Promiscuous truckers and HIV in Africa

Stephanie Nolen:

Mohammed Ali stroked his beard and thought it over: After several minutes, he concluded that it must have been 100,000 women.

Sex, that is, with 100,000 women, in the course of his 30 years as a truck driver on the long highways that snake into the heart of Africa.

That's probably something of an overestimate -- he would hardly have had time to drive -- but it speaks to the culture in which Mr. Ali, a conservative man by nature, has spent his working life.

"There are so many women on the road and they are tempting, the way they dress is very alluring and I'm very tempted by them," Mr. Ali said frankly.

When he started driving, it was a different one every night. Then he cut back to a couple of times a month. These days, he has cut back entirely.

"Sooner or later you end up with one who is positive. I have gone with many different ones, and I'm sure not many of them are infected, but by chance or by luck I ended up with one who was positive -- it was just bad luck."

Bad luck, no question, although the odds were not in his favour. Research on the key transportation corridors in Africa has found that as many as 80 per cent of the sex workers who work those routes are living with HIV/AIDS.

Mr. Ali, 48, learned that he is infected with HIV in 2003. So he's given up the indulgence of women on the road.

Africa's trucking routes are vitally important. Air freight is too costly for the cheap consumer goods that move through the continent, so long-haul trucking carries fuel as well as the products of industry and agriculture.

These days, truckers have an HIV infection rate believed to be at least twice that of the general population, and they remain a key group for the transmission of HIV.

A few projects work with truckers. Population Services International's Corridors of Hope program targets drivers at border points across Africa, for example, with condoms, education and health care right at the truck stops.

Yet people who work in the field say that, aside from some isolated success stories, little has changed in trucking culture despite the grim swath AIDS has cut through so many countries.

"They see those people playing with fire and they get burned, and then they go to play with the same fire," Ahmed Salem, deputy chairman of the Kenya Long Distance Truck Drivers' Welfare Association, said of the drivers.

Despite the importance of truckers in the fight against AIDS, recent research suggests that little has been done to figure out why that is, or to try to change it.

A study of the trucking routes by the Strengthening HIV/AIDS Control Project, a Canadian-funded joint venture of the University of Manitoba and the University of Nairobi, found that the trucking corridor through Kenya and Uganda alone could be the site of as many as 10,000 new HIV infections in a year.

But at the same time, fewer than 10 per cent of sex workers and no transport workers were being reached with anti-AIDS programs on that corridor.

"There's lots of research and data on transport but no response," said Manitoba's Chester Morris, the lead researcher on that study. Of 3,000 sex workers at truck stops between Kampala and the Kenyan border, for example, he found that fewer than 1 per cent were being reached by AIDS intervention.

Mr. Ali said that condoms were never available, ever, in all his years on the road. Nor was there any education about AIDS. But the culture of transactional sex flourished everywhere. It wasn't considered immoral for the truckers (almost all of whom are married) to be buying sex, but rather strange and suspicious if they didn't. Men need sex, and variety is important -- that's the operating principle, he said.

Mr. Ali didn't have a chance to learn more about AIDS until November, 2003, when the truck drivers' association opened up a small outreach centre in an old shipping container parked at a truck stop outside Nairobi. He was one of the first to go for an HIV test from the public-health nurse who worked there a few days a week, intending, he said, only to set a good example.

"It was a very big shock," he said about his positive test. "But I took it very easily because I'm a truck driver and I could die any time."

And indeed, a few days spent on the road with Mr. Ali makes clear that his life is exceedingly hard. The highways across Kenya -- a vital economic link for the continent -- are so bad that the shuddering of the truck cab causes his teeth to clack together sometimes when he tries to talk.

And so, said Mr. Ali, many others look for a little company when they come off the road.

"Many truck drivers end up having HIV/AIDS because they have so many problems -- the conditions of the roads, police corruption, low wages. When you have all these problems they affect the driver psychologically, so he finds a place to have entertainment and get relief."

The transactions at the truck stops are quick and almost unspoken. Women walk between the newly arrived rigs, and when one catches the eye of a driver, he tells her where he will meet her, once he's attended to the truck.

They might have some beer, or sometimes she simply climbs up into the cab. Finances first -- he hands over 150 shillings, just over $2 -- and then sex. For an extra fee, they may spend the night together in one of the small hotels.

"There's not much conversation -- these are prostitutes, they don't need much conversation," Mr. Ali said, about the negotiations. But there is plenty of chat and laughter over beer, the best antidote to the misery of the road.

He liked Ugandan assignments best: "Uganda has the best women, they are very welcoming, very kind," Mr. Ali recalled of his days as a consumer. "Very entertaining. And a good body: middle size, not fat but with a big backside and a small waist -- and not very big boobs -- that's what Ugandan women are all about."

Truckers are what's called a disease vector -- an entry point into the general population -- because they not only frequent sex workers routinely, they also have wives or long-term partners at home, to whom they regularly return, and who often pass the virus to their children at birth.

The lake where locals say it's easier to catch HIV than fish