Contextual barriers, motivations, and coping strategies in the uptake of HCT and condoms among truckers and female sex workers in Busia Township, Busia District

Contextual barriers, motivations, and coping strategies in the uptake of HCT and condoms among truckers and female sex workers in Busia Township, Busia District

Truckers and female sex workers who effectively use condoms and regularly check their HIV status were motivated by a responsibility to their families, as well as their personal safety. This is one of the key findings resulting from a rapid qualitative study conducted among 40 female sex workers (FSW) and 25 truck drivers in Busia, Uganda.

Using focus group discussions and follow-up in-depth interviews with some participants, the survey sought to "more closely understand the characteristics, decision-making factors, coping strategies and processes of those who adopt desirable HIV counseling and testing (HCT) behaviors and use condoms and to document any specific barriers to adoption of these desirable behaviors." These findings are informing behaviour change communication interventions being implemented by the CHC project.

The report offers the following recommendations based on the findings:

  • information: there is a need to address misconceptions and concerns through providing accurate information especially around condom use and HCT services. This will include promoting sustainable relationships with health providers.
  • motivation: condom use and HCT were motivated by a host of factors including personal desire for safety, health, and wealth. Condoms need to be repositioned as something that contributes to economic security and can still be enjoyable for those who cannot avoid sex while on the transport route.
  • ability to act: communication interventions can highlight practical steps to ensuring condom use and accessing HCT services, as cited by people who have adopted these behaviours - always carrying a condom, learning from a sex partners' condom use behaviour, and finding alternative leisure activities to support efforts to avoid alcohol and distractions that come with idle status. As well, "alcohol avoidance messages need to be enhanced through peers and in collaboration with programs targeting sex workers from a human rights/public health approach."
  • norms: a generalised perception that most truckers are HIV positive appeared to contribute to reluctance to take up HCT. "SBCC interventions to address these assumptions by encouraging HCT as a first step to personal protection and securing one’s life goals are needed to break this barrier." A key challenge is lack of a legal framework to protect sex workers, and opportunities for collaboration may be sought with other organisations to educate sex workers, their clients, bar owners, and the law enforcement sectors in hotspots about the benefits of a safer sex work environment as part of the response to HIV