Comprehensive Program Successfully Decreases HIV Risk Behaviors
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.
Research around the world has shown that men engaged in mobile work, such as truck drivers, tend to be exposed to greater HIV risk, and to have a higher prevalence of HIV and other sexually transmitted infections (STIs), than are men in less-mobile professions. Truck drivers, like other highly mobile groups, spend much of their time away from family and community, which increases the likelihood that they may engage in risky sexual behaviors and limits their access to health services. The Brazilian Ministry of Health asked the Population Council's Horizons program to determine which populations in Brazil's border regions were most in need of HIV prevention activities. The research revealed a highly mobile, international trucker community passing through the customs area at Foz do Iguacu, Brazil, a city of about a quarter million inhabitants at the border with Paraguay and Argentina. Each day approximately 400 trucks cross this border; at may given time as many as 1,500 truckers are in the customs area, which is in close proximity to a red-light district.
The research team designed and implemented a project at the Foz do Iguacu 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 Saude 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 Iguacu 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 Ignacu and 996 in Uruguaiana). At the end of the study, researchers interviewed 2,415 truckers (1,204 in Foz do Iguacu 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. …