Contextual Barriers, Motivations, and Coping Strategies in the Uptake of HCT and Condoms Among Truckers and Female Sex Workers in Busia Township, Busia District

Findings suggested that truckers and female sex workers who effectively use condoms and regularly check their HIV status were motivated by a responsibility to their families, as well as their personal safety.

This is one of the key findings resulting from a rapid qualitative study conducted among 40 female sex workers (FSW) and 25 truck drivers in Busia, Uganda. The survey was conducted as part of the Communication for Healthy Communities (CHC) project, which is a United States Agency for International Development-funded project implemented by FHI360 and its partner, Uganda Health Marketing Group (UHMG). Using focus group discussions and follow-up in-depth interviews with some participants, the survey sought to "more closely understand the characteristics, decision-making factors, coping strategies and processes of those who adopt desirable HIV counseling and testing behaviors and use condoms and to document any specific barriers to adoption of these desirable behaviors." These findings are informing behaviour change communication interventions being implemented by the CHC project.

In terms of truckers’ intentions for condom use, the findings indicate trust as an issue, such as distrust of free condoms and service providers, and sometimes misinformed trust in regular and young female sex workers. Other barriers to condom use among truckers include the cost of branded condoms and shyness at purchasing condoms. Interviews with female sex workers found financial factors significant, as well as lack of negotiating power and even violence from clients. Both truckers and sex workers cited alcohol consumption as a barrier to condom use, as it impairs judgement. Perceptions of risk also influenced choices. Truck drivers reported a feeling that a road accident was more likely than contracting HIV, while sex workers also reported having a greater fear of falling pregnant than of contracting HIV.

Both sex workers and truck drivers who practiced desirable behaviours for condom use and HIV Counseling and Testing (HCT) were more likely to refrain from drinking alcohol, were aware of the consequences of their actions on their families and loved ones, and had made up their minds to use condoms no matter the situation. Truck drivers who have had a close loved one die of HIV/AIDS, have access to information on HIV, and engage in other leisure activities are less likely to engage in risky sex. As with truck drivers, sex workers who are pro-HCT and condoms believe that their lives are far more important than any amount of money. "Most of the FSWs have children and siblings who depend on them for survival. These family dependents serve as inspiration for the adopters." Some FSW reported they had made a conscious decision to use condoms after seeing some of their friends and colleagues get infected and die from HIV.

The report offers the following recommendations based on the findings:

• Information: There is a need to address misconceptions and concerns through providing accurate information especially around condom use and HCT services. This will include promoting sustainable relationships with health providers.
• Motivation: Condom use and HCT were motivated by a host of factors including personal desire for safety, health, and wealth. Condoms need to be repositioned as something that contributes to economic security and can still be enjoyable for those who cannot avoid sex while on the transport route.
• Ability to act:Communication interventions can highlight practical steps to ensuring condom use and accessing HCT services, as cited by people who have adopted these behaviours - always carrying a condom, learning from a sex partners' condom use behaviour, and finding alternative leisure activities to support efforts to avoid alcohol and distractions that come with idle status. As well, "alcohol avoidance messages need to be enhanced through peers and in collaboration with programs targeting sex workers from a human rights/public health approach."
• Norms: A generalised perception that most truckers are HIV positive appeared to contribute to reluctance to take up HCT. "SBCC interventions to address these assumptions by encouraging HCT as a first step to personal protection and securing one’s life goals are needed to break this barrier." A key challenge is lack of a legal framework to protect sex workers, and opportunities for collaboration may be sought with other organisations to educate sex workers, their clients, bar owners, and the law enforcement sectors in hotspots about the benefits of a safer sex work environment as part of the response to HIV.