Globally, HIV is one of the most serious burdens of disease that contributed to 36.7 million HIV patients worldwide during the year 2015. The majority of people with HIV belong to low and middle income countries. In countries like India, people with HIV or HIV risk do not have proper access to healthcare services encompassing prevention, treatment and care. In addition, there is high risk of HIV among the Indian population.
Although there is a high level of HIV risk in sexual behaviour in India, there is little research on the determinants of HIV among the truck drivers in India. They are not aware of the possible causes of HIV transmission among the truck drivers in India. According to World Health Organization (WHO) the HIV transmission pattern is shifting from the metropolitan cities to the general population (Pandey et al. 2012). According to Centres for Disease Control and Prevention (CDC) India is the site of high priority for the prevention and explosion of the infections among the truck drivers in India (Ghate et al. 2011). The transmission and prevalence of HIV varies according to the geographic location of India and the long-distance truck drivers are involved in unprotected sexual activities that increase the risk for HIV transmission among them. This high risk of sexual behaviour among these truck drivers also put the general population at risk. There has been limited research that helps to understand the dynamics of HIV transmission among the Indian truck drivers. Moreover, it is also important to understand the determinants of the HIV among them that would be helpful in preventing and in reducing the HIV transmission among the truck drivers in India. This issue is important to study as it is a vital segment that experience decimation of reproductive health and lives of the truck driver population in India.
Aim of the Research
The aim of the research is to study the determinants of health and conduct a literature review that deals with the understanding of the determinants of HIV among the Indian truck drivers that would help to reduce and prevent the HIV transmission among the Indian truck driver population and into the general population.
HIV in Indian Truck Drivers
The determinants of HIV are remarkably seen among the Indian truck drivers where the long-distance drivers get involved in risky sexual activities with the sex workers or the migrant workers. it spread to the general populations through sexual contact or because of the steady sexual partners from these primary populations. This kind of transmission to the general population is a matter of seroprevalence in India (Pandey et al. 2011). In a survey conducted in Pune, India, it was witnessed that the married monogamous women who attended the clinic showed 13.6% of HIV positive (Pandey et al. 2012). The risk of this HIV infection has seen to spread to the occupation like the truck drivers or cleaners due to the sexual contact with the commercial sex workers (CSW). It has significantly spread and as many truck drivers’ sexual contact occurs with the CSWs, the HIV risk factors are intertwined in an intricate manner. The wives of these truck drivers are tested HIV positive indicating that they have inherited from their husbands and transmission from these high-risk groups is now spreading to the general population.
Risk Behaviour Among the Indian Truck Drivers
The truck drivers in India show risky sexual behaviours with the CSWs and similarities with the truck drivers of the other countries like Thailand and some parts of Africa. The Thailand and African drivers are less likely to use condoms and the best predictor is the type of relationship that determines the condom use. These truck drivers use condoms with the CSWs and vey less with their partners or wives that is perceived to be steady. However, among the truck drivers in India, there is a high rate of sexual contact with the CSWs along the highway rather than with their partners with less condom use. This shows that they perform unprotected sex with the CSWs with a low rate of condom use that indicates a high prevalence and transmission of HIV among the truck drivers In India. According to a study conducted by Mishra et al. (2012) among the 302 truck drivers in India, 82% of them admitted the CSWs along the highway and only 28% of them regularly used condoms. Another study conducted by Schneider et al. (2012) showed that among the 6000 Indian truck drivers, 87% of them had sex with CSWs and out of them, only 11% used condoms.
In an interview conducted by Sgaier et al. (2013) among the Southeastern Indian truck drivers showed that they have scant information regarding the HIV infection transmission or prevention. 300 Indian truck drivers who stayed for a half-day to three days were interviewed who performed the activities of loading and unloading from almost all the parts of India. The results also showed that the Indian truck drivers are one of the major vectors in the HIV transmission and shift to the general population. Similar study conducted by Sastry (2016) illustrated that the is lack of motivation in the Indian truck drivers to use condoms with partners or wives as they displayed negative attitudes towards using condoms, although they perform sex with the CSWs more than their partners. The results did not favour the use of condoms among the Indian truck drivers with their wives.
Determinants of HIV
The determinants of HIV are mostly determined by the behaviour that results in the transmission of HIV related to sexual behaviour. The sexual behaviour among the truck driver populations has been associated with the HIV transmission in India. In a cross-sectional study conducted by Singh and Joshi (2012) among the long distance truck drivers driving on the national highway in Bhopal, India showed that 49% of them had CSW exposure and prevalence of HIV was found in 21.51 %. They did not use condoms while exposed with CSWs and found careless. The incidence of HIV is seen at the sites of loading and unloading of the trucks where they stop for documentation inspection spending a considerable amount of time.
From a psychological aspect, the truck drivers are far away from their families due to their itinerant nature of the occupation that tend them to get exposed to CSWs. Moreover, the India’s trucking population is very disorganized and unstructured that have a loose structure comprising of users, intermediates and truck operators. In addition, India has a large trucking population with strength of 5-6 million classified into long-distance drivers. It has also been found that the long distance truck drivers in India have a substantial amount of exposure with the female sex workers (FSWs) in the major highway routes in India (Tan et al. 2012).
Another determinant is the lack of awareness and knowledge about the HIV infection and transmission. A study conducted by (Weine and Kashuba (2012) showed that out of 302 truck drivers were found to be affected by HIV infection. They play a vital role in the transmission of HIV in rural India. Apart from risk sexual behaviour, many of the Indian truck drivers are potential blood donors and that also acts as a potential cause for the transmission of the HIV infection. They are unaware of the HIV and the modes of transmission and spread. They do not have high levels of knowledge regarding HIV and are found careless in adopting the preventative measures. The truck drivers with greater income and long duration of stay away from home is long are more likely to get exposed to CSWs and have multiple partners. In addition, married truck drivers depicted risk sexual behaviour with less use of condoms as compared to the unmarried truck drivers (Saggurti et al. 2012).
The determinant of HIV spread is also witnessed at the roadside stops like the dhabas (road side hotels) where the truck drivers stop and have high exposure to CSWs. They stay there for eating and lodging and highly get exposed to CSWs. The mean age of the truck drivers were found to be between 18-40 years. Moreover, the health seeking behaviour is not appropriate among the truck drivers as they tend to seek the healthcare facilities after the progression of the disease or else prefer to get treatment from the unqualified practitioners or home remedies as they are more accessible. In a study conducted by Mitra and Sarkar (2011) showed that there is high level of lack of HIV risk perception among the truck drivers and significantly low or their partners of wives. This makes the truck driver population one of the major vectors in the HIV transmission in India. The availability of condoms is also less among the high risk population like the truck drivers and the dhabas are the main centres for the exposure to CSWs causing HIV transmission. Moreover, there is less access to the healthcare services that also acts as a potential cause for the spread of HIV among them.
Demographic Variables that Influences HIV Risk Behaviour
In a series of studies, it was consistently found that the more educated, younger, no-Hindu of the middle to upper caste Indian truck drivers are found to be more apt in using condoms. Moreover, the married truck drivers are found to be using fewer condoms with the non-marital partners like CSWs rather than the unmarried men among the Indian truck drivers. Caste distinction also showed regrettable results where 52% of them were of the middle caste; more than 40% of the truck drivers were of the lower caste and 7% of them were only of high caste. This shows that caste also acts as a barrier in the transmission and prevention of HIV infection (Thomas et al. 2012).
The databases used for the literature review are PubMed Central, Cochrane Library, Google Scholar, CINAHL and Cochrane library. These databases were used as they provide the appropriate information with entire coverage of literature for the students, professionals, researchers and educators. The key words or search items include HIV, determinants, India, truck drivers, risk behaviour, HIV transmission and infection. The timeframe of the search was 2011 onwards as there was limited information available from 2013 onwards. The articles and data were analysed on the basis of the themes that the research papers contain mainly focusing on the risk behaviour and determinants of the HIV infection among the Indian truck drivers. The papers of the year 2010 and below were excluded along with the papers that deviate from the main theme of determinants of HIV among the Indian truck drivers. There was no grey literature used in the research.
The above literature review shows that there were certain themes that helped in the analysis of the data focusing on 14 research articles focusing on the HIV determinants among the truck drivers in India. There are themes that explain the HIV determinants among the truck drivers are the risk behaviours, time away from home, income, urban and rural residence, condoms use, and place of HIV exposure were found to be the strongest themes that correlates and associated with the spread and transmission of HIV among the trucking population in India. The consistent predictors of the research were the risk behaviours and use of condom along with lack of knowledge and awareness for HIV among the Indian truck drivers.
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Mishra, R.M., Dube, M., Saggurti, N., Pandey, A., Mahapatra, B. and Ramesh, S., 2012. The association between adolescent entry into the trucking industry and risk of HIV among long-distance truck drivers in India. HIV/AIDS (Auckland, NZ), 4, p.141.
Mitra, A. and Sarkar, D., 2011. Gender inequality and the spread of HIV-AIDS in India. International Journal of Social Economics, 38(6), pp.557-572.
Pandey, A., Mishra, R.M., Sahu, D., Benara, S.K., Biswas, M., Sengupta, U., Mainkar, M.K. and Adhikary, R., 2012. Heterosexual risk behaviour among long distance truck drivers in India: Role of marital status. Indian Journal of Medical Research, 136(7), p.44.
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Saggurti, N., Nair, S., Malviya, A., Decker, M.R., Silverman, J.G. and Raj, A., 2012. Male migration/mobility and HIV among married couples: cross-sectional analysis of nationally representative data from India. AIDS and Behavior, 16(6), pp.1649-1658.
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