[Skip to Content]
[Skip to Content Landing]
June 27, 1994

Human Immunodeficiency Virus Infection in Long-Distance Truck Drivers in East Africa

Author Affiliations
From the Department of Medical Microbiology, University of Nairobi (Kenya) (Drs Bwayo and Ndinya-Achola, Mr Omari, and Ms Mutere); Department of Medical Microbiology, University of Manitoba, Winnipeg (Drs Plummer and Moses); and Departments of Epidemiology and Medicine, University of Washington, Seattle (Ms Velentgas and Dr Kreiss).
Arch Intern Med. 1994;154(12):1391-1396. doi:10.1001/archinte.1994.00420120123013

Background:  A cross-sectional survey was performed to determine the seroprevalence and correlates of human immunodeficiency virus (HIV) infection among long-distance truck drivers in Kenya.

Methods:  Truck drivers along the Mombasa-Nairobi highway were enrolled at a roadside research clinic. A standardized interview and serologic evaluation for HIV and syphilis were conducted.

Results:  We enrolled 970 truck drivers and their assistants of whom 257 (27%) had HIV antibodies. In univariate analysis, HIV infection was correlated with older age, non-Kenyan nationality, Christian religion, longer duration of truck driving, travel outside of Kenya, less frequent visits to wives, and more frequent visits to prostitutes. Uncircumcised status, history of genital ulcer disease or urethritis during the previous 5 years, and a positive Treponema pallidum hemagglutination assay for syphilis were each associated with positive HIV serostatus. Univariate correlates of uncircumcised status included younger age, non-Kenyan nationality, Christian religion, travel outside of Kenya, and less frequent visits to prostitutes. There was a significant association between uncircumcised status and 5-year history of genital ulcer disease or serologic evidence of syphilis, but not with 5-year history of urethritis. In multivariate analysis, HIV infection was independently associated with uncircumcised status (adjusted odds ratio [OR], 4.9; 95% confidence interval [CI], 2.8 to 8.4), history of genital ulcer disease (adjusted OR, 2.4; 95% CI, 1.5 to 4.1), history of urethritis (adjusted OR, 1.8; 95% CI, 1.1 to 2.9), more frequent sex with prostitutes (more than once per month; adjusted OR, 1.7; 95% CI, 1.1 to 2.8), and positive T pallidum hemagglutination assay (adjusted OR, 1.2; 95% CI, 1.0 to 1.4). The attributable risk percentage for the association between HIV and uncircumcised status was 70%, and the population attributable risk was 25%.

Conclusions:  Truck drivers in east Africa are at high risk of HIV infection. The strongest correlates of HIV sero-positivity were uncircumcised status and history of both ulcerative and nonulcerative sexually transmitted diseases.(Arch Intern Med. 1994;154:1391-1396)

Kreiss JK, Koech D, Plummer FA, et al.  AIDS virus infection in Nairobi prostitutes: spread of the epidemic to East Africa .  N Engl J Med. 1986;314:414-418.Crossref
Ngugi EN, Plummer FA, Simonsen JN, et al.  Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes .  Lancet. 1988;2:887-890.Crossref
Carswell JW, Lloyd G, Howells J.  Prevalence of HIV-1 in east African lorry drivers .  AIDS. 1989;3:759-761.Crossref
Bwayo JJ, Omari AM, Mutere AN, et al.  Long distance truck-drivers, I: prevalence of sexually transmitted diseases (STDs) .  East Afr Med J. 1991;68:425429.
Bwayo JJ, Mutere AN, Omari MA, et al.  Long distance truck-drivers, II: knowledge and attitudes concerning sexually transmitted diseases and sexual behavior .  East Afr Med J. 1991;68:714-719.
Greenblatt R, Lukehart SL, Plummer FA, et al.  Genital ulceration as a risk factor for human immunodeficiency virus infection .  AIDS. 1988;2:47-50.Crossref
Cameron DW, Simonsen JN, D'Costa LJ, et al.  Female to male transmission of human immunodeficiency virus type-1 risk factors for seroconversion in men .  Lancet. 1989;2:403-407.Crossref
Simonsen JN, Cameron DW, Gakinya MN, et al.  Human immunodeficiency virus infection among men with sexually transmitted diseases: experience from a center in Africa .  N Engl J Med. 1988;319:274-278.Crossref
Rothman KJ.  Modern Epidemiology. Boston, Mass: Little Brown & Co; 1986: 38-39.
Anderson RM, May RM, Boily MD, Garnett GP, Rowley JT.  The spread of HIV-1 in Africa: sexual contact patterns and the predicted demographic impact of AIDS .  Nature. 1991;352:581-589.Crossref
Yorke AY, Hethcote HW, Nold A.  Dynamics and control of the transmission of gonorrhea .  Sex Transm Dis. 1987;5:51-56.Crossref
Plummer FA, Nagelkerke NJD, Moses S, Ndinya-Achola JO, Bwayo J, Ngugi E.  The importance of core groups in the epidemiology and control of HIV-1 infection .  AIDS. 1991;5( (suppl 1) ):S169-S176.Crossref
Plummer FA, Simonsen JN, Cameron DW, et al.  Cofactors in male-female sexual transmission of human immunodeficiency virus type 1 .  J Infect Dis. 1991; 163:233-239.Crossref
Laga M, Manoka AT, Kivuvu M, et al.  Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study .  AIDS. 1993;7:95-102.Crossref
Whittington WL, Jacobs B, Lewis J, Lee F, Edwards T, Nahmias A.  HIV-1 in patients with genital lesions attending a North American STD clinic: assessment of risk factors . In:  Program and abstracts of the Fifth International Conference on AIDS; June 4-9, 1989 ; Montreal, Quebec. Abstract T.A.P. 118.
Parker SW, Stewart AJ, Wren MN, Gollow MM, Straton JAY.  Circumcision and sexually transmissible disease .  Med J Aust. 1983;2:288-290.
Taylor PK, Rodin P.  Herpes genitalis and circumcision .  Br J Venereal Dis. 1975; 51:274-277.
Hooper RR, Reynolds GN, Jones OG, et al.  Cohort study of venereal disease, I: the risk of gonorrhea transmission from infected women to men .  Am J Epidemiol. 1978;108:136-144.
Smith GL, Greenup R, Takafuji ET.  Circumcision as a risk factor for urethritis in racial groups .  Am J Public Health. 1987;77:452-454.Crossref