AIDS EDUCATION AND PREVENTION in Zimbabwe’s Transport sector

by Moses Chingono

The National Employment Council for the Operating Transport Industry (NECTOI) is a non-profit statutory body in Zimbabwe established in 1985. NECTOI represents the interests of 2,500 employers through the Transport Operators Association and the Zimbabwe Rural Transport Organisation, and between 70,000-100,000 employees through the Transport and General Workers Union. The Council has equal representation from employers and employees. NECTOI incorporated an AIDS education and prevention programme in its activities in 1992 as a result of the heavy toll exerted upon the industry by the AIDS epidemic, which threatens to cripple the country’s entire transportation workforce.

The majority of employees within the transport industry are mobile personnel who spend most of their working time away from their families. This fact places them among high-risk groups for sexually transmitted infections (STIs) and HIV/AIDS. Many long distance drivers have acknowledged the presence of commercial sex workers along their routes and have acknowledged indulging in casual sex relationships with them, resulting in the transmission of HIV/AIDS.

As in any other employment sector, most employees in the transport industry are among sexually active age groups. The industry also happens to be one of the country’s largest employers. Faced with the challenge of HIV/AIDS, the industry had little choice but to embark on an awareness campaign aimed at forestalling the impact of the epidemic.

All the following factors were considered before the AIDS education and prevention programme was launched.

Phase I

The programme, designed to promote behaviour change and responsible behaviour, is divided into three phases. Phase I began in 1992 to promote and design specific programmes for individual transport operators. It involved the following activities:
--inform senior managers in specific companies of the HIV/AIDS situation and its implications;
--carry out awareness and prevention programmes within specific transport companies;
--recruit and train company-based peer educators to carry out AIDS education activities within their companies; and
--establish a materials distribution network within the transport operating industry.

NECTOI recruited, selected and trained company-based health facilitators whose task was to coordinate AIDS education activities in their workplaces. The employees themselves selected the peer educators. A number of qualifications were laid out for peer educators:
--responsible and capable of teaching other people;
--willing to work as volunteers;
--motivated, interested and capable of carrying consultative and educational roles outside normal working hours (e.g. lunchtime);
--respected by their colleagues; and
--as close as possible to the majority of employees in terms of age, gender and status.

This phase was fully funded by NECTOI, with additional technical and material support from the Swedish International Development Authorities (SIDA).


Phase II

The outreach phase began in 1995 when it was realized that the more mobile employees of the transport industry were difficult to reach. This phase, funded by AIDSCAP through Family Health International, ran from 1995 to July 1998.

The project covered three major transport routes through Zimbabwe linking the capital city Harare to border posts leading to Mozambique, Zambia, South Africa and Botswana. Along these routes, 21 truckstop sites were identified for the outreach programme. Its objectives were to:
--reduce the prevalence of STIs among truck drivers and their sexual partners;
--reduce HIV transmission in high-risk sexual behaviour among truck drivers;
--promote reduction of sexual partners among the primary and secondary target audience; and
--promote self-diagnosis and early treatment of sexually transmitted infection.


Phase III

This phase, funded by the Norwegian Agency for Development Cooperation (NORAD), has been running since January 1999 and has as its objectives to: 
--strengthen NECTOI’s capacity to sustain workplace-based interventions throughout the transport sector;
--facilitate adoption and implementation of the Labour Relations Regulations on HIV/AIDS (Statutory Instrument 202 of 1998);
--provide technical support to companies in setting up care and counselling services for employees;
--build capacity for companies to provide facilities or referral systems for STD treatment; and
--help companies promote risk reduction among highly mobile employees through policy review of customs and immigration practices.

In Zimbabwe truck drivers are often left stranded at border posts when they await clearing of their goods. Their trucks, which are fully equipped with adequate bedding facilities, are not allowed outside customs premises and the drivers have to seek alternative accommodation.


NECTOI Programmes

NECTOI programmes include the following.
--A basic training course that runs for three days and is followed by a two-day refresher course. The main topics covered include basic facts about HIV/AIDS; prevention of HIV/AIDS; implications of AIDS in the home, workplace and community; alcohol and drug abuse; sexually transmitted diseases; and communication skills using participatory methodologies.
--intensive communication skills course
--community theatre skills course
--basic counselling course
--programme planning and management course
--capacity building course

In addition to 70,000-100,000 transport company employees, the programme also benefits their spouses, family members and social contacts, as well as their communities. It offers a range of services including peer education training in which workers’ representatives learn to offer ongoing informal education to co-workers; condom distribution; short presentations of factual information about HIV/AIDS; development, production and distribution of literature and posters; STI diagnosis and treatment at existing company-based clinics; counselling services; and voluntary HIV testing.

NECTOI develops, produces and distributes sector-specific information, education and communication (IEC) materials for use by transport companies. Materials include posters, charts, booklets in three local languages, t-shirts, caps, bags, newsletters, licence disk holders, peer education carrier bags, and weekly radio programmes on popular channels.


Successes and Constraints

NECTOI has managed to reach commercial sex workers and gain their confidence and trust. This has been very difficult given the reluctance of this group to provide information to outsiders. As a result of its activities, however, NECTOI has noted significant successes in its efforts. These include:
--an increase in demand for condoms;
--significant sexual behaviour change;
--establishment of an open communication channel between commercial sex workers and health authorities;
--more willingness by people to discuss issues related to sex;
--requests for training of more peer educators;
--insatiable demand for IEC materials;
--high attendance at IEC drama performances presented by NECTOI-trained peer educators; and
--policies initiated by transport companies that promote HIV prevention and education activities, such as offering bedding and condoms to their drivers.

The NECTOI programme’s success has been brought about by good and effective planning, professional implementation, and strong networking with local health programmes. The adult education principles employed by project staff also promoted community participation and yielded good results.

At the same time, the programme faces significant constraints. There continues to be unmet demand for condoms and IEC materials, as well as a lack of incentives for peer educators, which results in low morale. It is also difficult to carry out regular follow-up visits because of the distance between project sites.

There have been a number of lessons learned as a result of the programme. They include the following.
--Commercial sex workers are a highly mobile group who tend to congregate where they can earn a living.
--Some commercial sex workers are not keen to engage in other more acceptable income-generating projects than commercial sex.
--Didactic approaches are not effective in community programmes.
--Community theatre is highly acceptable for educating masses and breaking down barriers.
--Behaviour change for high-risk groups is a long process that only takes place after a lengthy period of time.
--Truck drivers are not very keen to discuss HIV/AIDS issues with strangers; they are happier discussing them with commercial sex workers.
--Long distance truck drivers are a reliable source of income for commercial sex workers.
--At border posts as many as 100 vehicles can be parked overnight, with local women providing entertainment and sex.
--At border towns, school-age females sometimes provide sex for money to support themselves and their families.

At present, NECTOI is undertaking a number of activities as part of its programme, including the following:
--recruiting and training peer health educators at major stopping places (project sites) and transport companies;
--carrying out awareness and prevention programmes at project sites and specific transport companies;
--networking with other AIDS service organizations;
--regular follow-up visits to project sites;
--literature related to HIV/AIDS prevention distributed to beneficiaries;
--promoting condom use through distribution of condoms at transport companies and project sites;
--motivating target audiences to change undesirable high-risk behaviour in order to reduce the risk of HIV infection; and
--carrying out an evaluation of the peer education programme to sustain its impact. 

Evaluation and monitoring take place through follow-up visits that assess progress and identify constraints faced by peer educators. The visits result in re-supplying condoms and IEC materials. Evaluation is also done through reports sent by different transport companies and projects sites. In addition, comments from the general public help to evaluate the programme.

Voices from Africa no. 10