Testing for a deadly disease

Long-distance truck drivers who engage in intercourse with female sex workers, operating along the main highways in South Africa, are vulnerable to contracting HIV/Aids. What is the best way to test for this disease? 

An estimated 12,6 percent of South Africans (or seven-million people) have HIV, according to the 2017 mid-year statistics published by StatsSA. The Joint United Nations Programme on HIV/Aids estimates that there were 290 000 new HIV infections in South Africa in 2016 with 140 000 Aids-related deaths.

Despite having the largest treatment programme in the world (with 20 percent of the people on antiretroviral therapy globally), South Africa still has the highest prevalence of HIV infection in the world with 19 percent of the global number of people infected, 15 percent of new infections and 11 percent of Aids-related deaths.

Sex workers and their partners are among the most vulnerable to infection, with a prevalence rate of 57,7 percent among female sex workers. Long-distance truck drivers who engage in unprotected intercourse with sex workers are thus also at great risk. Sex workers along the main highways are particularly vulnerable.

A 2014 study found that 90 percent of female sex workers along the N3 highway between KwaZulu-Natal and the Free State are infected with HIV. As a common rest stop for long-distance drivers, Beaufort West also has a high infection rate.

Tshego Lepule, in an article for IOL, quoted Nomafrench Mbombo, MEC for Health in the Western Cape: “Beaufort West is particularly vulnerable to HIV, largely because of the location of the town on the N1 between Johannesburg and Cape Town.”

According to Mbombo, the Central Karoo region had an HIV/Aids infection rate of 12 percent during 2016/17, while Beaufort West alone had an infection rate of 16 percent.

Although drivers have access to wellness centres, they are often not tested, argues Nosipho Faith Makhakhe and fellow researchers in their study titled: Sexual transactions between long-distance truck drivers and female sex workers in South Africa.

The researchers note: “While HIV testing is widely available for long-distance truck drivers in the wellness centres within the truck stops, most are still reluctant to be tested and hesitant to collect condoms. They experience feelings of fear and shame, which hinder them from seeking the help they need. Thus, they may unknowingly continue to spread HIV to their partners.”

Many organisations have wellness programmes that encourage drivers to test for HIV. Tertius Wessels, MD of Corridor Empowerment Project (CEP), notes the importance of the mobile wellness centres.

CEP manages the National Bargaining Council for the Road Freight Industry (NBCRFLI) trucking wellness programme, which provides transport operators with mobile wellness centres.

“The mobile wellness centres offer an on-site screening and testing service to industry personnel, allowing them to access the services during their working hours with a minimal impact on company operations. It also ensures that individuals do not have to take time off,” he notes.

Wessels adds that HIV/Aids is a concern for transport operators, as it results in a loss of productivity and skills. He says: “Proactive HIV policies, health information, behaviour change communication, early HIV diagnosis, appropriate referrals and care programmes can reduce this risk and impact on businesses.”

He also points out that this could reduce poverty throughout southern Africa, as employees can continue to support their dependants. An alternative to mobile wellness centres is HIV self-testing kits, which were introduced in South Africa last year and are now available at pharmacies. These kits aim to increase the uptake of HIV testing and treatment.

In an article for Daily Maverick, Amy Green quotes Professor Francois Venter, deputy executive director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand. He argues that HIV self-testing kits could increase the uptake and frequency of testing among men.

HIV testing is lower in men than women, as they are less likely to go to clinics. Venter explains: “Most health workers are women and women are usually experienced in accessing health services for contraception, pregnancy and when taking their children for immunisations, for example. For many men it’s a scary and unknown place.”

While the privacy and ease of use of the HIV self-testing kits might encourage more drivers to test their status, the cost of these kits could create a barrier. It is also important for drivers to know how to use the kit, and when to seek further medical treatment to confirm their status and start taking antiretroviral medication.

A 2017 study on the use of HIV self-testing kits among students in Gauteng and North West provinces found that
25 percent did not confirm the test results at a clinic. Confirming test results is key to controlling the epidemic.

The researchers note: “The role of educating people on what to do after self-testing cannot be over emphasised, particularly as HIV self-testing requires individuals to be more proactive than when testing using facility-based HIV counselling and testing approaches.”

The study found that, for at least half of the participants, the information leaflet accompanying the kits did not provide sufficient information. Wessels argues that mobile wellness centres provide long-distance truck drivers the counselling they need.

He notes: “Self-testing for HIV has garnered controversy for years and although there are quite a few valid arguments for self-testing, CEP feels that, in South Africa, there are still myths relating to HIV that need to be addressed.

“Although information regarding HIV is widely accessible, there is still some concern about potential lack of counselling, support and the accuracy of the test results. A mobile wellness centre provides an individual with the proper pre and post-test counselling and linkage to care through the NBCRFLI treatment programme,” he concludes.