Migrant-Related Stressors, Psychosocial Problems and HIV Risk Behavior Among Truck Drivers in Zambia

Background and Purpose: Zambia is a particularly burdened region with 13% HIV prevalence rates among those between the ages of 15-49 (Central Statistical Office, 2014). Mobile populations, including truck drivers have been noted as a key-affected population at risk for HIV in Zambia. Truck drivers from low and middle income countries are frequently employed in 3-D jobs, (dangerous, difficult and demeaning) where they are vulnerable to hazardous working environments, exploitation, and violence (International Organization for Migration, 2013). In Western settings, the relationship between trauma, psychosocial problems and HIV sexual risk behavior has been well established (El-Bassel et al., 2009).  However, no studies have examined the co-occurring issues of trauma/stressors and HIV sexual risk behavior among Zambian truck drivers. Understanding co-occurring issues related to HIV sexual risk behavior among truck drivers is critical to reduce the spread of HIV in Zambia. This qualitative study aims to 1) determine stressors, psychosocial problems and HIV risk behaviors among truck drivers in Zambia and 2) examine the relationship between stressors and HIV risk behavior among truck drivers in Zambia. Findings will inform the development of HIV prevention intervention efforts in the region.

Methods: This study employed qualitative methods. Fifteen semi-structured interviews were conducted with male truck drivers at truck companies and truck stops in Lusaka, Zambia. Purposive sampling methods were utilized and interviews were conducted until saturation occurred. The interview guide and subsequent analysis was guided by a Template Analysis approach where 5 a priori themes were determined (Migration, Stressors/Trauma, Psychosocial Problems, HIV Risk Behavior, Relationship between Trauma/Psychosocial Problems and HIV Risk Behavior). The interview guide was translated into Bemba, a local Zambian language, back-translated to English, and reviewed by the research team to ensure accuracy. All interviews were conducted by a male interviewer fluent in the local language. Interviews were recorded, transcribed verbatim and translated from Bemba to English by local certified translators.  The data was analyzed using NVivo qualitative software.

Findings: The average age of the participants was 46.6 years of age, with n=13 married. The mean education level was completion of grade 8, with an average of 8 years as a truck driver among the participants. Based on the a priorithemes, participants reported multiple stressors and traumatic experiences including delays and long waiting hours at borders, exposure to crime and violence, poverty, and job-related safety concerns. Participants also spoke of loneliness, feeling troubled, and time away from their wives as factors contributing to transactional sex with sex workers and migrant women. Two thirds of the participants (n=10) reported engaging in transactional sex. The majority of participants reported inconsistent or lack of condom use. Participants consistently discussed extreme fear of getting tested for HIV.

Conclusion and Implications: The findings suggest ongoing and multiple daily stressors, potentially traumatic events, psychosocial problems and prevalent sexual risk behaviors among truck drivers in the study. Findings suggest the critical need to develop HIV prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key-affected population.