Driving change: Fighting HIVAIDS one truck stop at a time

William Kikomo, a truck driver, is a married man who can be on the road for more than six months. Apart from the warmth of the truck heater, sometimes the body needs the warmth of another human. The easiest way is paying for sex.

We meet Kikomo at the Mlolongo weighbridge, where there is a clinic that provides health services to truck drivers.

“We experience so much on these roads. There’s danger, exhaustion, physical and mental suffering, and loneliness. Sometimes we get sex workers, agree on the amount, and go. But since I am responsible, I use condoms. When I don’t use protection, we usually get PrEP from these facilities near the weighbridges. They also teach us how to use PrEP,” he says.

Pre-exposure prophylaxis (PrEP) involves people with a substantial risk of contracting HIV taking a pill every day to prevent infection.

The facilities are strategically placed near weighbridges: One at Mlolongo (Machakos), Emali (Makueni) Mai Mahiu (Nakuru) and Salgaa (Nakuru).

Kikomo says the facilities have been instrumental in the fight against HIV/AIDS. However, not all truck drivers embrace them.

“There’s a truck driver who had an STI, but he didn’t go to the hospital. By the time he allowed me to bring him here, the infection had spread, and he couldn’t even walk. But he was assisted,” he says.

Outside the clinic, we spot another truck driver leaning against the clinic’s container, sipping water.

We introduce ourselves and explain why we are there. He is initially sceptical about talking to us but eventually agrees to share his story. Due to the nature of the story, he chooses not to use his real name. So we will call him Dave.

Dave is also married with children. He says he pays for sex but does not practise safe sex all the time, so PrEP comes in handy.

Like most men, he prefers having sex with women, but once in a while, he enjoys male company.

“Ni mara moja moja (It’s once in a blue moon), but most of the time, I prefer women. I am married. We always agree beforehand. If it’s with protection, the price is lower; without protection, the price is higher. The clinics provide condoms and other forms of treatment,” he says.

He adds that before the clinics were introduced, they would go to chemists, which were not as helpful.

Men Having Sex with Men (MSM)
After speaking with Dave, a nurse at the clinic introduces us to Steve, a man who has sex with men, also known as MSM.

Steve says he is not a sex worker but has multiple sexual partners.

His attraction to men started in high school. However, he began visiting the clinic after experiencing recurring infections.

“Apart from infections, the biggest challenge is stigma. When you look at me, you cannot tell I am an MSM. But this facility has helped me overcome stigma. North Star Alliance has trained us on acceptance and the importance of taking care of our health,” he says.

Steve says a large percentage of the men he has sex with do not like using protection, especially if they have been drinking.

However, after seeking treatment for multiple STIs, Steve’s mantra changed to “No Condom, No Sex.”

“Nimejikuta na STIs kadhaa (I have treated quite a number of STIs). From gonorrhoea, the one that shocked me was syphilis. That one almost ended me. I don’t even want to hear the name syphilis,” he says.

Steve laughs and adds: “Tulilaumu shetani (We blamed the devil), but I just decided to come for treatment, and now I am careful,” he says.

Steve says some of the men he has sex with are openly gay, while others are still in the closet. They are married with kids but still seek the adventures life has to offer with men.

Female Sex Workers

Thirty-three-year-old sex worker at Mlolongo, Maureen Muthai, says their hotspots are near the weighbridges, where truck drivers stop to rest.

“These men travel from Mombasa to Kampala. Long distance, na mwili ni mwili tu inaitisha (the body has needs), so they stop and ‘service’ their bodies,” she says.

On protecting herself against HIV, Maureen says she uses protection but is also on PrEP, just in case she encounters a client who does not want to use a condom.

“I cannot get a client who is offering Sh5,000 per night without a condom and say no. We can start at 9pm, then he leaves by 4am,” she says.

Sometimes they visit VCT clinics at night before embarking on a night of pleasure.

Maureen works at the clinic under North Star Alliance. She is one of the peer educators responsible for distributing condoms, lubricants, and counselling to other sex workers.

The first time she came to the clinic was when she had tuberculosis (TB). After recovering, she joined the North Star Alliance team.

High Workload
Judicaster Kanini John, a clinical officer at the Mlolongo North Star Alliance Clinic, says the one-block unit caters to a population of 21,000.

“We have 18 staff members—12 from Machakos County and six from North Star. We have around 28 peer educators. We also work closely with the gender desk at the Mlolongo Police Station,” she says.

In a month, they handle 4,000–4,500 outpatient cases, 2,173 female sex workers, 175 men who have sex with men, and 1,335 truck drivers.

Some 420 are under the defined package of care. According to the World Health Organization (WHO), the defined package of care includes HIV screening, treatment, prophylaxis for opportunistic infections, antiretroviral therapy, adherence support, and CD4 cell count testing to identify people with advanced HIV/AIDS.

“If a truck driver tests positive, we enrol them on ARVs. If they are negative, we do a follow-up. We screen for STIs and treat them. We handle GBV cases and work with paralegals. We also screen for depression as most of our clients face numerous challenges. Additionally, we screen for alcohol abuse. If the results are positive, we refer clients to specialists and provide serial counselling,” says Kanini.

Jackson Mutuku, coordinator of HIV and STI services in Athi River Sub-county, says the Mlolongo clinic has a very high workload, embracing integration.

“This facility rivals Athi River Level 4 Hospital in terms of workload. They serve key populations, vulnerable groups, and the general population,” he says.

Carol Ndung’u, from the Long-Distance Truck Drivers Union, oversees the health of truck drivers under the Highway Community Resource Centre, which was established after recognising the exposure drivers face to various diseases.

“HIV specifically, because some have multiple sexual partners along the highway. We have resource centres near weighbridges and border points for easy access. If we don’t take care of their health, we will face issues with other diseases. Remember, they travel internationally, so the exposure is high. We’ve seen this recently with Mpox; they are a leading population. This is a group we cannot overlook,” she says.

Eva Mwai, Director of North Star Alliance, says the organisation started by converting containers into clinics to provide HIV services following the health challenges truck drivers encountered.

“We expanded the scope to cover other diseases truck drivers present with. It is difficult for them to find health clinics. We have about 20 clinics in Southern and Eastern Africa. We provide services even in hotspots to deliver health services and education,” she says.

World AIDS Day 2024
This year’s global theme was “Take the ‘rights’ path,” emphasising the importance of human rights in the fight against HIV/AIDS.

The national theme was “It’s a race against time,” promoting the health and well-being of men and boys.

According to Caroline Kinoti, Deputy Director in charge of Health Promotion at the National Syndemic Disease Control Council (NSDCC), this year’s theme focuses on men because they exhibit poor health-seeking behaviour, leading to poor health outcomes.

“We need a transformative and impactful approach that acknowledges the power of family and social units to address declining social capital and responsibility for the health and well-being of the boy child,” says Kinoti.

She adds that there is a need for commitment to addressing cultural, policy, and legal barriers that create an environment facilitating positive behaviours and the uptake of health services among boys and men.

To ensure men participate in this year’s World AIDS Day commemorations, the NSDCC  organised a marathon at Nyayo National Stadium that included a half-marathon (21 kilometres) for professional runners, a 10-kilometre short race, a wheelchair race, a friendly race (five kilometres), a corporate race (five kilometres), a CEO race (five kilometres), and a race for children (two kilometres).