Heterosexual STI/HIV Risk Assessment among Bolivian Truck Drivers Using Mixed Methodology

Article excerpt

Abstract

In a study to evaluate knowledge, attitudes, and sex behaviors in an occupation that facilitates high HIV transmission globally, 71 Bolivian truck drivers participated in a multiple method needs assessment, in four phases. In all phases, majority of truckers reported contact with casual sex partners. Fifty-two percent of truckers in the qualitative phases reported having had a sexually transmitted infection (STI) and 27% indicated having anal sex with female partners. These data, combined with truckers demonstrating inconsistent STI/HIV knowledge and condom use, place Bolivian truck drivers and their spouses at risk for HIV/AIDS. Government and nongovernmental organizations need to increase efforts to include this population in prevention programs.

Key Words: Truck Drivers, Bolivia, Heterosexual Behavior, Mixed Methods, STI/HIV

Introduction

Bolivia is a moderately sized, landlocked country surrounded by five other South American countries. The population in 2000 was over 8,300,000. (1) The life expectancy for males in 2001 was 61.5 years and 64.9 years for females. Seventy percent of Bolivia's citizens live in poverty. (2, 3) Two major ethnic groups reside in Bolivia: Collas are highlanders of Indian origin, Cambas are lowland Bolivians.

Bolivia's Ministry of Health (MOH) reported syphilis rate of 53.9 (per 100,000) and 72.2 for gonorrhea in 2000.(4) Schmunis and colleagues (5) ranked Bolivia's syphilis rates second out of eight South American countries. Bolivia's rates increased throughout the 1990's, but since 1998 have stayed level. (3, 6) Bolivia maintains a relatively low HIV/AIDS rate, but this gap is closing compared to neighboring countries. For example, the 1996 AIDS incidence rate in Bolivia was 1.1 (per 100,000); in neighboring Brazil and Peru the rates were 142.2 and 59.6 respectively. But the 2001 incidence rate was 6.8 in Bolivia, 17.9 in Brazil, and 24.7 in Peru. (7) There were an estimated 5,300 HIV infected Bolivians by the end of 2002. About 60% of newly infected HIV cases come from the province of Santa Cruz in east Bolivia. (8)

Long distance truck drivers have been implicated as HIV transmitters throughout the world. Several studies have been conducted concerning their high risk behaviors, majority of these in developing countries. Some studies document moderate or high HIV prevalence (as high as 56%) in the trucking population. (9-11) Studies demonstrating lower HIV prevalence in truck drivers still reveal high risk because of high sexually transmitted infection (STI) rates, sex with multiple partners, sex with injecting drug users, or sex with commercial sex workers (CSWs). (12-17)

The purpose of this study was to assess the knowledge, attitudes, and behaviors of truck drivers in eastern Bolivia, and to describe this baseline risk information. Power (18) mentions that needs assessments are useful for describing social contexts in order to conduct interventions, especially in sex behavioral settings. Qualitative methods are particularly useful in the design of interventions for mobile populations. There are an estimated 3,500 long distance truckers working in the eastern province of Santa Cruz alone. (19) It was hypothesized that this population would show as much risk behavior as truck drivers from other developing countries. This article discloses findings from 71 Bolivian truck driver participants. Four phases were utilized in this needs assessment, each one representing a different mode of inquiry, and three of which were qualitative techniques. The authors report assessment findings and discuss the concordance and difference in information gleaned by the different methods. These results were used to develop an intervention involving condom use workshops. (16)

Methods

Sites and Population Characteristics

Seventy-one male truckers, from six different research sites within 50 km of the city of Santa Cruz de la Sierra (the capital city of the easternmost province in Bolivia), participated in this needs assessment. …