Trauma, Mental Health Problems and HIV Risk Behaviors Among Long Distance Truckers from Southern Africa

Background and purpose: In recent years, there has been a global demand to address the specific HIV-related health needs of migrant populations. The study aims to explore the multi-level factors that may contribute to labor migrant health and well-being at micro, meso- and macro levels. Using the structural-environmental framework, this study aimed to examine the relationship between the potentially traumatic events (PTEs), mental health problems and maladaptive coping behaviors such as risky sexual behaviors (causal and transactional sexual partners, inconsistent use of condoms etc.) and alcohol use among long-distance truckers from multiple countries in Southern Africa. We hypothesized that increase in exposure to PTEs, trauma and depression symptoms predict an increase in the likelihood of HIV risk behaviors and alcohol use.

Methods: A cross-sectional study was conducted among adult male truck drivers from Zambia, Tanzania, DRC, and Zimbabwe. A modified venue-based time-space sampling method was used to identify the most trafficked truck stops. Purposive sampling was used to recruit a total of 234 truck drivers from three truck stops. Validated self-report measures of the Life Events Checklist for DSM 5 (LEC-5), the Global Post Trauma Symptom Scale-Zambia (GPTSS-Z), Patient Health Questionnaire-9, Alcohol Use Disorders Identification Test (AUDIT) and an HIV Risk measure were employed for data collection. Following descriptive and bivariate analyses, we conducted a series of regression analyses to examine whether mental health outcomes (i.e., depression and post-traumatic stress) and PTE predict HIV risk behaviors and alcohol use.

Results: On average, participants reported more than 3 traumatic events experienced (M=3.73, SD= 3.32) higher severity of trauma symptoms (M=7.56, SD=7.25) and a mild to moderate range of depression symptoms (M= 3.57, SD=3.52). Primary findings indicated that an increase in depression symptoms increased the likelihood of engaging in sex with casual partners (OR= 1.17, p<0.01) and sex trading (OR=1.21, p <0.01). Similarly, an increase in trauma symptoms increased the likelihood of engaging in sex with casual partners (OR= 1.07, p<0.01) and sex trading (OR=1.08 p <0.01). Lastly, participants who reported higher PTE exposure were more likely to engage in sex with casual partners (OR= 1.11, p<0.05) than those who reported a lower exposure to PTE. For alcohol use, it was found that an increase in depression symptoms and post-trauma symptoms predict a higher rate of alcohol use (β= 0.66 and β= 0.34, respectively, p <0.001).

Conclusions and Implications: The findings provided evidence of several psychosocial stressors that are associated with risk behaviors amongst at-risk migrant populations. The study highlights the need to devise advanced research designs to examine the causal link between trauma exposures and the behavioral well-being of long-distance truckers in Zambia. At the community level, practice efforts are needed to improve the mental health programming that addresses the unique stressors faced by this at-risk population. In addition, policy level changes should be made to enforce night-time driving restrictions and develop safer truck stops to alleviate the risk of crime and victimization.