On the road again: concurrency and condom use among Uganda truck drivers

Condom, modern contraceptive, and dual method use are associated with HIV status and relationship concurrency in a context of high mobility: A cross-sectional study of women of reproductive age in rural Kenya and Uganda, 2016

OBJECTIVES

Mobility (international/internal migration, and localized mobility) is a key driver of the HIV epidemic. While mobility is associated with higher-risk sexual behavior in women, a possible association with condom, modern contraceptive, and dual method use among women living with HIV (WLHIV), is unknown. In addition, HIV status and sexual behaviors such as relationship concurrency may also affect condom, modern contraceptive, and dual method use.

STUDY DESIGN

We surveyed sexually active women (N = 1067) aged 15 to 49 in 12 communities in Kenya and Uganda participating in a test-and-treat trial in 2015 to 2016. Generalized (unordered) multinomial logistic regression models accounting for community clustering examined associations between mobility (overnight travel away from home in past 6 months and any migration within past 2 years) and condom, modern contraceptive (i.e., oral contraceptive pills, injectables, intrauterine devices, implants, vasectomy, tubal ligation; excluding male/female condoms), and dual method use within past 6 months, adjusting for key covariates such as HIV status and relationship concurrency.

RESULTS

WLHIV relative to HIV-negative women (ratios of relative risk [RRR] = 3.76, 95% confidence interval [CI]: 2.40-5.89), and women in concurrent relative to monogamous relationships (RRR = 4.03, 95% CI 1.9-8.50) had higher odds of condom use alone. In contraceptive use models, WLHIV relative to HIV-negative women were less likely to use modern contraceptive methods alone (RRR = 0.51, 95% CI 0.36-0.73). Relationship concurrency (RRR = 4.51, 95% CI 2.10-9.67) and HIV status (RRR = 3.97, 95% CI 2.43-6.50) were associated with higher odds of dual method use while mobility was marginally associated with higher odds of dual method use (RRR = 1.65, 95% CI 0.99-2.77, p = 0.057).

CONCLUSIONS

Mobility had a potential impact on dual method use in Kenya and Uganda. In addition, our findings highlight that WLHIV were using condoms and dual methods more, but modern contraceptives less, than HIV-negative women. Those in concurrent relationships were also more likely to use condoms or dual methods. These findings suggest that in a context of high mobility, women may be appropriately assessing risks and taking measures to protect themselves and their partners from unintended pregnancies and acquisition and transmission of HIV.

IMPLICATIONS

Our findings point to a need to strengthen accessibility of sexual and reproductive health services for both mobile and residentially stable women in settings of high mobility and high HIV prevalence.

Depression and sexual risk behavior among long-distance truck drivers at roadside wellness clinics in Kenya

Background

Truck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior.

Methods

We used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months.

Results

The mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners.

Conclusions

The high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.

Sexual health knowledge and practices and STI/HIV prevalence among long-distance truck drivers in Peru

Objectives

HIV and other sexually transmitted infections remain a challenge globally and many key groups have yet to be studied. Evidence shows that truck drivers may have high-risk behaviors and higher sexually transmitted infection/HIV prevalence because they are a highly mobile population. However, there is little to no information on this group in Peru. Therefore, we explored the sexual health knowledge and practices and carried out sexually transmitted infection/HIV testing among male truck drivers and their assistants in Peru.

Methods

We conducted a cross-sectional study utilizing cell phone-based behavioral surveys and sexually transmitted infection testing, including HIV, syphilis, gonorrhea, and chlamydia, with truck drivers and their assistants who were traveling on two major international highways in Peru.

Results

A total of 1150 truck drivers and assistants participated. Participants were middle-aged men (average age = 39.8 years), 96.0% had complete secondary education, 78.4% were in stable relationships, and 88.7% earned more than minimum wage. The majority were aware of sexually transmitted infections/HIV, but very few recognized sexually transmitted infection symptoms. Few participants (under 5%) reported recent sexually transmitted infection symptoms. Prevalence of sexually transmitted infections was also low: no one had gonorrhea; 0.1% had HIV; 0.4% had recent syphilis infection (rapid plasma reagin ≥1:8); and 2.0% had chlamydia. The prevalence of these diseases is not different from that of the general population in Peru.

Conclusion

When compared to other truck drivers worldwide, Peruvian truck drivers appear to have a lower risk of HIV/sexually transmitted infections. This may be since Peruvian drivers are older, more educated, have higher income, and spend fewer days away from home than their peers globally.