Tanga: An initiative by the Tanzanian government hopes to reduce HIV transmission along the country's expanding road network by targeting construction crews and the communities that surround them.
"The government requires that road construction companies implement HIV prevention services for their workers and for the community because this is one way through which HIV can very easily spread in a community," said Moses Kisimo, community HIV/AIDS coordinator in the northeastern district of Tanga. "The strategy is: Construct roads and also prevent the spread of HIV."
The Tanzanian government and the Millennium Challenge Account of Tanzania (MCA-T) - part of the Millennium Challenge Corporation, a US aid agency - have started HIV prevention initiatives, including condom distribution and HIV prevention education, among communities living along the roads they are constructing in the country.
Through donors such as the World Bank and the African Development Bank, Tanzania's road network has expanded significantly over the past decade, opening up remote rural areas to economic opportunities, but also to the dangers of HIV.
"Once you have road construction workers in an area, then one of the businesses that thrives there is sex work. You have women and girls selling food to these workers in the day and selling their bodies in the night," said Ernest Haraka, the district medical officer of Health in Mkinga, an area undergoing major road construction.
Research has found relatively high HIV prevalence in Africa's roads sector. Several studies have shown that long-distance truckers in Kenya and Uganda were more than twice as likely to be living with HIV as the general population.
Along the Tanga-Horohoro road, a 65km stretch of road connecting eastern Tanzania and Kenya, Suleiman*, a 35-year-old father of six, works as a truck driver. His current base is a construction workers' camp in Tanga. "We are here for six months then we move to another camp as work goes on," he said. "My family is far away. I need a woman to get back to after work. I can't lie to you that I use a condom every day," Suleiman added. "When you have a woman for six months, she is like your wife."
The MCA-T programme is trying to get both the construction workers and the community to significantly increase their condom knowledge, which remains low in many rural areas, as well as increase HIV testing.
"They should not just give condoms; they should teach people how to use them. Some people just take them but are afraid to say they don't know how to use them," said Paul Mukoja, a casual labourer at a construction site in Tanga. "Some people also think that condoms don't work well. I [also] need to be convinced they work. I know it will be difficult to make people go for [an HIV] test. People fear."
The MCA-T programme also uses local NGOs to teach staff at bars and lodges - many of whom double-up as sex workers - to negotiate safe sex.
Seventeen-year-old Julia has a construction worker boyfriend who supports her and her mother; she says the decision about condom use is his. "I met him when I used to sell food with my mother during weekends," she said. "I have left school to live with him; all I do is to sleep with him and wash his clothes."
According to Samuel Mtulu, programme manager at the Tanga AIDS Working Group, TAWG, a local AIDS NGO, HIV prevention is necessary, but equally important is poverty alleviation. "Most road construction work goes on in communities where people are poor and because these construction workers have comparatively more money," he said. "They use this to lure young girls and even married women into sexual relationships… Reducing poverty should be the main prevention method that the government ought to employ."
*Not his real name