RESEARCH ARTICLES

Human Immunodeficiency Virus risk behavior among truck drivers

Krisna Reis Faria^I; Renata Letícia Pessoa de Ávila^II; Taciany Karine de Almeida Ferreira^III; Ering Júnior Barros Coelho^IV; Martha Elisa Ferreira de Almeida^V; Helisamara Mota Guedes^VI

^I Nurse. Graduated from Centro Universitario do Leste de Minas Gerais, Minas Gerais-Unileste. Brazil. E-mail: monografiaenf_re.krisna@yahoo.com.br
^II Nurse. Graduated from Centro Universitario do Leste de Minas Gerais, Minas Gerais Unileste. Brazil. E-mail: renata.decalazans@facebook.com
^III Nurse. Graduated from Centro Universitario do Leste de Minas Gerais, Minas Gerais Unileste. Brazil. E-mail: taciany.drumond@hotmail.com
^IV Physiotherapist. Professor at Centro Universitario do Leste de Minas Gerais. Brazil. E-mail: eringcoelho@yahoo.com.br
^V Nutritionist. PhD in Agrochemical from the Federal University of Lavras. Associate Professor, Institute of Biological Sciences and Health, Federal University of Viçosa, Campus of Rio Parnaiba. Minas Gerais. Brazil. E-mail: martha.almeida@ufv.br
^VI Nurse. PhD in Nursing from the Federal University of Minas Gerais. Associate Professor, Department of Nursing of the Federal University of Vale do Jequitinhonha and Mucuri. Diamantina, Minas Gerais, Brazil. E-mail: helisamaraguedes@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.4376

ABSTRACT

Truck drivers as a professional category can contribute to the spread of the Human Immunodeficiency Virus (HIV). This study aimed to identify risk behaviors for HIV infection among truck drivers traveling highway BR-381. A structured form was used to identify some of these professionals' risk behaviors. In 2009, 109 truck drivers were interviewed: 99.1% were male, 47.2% reported little formal education, 67.9% were married, and 32.1% sought sexual partners on the road. , and between being aware or not of the risk of contracting HIV and choosing or not choosing sexual partners. There were significant differences between the frequency distributions of condom use and marital status (p<0.001), and between being aware or not of the risk of contracting HIV and choosing or not choosing sexual partners (p<0.001). It was concluded that there is need for preventive health education measures directed exclusively to this profession, addressing the issue of the sexual transmission of HIV, and emphasizing the health risks.

Keywords: Risk behavior; condoms; health-related practice; truck drivers.

INTRODUCTION

The human immunodeficiency virus (HIV) was identified in 1980, and the disease as named Acquired Immune Deficiency Syndrome (AIDS). According to estimates of Department of STD, AIDS and Viral Hepatitis approximately 718.000 people live with HIV/AIDS in Brazil, and 265.698 died. In the year 2012, 39.185 cases of the disease were reported in Brazil¹.

Although most AIDS cases are registered in the Southeast², the epidemic is expanding in the North and Northeast regions, while it has decreased significantly in the Southeast³. The main contamination means are through unprotected sexual contact, injection drug use, transfusions, use of contaminated sharps and from mother to child during birth and breastfeeding⁴.

The search for safe sexual practice contributes to mitigate the risk of contamination of this disease, and in this context nurses can develop actions to inform the different segments of the population about the importance of prevention. Thus, the study aimed to identify risk behaviors for HIV infection among truckers driving along the BR-381.

LITERATURE REVIEW

Truck drivers are a risk behavior group for HIV infection because they present habits of searching for casual sexual partners during business trips, having their practices made, most often without the use of condoms⁵. These professionals usually have knowledge on HIV prevention, but depending on the partner, they perform sexual acts without condom use⁶.

This professional group is also exposed to the risk of contracting sexually transmitted diseases (STDs), and if infected they may transmit them to others, since they travel through several cities and/or countries, and generally do not participate in health practices activities widespread in basic Health Units ⁵.

Thus, preventive actions toward this disease must be performed, since nurses will experience with infected patients the suffering resulting from the disease, in some cases the proximity of death and the dying process in addition to the risk of contamination⁷.

METHODOLOGY

This is a cross-sectional research with a quantitative approach, performed in Torque Diesel LTDA Gas Station, located on BR-381, in Timoteo, MG. This choice was based on the presence of the following sectors: gas supply service, tire repair, car accessories shop, oil change, restaurant, snack bar, bathrooms with showers within the gas station itself, the presence of a cargo carrier which concentrated many truckers waiting for loads and ample parking for the rest of these professionals.

The sample was calculated by Diman 1.0 program corresponding to a total of 109 truckers driving along the BR-381. Inclusion criteria were: one year or more working as trucker and to being aged ≥21 years old, since the Brazilian National Traffic Code Law provides that age as necessary to qualify for driving trucks.

The study was approved by the Research Ethics Committee of the Centro Universitario do Leste de Minas Gerais - Unileste/MG, opinion no. 13.55.08, and observed Resolution No. 196/96 which regulated research involving human subjects of the National Health Council⁸.

Data collection took place in June 2009. It was applied a pretest with 10 truck drivers and made the necessary adjustments in the data collection instrument, which was conducted through a structured questionnaire to assess sociodemographic characteristics, sexual practices, knowledge about HIV/AIDS, condom use and the perceived risk of acquiring HIV and AIDS. The data collection instrument had 10 questions and its application, performed individually, lasted around 15 minutes. In all items the participants could choose more than one answer. These professionals were approached individually in a private place.

We used the analytical statistics for categorical variables. In order to verify the relationship between the study variables, we used the chi-square test using the Statistical Package for Social Sciences (SPSS) program, with significance of 5%.

RESULTS AND DISCUSSION

Study participants were 109 truck drivers, 108 (99.1%) were males and one (0.9%) was female. The minimum age was 22 years old and the maximum was 64 years old, with an average of 39.6 years old, and 19 (17.4%) of respondents were 19 to 29 years old; 36 (33%) were 30 to 39 years old; 35 (32.1%) were 40 to 49 years old; 16 (14.7%) were 50 to 59 years old and 3 (2.8%) were elderly.

The minimum occupation period was 1 year and the maximum was 45 years, with an average of 16.7 years. The minimum time away from home was zero (0) and the maximum was 40 days with an average of 8.1 days. It was observed that 25 (23.9%) of the evaluated completed elementary school, 21 (19.3%) finished high school and 2 (1.8%) had completed higher education. The low education level can directly impact on the individual's health habits^6,9,10, since this fact makes people not to make condoms use a habit in their sexual relations, thereby increasing the risk of HIV infection.

Of the respondents, 74 (67.9%) were married and 24 (22%) were single. It was reported by 63 (85.2%) of the married respondents the lack of condom use with their partners and 13 (54.2%) of single respondents were using condoms. There were significant differences regarding the distribution of condom use frequency and marital status (p <0.001), as shown in Table 1.

TABLE 1: Distribution of condom use according to marital status, casual partners, stable partners and risk of infecting. Timoteo, MG, 2009.

(*)Statistical difference at p <0.05.

In another study it was observed that 77% of those who sought sexual partners were married, and contacts took place with various partners, and 67% of single respondents also had various partners⁶.

Significant differences (p = 0.026) regarding the use of condoms and the search for sexual partner during the trips were found. Among those who mentioned having regular partners during trips, 89 (94.7%) reported not using condoms, since they knew the partners.

Survey carried out with the general population¹¹ showed increased exposure to STD/AIDS, given that sexual partners tend to stop using condoms after some length of relationship, because they begin to feel confidence in the other person.

Study performed with truck drivers found a low frequency of condom use, as only 14.6% used it routinely during sex with stable partners. Frequent use of condoms with casual partners, and its use at last sexual relation were reported by approximately 50% of truck drivers¹².

Divergent data from this study was found among truck drivers in Campinas, in which it was observed that there is an awareness of the importance of condom use in sexual practices, and among the 47 (94%) of those who reported having casual partners, only 3 (6%) never used condoms in these relationships ¹³. However, in study conducted in South Africa ¹⁴ it was observed that 66% of truck drivers already had a STD, 37% always stopped for having sexual relations along the route and 29% never used condoms in casual relationships. In study conducted in 2000 by the National Coordination of STD/AIDS of the Ministry of Health¹⁵, with truckers from all over Brazil, it was observed that 30% did not use condoms during sex with casual partners. Among the regulars of a motel it was identified that 70.8% considered remote the possibility of HIV infection, since most of their partners were stable¹¹. This study found significant differences in condom use among participants who reported having a stable and not stable partner (p <0.001).

Confidence in the stable partner (wife and lovers) contributes to the non-use of condoms. This risk behavior is present in the population as a whole, since the logistic regression analysis of a study conducted in motels revealed that the factor that most contributed to the non-use of condoms was the presence of stable partners¹⁶. In this study it was found that among stable partners there was minimal use of condoms, regardless of the type of practice and with frequent partners condom use was higher both in vaginal (56.6%) and anal intercourse (45%). With casual partners, condom use was also common both in vaginal (67%) and anal intercourse (54%). This shows that the stable partner is the most vulnerable with regard to HIV infection or any other STD ¹⁷. In study with short-route truck drivers¹⁸ it was observed that AIDS prevention was highlighted by the use of condoms in extramarital relations and by the fidelity of the wife.

In this study, both truckers using condoms as those who did not use reported risk of contracting HIV, being therefore a risk behavior group to acquire AIDS and also other STDs.

Stable partners attribute the non-use of condoms to prejudice that its use is associated with prostitution, promiscuity and extramarital relations. However, the non-use of condoms with stable partners is often considered by couples as a way of showing loyalty¹⁹. The non-use of condoms among stable partners of couples is also related to arguments such as the use of other contraceptive methods; the fact that the partner do not like to use it; prior completion of HIV tests which makes the relationship safe; in addition to the female submission in marital relations¹⁹.

The idea that there was no probability to be contaminated with HIV was reported by 36 (65.5%) of truck drivers who did not choose the partner for sexual relations. There was a significant difference between the risk of contracting HIV or the fact of not choosing sexual partners (p <0.001), as shown in Table 2.

TABLE 2: Distribution of risk of HIV infection and the choice of partner when traveling. Timoteo, MG, 2009.

(*)Statistical difference at p <0.05.

It was noted that there is a lack of theoretical knowledge of these drivers to infer that physical appearance is able to tell whether there is a risk of HIV transmission. In study conducted with truck drivers²⁰, 69% thought they were not at risk, and 40% said they were protected by having stable partners, 31% highlighted not having any risk of infection and 27% had no fear of contracting the disease. Having knowledge of the ways of HIV transmission does not ensure condom use because the prevention of contamination by this virus needs to be of interest of the individual ¹¹.

Men are highly exposed, since many have multiple partners and do not use condoms, and there is the perception that AIDS is limited to certain groups, conceiving it as a disease out of their context. Thus, preventive measures are not adopted by these individuals, who do not consider themselves a risk group²¹.

Truckers form a professional category that may contribute to the spread of HIV, because besides being continuously traveling for various regions they are at risk of contracting various STDs, since they practice sex without condom use with partners they consider friends and free of HIV virus²⁰.

Of those interviewed, only 31 (28.4%) had done an HIV test, and 39 (35.5%) demonstrated knowledge of its mode of transmission, 22 (20.1%) correctly reported ways of preventing, 28 (25.4%) reported little information and 20 (19%) highlighted that AIDS is a disease that can lead to death. Among the methods of prevention, condoms were mentioned by 89 (81.7%) of respondents. It was reported by 90 (82.6%) of participants that information on HIV were conveyed by television, as shown in Figure 1.

FIGURE 1: Percentage distribution of the media on HIV according to truckers. Timoteo, MG, 2009.

Another study showed that television was the main source of information about HIV transmission; it was observed that 50.4% of respondents never attended lectures on HIV prevention, for they are held far from their work places, making it difficult to access⁹. However, it was reported by 88 (81%) of truckers of this study the desire to participate in talks on this issue, as well as in educational campaigns of free distribution of condoms in loading and unloading terminals, and at gas stations.

Most respondents of this research had risk behavior, as they had never been screened for HIV. This finding is similar to those of another study, in which 67.1% did not know whether they had done the exam, which led the authors to conclude that they possibly did not do the test⁹. Other truckers had knowledge of STDs and AIDS, and most did not use condoms, which could contribute to the contraction of STDs²². Some cultural aspects make men more vulnerable to risky practices for STD and AIDS, by reinforcing feelings and behaviors such as feeling strong and immune to disease; being impetuous and taking risks; inability of refusing a woman; considering that man has more need for sex than women and that this desire is uncontrollable²³. Given the above, health actions are needed in the workplace.

Since this was a population group with high vulnerability to HIV infection, it has been suggested the implementation of strategic planning actions regarding the awareness of this condition, which is influenced by individual, cultural, social and economic factors, to understand the social and epidemiological dynamics of this virus infection and thus prevent contamination of other individuals^24,25.

When analyzing the knowledge on ways to prevent HIV, data evidenced the need for information for this public about the risks of infection, highlighting the educational interventions so that all of them rethink their sexual practices.

This study presented as limitation the fact that the data represents the reality of drivers of a single gas station in BR-381, which prevents its external validity. However, it points out different risk behaviors to which truckers are exposed and must be considered in the interventions of public policies.

CONCLUSION

Most truckers had low education, looked for sexual partners while traveling and did not use condom frequently with stable partners. Such risk behaviors favor exposure to HIV and STDs, as even though preventive methods were known by most of them, they were not practiced in many situations.

Preventive health actions should be carried out in their work environment through educational lectures, especially for professionals who report having little time for access to care means.

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