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Epidemiology

Risky journey

Macho culture of truck drivers contributes towards disseminating Aids virus

LUIZ CARLOS MURAUSKAS / FOLHA IMAGEMNurse Evely Pereira Koller already knew that truck drivers are not worried about the possibility of contracting HIV, the Aids virus, twice as common amongst them than in the rest of the population. Almost half of them never use a condom with their own wives, and as many again only use one sometimes with their occasional girlfriends. To understand why they adopt this behavior and risk contracting sexually transmitted diseases, she and another four researchers from the University of the Itajaí Valley (Univali), in Santa Catarina, talked at length with the truck drivers who go in and out of the port of Itajaí, one of the largest of the country, on the north coast of Santa Catarina – there are over 500 of them a day. In search of a more complete view, they also heard gas station employees and male and female prostitutes.

Evely’s team discovered that part of the behavior of the truck drivers of Itajaí can be explained by the pressure of work and for the short time limits for covering long distances, besides the lack of healthcare units prepared to deal with them. Other factors that weigh in are the macho culture that predominates amongst the truck drivers and the loneliness on the highways, evident in testimonies like the one from this 27-year old driver: Truck drivers are a sort of soldier at war, you know? I mean, they spend from two weeks to six or eight months, away from home… My God, for a guy like that, any woman is delicious.

Presented at Aids Care in July 2006, the result of three years of roving by this group from Univali calls attention to the need for new measures to reduce the risk of contamination by HIV and other sexually transmitted diseases. “Perhaps, more than traditional educational campaigns, it has to be explained to the truck drivers why they have to use condoms in their sexual relations away from home”, Evely comments. “Perhaps educational campaigns have to be created for the wives of these drivers for them to begin to put condoms together with their husbands’ clothes before the journey, and so protecting themselves.” Monica Malta, an epidemiologist from the Oswaldo Cruz Foundation who took part in this study, adds:  “It is difficult to believe that, over to decades after the first cases of infection by HIV were identified, many people still do not feel vulnerable, even though they have unprotected and use drugs”.

Generally speaking, those who live at the wheel of a truck maintain sexual relations with more than one person. The truck drivers themselves attribute this behavior to the conditions of work and to the culture of the profession itself. They often have to wait for days at the port before leaving one cargo or managing to get another. Without having anything to do, already weeks away from home, it is not difficult to arrange company, since, they say, the harassment of the call girls is intense. It is a 49-year old driver who says: There is, shall we say, a sort of persecution, you know? These women go after us. And we are human beings, my God! They begin like this: “Hey, dear, do you want to enjoy yourself” We simply cannot manage to resist…

What most concerns Evely is not the moral question of a man having lovers – women, men or transvestites – and betraying their wives, but the fact that their sexual habits make them highly vulnerable to sexually transmitted diseases and to contaminating other people in distant regions. “The truck drivers work like a bridge-population for the viruses”, Monica observes.

The macho culture is added to the disdain for the possible consequences of unprotected sex – and so the truck drivers feel less vulnerable. “They never think that it can happen to them as well”, says Evely. As a consequence, the men on the road adopt rather unreliable criteria both as to choosing partners and as to deciding whether it is safe to have sex without a condom. A girl in a restaurant, in a snack bar, she is a bit different. You can trust her…, said  one of the drivers interviewed. The lack of access to health services aggravates this scenario of lack of information about sexually transmitted diseases and other ailments common amongst drivers, such as diabetes and high blood pressure.

“This behavior is not exclusive to the region of Itajaí”, says Helena Lima, a psychologist with a doctorate in public health. From 2002 to 2005 she coordinated a nationwide study, funded by the Ministry of Health and by the Centers for Disease Control and Prevention (CDC) of the United States, confirming what almost ten years ago sanitarians Regina Lacerda and Neide Gravato had observed in the port of Santos, the largest in the country, through which from 2 to 5 thousand trucks pass a day.

“The sexual habits and consumption of alcohol and drugs are always the same in the port cities”, says Regina, a technician from the City Department for Health in Santos and a member of the nongovernmental organization Santos Research, Prevention and Education Association (Asppe in the Portuguese acronym), which works with carriers of HIV and other sexually transmitted diseases. For three years, Regina and Neide brought together health agents, mapped the sexual behavior of the truck drivers of the port of Santos and started campaigns giving guidance on sexually transmitted diseases and other health problems, in partnership with the trade unions of the truck drivers and port workers.

All this mobilization went on a bit and then stopped. “Nothing more has been done in a systematic way since 2003”, laments Regina, who still has reasons for being worried about the situation. She has just concluded a study with 175 prostitutes from the port of Santos showing that 5.7% of them carry HIV in the blood. It is a rate similar to the rate of almost 20 years ago, when the programs for preventing sexually transmitted diseases began in the ports.

“The port is the center of a great transport corridor, which facilitates the circulation of diseases”, she says. “As there is no time there for being concerned with health, the work of prevention must be constant, with the offer of information, condoms and rapid tests for detecting HIV.”

In Itajaí, Evely insists on meetings with truck drivers and call girls to see whether they are capable, for their own account, of getting involved in campaigns to prevent the dissemination of sexually transmitted diseases and demanding the implantation of health services on the highways and in the ports.

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