India has one of the largest road networks in the world and an estimated 5 million long distance lorry drivers. These men are away from their families for long durations, and in the unhealthy environment along the highways they become easy prey for commercial sex workers. This environment has brought new dimensions to their lifestyle. A recent study of Thai long haul truck drivers found that 86% of the single men and 63% of the married men had had commercial sex.1 We studied the sexual lifestyle of long distance lorry drivers in India.
Subjects, methods, and results
A total of 5709 consecutive long distance lorry drivers who consented to take part in the questionnaire survey while passing through a check post on National Highway 5 at the Andhra-Orissa border were interviewed by three trained investigators over 105 days between March 1994 and August 1994. Interviews took 15-20 minutes.
The table shows that 87% of subjects (4949 men) were sexually promiscuous, of whom only 11% (563) used condoms during commercial sex. The percentage using condoms decreased with increasing age. In the 21-30 age group (n=1766), 78% of unmarried sexually promiscuous men (331/425) reported having 31-60 sexual partners during the past 12 months.
Only 29 of the 40 married men aged under 21 reported having sex daily. Almost half of subjects (2714; 47%) drank alcohol daily early in the morning and got tremors if they didn’t drink; the proportion increased with age, from 34% in men under 21 to 59% in men over 40. Of the men interviewed, 69% (3938) were educated—that is, they could read and write fluently in their mother tongue or had a higher qualification. A significantly higher proportion of men over 40, compared with men under 21, were sexually promiscuous and misused alcohol and a lower proportion had AIDS knowledge (P<0.001, χ2 test; table).
Comment
During their journeys, long distance lorry drivers stop at “dhabas,” roadside hotels that usually provide food, rest, sex workers, alcohol, and drugs. They pick up the women, use them, and leave them at some other dhaba, where they are used by other drivers and local youths. Thus long distance lorry drivers are crucial in spreading sexually transmitted diseases and HIV infection throughout the country in a short time. They have an HIV infection rate of 10/1000, far higher than the Indian national average of about 0.5/1000.3
We found that drivers aged over 40 were highly vulnerable, and the potential for transmission of sexual diseases by this group is the most threatening. Though their AIDS knowledge is fairly good, their use of condoms is poor. As in Tanzania,4 condom use should be promoted along truck routes by distributing condoms freely along national highways through condom outlets. Research is urgently needed to find effective strategies to persuade lorry drivers to change their hazardous sexual behaviour.
Table.
Sexual behaviour of 5709 long distance lorry drivers in India. Values in body of table are numbers (percentages); values in headings are numbers of respondents to question
| Age group | Sexually promiscuous* (n=4949) | No of sexual partners during past 12 months
|
Regular condom use in past 12 months during commercial sex (n=563) | AIDS knowledge† (n=3997) | Sexual practice‡
|
Alcohol misuse§ (n=2714) | Sexually transmitted disease¶ (n=1748) | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ⩽30 | 31-40 | 41-50 | 51-60 | Vaginal sex only (n=4572) | Vaginal sex plus:
|
|||||||
| Anal sex (n=162) | Oral sex (n=215) | |||||||||||
| <21 years: | ||||||||||||
| Married (n=61) | 40 (66) | 19 | 10 | 5 | 6 | 31 (78) | 39 (64) | 36 (90) | 2 (5) | 2 (5) | 28 (70) | |
| Unmarried (n=166) | 111 (67) | 54 | 15 | 22 | 20 | 4 (4) | 124 (75) | 107 (96) | 2 (2) | 2 (2) | 60 (54) | |
| Total (n=227) | 151 (66) | 73 | 25 | 27 | 26 | 35 (23) | 163 (72) | 76 (34) | 88 (58) | |||
| 21-30 years: | ||||||||||||
| Married (n=1087) | 978 (90) | 614 | 163 | 93 | 81 | 102 (10) | 701 (64) | 967 (98) | 5 (1) | 6 (1) | 360 (37) | |
| Unmarried (n=679) | 425 (63) | 94 | 66 | 143 | 122 | 16 (4) | 581 (86) | 413 (97) | 7 (2) | 5 (1) | 260 (61) | |
| Total (n=1766) | 1403 (79) | 735 | 229 | 236 | 203 | 118 (8) | 1282 (73) | 656 (37) | 620 (44) | |||
| 31-40 years: | ||||||||||||
| Married (n=2408) | 2207 (92) | 1417 | 590 | 189 | 11 | 216 (10) | 1803 (75) | 2060 (94) | 61 (3) | 86 (4) | 704 (32) | |
| Unmarried (n=190) | 134 (71) | 59 | 23 | 35 | 17 | 71 (53) | 81 (43) | 104 (78) | 12 (9) | 18 (13) | 52 (39) | |
| Total (n=2598) | 2341 (90) | 1476 | 613 | 224 | 28 | 287 (12) | 1884 (72) | 1320 (51) | 756 (32) | |||
| <40 years: | ||||||||||||
| Married (n=1060) | 1012 (95)** | 528 | 284 | 140 | 60 | 101 (10) | 641 (60)** | 866 (86) | 69 (7) | 77 (8) | 280 (28)** | |
| Unmarried (n=58) | 42 (72)** | 18 | 9 | 15 | 0 | 22 (52) | 27 (47)** | 19 (45) | 4 (10) | 19 (45) | 4 (10)** | |
| Total (n=1118) | 1054 (94)** | 546 | 293 | 155 | 60 | 123 (11) | 668 (60)** | 662 (59)** | 284 (27)** | |||
Frequent and indiscriminate change of sexual partners, irrespective of marital status. †Correct answers to questions about the transmission and severity of AIDS.
Usual practices during previous 12 months by men who had extramarital sex. §Drink daily early in the morning and get tremors if they don’t drink.
Genital ulcer, genital discharge, or both, during last 12 months, in men who had extramarital sex. **P<0.001, χ2 test, compared with men aged <21 years.
Acknowledgments
We thank the authorities of Srikakulam District, Department of Commercial Taxes, Government of Andhra Pradesh, for permitting us to work at the check post. We also thank the long distance lorry drivers for their full cooperation.
Footnotes
Funding: AIDS Prevention Division of the Child Foundation of India, Visakhapatnam.
Conflict of interest: None.
References
- 1.Institute for Population and Social Research, Mahidol University, Bangkok. Behaviour pattern of Thai long haul truck drivers. In: Bloom DE, Lyons JV, editors. Economic implications of AIDS in Asia. New Delhi: UNDP Regional Bureau for Asia and the Pacific; 1993. pp. 80–81. [Google Scholar]
- 2.Joseph L, Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley; 1981. pp. 138–143. [Google Scholar]
- 3.Singh YN, Singh K, Joshi R, Rustagi GK, Malaviya AN. New Delhi: Department of Medicine, All India Institute of Medical Science; 1992. HIV infection among long distance truck drivers in Delhi India; AIDS and Asia: a development crisis. (UNDP Regional Project on HIV/AIDS.) [Google Scholar]
- 4.Huddart J. Boston: United Nations Development Programme; 1993. HIV in the work place: Dealing with issues—role plays. [Google Scholar]