1. SEXUALLY TRANSMITTED
INFECTIONS AMONG LONG-
DISTANCE TRUCK DRIVERS IN
INDIA: A SOCIAL PERSPECTIVE
Prepared and presented by:
Ety Rani Nag PG11-27-13-033
Shafayet Ullah PG11-27-13-034
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2. Global Health Council (2002) 'Truckers carry
dangerous cargo', May 1
"There is no entertainment. It is day-in-day-out
driving... When they stop, they drink, dine and
have sex with women. Then they transfer HIV
from urban to rural settings".
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3. Methodology
 This presentation was constructed from
material collected from journals and websites
of donor agencies.
 Google search
 Medscape Education
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4. What is STI?
 Sexually transmitted infections/diseases are a
group of communicable diseases transmitted
predominantly by sexual contact. ( Singh,
2008)
 Four most significant modes of STI
transmission:
 Sex with CSW
 Sex with other women
 Homosexual contact
 Heterosexual contact.
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5. Most common STI‟s
 Ulcerative: Herpes, syphilis
 Discharge syndrome: gonorrhea, Chlamydia,
trichomonas
 Other: Hep B virus, Human papilloma virus
(HPV), Human Immunodeficiency virus (HIV)
Medscape Education ( Slides by Jane Schwebke, MD) as of
09/04/2013
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6. Epidemiology
 1996, the WHO estimated that more than 1 million
people were being infected daily.
*About 60% of these infections occur in young people
<25 years of age, and of these 30% are <20 years.
Between the ages of 14 and 19, STIs occur more
frequently in girls than boys by a ratio of nearly 2:1.
 Estimated 340 million new cases of syphilis, gonorrhea,
chlamydia and trichomoniasis occurred throughout the
world in 1999.
**2011: 448 million new infections of curable sexually
transmitted (syphilis, gonorrhea, chlamydia and
trichomoniasis) infections
*http://www.avert.org/std-statistics.htm
** http://www.who.int/mediacentre/factsheets/fs110/en/index.html
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7. Age-standardised disability-adjusted life year (DALY) rates
from STDs excluding HIV by country (per 100,000
inhabitants).
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8. Global burden of STI‟s
 Approximately 340 million new cases of
curable STI‟s occur every year.
 Prevalence highest in the developing world.
 Nearly as common as malaria.
 Ranks in the top 5 diseases for which adults in
developing countries.
 For women aged 15-44 years old, morbidity
and mortality associated with STI‟s, excluding
HIV second to maternal causes.
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9. Complication‟s associated with
STI
 Direct and indirect costs of treatment
 Preterm birth/ low birth weight- Gonorrhea,
Chlamydia
 Congenital defects- Syphilis
 Reproductive health: Ectopic pregnancy, pelvic
inflammatory disease, infertility (Gonorrhea,
Chlamydia)
 Increased risk of HIV acquisition- Ulcerative,
discharge syndromes
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10. Global control of sexually
transmitted infections
 Neglected as a public health priority and
efforts continue to fail.
 STD‟s cause substantial diseases, death and
misery but not enough for societies to
overcome the stigma that prevent investment
in effective control measures.
Lancet: Low et al. Global control of sexually transmitted
infections, October 2006
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11. Introduction: India‟s trucking
industry
 India‟s trucking population estimated at 5-6 million
truckers and helpers.
 Approximately 3.5 million identified as long-distance
truckers. ( World Bank, 2008)
 Largely unorganized.
 Private domain.
 Loose system of truck operators, intermediaries and
users.
 Predominance of middlemen and small operators:
undermined the visibility to transport planners and
policy-makers.
Pandey et. Al (2008) AIDS, 22 (suppl 5): S81-S90
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12. Socio-demographics
 High proportion (44-51%) aged between 25 and 34r years
 In the northwest region median age 28 years and southeast 33
yrs.
 More than 4/5th able to read and write.
 Approximately three quarters married.
Risk-behavior :
 Median age of sexual debut- 19 yrs ( 18 yrs in NE and NW
region)
 In a 2008 study, 31% reported having paid partners in past 12
months.
 Highest in SE route (44%) and lowest on NE route (25%)
 17% on the NE route reported never using condoms.
 2.1% truckers reported having male/hijra sexual partners in past
12 months.
 99.2% reported having sex with their wives in past 12 months (
Only 3% condom use)
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13. Factors affecting Vulnerability:
From a truckers viewpoint
 Truckers are of an age to be sexually active.
 Separation from regular partners for extended time
period.
 Poor road conditions, long work hours.
 Urgency to reach a destination within a given time
causes stress.
 Absence of entertainment.
 Consumption of alcohol.
 Truckers carry significant cash—Attractive customers
to the sex industry.
 Senior truckers use younger assistants for sex.
 Power dynamics: Cleaner or younger trucker is largely
helpless, ignorance about risks means transmission.
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14. Factors affecting Vulnerability: The
Environment
 Highly active and easily accessible sex
networks.
 Limited sexual health services available on
highways.
 Treatment for STI or condom collection
generally available at final destination.
http://www.ilo.org/wcmsp5/groups/public/edprotect/pro
trav/iloaids/documents/legaldocument/wcms_11732
0.pdf
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15. Behavioral Factors
 Truck-drivers and their helpers spend long time on high-ways.
 Away from home for long periods.
 Meeting points: Trucks, bus terminals, rest stops, dhabas /roadside
eateries
(World Bank, 2008)
 Long distance lorry drivers pick up CSW from dhabas; use them and
drop them at other dhabas where they are used by other drivers and
local youths.
 Typical claim: usually 3 partners in the previous week.
 In a year: non-regular partners can range from 50-100
( Charles et al, 2012)
 Low knowledge of STI/ HIV
 High reported cases of STI
 Low or inconsistent condom use
 Engagement in illicit drug use
** Married truckers have more favorable attitudes: Discuss and use
condoms with non-married partners to protect themselves and their
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16. Social factors
 “My husband is a truck driver and I got HIV through him. I had
never heard of HIV or condoms before that and because I can't
read, I couldn't understand any of the posters or banners.”
BBC.co.uk news (September 2005), 'Indian women face peril of HIV'
 Marital relationship
 Safe marital sex
 Poor marital communication about sexuality and sexual risk
 Limited capacity for a wife to refuse a husband‟s demand for sex
 Spousal infidelity
 Limited use of condom in marital sex as protection against
disease transmission
** Condom use with wife or intimate partner- Strong sense of
infidelity so both partners disinterested to use condom. (Pandey
2012)
 Cultural constructions of gender
 Limited social support
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17. Environmental factors
 High mobility, anonymity, easy availability of
women
 Lack of exposure to interventions
 Low fear of acquiring infections
 Inadequate time spent with families
 House-hold situation such as joint family or having
grown up children
 Relations with sex workers occur at roadside
„dhabas‟, which act as both brothels and hotels for
truck drivers.
Charles et al (2012), Journal of AIDS and HIV
Research Vol 4(8), pp 203-212
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18. Conclusion
 Due to less social support and lower satisfaction in
sexual activity: Higher risk taking behavior among
truckers.
 Prevention programs need to focus more on
unmarried truckers.
 Positive behavior changes.
 Availability of condoms in high-risk settings.
 Awareness of truckers of acquiring STI/HIV.
 Low percentage of truck drivers with comprehensive
knowledge: Area of concern.
 Future research: **Among married truck drivers-
Sexual culture and risk behavior among their wives.
(Pandey et al, 2012)
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19. References
 http://www.who.int/healthinfo/global_burden_disease/gbddeathdalyco
untryestimates2004.xls
 Medscape Education ( Slides by Jane Schwebke, MD) as of
09/04/2013
 Lancet: Low et al. Global control of sexually transmitted infections,
October 2006
 http://www.avert.org/hiv-india.htm ( as of 09/04/2013)
 http://www.ilo.org/wcmsp5/groups/public/ed
protect/protrav/iloaids/documents/legaldocument/wcms_117320.pdf
 Global Health Council (2002) 'Truckers carry dangerous cargo', May 1
 Pandey et. al (2008) Risk behavior, sexually transmitted infections
and HIV among long distance truck drivers: a cross-sectional survey
along national highways in India AIDS, 22 (suppl 5): S81-S90
 Charles et al (2012) Trends in knowledge, risk behavior, STI
symptoms and associated factors among truckers in South India over
a 12 year span. Journal of AIDS and HIV Research Vol 4(8), pp. 203-
212
 Pandey et al (2012) Heterosexual risk behavior among long distance
truck drivers in India: Role of marital status. Indian J Med Res 136
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20. Thank You
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