This community-based cross-sectional study was conducted during a health screening camp (October, 2018) organised in Transportation Company at Faridabad, Haryana. As requested by the company, a health screening camp for diabetes, asthma, Chronic Obstructive Pulmonary Diseases (COPD) and colour blindness including general health check-up was organised by a team from the tertiary care hospital and medical college of district Faridabad. Keeping in view a large number of truck drivers, as their employees, HIV counselling services were also provided by an expert HIV counsellor. The ethical clearance was sought from Institutional Ethical Committee. (IEC no. 134/A/11/16/Academics/MC/2016/174).

Inclusion and Exclusion criteria: During the one-day camp, out of total 153 employees, 117 truck drivers and their helpers were interviewed. The study enrolled only those that were currently working in the transportation company. All the participants had income less than 21,000 per month and were covered under Employee State Insurance (ESI) Act. Those who were uncomfortable in answering all the questions and did not consent to participate were excluded.

Study tool and data collection: The study tool used was a structured, close ended questionnaire. The questionnaire consisted of three parts: the first part covered socio-demographic profile and information regarding substance abuse. Second part of the questionnaire was used to assess the sexual practices and misconceptions regarding condom usage prevalent among truck drivers. Third part of the questionnaire dealt with their status of HIV Testing. After the general health screening by the physicians, the participants visited the counsellor. All the truck drivers were interviewed after obtaining the informed consent in a separate enclosure to maintain privacy and confidentiality during data collection. After the completion of interview, the truck drivers were educated about various modes of acquiring and preventing HIV infection and promotion of use of condoms.

Data was entered in Microsoft Excel. Commercially available statistical software (SPSS version 21) was used for analysis. Results are expressed as absolute numbers and percentages. Fischer’s-exact and Chi-square tests were applied to test differences in proportions. Student t-test was applied to test the differences in mean between two groups. Differences were considered to be statistically significant at p-value <0.05.

The present study included all male participants with mean age 31.36 years (SD±7.46). Majority of the study participants were migrants (97.4%) and having qualification either less than high school (38.5%) or graduate (17.9%). Total of 23.1% of the study participants were married, 51.3% participants were chronic alcoholics and habit of tobacco intake was observed in 53.8% [Table/Fig-1].

Majority of study participants were sexually active (102; 87.2%). Among the sexually active participants, condom usage (general use) was found to be 41.2% (42/102). Condom used during the last intercourse was reported by 5.9% of participants. Education status did not show any significant trend of regular condom usage as it was prevalent among 46.2% of those who were educated less than high school and among 57.1% were graduates. Half of the chronic alcoholics reported of using condom (50%), as compared to 28.6% of non-alcoholics (p=0.041). Condom usage was reported by 38.1% of those consuming tobacco in any form. Majority of the sexually active study participants (92.8%) had more than one sexual partner in last 12 months. Around one fourth (25.9%) of the sexually active participants with 2-3 partners were using condom. And this proportion increased as the number of sexual partners increased (p<0.001). Among the sexually active study participants, 14.7% (15/102) were married; 80% of the married sexually active participants (12/15) were not staying with their spouse. Majority of participants stayed sometimes with their spouse/partner (73.5%) and out of these 92% had 2-3 sexual partners and 8% had four or more partners [Table/Fig-2].

When inquired about the reasons for non-usage of condoms during last intercourse, majority responded that a condom is not required while having sex with wife (36.4%) [Table/Fig-3]. Preferred location for buying condoms was a chemist’s shop in 46.1% (47/102).

Only 14.7% (15/102) of all the sexually active participants were ever tested for HIV. Trends from the study show that HIV testing was more prevalent among those who were serving for longer durations in the profession (7.02±5.49 years) as compared to those who were in the profession for short duration (5.47±5.89 years). Half of the sexually active participants living with their spouse/partner (50%) tested for their HIV status as compared to 12% of those who sometimes stayed with the spouse (p-value=0.041). Total 20% (3/15) of the married sexually-active participants got tested for HIV, out of which none stayed with their spouse. The 13.7% (12/87) of unmarried/divorced/widower sexually-active participants tested for HIV. Surprisingly, participants having low education status underwent HIV testing whereas none of the graduates from the sexually active study population tested themselves for HIV status [Table/Fig-4].

Total 87.2% of study population was sexually active while 23.1% were currently married. Among the sexually active truck drivers, condom usage (general use) was 41.2% and 5.9% in the last intercourse. Sexual intercourse with wife was one of the major reasons of not using condoms; 14.7% of sexually active participants got their HIV status checked. Sawal N et al., in his retrospective analysis found condom usage to be 45% [6]. Condom usage during last intercourse was reported by Schneider JA et al., as 19%., and this was higher as compared to current study (5.9%) [7].

In a study conducted by Singh RK and Joshi HS more than half of truck drivers of their study area reported of having more than one sexual partner in last three months. The present study also has 92.8% of participants having more than one sexual partner [8]. Possible reasons could be long absence from home and readily available commercial sex partners at their resting places. A higher proportion of condom usage was reported by Singh RK and Joshi HS among those who visited Commercial Sex Workers (CSW) as compared to those who did not [8]. Present study also observes better condom usage among those having multiple partners as compared to single partner. Although CSW visit was not enquired about in the current study but multiple sexual partners were considered as a proxy of high risk behaviour. Improved condom usage was probably due to the fear of contracting sexually transmitted diseases as the number of partners increase.

Similar to current study Sawal N et al., did not report a significant relationship between pattern of condom usage and education status [6]. Lagarde E et al., their study among adults aged 15-49 years from sub-Saharan Africa, also reported a significant increase in condom usage with increasing education of both men and women [9]. The two surveys in Tanzania also identified educational level as a determinant of condom use [10,11]. The mean age of condom users was lower as compared to nonusers in current study. The younger generation seems to be more aware about usage and advantages of condom as compared to older age group. Alcohol users tend to have reported more usage of condoms as compared to non-alcohol users. Thakur A et al., in their study on truck drivers reported addiction to alcohol and tobacco in around 91% respondents and a low condom usage (36%) overall [12]. However, contrasting observation is reported when alcohol is taken with other stimulator drugs. No effect of alcohol use was also reported by a study in Sub Saharan Africa [9].

Pandey A et al., Singh RK and Joshi HS, Thakur A et al., and Mc Cree DH et al., in their study reported nonavailability of condoms, uneasy feeling during intercourse and not feeling necessary to use as some of the common reasons given by the truck drivers while visiting CSWs [2,8,12,13]. The responses on reasons of not using condoms are alarming as even after about three decades of launch of NACP, there are certain myths regarding usage of condoms which must be addressed properly in order to prevent risk behaviour among truck drivers.

Sex education for safe sex among the truck drivers is required so that they understand the importance of using condoms. Social vaccine as pointed by Ubaidullah M comprises of spreading education on how to protect oneself, hundred percent condom uses and changing sexual behaviour [14].

Preferred location for buying condoms in this study was chemist shop. The reason behind this preference may be that exceptionally high mobility observed among truck drivers and helpers affects their health seeking behaviour. Policy makers should strengthen the arrangements for condom distribution on highways by ensuring availability of the condoms through installation of vending machines at the Dhabas (roadside restaurants).

The single centric design of the study limits the findings to be generalised to all the truck drivers of the country. The study was conducted in a camp, hence, the small sample size and non-probability sampling strategy was there.

Long distance truck drivers and helpers have high risk sexual behaviour owing to their nature of work and longer durations of staying away from their homes. The major reason cited by the study participants for non-usage of condoms was that it is not required while having sex with wife. This myth may prove catastrophic and needs to be addressed on an urgent basis as truck drivers serve as a bridge population between high risk groups and general population in spread of HIV/Sexually Transmitted Infections (STIs). As most of the truck drivers were buying condoms from Chemist shops there is a need to strengthen the public system to gain faith of the community and to promote social marketing of condoms. The conclusion drawn from the present study is that health screening camps organised by various public and private agencies in the premises of factories/companies should be utilised for screening and counseling for HIV/STDs as well as for condom promotion.