Truck drivers-at increased risk of HIV infection amongst STD clinic attendees

To the Editor

Among women, the profession of commercial sex confers an extraordinarily high risk of acquisition of human immunodeficiency virus (HIV) whereas in men, one male occupation that appears to be associated with increased risk of HIV infection is long distance truck driving, a profession that requires prolonged absence from home and family.[1] In order to establish the above fact, we analyzed our data of STD cases in our STD clinic (a referral center in South India) From January 1998 to December 2000 (of 3 years) and particularly looked for relationship if any of HIV seropositivity with occupation of the patient.

A total of 546 patients of different occupations were screened for HIV antibodies by double ELISA method during the 3 years period. Overall HIV seropositivity amongst STD clinic attendees was found to be 22.71%. HIV seropositivity rates in different occupations recorded were 56.86% (29/51) in drivers, 32.81% (21/64) in house wives, 25% (2/8) in commercial sex workers (CSW′s), 20.47% (43/ 210) in labours, 13.33% (8/60) in sales men and business men, 13.15% (5/38) in students, 8.33% (2/24) in executive officers, and 15.38% (14/91) in other miscellaneous occupations. Male to female ratio of our cases was 3.6:1 (males-428, females-118) and their mean age was 24.75 years (range 16 to 60 years). Heterosexual route was the predominant mode of acquisition of HIV infection.

An early study of truck drivers in Uganda demonstrated an HIV seroprevalence rate of 35%.[2] In East Africa, 27% of truck drivers and their assistants were found to have HIV antibodies.[1] Three quarters of these men in truck drivers and their assistants in profession had a history of sex with prostitutes, and the median frequency of prostitute visits was one time per month. A study of Thai long haul truck drivers found that 86% of the single men and 63% of the married men had commercial sex.[3] In India, long distance lorry drivers during their journey pick up sex workers from "dhabas" (which usually provide food, rest, alcohol, and drugs) on road side, use them and leave them at some other dhaba where they are used by other drivers and local youths.[4] In a study from India, 87% of long distance lorry drivers were found to be sexually promiscuous, of whom only 11% used condoms during commercial sex. In the 21-30 age group (n= 1766), 78% of unmarried sexually promiscuous, men (331/425) reported having 31-60 sexual partners during the past 12 months.[5] Indian distance lorry drivers have an HIV infection rate of 10/1000 far higher than the Indian national average of about 0.5/1000.[4]

In our study, we found that a high proportion of HIV positive patients amongst STD clinic attendees were truck drivers, who generally acquired infection from commercial sex workers (CSW′s) on the highways. Even though, labourers outnumbered others in the list (210/546), only 20.47% (43) labourers were found to be HIV seropositive. But more than half of truck drivers (56.86%) were found to have HIV antibodies. Next occupation with higher proportion of HIV seropositivity was that of house wives (32.81 % HIV seropositive). Seven of these were wives of truck drivers. Amongst the fifty-one truck drivers screened, 90.19% (46) had history of multiple sex partners and 64.7% (33) gave history of having had unprotected sex with CSW′s. Similarly, previous studies have documented high prevalence of HIV and STD′s among truck drivers.[1],[2],[3],[4],[5] Thus, effective strategies to change their hazardous sexual behaviour need to be launched.

The identification of high frequency transmitter core groups such as prostitutes or patients at STD clinics, which are characterized by a large number of sexual partners and a high prevalence of STD′s is important because of their critical role in sustaining STD/HIV epidemic.[1] Truck drivers may be particularly important core group in the geographic dissemination of HIV because of their mobility. With India′s population nearing one billion and an estimated four million HIV infected people (being largest number of people infected with HIV in the World),[6] this mobile population of truck drivers need to be taken seriously as it may spread the HIV infection in general population.