June 2004

Study in Brief
Southern Brazil—“Health on the Road”: Designing HIV/AIDS Programs for Truck Drivers

The mobile health unit created for truckers just outside the customs area at Foz do Iguaçu, on the border between Brazil and Paraguay. Photo credit: Johannes van Dam

Highly mobile populations—transport workers, migrant laborers, construction crews—are key targets for HIV/AIDS prevention and treatment efforts but can be difficult to reach with traditional programs. Truck drivers, for example, spend much of their time on the road, where—away from family and community—they may be particularly vulnerable to HIV and other STIs. Their mobility also makes it less likely that they will receive sustained prevention messages from public health campaigns, or use “stationary” health and prevention services that are appropriate for fixed populations.

In Brazil, the government has sought to meet the challenge of providing effective prevention and care to the country’s hard-to-reach and mobile populations. In 2001 the Ministry of Health asked the Brazil office of the Population Council to perform an HIV/AIDS-related assessment in six border towns to inform policymaking and identify appropriate interventions for disadvantaged border and mobile populations. Interviews were conducted in towns bordering Bolivia, Colombia, Peru, Argentina, Uruguay, and Paraguay; study findings identified truckers in southern Brazil as a key population to target with HIV/AIDS activities. The assessment provided the framework for a new Population Council and Horizons collaborative intervention study focused on truckers, which was designed and implemented in collaboration with the Municipal STI/AIDS Program of Foz do Iguaçu, in southern Brazil.

The formative research revealed that truck drivers view their trucks as both their life investment and their home away from home, and thus do not like to venture far from them. Since trucks may remain parked at border checkpoints for anywhere from one day to several weeks waiting for documents and for cargo to clear customs, setting up mobile prevention and care services in the customs area was a logical choice for reaching as many truck drivers as possible.

Truckers also expressed substantial concerns about HIV-related stigma and discrimination during the formative research. They were highly sensitive about being labeled as rootless vectors of disease and felt that targeting truckers with an HIV/AIDS program would only reinforce negative stereotypes.

“Although many truckers have regular or casual partners while on the road, they see themselves as devoted family men, who call home often and take their family responsibilities very seriously,” said Dr. Juan Diaz of the Population Council, one of the study’s principal investigators. “Because of their self-perception as dedicated family men, truckers feel that any blame for spreading disease is unwarranted.”

Alerted to these concerns, the study team developed a holistic intervention to provide HIV and STI services. Rather than focusing solely on HIV and STIs, the Saude na Estrada (“Health on the Road”) Project provides additional services, including blood pressure measurement, glucose testing, and educational activities focusing on common health issues for truckers. The project has also implemented health activities in partnership with other municipal health programs, such as the nutrition and vaccination program, and has sought out sponsoring organizations, including Goodyear Tires.

This mobile health unit, located inside the customs area of Foz do Iguaçu, serves the dual purposes of allowing truckers to feel less stigmatized for seeking health services while also recognizing their mobility and catering to their unique needs. More than 800 Brazilian and foreign truckers received services during the first months of activities in 2004, including a behavior change message campaign that uses brochures and radio spots, condom distribution, and voluntary HIV counseling and testing, as well as testing and treatment for other STIs. Educators provide outreach to the truckers in the customs station, leading discussions about truckers’ health and HIV/STI risk. Truckers who test positive for HIV are referred to a specialized network within the Brazilian health system for treatment and care and are followed by the project for one year to document their experience and ensure that they receive the care they require.

The Saude na Estrada Project continues until 2005, when Horizons and the Brazil office of the Population Council will publish results of its study. If successful, the researchers anticipate that national and local authorities will continue the program to offer these essential services to truck drivers and ultimately expand to other sites.

For more information about this study, contact Julie Pulerwitz at jpulerwitz@popcouncil.org. To receive e-mail notice when new publications about this research and other studies are available, sign up at www.popcouncil.org/ horizons/signup.html.

Alison Clarke