PHCA9509 Public Health Practice Development


This is my third and final assignment. In continuation of my previous assignment, I am sending my second assignment. To continue the third assignment, it is requested that you use the references from the second assignment.

My topic is “to explore the HIV-related factors among truck drivers in INDIA”.

Please refer to the marking criteria that I have sent along with my previous assignment.

All literature should be written.

I would like to send you a rough idea of the structure of your assignment. Also, I have a sample of Narrative review literature review that may be helpful.

Examine the evidence and adapt the findings to your culture/setting.

Take a look at the results of the literature review and think about the implications for the topic you are interested in.

What you can expect from the paper.


Summary of Assignments 1 and 2 + AIM


How was the search conducted (again, how much of this can you carry over from Assignment 1 or 2?


Thematic analysis reveals themes that are worth listing.


Discussion of the SDoH in general under each theme


Discussion implications for PH practice within setting.


Summary of the report and future recommendations?



Since independence, India’s number one public health issue is HIV/AIDS.

The large proportion of people who are directly or indirectly affected by HIV/AIDS is the reason for this.

HIV represents one of the most severe diseases in the world. It was responsible for 36.7 million HIV-positive people worldwide in 2015.

UNAIDS (2013) reports that India is the country with the highest number of HIV-positive people in the world.

People with HIV/AIDS or at risk in countries like India don’t have access to proper healthcare services that include prevention, treatment and care.

There is also a high HIV risk among Indians.

Although truck drivers are known to engage in sexual activity, it is not clear if there has been any research into the social determinants that HIV affects Indian truck drivers.

They don’t know much about how HIV was spread to Indian truck drivers.

The HIV transmission pattern in India is shifting away from urban areas to rural populations, according to the World Health Organization (WHO) (Pandey and al.

Center for Disease Control and Prevention, India (Ghate et. al.) is a top priority location for the prevention and explosion infected truck drivers.

HIV prevalence and transmission rates vary depending on where you are located in India. Long-distance truck drivers engage in unprotected sexual activities, which increases the risk of HIV transmission.

The general population is also at risk due to the high rate of sexual activity among truck drivers.

The dynamics of the viral infection transmission among Indian truck drivers has not been fully understood.

It is important to reflect on the Human-Immune virus among Indian truck drivers. This would help in preventing and reducing HIV transmission.

This is an important issue to examine as it affects the reproductive health and quality of the Indian truck driver population.

The Research Goal

Although there has been a high level of HIV transmission risky sexual behavior in India, it is not well studied.

This research aims to examine the determinants and to review the literature to understand the HIV transmission patterns among Indian truck drivers.


This research used three main research methods: interviews, questionnaires, and the use of internet websites.

Interviews were used to gather information from Indian truck drivers.

Interviews were used to obtain information from the Indian truck drivers. They were asked about their lives on the highways and if they had ever been exposed to commercial health workers.

The couple was also asked about their lives and how they cope with being separated from their spouses.

This was the subject of 300 interviews with Indian truck drivers.

A few relatives were also interviewed about their HIV status and treatment.

A questionnaire is a way to collect data. It asks a series of questions that will gauge the opinions of individuals on a topic.

This study provided easy-to-read and understandable questionnaires to patients.

Although questionnaires can be used to research on many samples, interviews can provide more detailed responses and opinions.

You can access reliable information from a variety of websites without having to travel.

Websites can provide useful information for data collection and research.

PubMed Central, Cochrane Library for systematic review, Google Scholar and Scopus are the databases that were used to conduct literature reviews.

These databases are used because they have complete coverage of literature and provide information that is relevant to students, professionals, researchers, educators, and others.

These databases provided extensive information that was very helpful in our research.

Search terms or key words included



Sexually transmitted diseases


Style is everything


Truck drivers

Drivers of lorries

Education status

There are many reasons

Because there was not much information available after 2013, the timeframe for the search was 2011.

Analyzing the data and articles was done based on the main themes of the papers, which mainly focused on the risk behaviour and determinants for HIV infection among Indian truck drivers.

All papers from 2010 and later were excluded, as well as papers that diverge from the main theme of HIV-determinants among Indian truck drivers.

Criteria for inclusion and exclusion

INCLUSION- Article from 2011 to 2017.

Only English-language publications

This article will focus on long-distance drivers in India, so that it does not diverge from the subject of research.

Grey literature

EXCLUDED – Article published in a language other than English

This article is not just about truck drivers, but also on the population of migrants.

Article published before 2011.

Abstract that does not contain many key words

We were able to gather sufficient information about the factors that lead to HIV in Indian truck drivers, as well as their impact on public health. Also, we learned how to reduce HIV spread among Indians (Saggurti et. al.


All 200 journals, books, government papers, and student papers were taken into consideration.

Analyzing the abstract, 132 articles were omitted. They do not have the required focus on the determinants of the desired population.

The literature review that was done later revealed that certain themes were used to analyze the data. These included 14 research articles that focused on HIV determinants in Indian truck drivers.

The strongest themes associated with HIV transmission and spread among Indian truckers are time away from home and income.

Research revealed that the most consistent predictors were the use of condoms and risk behaviors, as well as the insufficient knowledge and awareness about HIV among Indian truck drivers.


HIV is a problem for Indian truck drivers

It is remarkable to see HIV in Indian truck drivers, where long-distance drivers engage in risky sexual activities alongside migrant workers and sex workers.

HIV spreads to the general population through sexual contact and the constant sexual partners of these primary populations.

This transmission to the general population is not a problem in India (Pandey and al.

A survey was conducted in Pune, India. It was found that 13.6% of HIV-positive women were married monogamous (Pandey and al.

Due to sexual contact with commercial sex workers, the HIV risk has been seen to have spread to other occupations like truck drivers and cleaners.

The HIV risk factors have been intertwined as truck drivers frequently have sexual contact with commercial sex workers. This has led to a significant increase in the spread of the virus.

HIV testing has been done on the wives of truck driver drivers. This indicates that they have contracted the virus from their husbands. HIV incidence is also increasing in the general population (Saggurti and al., 2012).

Drivers of Indian trucks are known for their risky behavior

Indian truck drivers are known for their risky sexual behavior with commercial sex workers. They also have similarities with truck drivers from other countries, such as Thailand and parts of Africa.

Condom use is less common in Thailand than in Africa. The best predictor of condom use is the type and level of the relationship.

Condoms are used by truck drivers with commercial sex workers, but not with their wives or partners who are considered to be stable.

Truck drivers in India were more likely to have sexual contact with commercial sex workers on the highway than they were with their partners who used less condoms.

This suggests that truck drivers in India have unprotected sexual contact with commercial sex workers, which indicates that there is a high incidence and transmission of HIV among them.

Mishra and colleagues.

2012, among 302 Indian truck drivers, 82% admitted to having sex with commercial sex workers on the roads. Only 28% used condoms regularly.

Schneider et. al. also conducted a study.

Schneider et al. (2012) found that 87% of Indian truck driver had sex with commercial prostitutes and only 11% of them used condoms.

HIV and Indian truck driver HIV were found to be strongly correlated.

Truckers who abuse drugs and alcohol had a higher chance of contracting HIV.

It can also be due to the irresponsible behaviour that people exhibit when they are under the influence alcohol and drugs.

Drunk drivers forget to use condoms when having sex with Indian commercial health workers (Mishra and al., 2012).

Sgaier and colleagues conducted an interview.

(2013) showed that South-eastern Indian truck driver drivers have little information about HIV transmission and prevention.

Interviews were conducted with 300 Indian truck drivers who visited for one to three days. They performed activities in almost all parts of India, including import and export.

These results showed that Indian truck drivers are a major vector in HIV transmission to the general population.

Sastry (2016) conducted a similar study. It revealed that truck drivers lack motivation and have sex only with their partners. However, they are more likely to engage in sex with commercial sex workers than with their partners.

According to Saggurti and colleagues, condom use was not encouraged among Indian truck driver wives.

HIV Determinants

HIV is mainly determined by sexual behavior, which results in HIV transmission.

HIV transmission in India has been linked to the sexual behavior of truck drivers.

Singh and Joshi (2012) conducted a cross-sectional study among Indian truck drivers on the Bhopal national highway. They found that 49% had been exposed to commercial sex workers and that the prevalence of HIV was 21.51 %.

While they were exposed to commercial sex workers, they did not use condoms and were careless.

HIV incidence is most evident at the truck loading and unloading sites, where they stop for documentation inspections spending considerable time (Ghate and al.

Truck drivers often live far from their families because of their itinerant occupation. This makes them more vulnerable to sex workers.

India’s trucking workforce is disorganized and chaotic. It has a loose structure that includes users, intermediates and truck drivers.

India is home to a large number of long-distance drivers and a strong road network.

Tan et al. found that Indian truck drivers are more likely to be exposed to female sex workers (FSWs), on the major highways in India.

A lack of knowledge and awareness about HIV transmission and infection is another factor.

According to a study by Kashuba and Weine (2012), HIV-infected truck drivers made up 302 of the 302.

They are the bridge population that transmit HIV to rural India.

Many Indian truck drivers can also be potential blood donors. This is a way for HIV to spread and carry out risky sexual behaviors.

They don’t know anything about HIV or the spread of it.

They lack knowledge about HIV and are not able to take preventative steps.

Truck drivers who have more income, a longer stay away from their homes, and multiple partners are more at risk.

Married truck drivers showed more risky sexual behavior than unmarried truck drivers (Saggurti, et al.

HIV spread can also be seen at roadside stops such as the dhabas (road side hotel), where truck drivers stop and are exposed to sex workers.

They use the dhabas as lodging and eat and are highly exposed to sex workers.

The average age of truck drivers is between 18 and 40 years.

Truck drivers are not known for their health-seeking behavior. They tend to seek treatment after the disease progresses or prefer to receive care from unqualified practitioners and home remedies.

Mitra and Sarkar (2011) found that truck driver drivers have a low HIV risk perception and their wives and partners are less likely to be affected.

This means that the Indian truck driver population is a major vector of HIV transmission.

Condom availability is also lower among high-risk truck drivers. The dhabas are also the main centres for HIV transmission to commercial sex workers.

They also have less access to healthcare services, which could lead to HIV spreading among them (Saggurti and al.

HIV Risk Behavior Influenced by Demographic Variables

A series of studies consistently showed that middle- to upper-caste Indian truck driver are more likely to use condoms than their younger, non-Hindu counterparts.

It was also found that married Indian truck driver drivers were more likely to have protected sex than the ones who weren’t married.

Caste distinction was also a problem. 52% of Indian truck drivers were middle-caste and more than 40% were from the lower caste. 7% were only high-caste.

This shows that HIV transmission and prevention can be hindered by caste (Thomas, et al.


These results demonstrate that there are many things that can be done to reduce the spread of HIV among Indian truck drivers.

Truck drivers travel long distances and contribute to HIV/AIDS spreading faster to a larger population.

This is why public health strategies to curb this threat should be targeted at a large population and provide long-term benefits (Weine & Kashuba 2012).

These measures are based on educating Indian truck drivers about HIV prevention and how to protect themselves from contracting it.

These truck drivers will be more aware of the dangers of HIV and can take preventative measures.

It is important to educate those who are positive. They will be able to learn how they can protect their family members and themselves.

Information on major media houses covering Indian truck drivers’ areas can help increase HIV/AIDS awareness.

Television and radio have the advantage of being able to cover large areas and transmit accurate and timely information about HIV, its causes and prevalence, as well as how to live with it (Saggurti and co-authors, 2012).

It is possible to encourage truck drivers to form working groups, especially if they are on the same routes or highways.

These groups have their leaders trained in HIV and are expected to pass on the knowledge gained during training to their members.

This is the best way for Indian truck drivers to be HIV-aware. They can engage in education and make decisions about the future.

They might decide to end unprotected sex or to continue to be faithful to their wives while they are away (Saggurti and co., 2012).

The Indian truck driver should have access to sufficient condoms.

Condom use offers 99% protection against HIV and other sexually transmitted diseases.

Promoting condom use among Indian truck drivers as well as the general population will help to reduce HIV incidences and spread.

As HIV can be contracted from any mistakes in condom usage, education should be given on how to use condoms correctly.

To prevent HIV transmission to their families, condom use should be encouraged even when they have sex with their wives.

(Weine & Kashuba (2012)

The public health sector can also help to reduce HIV spread by removing commercial sex workers from highways.

The public health sector can help reduce the number of commercial sex workers by offering them alternative income sources such as jobs in the farms and industries.

This will reduce the number and spread of HIV/AIDS-related morbidity and mortality in the sex industry and the overall population.

Public health also has a part to play in providing health equipment and materials such as dressings, drugs, etc.

Indian truck drivers should be able to access these materials.

Clear and precise results should be given by HIV testing machines.

Truck drivers need to be able to determine their HIV status in order for them to make informed decisions about their future behavior.

Commercial sex workers should have access to the test kits so they can quickly test their status as well as that of their clients prior to engaging in sexual activities.

People who test positive should be encouraged to show positive behavior (Ghate and al.

One of the conclusions was that HIV spread among Indian truck driver was made easier by their inability to spend enough time with their spouses and home.

By allowing truck drivers to return home more often, and giving them shorter trips, this can be fixed.

To build trust and faithfulness, the spouses should keep in touch.

They should be allowed to travel together on long-distance trips (Saggurti and co. 2012).


Long truck drivers in India are often forced to work long hours and be away from their spouses and families because of the nature of their job.

Because this group is sexually active, it is inevitable that they will be exposed to commercial health workers.

HIV infection is more common in these truck drivers, who are at high risk of contracting the disease.

This is why it is important to change the sexual behavior of truck drivers in order to protect them from HIV infection and prevent the spread of HIV to the rest.

Despite numerous public health campaigns being launched to raise HIV/AIDS awareness among these truck drivers, this study shows that there are still lacunae in their sexual behaviour.

These areas require strong action and significant efforts to overcome the lacuna.

Give sufficient information on HIV/AIDS transmission, and other sexually transmitted diseases.

There are many ways to transmit HIV/AIDS. This includes sharing sharp materials, such as needles, with heterosexual or homosexual partners.

Truck drivers, who are often drug addicts, may need to share needles in order to inject a drug substance intravenously. (Ghate and al.

Truck drivers should be encouraged to use condoms.

You can involve other stakeholders to obtain enough condoms for all truck drivers and commercial sex workers working on major highways.

These condoms can be distributed and delivered by truck drivers’ union leaders, transport owners, and other non-governmental organizations (Saggurti and co., 2012).

Refer to

Ghate M. Deshpande S. Tripathy S. Godbole S. Nene M. Thakar M. Risbud A. Bollinger R. and Mehendale S.

Infected HIV-infected persons in Pune, India. Mortality.

Indian Journal of Medical Research, 133.4, p.414.

Mishra R.M. Dube, M. Saggurti N., Pandey A., Mahapatra B., and Ramesh S. (2012)

There is a strong association between long-distance truck driver in India and adolescent entrance into the trucking business.

Mitra, A., and Sarkar D. (2011).

Gender inequalities and HIV-AIDS spread in India.

International Journal of Social Economics 38(6) pp.557-572.

2012, Adhikary, R.

Long distance truck drivers in India are at higher risk of heterosexual behavior: The role of marital status.

Indian Journal of Medical Research, 136.7(7), p. 44.

Adhikary R.

Moving towards safer roads: An assessment of Avahan’s prevention program among Indian long-distance truck drivers.

BMC Public Health 11(6), p.S15.

Pandey A., Sahu D. Bakkali T.. Reddy D.C.S. Venkatesh S. Bhattacharya M. Raj, Y. Haldar P. Bhardwaj D. and Chandra N. (2012)

The 2008-2009 estimates of HIV prevalence in India and the number of HIV-positive people living in India.

Raj, A.

Cross-sectional analysis using nationally representative data from India on male migration/mobility and HIV in married couples.

AIDS and Behavior 16(6), pp. 1649-1658.

Long-distance truck drivers and the health context: A culture-centered study of Indian truckers’ health stories.

Health communication, 31(2) pp.230-241.

Rapid HIV testing, circumcision and preexposure prophylaxis acceptance are the most important factors in determining social network and risk-taking behaviour among high-risk Indian men.

AIDS patient care, STDs, 26 (10), pp.631-640.

Sgaier S.K. Ramakrishnan A.. Dhingra N. Wadhwani A.. Alexander A. Bennett S. Kumta S. Jayaram M. Gupta P. and Piot P.K. (2013)

The transition of the Avahan HIV prevention programme from the Gates Foundation into the government in India.

Singh, R.K., and Joshi H.S. (2012)

Sexual behavior among truck driver.

Indian Journal of Public Health 56(1), p.53.

Johnson, B.T.

A meta-analysis of HIV/AIDS prevention strategies in Asia, 1995-2009.

Social Science & Medicine 75(4), pp.676-687.

Thomas, B.

Male HIV risk behaviors in men who have had sex with women from Chennai, India.

Kashuba, A.B. (2012).

A systematic review of the literature on labor migration and HIV risk.

AIDS and Behavior 16(6), pp. 1605-1621.

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