Multi-Level HIV Risk Factors Among Female Fish Traders and Male Truckers in Zambia: A Qualitative Study Comparison

Background:  Zambia is heavily burdened with HIV: 13% of the general population aged 15-49 are infected. Mobility has been noted as a driving factor which increases risk for HIV infection. Male truck drivers and female fish traders are both internal labor migrant populations, noted as key-affected populations at risk for HIV in Zambia. Few studies have examined associated multi-level HIV risk factors among both groups, which can potentially inform contextually relevant HIV intervention efforts. The current study aims to fill a gap in the extant literature through a comparison examination of individual, social and structural risk factors associated with HIV among two mobile key-affected populations in Zambia, i.e., female fish traders and male truck drivers. Specifically, we examine potential similarities and differences in order to inform the development of culturally and contextually relevant HIV interventions among mobile populations in Zambia.

Methods: We conducted semi-structured interviews (n=15 for truckers and n=20 for fish traders) and a focus group (n=12 participants for fish traders) among purposively sampled truckers at trucking companies in Lusaka and fish traders in the Kafue Flatlands and John Lainge Fish Depot. The interview guide was translated to the local language, back translated to English and then reviewed by the study team and local partners to ensure accuracy in meaning. Participants were recruited by a local Zambian researcher fluent in the local language. Information was elicited for both groups about mobility, migrant-related stressors, HIV sexual risk behaviors and psychosocial problems related to migrant-related stressors. Template analysis was conducted to analyze the data. We compared individual (mental health problems, trauma), social (relationships with peers) and structural level factors (i.e., mobility, work-related factors/policies) which were associated with HIV risk.

Results: The majority of fish traders reported that mental health problems were related to ongoing daily traumatic events experienced at the rivers (e.g., witnessing other drown, gender-based violence), which increased maladaptive coping mechanisms such as alcohol use and sexual risk behavior among female fish traders. The majority of truckers noted that mental health problems, specifically intense anxiety, fear and avoidance of HIV testing, was a result of engaging in sexual risk behaviors on their route. Results also revealed intense lack of social support among the majority of female fish traders, increasing competition for fish at the rivers, further increasing HIV risk.  Truckers, conversely, reported heavy reliance on the support of other truckers to survive, which served as both a protective and risk factor for HIV. Both populations discussed policies which contributed to their stress, financial burden and subsequent HIV risk (i.e. the annual fish ban and lack of services at the rivers among fish traders; night driving restrictions, as well as long delays at the borders among truckers).

Conclusions: Results support a relationship between migrant-related stressors, psychosocial problems and HIV risk behaviors among fish traders and truckers. However, the pathways noted revealed differences between both groups. The findings suggest the development of HIV prevention interventions which are gender-specific, contextually relevant and account for the specific migrant-related needs of these at-risk populations.