HIV Vulnerability along Mombasa-Kampala transport corridor – A Research Perspective Alan Ferguson Constella-Futures

2 OBJECTIVES Measure volume and characteristics of highway-based transactional sex on section of Northern Corridor highway between Mombasa and Kampala –Identification of ’Hot Spots’ –Risk-avoidance practices and un-met needs –Characteristics of sex worker clients on the highway –Use of GIS in visualization and planning Fieldwork carried out between April 2005 and June 2006

3 Northern Corridor Routes

4 Summary of Methodology Method 1.Sex Worker Diaries (recorded for 28 consecutive days) 2.Health seeking behaviour survey of Truckers 3.Bar and Lodgings census 4.FGDs – Sex workers and truckers 5.Truck census (for 7 consecutive nights) 6.GIS Information 1.Nos of partners, liaisons, sexual acts, types / occupations of clients, condom use, mobility, sex during menses 2.Partner numbers, condom use, STI reporting, health seeking behaviour 3.Patron types, beer sales, room numbers, condom sales 4.Contextual issues, conflicts, preference for stopovers 5.Truck volumes per stopover 6.Local and regional mapping, visualization

5 Stopover points: n=47

6 Mean no. trucks / FSW estimates

7 Example of thematic map of single hot spot

8 Mean levels of transactional sex (n=578 diaries)

9 Variations in mean monthly # sexual acts

10 Transactional sex by type of partner

11 Condom use per liaison by type of client

12 Client occupations n=7,700

13 Variations in stopover clientele: Kampala-Juba Highway

14 Estimation of HIV Transmission Using AVERT model, estimated that 3,200 – 4,200 new infections per annum from transactional sex on highway Raising condom use to 90% would avert almost 2/3 of these new infections

15 Further evidence from IOM study of Kampala- Juba corridor, 2007 Mean of 64 sexual acts per month, range % clients are casuals, but account for 60% of all sexual acts 77% condom use by FSW with casual clients, 64% with regulars 28% clients are truckers, 72% have other occupations

16 Three basic conclusions to guide programmatic responses Truckers are usually a Minority of clients of sex workers at most hot spots on the highway – programmes need to engage the wider communities at stopovers and address the local context The normal trade-off between risk-taking and intimacy means that condom-promotion is not a ‘magic bullet’ – the reduction of concurrent partners also needs building in Stopovers can be very volatile* – programmes should be flexible and avoid major expenditures on infrastructure. * Half of the bars and lodges on the Kampala-Juba route have been established since 2005

17 References 2006A. Ferguson, C. Morris and C. Kariuki “Using diaries to measure parameters of transactional sex: an example from the Trans-Africa highway in Kenya”, Culture, Health & Sexuality, March– April 2006; 8(2): 175– C. Morris and A. Ferguson “Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: the continuing role for prevention in high risk groups”, Sex Transm Infect. Published Online, July A. Ferguson and C. Morris “Mapping transactional sex on the Northern Corridor highway in Kenya” Health and Place, 13 (2007) 504– Morris, C. and A. Ferguson “Sexual and treatment-seeking behaviour for sexually transmitted infection in long-distance transport workers of East Africa” Sex Transm Infect 2007; 83: