Addressing the HIV Prevention, Testing, and Treatment Needs of Mobile Populations: Focus on Truckers in Brazil

This 6-page resource explores communication strategies for increasing uptake of HIV testing by truck drivers in Brazil. As detailed here, in recognition of the fact that highly mobile populations who spend much of their time on the road are more likely to engage in sexual risk behaviours and yet are often challenging to reach with traditional voluntary counseling and testing (VCT) services, the Horizons Program at Population Council carried out a research-based, communication-centred intervention in Foz do Iguaçu, a town on the triple border between Brazil, Argentina, and Paraguay. This research update summarises the formative research, the implementation of (and strategies informing) the intervention, and preliminary results.

Interpersonal, face-to-face interactions were central to the initiative, with some use of printed materials and information and communication technologies (ICTs) for educational purposes. Specifically, the study began with focus group discussions (FGDs) and in-depth interviews with truckers, sex workers, and customs officials to learn more about HIV risk among truckers. Based on the findings of this research - and with support from the United States Agency for International Development (USAID) Mission in Brazil and the Municipal Secretariat of Health of Foz do Iguaçu - Horizons developed a multi-faceted intervention. During an 18-month period (September 2003 to March 2005), 2 educators gave materials to truckers waiting to complete administrative procedures to cross the border and invited them to the mobile trailer to receive health services, which included condom promotion and free distribution, access to HIV and sexually transmitted infection (STI) counseling and testing, and syndromic management of STIs - but which also included preventive health services such as blood pressure and diabetes screening. In the last 6 months of the intervention period a computerised educational programme that provided information on nutrition, alcohol and drugs, and HIV/STIs was available for use by truckers in the trailer.

The intervention was evaluated by comparing cross-sectional data collected from truckers passing through the customs station in Foz do Iguaçu with truckers crossing a comparison border town (Uruguaiana) before and after the intervention. Interviews were also held with truckers and sex workers; truckers who came to the trailer for HIV and syphilis testing and counseling also completed a questionnaire on the quality of services received. Here is a summary of key findings:

• The intervention was successful in reaching a substantial proportion of truckers: about half of the truckers who gave follow-up interviews in the intervention site had participated in the intervention. A third reported visiting the trailer and accessing VCT, and an additional 22% participated in educational activities or received educational materials or condoms. Service statistics also indicated that the intervention reached thousands of truckers with educational activities, materials, and condoms.
• At baseline, less than half of respondents in both sites had ever had an HIV test. At follow-up, ever having an HIV test increased by 49% in the intervention site but only by 15% in the comparison site. In addition, 105 men and women who worked at the custom station in Foz do Iguaçu went to the trailer for VCT.
• During the intervention period, 1,944 truckers received pre-test counseling for HIV and syphilis and 1,795 gave a blood sample. Of these, 1,492 truckers (83%) returned 15 days later for test results and post-test counseling.
• Truckers were highly receptive to the intervention; FGDs revealed that truckers strongly recommended the services to their peers because there were no long waits, services were clean, the staff was attentive and nonjudgmental, and condoms and other medications were available free of charge. Almost all survey respondents (99%) rated the services as "great" or "good", citing the easy access to services (29%), the utility of the educational messages (23%), the fact that the services were not only for HIV/STIs but also for other common diseases (19%), and the fact that they were free (8%).

In conclusion, the authors endorse the strategic placing of services to reach truckers and other mobile populations. They emphasise that the strategy of offering a range of basic health services in addition to VCT and HIV/STI prevention was found to encourage participation among truckers. Further, high-quality, confidential care - offered by attentive staff free of stigmatising attitudes - was found to be essential. The authors also stress that, to sustain activities and to enhance the project's credibility, partnerships with both private and public local institutions are critical.