Facing the global challenge

Introduction Spread of HIV/AIDS Community change agents Changing behaviour Introduction The HIV/AIDS epidemic in Vietnam is spreading rapidly. There is a relatively low percentage of HIV infection in the general population (0.3%, 2004) but it is high for injecting drug users (30%) and female sex workers (6%). Programs to prevent stigma and discrimination against people living with HIV/AIDS, and strengthen the involvement of communities in HIV prevention, care and support are important. A proactive strategy of working with highly mobile occupation groups, such as truck-drivers and the communities with whom they come into contact, was adopted to limit the spread. Spread of HIV/AIDS Many countries in Africa, as well as India and Thailand have found that major transmission of HIV first occurred along transport routes before spreading throughout the country. This is because truck-drivers, away from their families for long periods, are likely to have multiple sex partners at different truck stops along the highway. Poor women (and young girls) living near truck stops resort to commercial sex for income and are therefore vulnerable to HIV infection. In turn the infection spreads to the families of both drivers and sex workers. The spatial association between truck routes and HIV infection has led to the National Highway One Project in Vietnam, funded by the Australian Government's overseas aid program and implemented by World Vision. The project aims to prevent the spread of infection by increasing awareness of HIV infection and prevention among truck drivers and communities and by encouraging a change in behaviour. Due to the nature of their work, mobile groups such as truck drivers have limited access to health services and to health care information and this make them a vulnerable risk group for HIV/AIDS infection. National Highway One is the main channel for movement of both goods and people between north and south Vietnam. Importantly it is also linked to cross-border traffic with China, Cambodia, Laos and Thailand. The project involved prevention activities at nine locations along 300 kilometres of road in four provinces. Community change agents Community members, such as restaurant workers and other service workers who are in frequent contact with truck drivers, were trained to distribute information and educational materials (including leaflets, key-rings, and audio-cassettes containing songs interspersed with conversations between truck-drivers) and supply condoms. The aim was to convince drivers to change their sexual behaviour in order to reduce the risk of HIV infection. While a variety of information materials was used, pocket-size material that could travel with the truck drivers has been particularly effective. Truck drivers themselves provided suggestions about the design of the materials and a tyre-carrying condom character appeared in various forms, from pictures to roadside statues (see photo). The message is simple: a spare tyre and a condom - two rubbers a driver should never leave home without! The spare tyre-carrying condom appears in eye-catching statues beside Highway One, reminding drivers to carry two kinds of "rubbers". The text says "Safe sex helps people stay healthy"      Murals painted by community members helped to remind everyone that "Condoms help to prevent HIV/AIDS."; Choosing to contact the drivers at small truck stops meant there was more opportunity for conversation, without the distractions provided by larger towns. Young men and women in roadside locations took part in education sessions and produced colourful murals and billboards which reinforced the message that HIV/AIDS threatens everyone, not just 'high-risk groups'. By educating the wider community, and urging sex workers to insist on the use of condoms and to seek treatment for sexually transmitted diseases, the project aimed to create an environment that would encourage a change in behaviour. Changing behaviour A survey of truck drivers passing through the project locations found that the educational materials have been distributed as far away as Ho Chi Minh City and Hanoi. The demand for condoms is increasing and condoms are becoming more available and more acceptable locally. One villager commented, "Sex without condoms is like walking barefoot." Since this project began in 1998, interest in the link between HIV and mobility has increased, and other projects are being implemented within Vietnam and in the greater Mekong region.

National Highway One runs the entire length of Vietnam from Hanoi to Can Tho. It is also linked to cross border traffic with China, Cambodia, Laos and Thailand.   The project aimed to spread the message about preventing HIV/AIDS along major transport route.