Truck drivers, middlemen and commercial sex workers: AIDS and the mediation of sex in south west Uganda.

Although long distance truck drivers have been implicated in the spread of HIV in Africa, there is a paucity of studies of their sexual cultures. This paper reports on a study of the sexual culture of drivers, mediators and commercial sex workers (CSWs) in a roadside truck stop on the Trans-Africa highway in south west Uganda. Sixty-nine truck drivers, six middlemen and 12 CSWs were interviewed using semi-structured questionnaires. Interviewing truck drivers also entailed participating in the town's nightlife and spending much time in the bars. Truck drivers stop briefly at the truck stop for various reasons: to eat, sleep, have sex and sell goods they are carrying. Middlemen mediate the latter two activities. Middlemen buy goods from the drivers and introduce them to 'suitable' women with whom they can have casual sex. Most drivers have sex when they spend the night at the truck stop, and most make use of the services of the middlemen. The most important reasons why drivers use middlemen are that the latter speak the local languages and, in particular, know the trustworthy and 'safe' (HIV-negative) women. The CSWs use middlemen mainly because they are a guarantee that the driver will pay and they usually ensure that drivers pay well. The mediation system is becoming increasingly professionalized. Most drivers claimed to use condoms during casual sex, and this was confirmed by the CSWs. General use of condoms is encouraging, particularly given the context of a culture generally opposed to condoms. The idea that middlemen can recognize 'safe' women is worrying. However, given their key position, middlemen could form the hub of an opinion leader type intervention focused on drivers and the professional group of sex workers described here, providing condoms, advising about the importance of condom use in all casual sexual encounters, giving information about HIV and STDs, and possibly referring drivers and women to appropriate sources of HIV counselling and testing and STD treatment.

Sexual networks in Uganda: casual and commercial sex in a trading town.

A longitudinal study of the sexual behaviour of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 "high-class' women who charged a mean price of over US $4/- per contact. The majority of their clients were from large urban areas of Uganda (55%) or neighbouring countries (32%)-70% were truck-drivers or their mates; (2) 18 "low-class' women, charging an average of US $0.4 per contact, who were patronized predominantly by men resident in the town (71%) who were unskilled casual workers (58%); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-cost bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the town and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25% were with new partners.

PIP: A longitudinal study of the sexual behavior of men and women living in a trading town on the trans-Africa highway (100 km south-west of Kampala, Uganda) revealed the presence of distinct networks of casual and commercial sex. 48 commercial sex workers recruited from bars and hotels on or away from the main road and 38 potential male clients located in bars away from the road were followed for a mean period of 16 and 13 weeks, respectively. Among women, a total of 4573 sexual contacts were recorded over 787 woman-weeks of observation, for an average of 5.8 contacts per week; 472 contacts (10%) were with regular partners. Condoms were reportedly used in 99% of casual and 59% of regular contacts. Clients of high-class prostitutes (charging over US$4/contact) were generally drivers from other urban areas or neighboring countries, while those of middle-class sex workers (US$2/contact) tended to be from fishing villages and those of low-class sex workers (under US$0.50/contact) were predominantly local unskilled workers. Among male respondents, 1621 sexual contacts were reported during 516 man-weeks of observation, for an average of 3.1 contacts per week; 584 contacts (36%) were with regular partners and 406 (24%) were with new partners. Men reported condom use in 3% of regular contacts and 87% of casual contacts. In-depth interviews with a convenience sample of six men revealed a total of 32 sexual contacts in the previous 2 weeks, of which eight involved wives or regular partners, 11 were with a sex worker encountered in discos or on the road, and 13 were with a woman known for 2-3 days. The condom use rates reported by respondents for casual partners are considered inflated, especially in light of the drunkenness that usually accompanies sexual encounters initiated in lower-class bars.

Sexual behaviour in a fishing community on Lake Victoria, Uganda.

This study describes the sexual behaviour of men and women in a fishing village on the shores of Lake Victoria in southwest Uganda. The village is near a well known trading town-truckstop on the main trans-Africa highway with a high recorded prevalence of HIV infection. Data were obtained on the daily travel and sexual activities of 26 women and 54 men with particular attention paid to the rate of partner change and the proportion of sexual contacts with people outside the village. During a total of 587 person weeks the men made 1086 trips, mostly returning home the same day. They had a total of 1226 sexual contacts, most of which occurred either in their own village (83%) or a neighbouring fishing village (11%); 17 per cent of sexual contacts were with new partners. Fifteen of the women described themselves as married; 42 per cent of their sexual contacts were casual, paying partners. Of the eleven women who were single, between 80 and 100 per cent of contacts were with paying partners. Most of the women's partners were resident in the village. These data show a very high rate of sexual mixing within the village. Such communities should be targeted in future STD control programs.

PIP: The first cases of AIDS in Uganda were identified in fishing villages on the shores of Lake Victoria in 1985. This paper describes the sexual behavior of men and women in one such village. The village is located 5 kilometers from a well-known trading town on the main transAfrica highway with an HIV prevalence of 40% in 1991, and is home to an adult population of approximately 250. Many residents make frequent trips to the town by foot or bicycle. Data were obtained over a 6-month period on the daily travel and sexual activities of 26 women and 54 men with focus upon the rate of partner change and the proportion of sexual contacts with people outside of the village. Over 587 person-weeks, the men made 1086 trips, mostly returning home the same day. They reported a total of 1226 sexual contacts, 83% of which occurred in their own village and 11% in a neighboring fishing village. 17% of sexual contacts were with new partners. Although 15 of the women reported being married, 42% of their sex contacts were with casual, paying partners. Of the 11 women who were single, 80-100% of contacts were with paying partners. Most of the women's partners were resident in the village. A high rate of sexual mixing therefore exists in the village, but with little contact with people from outside. Such communities should be targeted in future sexually transmitted disease control programs.

Sexual mixing patterns in Uganda: small-time urban/rural traders.

OBJECTIVE: To document the extent to which rural and urban-based male traders have sexual contacts away from their place of residence. METHODS: Fifty-one traders (46 who travel by bicycle and five others) kept daily diaries of all their journeys and sexual contacts for a total of 584 person-weeks. Twenty-five were resident in a trading town where HIV prevalence was about 40% and 26 lived up to 25 km away in rural areas where HIV prevalence was approximately 8%. RESULTS: A total of 2147 return trips were made (mean, 3.7 per week). Eighty per cent were between the trading town and the surrounding rural area. A total of 1377 sexual contacts were recorded (mean, 2.3 per week); 95% of the contacts of urban-based men occurred in the town, 3% in other urban areas and 2% in a rural area. For rural-based men 82% of sexual contacts took place in their home village, 14% in a neighbouring village, 2% in the trading town and 3% in other urban centres. CONCLUSION: Despite considerable economic interaction there is very little sexual mixing between the town and surrounding rural areas. This may explain why the high HIV prevalence found in some trading towns in Africa has not diffused out to rural areas.

Sexual mixing patterns in Uganda: small-time urban/rural traders

OBJECTIVE: To document the extent to which rural and urban-based male traders have sexual contacts away from their place of residence. METHODS: Fifty-one traders (46 who travel by bicycle and five others) kept daily diaries of all their journeys and sexual contacts for a total of 584 person-weeks. Twenty-five were resident in a trading town where HIV prevalence was about 40and 26 lived up to 25 km away in rural areas where HIV prevalence was approximately 8. RESULTS: A total of 2147 return trips were made (mean; 3.7 perweek). Eighty per cent were between the trading town and the surrounding rural area. A total of 1377 sexual contacts were recorded (mean; 2.3 per week); 95of the contacts of urban-based men occurred in the town; 3in other urban areas and 2in a rural area. For rural-based men 82of sexual contacts took place in their home village; 14in a neighbouring village; 2in the trading town and 3in other urban centres. CONCLUSION: Despite considerable economic interaction there is very little sexual mixing between the town and surrounding rural areas. This may explain why the high HIV prevalence found in some trading towns in Africa has not diffused out to rural areas