Horizons Projects | HIV Prevention, Testing and Treatment for Mobile Populations: Focus on Truck Drivers in Brazil

HORIZONS PROJECT
HIV Prevention, Testing, and Treatment for Mobile Populations: Focus on Truck Drivers in Brazil

Highly mobile populations, including truck drivers, are key targets for HIV prevention and treatment efforts but can be difficult to reach with traditional programs. Horizons examined the feasibility and impact of an intervention that combined HIV/sexually transmitted infection (STI) prevention, voluntary counseling and testing (VCT), and general health care services for mobile truckers.

Formative research was carried out in August 2002, and included focus group discussions and in-depth interviews with truckers, commercial sex workers, and customs officials in Foz do Iguaçu, a town on the triple border between Brazil, Argentina, and Paraguay. This research suggested that truckers should optimally be offered services at the customs station, and that they were worried about HIV-related stigma and discrimination. In response, the study team developed the Saude na Estrada (“Health on the Road”) project, which in addition to HIV and STI services provided regular health services for truckers in a mobile health unit located inside the customs area of Foz do Iguaçu.

The intervention was evaluated through interviews with 1,775 truckers before the intervention (779 in Foz do Iguaçu and 996 in Uruguaiana, the comparison site) and 2,408 truckers after it (1,201 in Foz do Iguaçu and 1,207 in Uruguaiana). Focus group discussions and in-depth interviews also were conducted.

The intervention reached thousands with educational materials and condoms. In addition, a large number of truckers took advantage of VCT services. Almost 2,000 truckers received pre-test counseling for HIV and syphilis, and 1,794 gave a blood sample. 1,492 truckers (83 percent) returned 15 days later for test results and post-test counseling.

Key findings include:

At baseline, a sizable proportion of truck drivers in the study reported sexual risk behaviors.
Significant improvements were found in truckers’ access to VCT after intervention.
Significant increases were found in partner communication about condom use and HIV testing.
Significant positive changes were seen in condom use with occasional partners and in proportion of truckers with concurrent sexual partners.
HIV prevalence among truckers was unexpectedly low.

Truckers were highly receptive to the intervention. Almost all of the VCT participants rated services as “great” or “good.” Focus groups revealed that truckers strongly recommended the service to their peers. The operation of health services has been transferred to a local university, which will continue providing them free of charge.

Location

Foz do Iguaçu and Uruguaiana, Brazil

Duration

November 2002–August 2006

Horizons and Population Council researchers

Julie Pulerwitz, Juan Díaz, Johannes van Dam, Magda Chinaglia, Cristina Ogura

(For more information about this study, please contact horizons@popcouncil.org.)

Non-Council collaborators

Silvia Pedroso, Maria Setubal (consultants)

Sheri Lippman, Arthur Reingold (University of California, Berkeley)

DKT

EADI Customs Administration

Goodyear Tire & Rubber Company

National, state, and municipal STI/AIDS programs in Brazil

Pathfinder do Brasil

USAID/Brazil

Donors

US Agency for International Development

Ministry of Health, Brazil

Publications/Resources on this project