Truck drivers travelling the national long-haul freight routes in South Africa are away from their homes, families and friends for long periods of time. Many of the truckers encounter sex workers and other women who exchange sex for money or presents at truck stops and along major trucking routes and are tempted to start relationships with these women.

Urgent need for interventions

As a result of the depressed economy, the commercial sex market is growing in South Africa and unfortunately so is the rate of HIV/STIs due to unprotected sex with several partners. A study conducted at five truck stops in the heavily affected region of KwaZulu-Natal in 2000 with men who visited sex workers found high levels of HIV prevalence (56%) among both truck drivers and sex workers. Two-thirds of the men reported having an STI in the previous six months. Condom use was not very high; almost a third of the truckers reported never using condoms with sex workers, while less than half reported always using condoms. According to this study, the truck drivers and their partners need:

• information about HIV/STIs and condom use
• condom distribution at truck stops, toll plazas, work places and border posts
• peer education by truck drivers and sex workers to spread positive messages
• provision of syndromic STI treatment and HIV counselling at strategic points along major trucking routes (e.g., through mobile clinics).

The Learning Clinic was appointed to be the project manager for two major anti-AIDS projects within the road freight industry, "Trucking against AIDS" and "Focus on AIDS", sponsored by the National Bargaining Council for the Road Freight Industry (NBC) and the Road Freight Association (RFA), respectively.

Roadside Wellness Centres

As truck stops are an ideal spot for HIV prevention activities, with the possibility of reaching both truck drivers and sex workers, the Learning Clinic introduced the first Roadside Wellness Centre in 2000 at Beaufort West (along Route N1). By June 2003, more centres had been established near several main roads and border posts in South Africa: Harrismith, Port Elizabeth Truckers Inn, Ventersburg, Tugela, Beit Bridge Border Post and Komatipoort. The N7 route was under investigation as a new site.

The centres were established to undertake HIV/AIDS awareness education, primary health care, STI treatment through syndromic management and condom distribution to truck drivers spending an overnight rest stop in town. These services were also made available to their occasional sex partners (mainly sex workers), who are usually members of the local community. Each centre consists of two modified six-metre containers. One container is fully equipped with medications; a nurse undertakes health-care programmes and counsels patients suffering from STIs. The second container is equipped to undertake awareness and education training on the health consequences of having unprotected sex with several partners.

Trusting relationship

Truck drivers are invited to attend group education sessions, which last for approximately 45 minutes. Topics include: basic information on HIV/AIDS/STIs; prevention, care and support; the link between tuberculosis and other opportunistic diseases and HIV/AIDS; and abuse of women. In 2002, over 30,000 people received information about HIV/STIs and an estimated 350,000 condoms were distributed. While the main focus of the medical container is to provide syndromic STI treatment, it also includes a basic medication stock with headache tablets, vitamins, etc. In 2002, over 7300 people received treatment at the clinics (including sex workers); more than 3200 (44%) were treated for an STI.

At first the drivers were sceptical about the programme and it took a while to build up a trusting relationship. They are encouraged by a coordinator based at the clinic to attend the training and afterwards visit the medical site if necessary. A fair amount of outreach is needed to convince them of the usefulness of the services; however, as soon as they experience the non-judgemental environment, the truckers tend to spread the word about the clinics and come around freely.

Sex workers and the truckers' other sex partners are also welcome to visit the Roadside Wellness Clinics for awareness, education and health-care programmes. There is no huge difference in motivating the drivers and sex workers to visit the educational sessions, although it seems that sex workers are more approachable due to their attitude towards the subject of HIV/AIDS. To encourage them to practise safer sex, workshops are held at the container clinics. Their programme consists of HIV/STI awareness and education and the importance of using condoms at all times.

Truck drivers usually visit the Roadside Wellness Centres between the hours of 5 and 12 p.m. Women's workshops are therefore conducted during daylight hours when truckers normally do not patronise the clinics. Some clinics have different operating times because of factors such as border-post operational times.

Future dreams

The increased number of clinics since 2000 is due to partnerships between the two original sponsors with the Health Department of Port Elizabeth and several Provincial Departments of Health in Free State, Western Cape and KwaZulu-Natal. These partnerships have proved invaluable in expanding the network to offer the freight industry's workforce a wider choice of Roadside Wellness Centres, where health-care programmes and condoms are available.

The Learning Clinic's long-term vision is to have a comprehensive network of clinics along national routes and at all border posts in South Africa. A computer system has been instituted to link all the container clinics. Drivers are given a personal number for use at the centres (no names are required). In this way, the truckers' progress can be traced throughout South Africa, regardless of which clinic they choose to use. What we hope to accomplish with the computer system is to have numbers available in terms of illnesses, prescribed medications and the truckers' history of use of these centres. This information will help the project managers to determine if a clinic is still viable in the specific area, if it is being used optimally or should be relocated, etc.