HIV and the Highway
by Duff McCutcheon
As India joins its massive Asian neighbor, China, in the race to dominate the world’s economy over the next century, the country has been spending billions modernizing its national highway system to keep pace with the growth.
The federal Golden Quadrilateral highway project consists of 5,846 kilometers of four six-lane expressways connecting Delhi in the north, Mumbai to the west, Chennai in the south and Kolkata in the east. The newly upgraded highway system will promote commerce in India by allowing more traffic and freight to be moved across the country than ever before – propelling India into one of this century’s more vibrant economies.
Unfortunately, it’s not just freight that’s moving faster along the new highway system. There’s tremendous concern that the spread of HIV, the virus that causes AIDS, will be advanced by the new highways, helped along by the thousands of roadside brothels and the migratory clients – including truckers – that frequent them.
The new highway’s role in spreading the disease is an unwelcome consequence in a country that now rivals South Africa as the country with the highest incidence of HIV/AIDS in the world. Over five million people live with the virus in India, but in a nation with over one billion people, that figure is diluted by sheer numbers – the national prevalence is about 0.9% of the population.
Unlike the West, where HIV has largely affected specific groups like “men who have sex with men” and intravenous drug users, HIV in India is mostly spread by prostitutes, their clients – and a lack of condom use. Along the highways, prostitutes set up shop near the truck stops in hopes of luring in one of the country’s seven million truck drivers. The public, seeing prostitutes at the truck stops, has begun to associate truckers with the spread of the disease.
Is it fair? Hardly – it’s not like truckers are the sole clients of India’s prostitutes. And it’s doubtful that all truckers are flocking to brothels. But the stigma against drivers in some parts of the country is such that fathers won’t allow their daughters to marry truckers, according to a recent New York Times article highlighting this issue.
There For The Asking
Truckers in this part of the world find respite not at the likes of our North American Travel Palaces, but at simple roadside tea houses where a tired driver can pull over for a cup of tea, some hot food, a cot to lie down on for a few hours – and sex if he wants it.
Like the tell-tale red lights in European sex districts, Indian truck stop prostitutes advertise their availability by hanging white sheets or saris on trees near the truckstops, or shining flash lights at oncoming truck traffic.
“It’s not obvious if you don’t know what you’re looking for, but you find these little apa dabas – little roadside tea shops and food stalls that cater to trucks,” says Dr. Jaya Shreedhar, a doctor and journalist in Chennai – India’s fourth largest city, located on the Bay of Bengal – who has written about HIV/AIDS in the trucking community. “Here you’ll find 10-15 trucks parked late at night with someone making chapattis (bread) and hot food for the truckers. You’ll have little cots with dinky little fans running for them to rest.”
And off in the darkness not far away is a collection of discrete shacks where the women are. “The truckers have a little alcohol, eat some food, sleep for a bit, and then maybe use these women,” she notes.
And sometimes they walk away with more than they bargained for. If they’re lucky they might escape with a dose of the clap; if they’re not, they unwittingly get back in their trucks carrying HIV, which, like the drivers, continues its journey, throughout the country – and all too often, back to the drivers’ wives. “The truck stops and the women have always been there, but it escaped public notice until HIV/AIDS hit,” says Dr. Shreedhar.
Truckers, of course, aren’t somehow more naturally receptive to contracting HIV, but their relative youth, the fact that it’s an almost exclusively male occupation in India, and the fact that they’re very mobile, have made them targets for outreach and education programs by AIDS prevention groups working in India.
“Thanks to behavior surveys that have been conducted, it became clear that sexually active young men who are away from their families and on the roads for long periods of time with other males for company are more prone to risky behaviors,” says Shreedhar. “The culture [among these drivers] is that they stop now and then along the highway and they believe their bodies get heated up, and the way to cool it down is to have sex.
“It’s similar to the migrant male population. For example, when construction workers move to another region for work for a few months, there’s often a little floating community of sex workers that set up nearby to cater to them. They are away from their families, the supervision of elders or community leaders, they have money, they’re bored and have nothing to relieve the stress of work. They drink and the sex just happens.”
Truckers’ Role “Overblown”
Dr. Stephen Moses is a University of Manitoba physician who heads up a team from his school that’s been involved in HIV prevention programs in two states – Rajasthan and Karnataka – for the last five years. “We’ve been primarily focused on scaling up prevention programs and services to high risk groups, particularly prostitutes and their clients,” he says. While he admits truckers are in a higher risk category for contracting HIV/AIDS, he feels recent reports in newspapers like the New York Times about truckers’ role in spreading the disease is “overblown.”
“I don’t think their role in the epidemic is as great as some people think,” he says. “Even though there are large numbers of truckers, compared to the population of India it’s not that large. And not all truckers engage in high-risk behaviors.”
He also argues that while the epidemic is largely centered in India’s southern states, truckers obviously traverse the entire length of the country’s highways – “so if truckers were the main reason for the spread of HIV then we wouldn’t expect that kind of pattern.”
And Dr. Shreedhar admits that evidence of truckers’ role in spreading the disease is largely anecdotal. “You would have to do a molecular epidemiology study to track the virus and see if it’s the same strain being spread around, and nothing like that has been done to date,” she says. “It’s just naturally understood that truckers act as vectors for this disease. The evidence we see is the concentrations of the disease in trucker communities.”
The real innocents of India’s HIV/AIDS epidemic can be found in, among other places, “trucker communities” like Namatjel in Tamil Nadu – towns and villages that have essentially sprung up as mini economies that service the trucking industry. Namatjel and other trucker communities “are places where there are several trucking companies and the village is essentially made up of truckers, mechanics, etc, and their families. The economic pulse of the place is trucking,” says Dr. Shreedhar.
The communities are also home to growing numbers of HIV widows and their families – the wives of truckers who became infected on the road, only to come home to sicken and die – but not before passing the disease along. In Namatjel, like other villages in Tamil Nadu, health care workers are witnessing a third generation epidemic where children are born carrying the virus. Fortunately, the state has established a very successful parent to child intervention program to slow down transmission between mother and child.
The Good News
Despite the fact that there are more than five million people in India infected with HIV/AIDS – with 75 percent of those infections found in the southern states – there is still good news coming out of India. A joint study by researchers from the University of Toronto and the Postgraduate Institute of Medical Education and Research in Chandigarh, India has found that there has been a one-third decline in new HIV infections in the worst hit southern states.
The study, published recently in the UK medical journal – The Lancet – tracked HIV prevalence among young women presenting at prenatal clinics. Researchers often look at HIV trends at pregnancy clinics as a proxy to monitor infection in the general population. The researchers say the big declines are likely due to men using prostitutes less often or using condoms more often when they do, meaning education outreach programs are paying off.
This is extremely good news for India, a teeming country straddling the divide between the Third World and a rapidly modernizing economy that in all likelihood will become one of the world’s largest in the coming decades. Truckers, of course, will play a big role in all this growth so it’s great to see efforts being made to keep them healthy for the job ahead.