HIV/AIDS is a new problem that the transport sector must address as better infrastructure and providing services increase the mobility of passengers and operators. There is strong evidence to show that increased mobility is linked to the spread of HIV. In addition workers involved in the construction and maintenance of infrastructure may comprise a mobile and at risk population. These issues are of particular importance to the European Commission, as its investments in the transport sector are a significant part of its development co-operation. Therefore the transport sector has to find ways to reduce the spread of HIV/AIDS when carrying out construction, maintenance, and the operation of passenger and freight services.
DOCUMENT 3 (A) HIV/AIDS AND THE TRANSPORT SECTOR
European Commission support to transport
Co-operation in transport is particularly aimed at fostering the movement of goods, services and people at the national, regional and international level, through "development of road transport railways, port installations and shipping, transport by domestic waterways, and air transport"1 Transport supports development strategies by facilitating economic production and trade; helping increase production in the agricultural sector; investing in people through education; employment creation; and improving access to health. European Union investment via the European Development Fund accounted for 20 % of donor support to transport networks in the 1980s and was approximately 25 % of programmable development aid for the first half (1990-1995) of the Lomé IV Convention. Support to the roads sector dominates, and not surprisingly Sub-Saharan Africa is the largest recipient.
EC Transport Sectoral Guidelines Recognise HIV/AIDS
"While new and improved infrastructure brings economic and social benefits, it can also facilitate the spread of disease. Opening up new traffic routes and improving access and personal mobility can contribute to the rapid spread of communicable disease such as AIDS. Extra health measures must be given by health agencies and contractors during the construction stage when there might be many temporary migrants in a community. When works are complete, health agencies must cope with the greater number of travellers who can both bring and carry away infections".Towards sustainable transport infrastructure: a sectoral approach in practice.
Director-General for Development European Commission, July 1996People at risk
There are four main areas of concern: people employed in building and maintaining infrastructure; those who work in the railways, roads, airlines and shipping services; professionals engaged in the management of the sector; and the passengers. These specific groups must be appropriately targeted if the spread of HIV and the impact of AIDS is to be reduced.Building and maintaining transport infrastructure. These activities may involve groups of workers who are housed away from their families, often for long periods of time. For example a construction company might send a team into a remote part of the country to built a new road or carry out maintenance. The workers are usually men, housed in an all male environment, and being away from their families increases the likelihood of their having more sexual partners.
Furthermore their comparative wealth enables them to purchase sexual partners. Studies have shown that in Malawi road construction has been linked to the spread of HIV2, while in Lesotho the Highland Water Project has led to an increase in sexually transmitted diseases in the remote mountain areas3. Thus, the extra sexual activity associated with the circumstances in which the workers find themselves increases the chance of exposure to HIV, not only for the workers but also for the communities in the areas in which they are working.
Reducing the exposure to HIV during road building and maintenance programmes (for both workers and communities) must involve several agencies and organisations. Governments and private sector firms using a mobile labour force should, through training, increase awareness of HIV/AIDS and improve the sexual health of their workers. Where on-site health services are provided they can be used for HIV/AIDS education; distribution of condoms and treatment of sexually transmitted diseases (STIs). Condoms should be provided and early treatment of STIs encouraged, even if there is no company health facility.
Employment conditions for workers should provide for movement of families where practicable, and where this is not possible, frequent leave should be encouraged. Furthermore, government should encourage the employment of local labour and require building and maintenance contract documents to cover these issues. Most countries have HIV/AIDS control programmes and people involved in the construction and maintenance of the transport infrastructure should link with the programmes in order to obtain their support.
Operating transport services. Improving transport services means more people; drivers, train crews, airline crews, and sailors spend longer away from home and their families. These people will be faced with the same likelihood of increased sexual activity as those in construction. The consequences may be regional and even international as many transport operatives cross borders. In Southern Africa transport drivers travel from the South African port of Durban to the mines of Southern Zaire, spending weeks on the road, and often having to spend days waiting to go through border formalities. Road service operators are particularly at risk. A survey of 168 bus and truck drivers in Cameroon in 1993 found that they spent, on average, 14 days away from home on each trip. Some 62% had sex during the trip and 25% had sex every night they were away. In Tanzania on the Dar-es-Salaam highway HIV prevalence was 28% for truckers and 56% for their female partners in 1991.4 As people in the sector form a small and relatively easily reachable group the problem can be addressed. Designing awareness campaigns for the sector has been done with some success by Amref in Tanzania, where both truckers and the women serving them at truck stops have been targeted.
Companies gain by protecting their employees, as they will avoid the costs of illness and the need for eventual replacement and costly training. Companies do not need to develop their own education packages, they can draw on government or non-governmental organisations. Companies need the will to introduce programmes, including making condoms continuously and easily available.
There are other actions that might be developed in relation to working practices and conditions. For example some trucking companies in South Africa have established rest stops. The benefits are: security, and meal and rest facilities for drivers who are also less likely to have risky sexual intercourse. Although the stops were established primarily for improved security, the benefits in HIV prevention have been considerable. Government needs to be supportive of transport sector initiatives, but actions they might also take for example, border crossing formalities, could be speeded up to reduce drivers waiting time.
Management.Transport managers, in both the government and the private sector, are drawn from a small group of educated and professional people in developing countries. They are in scarce supply, expensive to train, and take time to replace. Evidence suggests that in Africa the levels of HIV among managers and professionals are as high or higher than in the general population. Therefore management needs to identify key personnel and put in place contingency plans for increased illness and death. Moreover, continuous HIV education and training programmes are vital for this group.
Travellers.Improved transport infrastructure increases mobility generally. Mobility is associated with a greater opportunity for sexual encounters - people away from home and familiar surroundings are subject to a range of social, psychological and economic pressures. However, increasing mobility is usually a national development goal: it leads to economic growth, increases access to services, and improves quality of life.
Today vast numbers of people travel in search of work all over the world, but unlike previous generations they will return home every year, or possibly more frequently. Leisure travel is one of the most rapidly growing economic activities in the world, and again may play a role in speeding the transmission of HIV. Providing HIV education for their clients is not the responsibility of the transport sector, however it has two important roles: firstly the National AIDS Control Programme should be made aware of potential increases in movement in order that the mobile populations can be targeted; secondly the transport sector should cooperate with AIDS prevention initiatives. For example, minibus drivers might play anti-AIDS messages in their vehicles and migrant workers might be reached with special messages at departure points, and airlines might put information leaflets in seat pockets.
How to Use this Guide
For those working in the transport sector the following steps may be taken to address HIV transmission.Step 1. Establish if it is appropriate to consider the issue of HIV/AIDS in the country. Use "Document 2: Assessing the National Importance of the HIV/AIDS epidemic" in this Toolkit.
Step 2. In order to establish the broad scope of the problem, apply the checklist in "Document 3: A Sectoral Checklist", - Figure 1 Assessing Sector Susceptibility/Vulnerability.
Step 3. Specifically consider the issues as laid out in the Figure 1 below.
Step 4. Using the information gained from this sector study, use "Document 4: Guidelines for Including HIV/AIDS in Project Cycle Management" to ensure that HIV/AIDS is included in this process.
Step 5. If consultants are used by the transport sector ensure they are given "Document 5: Including HIV/AIDS in Consultants' Terms of Reference".
Figure1 . A Response for the Transport Sector Activity Possible Problem Potential Remedy Wider Action Building/maintenance Mobility of Workers. Increase in sexual partners due to separation from family and relative wealth of labour force. Increase use of local labour. Contract documents. i) require contractor to provide health education measures.
ii) distribute condoms.
iii) treat STIs.
iv) include in tender documents.
Liaise with Ministry of Health and AIDS Control programme. Increased illness and death among workers. Plan human resources and benefits to take account of this. Company and government liaise on human resource requirements. Transport Services Mobility of service operators. Highly mobile group with likely increased exposure to STIs and HIV/AIDS. Targeted health education, AIDS prevention and condoms.. AIDS Control programmes, NGOs and operators. Reduce time spent away from home. Operators. Provide controlled rest areas. Operators. Reduce time at border posts. Governments. Management Planning and running transport. Professional and skilled cadres also experience HIV-related mortality and morbidity hard to replace. Govt. benefits allow long periods of sick leave. Identify key personnel , human resource plans to take account of increased morbidity and mortality. Government. Operators.
Passengers Increase mobility of the population for trade, employment and leisure. People who travel away from families and home are more likely to have sexual partners. Transport sector should monitor traffic flows (and types) of movement and inform others who will provide appropriate education. Government. AIDS Control programme.
Notes:[1] Lomé IV Convention, Part Two The Areas of ACP-EC Cooperation, Title IX Development of services, Chapter 4 Transport, communications and informatics.[2] J M Ponninghaus & S M Oxborrow, The Lancet , 1990, 336 (Nov. 10), 1198.
[3] Dale McMurchy, HIV and The Lesotho Highlands Water Project, Summary of the Epidemiological Report on Phase 1B of the Lesotho Highland Water Project (LHWP), AIDS Analysis Africa 7.4 .
[4] Data for Cameroon from AIDS Analysis Africa, Vol. 4 (5), September/October 1994, for Tanzania from AIDS Analysis Africa,Vol. 5 (2), March/April 1995.
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