Taking HIV prevention on the road
22 March 2010
For many in West Africa, the road network is a vital socio-economic lifeline but it can also be a way for the spread of HIV. An ambitious programme, the World Bank Abidjan-Lagos Transport Corridor (ALCO) project, has seen marked success in helping people living and working along this highway to reduce their vulnerability to HIV. ALCO’s results, opportunities and challenges are analyzed in a recent World Bank report, part of its HIV/AIDS in Africa: Getting Results series.
The report highlights that HIV prevalence in the transport sector is higher than in the general population, and with some 14 million people travelling along the 1,000 kilometre corridor each year, need for an effective intervention was clear.
The ALCO project, set up in 2004 and sustained since 2007 by a grant from the Global Fund, identified some of the circumstances on the road stretching from Cote d’Ivoire to Nigeria conducive to high risk behaviour. For example, many truck drivers and other mobile workers spend large amounts of time away from their families and often have multiple partners. These include sex workers and others living along the highway and around truck stops.
The aim of the project was to provide HIV prevention services to people in these areas such as truck drivers, sex workers, travellers, border communities and military and customs officials.
Multiple partners participated in the project, including national and local government and the health and transport sectors. Stakeholders were brought together on a number of levels and often with distinct concerns and priorities. 87 implementing agencies were engaged in total, with the World Bank offering targeted technical support. UNAIDS, according to the report, provided technical and financial support and was crucial in bringing the project to completion.
The programme had three facets. The first one involved HIV prevention and concentrated on behaviour change, increase HIV awareness and condom distribution. In three and a half years, more than 600 condom sales points were set up along the route and nearly nine million condoms distributed.
The second component, care and support, included providing voluntary HIV counselling and testing, community based care, diagnosis of opportunistic and sexually transmitted infections and antiretroviral treatment.
The final aspect involved inter-country coordination, training and policies to maximise the benefits of working across borders on a regional project, and reduce the long waits at border crossings.
Several lessons were learned, such as the importance of the strong participation of HIV-positive people: the West African Network of People Living with HIV/AIDS was a key partner. According to the project’s managers, the integral involvement of PLHIV and the sense of their ownership of the project helped to make it a success. There was also a harmonised, cross-border, evidence-based communications strategy which provided consistent messaging, emphasised community participation and engaging gatekeepers, built communications capacity in both traditional and non-traditional service providers and paid specific attention to gender issues.
By the end of the project’s first phase, some 28,000 people along the corridor had accessed voluntary HIV counselling and testing services and nearly 1,500 border town residents had been trained as key community AIDS information, education and communications activists.
HIV prevention knowledge increased dramatically in the target populations, from 50-68% to 83-88%. Condom use at last encounter increased significantly, and prevalence of other sexually transmitted infections among sex workers fell markedly. Other knock-on effects have included an increased commitment to workplace AIDS programmes in the transport sector.
The project has not been without challenges. From programme materials to systems and the forging of new partnerships had to be set up from scratch. Building grassroots capacity was described in the report as difficult and costly. The cross-border nature of the project also required a huge effort in coordination, time and diplomacy, with a need to work in both English and French and an array of local languages.
However, the Corridor project has made a real and measurable difference in HIV-related knowledge and behaviour amongst people living along West Africa’s Abidjan to Lagos transport route. The five year follow-on grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria is making it possible to sustain this success.
According to the report, “Perhaps the most important contributions of the Abidjan- Lagos Corridor Project have been bringing HIV prevention programmes to very hard-to-reach and vulnerable people and establishing a platform for regional integration beyond AIDS and transportation.”