International Journal of Medicine and

Pharmaceutical Science (IJMPS)

ISSN(P): 2250-0049; ISSN(E): 2321-0095
Vol. 6, Issue 2, Apr 2016, 97-102
TJPRC Pvt. Ltd.

THE RISK OF HBV AND HIV TRANSMISSION IN LONG-HAUL

TRUCK DRIVERS IN EGYPT
MOHAMED YUSSIF1, SABRY ABOU SAIF2, SHERIEF ABD-ELSALAM3,
ABDELRAHMAN KOBTAN4, ESLAM HABBA5 & MOHAMMED ATTIA6
1,2,3,4,5

Department of Tropical Medicine & Infectious Diseases, Tanta University, Tanta, Egypt
6

Department of Clinical pathology, Tanta University, Tanta, Egypt

ABSTRACT
Introduction
In many countries Long-haul truck drivers and their commercial sex contacts (CCs) have been associated
with the spread of blood born and sexually transmitted infections (STI). However, there is no sufficient information
about the Blood born and STI risk behaviors of these populations in Egypt. We conducted this study to explore blood
born and STI-related risk behaviors among the drivers in Tanta and Kafr El-Sheikh governorates, Egypt and to study
their knowledge about HIV & STI transmission.

Between march and october 2014, we conducted face-to-face unstructured and semistructured qualitative
interviews at trucking venues, health department facilities, and a community-based organization to solicit information
on sexual behavior and condom and illicit drug use especially intravenous drugs. The interviews were audiotaped,
transcribed, reviewed for quality control, and then coded and analyzed.
Results

Original Article

Methods

Fifty long-haul truck drivers completed the interview. The truck drivers were male with a mean age of 40
years. Data suggested risky sexual behavior and drug use (i.e., inconsistent condom use, illicit drug use including
intravenous drug use, and the exchange of sex for drugs) that could facilitate STI/human immunodeficiency virus
(HIV) and hepatitis virus transmission. Results also showed a low knowledge about STIs and lack of access to general
health care for both populations. Fortunately, we found that all the drivers were seronegative for hepatitis B virus and
human immunodeficiency virus.
Conclusions
Additional studies are needed to further assess risk of development and prevention of blood born and sexually
transmitted diseases in long-haul truck drivers.
KEYWORDS: HIV; HBV; Sexually Transmitted Diseases; Truck Drivers; Egypt

Received: Mar 20, 2016; Accepted: Apr 05, 2016; Published: Apr 08, 2016; Paper Id.: IJMPSAPR2016011

INTRODUCTION
Long-haul truck drivers and their commercial sex contacts(CCs) (i.e. women and men with whom they
exchange money and/or drugs for sex) have been implicated in the spread of human immunodeficiency virus
(HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STI) along major transportation routes in

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Mohamed Yussif, Sabry Abou Saif, Sherief Abd-Elsalam,

Abdelrahman Kobtan, Eslam Habba & Mohammed Attia

many countries [1, 2].

Results from studies of long-haul truck drivers suggest that they have low STI knowledge [3], have higher
reported rates of STIs [3, 4, 5], engage in sex with multiple regular and commercial partners while on the road [4, 6, 7, 8],
report low condom use [3, 9, 10, 11]and engage in illicit drug use [11].
A study of truck drivers/assistants in southern India found that prevalence of HIV, syphilis and hepatitis B were
15.9%, 13.3% and 21.2% respectively. Longer truck driving careers and trips were significantly associated with HIV
infection [7]. Studies conducted in Thailand, Bangladesh, Indonesia, Nigeriaand Florida (USA) indicate that condom use
among truck drivers is low and/or inconsistent [4, 11, 12, 13, 14]. A study of HIV-positive truckers in Bangladesh found
that over one third did not change their sexual behavior after learning that they were HIV-positive [11].
A study conducted with 300 male truck drivers in Santos found that the use of 'rebite' (a stimulant) was reported
by 43% and was associated with syphilis [15]. A second Santos study found that 69% of truck drivers had a low selfperceived HIV risk in spite of their inconsistent condom use with multiple partners [16].

METHODS
A rapid assessment study was conducted in 2014 using in-depth interviews, focus groups, field observations and
mapping [17, 18].
In-depth interviews were used to explore local meanings and understandings of health problems and health
behaviors related to HIV/ AIDS, HBV and drug abuse. Truck drivers were 50 all of them were men and mainly recruited in
three main roadside truck stops.
Interviews were semi-structured, lasted 90-120minutes and used questions about drug use, sexual risk behavior,
HIV/STI knowledge and attitudes, access to voluntary counceling and testing (VCT), health services and HIV/AIDS
interventions and effectiveness of available health services. Contact sheets were used to summarize interviews or other
field contacts and to select subsequent contacts [19].
Seven focus groups were conducted with truck drivers and comprising six to eight persons and lasting 60-120
minutes. All truck drivers were male as we said before unfortunately CCs could not be interviewed.
Field observations were conducted in locations where truck drivers and/or CCs spent free time, bought or
consumed alcohol and drugs and where truck drivers reportedly looked for sexual partners.
The time of the day was varied systematically to cover the morning, afternoon, evening and late night.
Observations were recorded by the field team (5 observers) in a daily diary.
The above information was used to map three main routes related to networks, risk scenes and available health
services targeting truck drivers.
Measures
The study consisted of open-ended questions that solicited demographic information, including age,
race/ethnicity, residence, information about typical daily activities, knowledge and history of STIs, sexual behavior (e.g.
types and number of sex partners, condom use, venues where sex is sought), best venues including location and time of day
for interviewing truck drivers and CCs, and best recruitment strategies for truck drivers and CCs. Additionally, questions
Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

The Risk of HBV and HIV Transmission in Long-Haul Truck Drivers in Egypt

99

related to driving history (e.g., driving status [independent vs. company driver], and driving history [number of years
driving, mean number of miles driven per month, and mean number of nights away from home per month]) were included
on the instrument for truck drivers, and questions related to length of time exchanging sex for money and/or drugs were
included on the instrument for CCs. All drivers were tested for HIV and HBV.
Data Analysis
Transcribed in-depth interviews, focus groups and field observations were read to discern participants' views and
behaviors regarding the roles of sexual behavior and drug use and HIV/AIDS risk. Descriptive notes were written in the
margins to facilitate coding, these were compared, contrasted and merged to create a single coding scheme.

RESULTS
Of fifty long-route truck drivers participating in in depth interviews, all of them were males and most were aged
40-49 years old. Thirty-five of them were married or lived with a stable partner and the majority had up to 10 years of
education. The majority of truck drivers spent 11-17 hours/day on the road (Table 1).
The following main themes were identified: (a) influence of availability and/or inevitability of transactional sex
on unsafe behaviors, (b) unsafe sex with different sex partners, (c) frequency of alcohol and drug use and (d) knowledge
and attitudes about HIV/STI infection. The majority of them has never had a road accident, and spent up to one week away
from home. Only five drivers were abusing alcohol, but most of them were using tramadol containing drugs.
Most of the drivers work in team and fortunately all of them were negative to HIV and HBV testing.
Table 1: Drug Abuse among the Drivers and Length of their Stay Outside Home
Variable
How long stay away
from home
-up to 1 wk
-1-2 wks
-2-4 wks
-more than 1 month
Alcohol Use
Drug Use
-Injection
-Stimulants
-Tramadol
-Don't use
Team or Solo Driver:-Team
-Solo

Number
(Total-No=50)

Percent
%

20
10
15
5
5 cases only
not daily

40
20
30
10

No
10
30
10

0
20
60
20

40
10

80
20

10

DISCUSSIONS
High-risk sexual behavior was common among truck drivers, who reported engaging in unprotected sexual
intercourse with female CCs and other concurrent partners and using alcohol and drugs. The infrequent use of condoms
among truck drivers and their low perceived risk was congruent with studies in both developed [12] and developing
countries [7, 20, 21, 22].

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Mohamed Yussif, Sabry Abou Saif, Sherief Abd-Elsalam,

Abdelrahman Kobtan, Eslam Habba & Mohammed Attia

The context of sexual partnerships was an important element that contributed towards unprotected sex among
truckers. Truckers reported using condoms more often with CCs who were 'one-night stands' but less frequently with CCs
or trucking industry employees they had formed relationships with. Interventions geared towards long-haul truck drivers
will need to consider their sexual interactions with other players working along truck driving routes, such as women
working in truck stops and restaurants, 'traveling ladies' (who mayor may not be CCs) and male sex workers.
There was infrequent use of alcohol and frequent use of drugs especially tramadol among truck drivers to relieve
job-related stress, which in turn led to inconsistent condom use. Structural interventions to change conditions in the
workplace are needed, for example to limit the number of consecutive hour struckers are on the road and/or to establish a
minimum rest period. Such efforts could directly or indirectly reduce the likelihood that truck drivers engage in substance
use or have unprotected sex.
Our study supports previous studies that suggest that successful interventions among truckers should provide peer
education and [23], improve their knowledge about STDs [15] and foster interdisciplinary approaches [24].
In order to eliminate sampling bias and the danger of repeating studies amongst the same social networks, more
rigorous techniques, such as random nomination selection, need to be considered in further studies with this population.
Our reliance on self-reported data might lead to some 'socially acceptable' responses, such as consistent condom
use, that may have been over reported. Despite these limitations, the multi-method approach used in this study helped
triangulate findings and uncover hotspot areas where interventions could be targeted to truckers, CCs and other employees
in the trucking industry. Prevention efforts need to take into account the conditions and beliefs that affect their behavior
[25, 26].
To reduce the risk of HIV infection among truck drivers and CCs working along trucking routes, prevention
programs need to overcome several impediments, including myths about HIV transmission, low self-perceived risk and
denial about the risks associated with unprotected sex and the limited number of venues where HIV/STI education and
testing can be confidentially sought. Since we found that truckers readily discussed their working conditions, effective
interventions could be developed by recruiting truck drivers and/or CCs to help prevention strategies or by using media
figures popular with truck drivers to disseminate public health messages.
The highly mobile nature of these populations indicates the need for interventions that traverse cities and states
and even borders with neighboring countries.
In our study we found that 60% of the drivers heavily used tramadol containing drug and 20% used stimulants for
sex these results in accordance with Malta et al., 2006 [27] who found about 36% and 6.5% of truck drivers addict
metamphetamines and stimulants respectively.
Alcohol was consumed in only 10% of our drivers and not in a daily base, this result disagreed with Malta et al.,
2006[27] who found that more than 60% of drivers were abusing alcohol.

CONCLUSIONS
In our study all of the drivers were seronegative to HBV and HIV, these results were in disagree with Manjunath
et aI., 2002 [7]. A study of truck drivers/assistants in southern India found that prevalence of HIV, syphilis and hepatitis B
were 15.9%, 13.3% and 21.2%, respectively.
Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

The Risk of HBV and HIV Transmission in Long-Haul Truck Drivers in Egypt

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Ethical Approval
The study protocol was approved by the ethical committee of faculty of medicine, Tanta University. Informed
consent was obtained from each patient before participation in the study.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
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Impact Factor (JCC): 5.4638

NAAS Rating: 3.54