) - wherever the incidence of STDs is reduced, the rate of HIV infection also goes down. We had charts of symptoms up on the walls and the drivers found it easy to recognise and relate the symptoms to themselves. Out of this first project was born our Roadside Container Clinics."

The Roadside Container Clinics project is currently spreading across the country. Two huge containers are fitted out, one as a classroom for HIV and STD education while the other becomes a primary health care clinic with a focus on STDs. "Our vision is to have a network of Roadside Container Clinics on all trucking routes, like the truck stops or the Ultracities - wherever drivers habitually stop," Matthew says.

The Learning Clinic has been rolling out Container Clinics in places like Harrismith and Beaufort West, where they have become more popular with the community as a whole than existing facilities. The nurses are trained to be friendly, accessible and down-to-earth. They expect to have clinics up and running soon in other hot-spots like Komatipoort, Beit Bridge and Ventersburg, while stops along the N2 and N7 are being explored. "The aim is that a driver leaving Cape Town will have support from there right up to the furthest border post."

Without a doubt, support for truck drivers is very necessary. While no official prevalence dfigures are available as yet for the industry, indications are that the incidence of HIV infection among drivers is somewhere between 55% and 65%. "There's no doubt that the industry has a serious problem," says Matthew. "At present, we are losing about 2000 drivers per annum - that's 2000 deaths a year - and the industry is struggling to train about 200 replacements. And because truck drivers fall within the high-risk age group, the chances are some of those new employees are themselves HIV-positive already. So it's critical for the industry to do everything it can to reduce the rate of infection."

The need for the project is self-evident. There are some 35 000 transport drivers employed in South Africa. It is likely that at least 17 500 are infected, and with 200 dying a year, the number of experienced drivers will be reduced by half in about a decade.

The industry bodies to which Matthew reports have been very flexible about the direction he and his team are taking. "If it works, they give us the go-ahead to do it. If it's not working, we can change track at any time."

One of the angles The Learning Clinic is exploring is to train commercial sex workers as peer educators, using the facilities at the Roadside Container Clinics. It is an obvious route to take, since sex workers are the other element in the equation. Less than 10 years ago, it was virtually unheard of for many companies and industries to acknowledge that sex workers played any kind of role in their employees' lives. "Getting involved with the sex workers is very enlightening," says Matthew. "For instance, we're handing out condoms left, right and centre, but talk to the sex workers and they'll tell you drivers still don't use them."

It is not easy for a very poor and uninformed sex worker to fight for condom use, especially in a depressed economic climate with huge unemployment. "What can you expect her to do if she has hungry children at home and a driver offers her an extra R20 for unprotected sex?"

Training the sex worker as a peer educator empowers her to protect herself as well as the trucker. Sex worker workshops are conducted at the Roadside Clinics during the day when the drivers are out on the road.

The Learning Clinic's response to the epidemic is wide-ranging. The team is engaged in training nominated employees of road freight companies as peer educators in awareness education, handing out printed material and condom distribution, but the most important focus has become managing and treating STDs. The Roadside Container Clinics are a highly efficient mechanism to address STDs, since they operate right where the connection between trucker and sex worker takes place.

"This is how we can make the most profound impact," says Matthew. "If we can help drivers and sex workers recognise STDs and get treatment quickly, we can help them reduce their risk of infection significantly." In an industry that's taken a huge battering already, that's a welcome assurance.