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October 2007, Vol. 13, No. 2HIV and AIDS Researchers with the Population Council’s Horizons program recently concluded a project to provide HIV-related testing and counseling services to truck drivers traveling through a customs station at the southern border of Brazil. These services were offered as part of a broader set of health services, including testing for diabetes and high blood pressure, in order to reduce the stigmatization associated with HIV services. A study found that the project greatly improved access to voluntary counseling and testing for HIV and significantly reduced the incidence of behaviors known to increase HIV risk, as compared to a control site that did not offer the services. Mobile
population The research team designed and implemented a project at the Foz do Iguaçu customs station. They compared truckers passing through that station with truckers passing through a similar station in Uruguaiana, which had no such program. The design of the intervention was informed by data collected in interviews with truckers from Brazil and neighboring countries, staff members from the customs stations, sex workers, and others. As part of the resulting project, truckers who were waiting to cross the border were approached by two outreach educators who gave them informational materials. The educators also invited the truckers to receive health services, including testing and counseling for HIV and syphilis, at a mobile clinic inside the customs area—called Saúde na Estrada (“health on the road”). Those who agreed to take part in voluntary counseling and testing for HIV and syphilis received pre-test counseling, provided a blood sample, and were given a follow-up visit at the site in 15 days to receive test results and post-test counseling. In addition, all truckers were offered education about HIV and other STIs; free condoms; preventive health services, such as blood pressure and diabetes screening; and a syndromic management consultation for STIs. (Syndromic management of STIs involves diagnosing infection based on the presence of symptoms and signs, rather than on laboratory tests.) To evaluate the success of the project, the researchers collected cross-sectional data from male truck drivers passing through the customs station in Foz do Iguaçu before the services began, in April–July 2003, and then again between April and June 2005. Researchers compared that data with data from truckers going through customs in Uruguaiana (where the program was not instituted). Before the start of the project, researchers interviewed 1,775 truckers (779 in Foz do Iguaçu and 996 in Uruguaiana). At the end of the study, researchers interviewed 2,415 truckers (1,204 in Foz do Iguaçu and 1,211 in Uruguaiana). In addition, truck drivers who visited the health post were asked to complete surveys to determine satisfaction with the services. The costs of implementing the project were also tracked. Key
findings Before the study, 45 percent of all respondents reported having more than one sexual partner during the past six months. Reported condom use varied widely by type of partner; the majority of respondents—85 percent—reported consistent condom use during sex with sex workers, fewer reported consistent use with occasional partners, and almost no truckers reported consistent use with regular partners, such as their wives. Prior to the study, the researchers surmised that lack of condom use with occasional partners was likely to be the most easily changed sexual risk behavior. The study results proved this to be true. Between the beginning and end of the study, the percentage of participants who reported ever using condoms with an occasional partner increased significantly, by 21 percent, in Foz do Iguaçu, but decreased by 3 percent in Uruguaiana. In both locations, condom use with sex workers did not change much; condom use with regular partners remained low. The researchers found a significant increase in reported communication about condoms with all types of sexual partners in Foz do Iguaçu following the study. Communication about condom use did not change in Uruguaiana in the two years between surveys. Similarly, more truckers in the intervention site reported discussing HIV testing with their partners, with the greatest percent change demonstrated among truckers speaking with their regular partners about testing. Communication about STIs improved significantly between truckers and their regular partners, again only in Foz do Iguaçu. Access
to voluntary counseling and testing Truckers responded positively to the intervention activities and found them to be non-stigmatizing. One Brazilian trucker told researchers, “This service is the best thing in this region. Now, you have a problem and you have all you want here. There is no need to go to other places. You use the time when you are waiting for the liberation of your truck.” Another trucker, from Paraguay, told researchers, “I really loved the way I was treated. The nurses and all the health workers are very helpful and kind. They know how to treat people.” Only five of the 1,821 truckers tested for HIV were positive (0.3 percent), a prevalence comparable to that of the general population in Brazil. This unexpectedly low prevalence was corroborated by independently collected data from Uruguaiana, which found an HIV prevalence of 0.7 percent among truck drivers tested during 2001–2005. Prevalence of syphilis (active and past infections) among truckers tested in Foz do Iguaçu was also lower than expected at 4.4 percent.Conclusions Source Outside funding Related Project See Also
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