Global HIV Prevention Programs for Long-Haul Truckers: Considerations for the U.S

By Winkelman, Sloane Burke; Kimuna, Sitawa R. et al. | International Electronic Journal of Health Education, Annual 2012 | Go to article overview

Global HIV Prevention Programs for Long-Haul Truckers: Considerations for the U.S


Winkelman, Sloane Burke, Kimuna, Sitawa R., Haithcox-Dennis, Melissa, International Electronic Journal of Health Education


Introduction

In the United States, an estimated 1.2 million people are living with HIV/AIDS, and approximately 50,000 new cases of HIV are diagnosed each year. (1) Globally, it is estimated that 33.3 million people are living with HIV. (2) From an international perspective, countries greatly impacted with those infected and living with HIV/AIDS include Sub Saharan Africa (SSA) with 22.9 million people or 5% of the population, Southeast Asia at 4 million, followed by Latin America and Eastern Europe at 1.5 million. (2) Specific prevalence and incidence rates of HIV/AIDS among US truck drivers are currently unknown; however, one study conducted among a sample of US truck drivers in New Mexico found the incidence rate to be 0.2%. (3) This figure may be grossly underestimated due to undocumented or unknown cases and seropositive conversion rates. (3)

Demographics of U.S. Truckers

According to the US Department of Labor, nearly 2 million long-haul truckers are employed in the United States. (4) Two-thirds of the truck drivers are white, 18.7% are Hispanic/Latino, and 13.4% are black/African American; most (over 60%) are over 35 years of age, and 5.2% are women. (4) As a highly mobile population, truck drivers present a special challenge for public health efforts aimed at preventing and controlling HIV infection. (3,5-25)

Limited U.S. and international research supports that truckers are at an increased risk for physical and psychosocial health problems. Truckers may engage in high-risk behaviors for STIs once they are "on the road" due to opportunity, loneliness, isolation, and long waits at truck inspection sites. (8,10-20) High-risk behaviors include unprotected sex with partners outside of marriage; engaging in anal sex; sexual relations with sex workers; substance abuse and misuse, including intravenous drug use; and gambling. (8,10,20) Workers far away from home may have more opportunity to readily engage in casual sexual relationships while traveling. (20) Moreover, the coupling of substance abuse (truckers sometimes use alcohol, prescription drugs, and marijuana to relax or sleep and cocaine and/or methamphetamine to stay awake on long hauls) and high-risk sexual behavior creates an optimal environment for STI/HIV transmission for these workers. (5-9) Most high-risk sexual behavior occurs at truck stops, lower-end motels, and rest areas with wooded areas or bathroom stalls. More recently such behavior has also occurred through meeting potential partners on Internet sites such as Facebook, Craigslist, and homosexual trucker sites. (8,9,27)

In addition to engaging in high-risk sexual behaviors, truckers often operate under high-pressure environments filled with the stress of short or strict deadlines, road hazards, and loneliness at a rate greater than the general working population. In general, there are limited to no worksite wellness programs to address these issues. In addition, some truck drivers (at least 8%) are contractors or self-employed and lack access to preventive or wellness resources. (4) Furthermore, as a mobile population, truckers are exposed to and sometimes frequent high-risk establishments along their routes, including adult video stores, legal and illegal brothels, bars/nightclubs, and strip clubs. (8,28-29)

Moreover, because of the transient nature of truckers, linking them with healthcare initiatives is difficult, since they may lack access to healthcare services and a stable health service environment. As most truck drivers are men (94%)--their healthcare utilization can be lower than women based on gender. (4,5,9) In addition--some truckers are self employed (8%) and as such can be either underinsured or not insured at all. (10) Sexual contacts with their spouses (who also may be unfaithful while their partner is on the road) and/or secondary partners may jeopardize the health of the general population. (3,5,7-9)

Risk

Review of the research literature found only 3 published studies examining HIV risk among US truck drivers. …

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