Integrated Biological And Behavioral Surveillance Survey (Ibbs) Among Truckers In 22 Terai Highway Districts of Nepal

Abstract

Background The Integrated Biological and Behavioral Surveillance Survey among Truckers (IBBS 2009) was launched on February 20, 2009. A total of 400 truckers were recruited for the study at the Pathlaiya study site. Data for the study was collected between February 28, 2009 and April 25, 2009. The survey measured HIV and syphilis prevalence among truckers along with information on variables which are associated with a risk of HIV infection, such as condom use, sexual behaviors, knowledge of HIV/AIDS, reported cases of sexually transmitted infections (STI), STI treatment behaviors, exposure to HIV/AIDS messages and alcohol and drug habits Study Objective The objective of the study was to determine the prevalence of HIV and syphilis among truckers who drive on the East-West Highway and to assess their HIV/STI-related risk behaviors and to analyze trends by comparing the data obtained from the previous rounds of the IBBS. Study Methodology To allow comparison over time, the 2009 survey followed the same sampling procedure used in the IBBS with truckers in the previous rounds of study. ACNielsen’s research team visited Pathlaiya to observe the flow of trucks and locate sites where the trucks stopped for new assignments, loading/unloading goods and for the night halt as well. Discussion with the local authorities dealing with the truckers revealed that almost all the truckers driving long distances on the terai highway passed through this point at least once or twice in a month, and most of them stopped for new assignments. So, as in the previous rounds, truckers were recruited from this point of the terai highway of Nepal. To meet the criterion of covering at least 30 clusters to generate a representative sample for the survey, a total of 40 clusters were covered to achieve a sample of 400 truck drivers/helpers. Each day was considered a cluster. Looking at the average flow of truckers per day through the Pathlaiya point, every fifth truck passing through the highway was selected for the sample. To implement the above methodology, 3-4 interviewers were placed at 3-4 strategic points (one interviewer in each point) of the survey site. While selecting these strategic points, it was ensured that the entire truck traffic passed through the interviewers standing at their respective points. While selecting such locations, it was also ensured that the interviewers did not count the same truck twice. Every fifth truck passing through the Interviewer/counter was intercepted, and the truck numbers were recorded in the respondent selection sheet. Each of the listed trucks was traced at the parking locations, in and around the selected survey site. The drivers of the intercepted trucks were screened to ensure eligibility with respect to their age. Once the truckers were randomly selected through the process mentioned above, they were approached for briefing about the objectives and methodology of the study. Then informed oral and witnessed consent was obtained from each trucker selected for the interview. An informed consent form was administered by the interviewer in a private setting and witnessed by another staff to ensure that the study participants understood the questions well as well as the services that would be provided to them during the study, and that they were participating in the study with informed consent. Both the interviewer and the witness were required to sign the consent form and date it. This was followed by an interview with the full consent of the study participants. The interviewer administered the standard questionnaire in a private room. Biological component For collecting blood samples, a clinic was set up at Pathlaiya. After obtaining informed consent, blood samples were collected, and syndromic treatment was provided for STI problems after examination by a health assistant. All study participants were also provided pre-test counseling for HIV and STIs. Lab analysis included testing for HIV and syphilis among the truckers. Key Findings - The truckers were of the same age group as reported in 2003 and 2006, with their mean age being 27.2 years, and their ages ranging from 17 to 59 years. - The major ethnic/caste group of the truckers were the same as in the 2006 study; Brahmin/Chhetri/Thakuri: 43.24 percent and Gurung, Magar, Tamang, Rai, Limbu and Newar: 39 percent. - The truckers were away from their family for a mean duration of 19.5 days in a month. Altogether 47.1 percent of the married truckers reported that they spent around 15-21days per month away from their families. - The proportion of truckers who admitted ever having sexual intercourse with women (96.8%) was as high as in 2006. Among them, 64.1 percent had their first sexual encounter at the age of 15-19 years. Among the truckers having ever had sex with women, 62.8 percent mentioned having done so with a sex worker (63.9 in 2003 and 69.3% in 2006). - A total of 117 truckers (48.2%) had had sex with sex workers in the year preceding the survey. Almost 42 percent of them had sex with 2-3 sex workers. - Among the truckers who had sex with the sex workers, 13.6 percent of them had it with the sex workers in India at least once (18.8% in 2003 and 13.9% in 2006). Among them, 54.5 percent had visited one sex worker in India so far, while 15.2 percent had been to 4-5 sex workers. - All truckers who had visited a sex worker in India in the past year had used a condom during their last sex and had also been consistent condom users. - Among those who had sex with sex workers in the past year, 81.2 percent of the truckers had used condoms every time, and 74.1 percent of them who had sex with their female friends in the past year consistently used a condom. However, consistent use of condoms with girlfriends was 45.5 percent and with wives only 3.6 percent. - Only 19.4% of the truckers said that it took them more than 15 minutes for them to get a condom from the nearest place. Majority of the truckers (94.1%) reported that they could get condoms from the pharmacies - Some 17.1 percent of truckers reported that they obtained condoms from the NGOs/health workers/volunteers as compared to 48.9 percent in 2006. - The pharmacy was reported to be the most popular source of information on condoms by 97.8% of the respondents. Other popular information sources as mentioned by them were newspapers/posters (95%), bill board/sign board (94.5%) and health post/health center (94.3%). - Number One was the most popular brand for 34.8 percent followed by Jodi and Panther - 24.8 percent and 20.8 percent respectively. About half of the truckers reported always carrying a condom with them. - Only 35.5 percent of the truckers were aware of all three HIV preventive measures - A (abstinence from sex), B (being faithful to one partner or avoiding multiple sex partners) and C (consistent condom use or use of condom during every sex act), and 45.7 percent of them rejected the common local misconception that mosquito bite transmitted the HIV virus. A total of 90.1 percent knew that a healthy looking person could be infected with HIV, and 84.3 percent said that sharing of meals with an HIV-infected person did not transmit the virus. - About 60 percent of the truckers knew that they could have a confidential HIV test in their community. However, only around 37 percent of them had been tested. - For around 44 percent of the truckers STI meant HIV/AIDS and 43.3 percent of them considered ulcer or sore around genital areas as STI symptoms. - Only 11 among 400 truckers had experienced at least one STI symptom in the past year. - Almost 43 percent of the truckers visited a pharmacy for the treatment of the STIs. - Around 11 percent of the truckers had at least once met a peer/outreach educator from the various HIV/AIDS-related programs, and only 4.5 percent of them had visited a DIC in the past year. Of the truckers, 3.3 percent had visited a STI clinic and VCT center in the year preceding the survey. - Of the peer/outreach educators whom the truckers had met, most of them were from AMDA. The DICs that most of the truckers had visited were run by GWP. For STI services, the truckers had visited private clinics and the AMDA clinic, and of the truckers who had visited a VCT site, most had visited a VCT center run by AMDA and GWP. - The participation of the truckers in HIV/AIDS-awareness programs/community events was also minimal, with only 20 percent of them reporting to have ever been part of such events. Among them, 12.5 percent had participated in programs conducted by the NRCS. - Among the 400 truckers who participated in the study, no one was found to be HIV positive. HIV prevalence rate was 1.8 percent in 2003 and 1 percent in 2006. - Only 0.2 percent of the truckers were found to be currently infected with syphilis, and 1.8 percent of the respondents had a history of syphilis. The prevalence of syphilis history and current syphilis has decreased since 2003. Recommendations • The knowledge of the truckers about the causes of HIV/STI transmission was reported very poor. This may be due to the minimal participation of the truckers in HIV/AIDS awareness and prevention programs. More programs should be launched targeting this particular group on the highways, and coverage of the programs should be increased. Such programs may include visits by peer educators and outreach workers to raise awareness about HIV and STI and to promote condom use. • The truckers do not use condoms consistently with familiar partners like their girlfriends and spouses. HIV/AIDS prevention programs should focus more on the need for consistent condom use for HIV/STI infection prevention purposes with all kinds of partners. • Truckers should be encouraged to use a condom consistently through the expansion of free condom distribution programs by NGOs/health workers/volunteers as part of a HIV/AIDS awareness campaign. • IEC materials like posters/pamphlets and billboards/signboards are found popular in disseminating HIV/AIDS awareness information to the truckers. Such activities should be continued and further extended to cover major highways.