AIDS - Acquired Immune Deficiency Syndrome - is a severe life threatening illness. It represents the late clinical state of infection with a virus called Human Immuno-deficiency Virus (HIV). This virus progressively destroys the self protective immunity system of the body against infecting germs (bacteria, parasites and viruses). These germs take advantage of the opportunity to invade the body when it reaches the clinical state of AIDS and induce ‘opportunistic infections’ which can grow freely despite the use of commonly effective medicines. The free growth of these infections allow disease of various organs like lungs, intestines, and the brain to cause the patient’s death. People infected with HIV are destined to die when their body reaches the clinical stage of AIDS as victim of one or multiple ‘opportunistic infections’ (Nag Moni, 1996).
Most of the people infected with HIV in India are not aware of their infection. Even if they are aware, they may not disclose the fact to others who are at a high risk of being infected by them. Generally, the major risk groups identified are Commercial Sex Workers (CSWs), Truck Operators (TOs) and Injecting Drug Users (IUDs) who may spread HIV to the common people. The risk behaviour of CSWs are their involvement in sex with multiple partners. Truck Operators also have the risk behaviour of frequenting the sex workers. Injecting Drug Users share the needles and syringes with their drug partners which poses the risk of transmitting HIV from infected persons to others.
It is the risk behaviour, not the mere risk group, which is causing great concern. Everybody including risk groups are at equal risk of catching the virus. The virus does not discriminate between people. The social stigma and the general perception associated with AIDS is further complicated by widespread ignorance, poor information and misconceptions in the society. In India people avoid talking about sex and hide their sexual behaviour. The hidden but unsafe sex with multiple partners is very much prevalent in the community which does not realise AIDS as a problem. The premarital sex with multiple partners is increasing out of modernism and openness in adolescents too. The curiosity and needs due to physical changes lead adolescents to experimentation which poses great risk of catching HIV to a new generation. (Kalra, R.M. and Kalra S. 1996).
Although HIV can be transmitted through blood/blood products and from infected mother to her child, the principle mode of infection in India is sexual behaviour, mainly the heterosexual intercourses. Both STDs and HIV/AIDS are associated with the same risk behaviour, that is sexual intercourse with multiple partners. There is growing evidence to show that the presence of an STD greatly facilitates both the acquisition and transmission of HIV infection. Early diagnosis and treatment of STD has, therefore, the potential to reduce the transmission of HIV infection.
This has important implications for any attempt to prevent the spread of HIV. Out of the total 3188 infected persons till 31st January, 1997, 2333 (73.3%) were infected through heterosexual promiscuity. Other important modes of infection are sharing infected needles and syringes used in taking intravenous drugs (8.2%) and blood transfusion (6.8%).
A research study called the "Knowledge, Attitude and Practice (KAP) About STDs and HIV/AIDS: A Comparative Study of Risk Groups and General Population" was undertaken among 153 Truck Operators (TOs) covering `Dhabas’ at different highways in Rajasthan (Mishra Rajesh, 1997).

Observations and Findings
In the first part, the results on the knowledge, attitude and practice are discussed and analysed for TOs. In the second part of the analysis, some composite indices have been developed to present the complete knowledge of STDs and HIV/AIDS (comprises all segments of knowledge like; medium of infection, precautions for safety, symptoms etc.) and STD prevalence. The findings of STDs prevalence have been reached by combining the responses on risk behaviour and treatment practices. The limitation of the findings is that these are based only on symptoms and responses of the people and not on confirmatory laboratory tests. The findings should be viewed in the light of these limitations inherent in the study.

Table 1: Knowledge about STDs

The table presenting the knowledge of TOs about STDs shows very interesting facts. The level of knowledge on different aspects of STDs is surprisingly very high in comparison to the other risk groups. This may be attributed to the fact that there is high prevalence of STDs among TOs. More than half of the TOs are fully aware about the symptoms, reasons of infection, safety precautions and future complications of STDs.

Table 2: Attitude Towards sexual contact with a partner suffering from STD

The highest proportion of TOs (56.1%) expressed the feeling that they would not establish any sexual contact, knowing that the partner is suffering from STD. 39.4% of TOs had the attitude of having relation but with condom. A small proportion (only 4.5%) had no fear in having sexual contact with a partner suffering from STD. These results show a positive attitude of majority of TOs.

Table 3: Safety Precautions for STDs

In multiple responses to safety measures adopted by TOs, the highest proportion goes to cleanliness. It is followed by 56.8% of TOs using condoms during sex with multiple partners (mostly with sex workers). Around 48.5% of the total 132 TOs used to go for regular check-ups to avoid the problem of STDs, especially they go to the clinic when they face some problem in their genital organs. Thus, we can say that half of the TOs are taking precautions for the safety from STDs.

Table 4: Treatment Practices for STDs

The treatment practices of the TOs who has suffered from one or another type of STDs is presented in the above table. This shows STDs prevalence alarmingly high in TOs. Around 75% of total 132 TOs have suffered at least once from minor to major problems of STDs during last one year. Around 46.2% consulted doctor for treatment followed by 18.2% with no treatment, 26.5% of TOs expressed that they never faced the problem of STDs.

Table 5: Knowledge about HIV/AIDS

72.7% of the total 132 TOs had accurate knowledge about AIDS as a disease which has no treatment. 62.1% know about the ways of infection followed by 50% knowing the means of protection from HIV/AIDS. Though the knowledge of separate aspects of HIV/AIDS is much higher, but taken all these aspects together, this proportion falls down. It shows that they have knowledge but not the complete knowledge.

Table 6: Use of Condoms

*Total number of TOs visiting Commercial Sex Workers.

As the above table shows only 14.3% of the total 112 TOs visiting CSWs use condoms during sex. It is followed by 10.7% using condoms most of the time but sometimes non-availability of condoms causes them to establish sexual relation without condoms. 47.3% TOs use condoms at times but not regularly. Around 27.7% of TOs were found not using condoms at all.

Table 7: Source of Knowledge about HIV/AIDS

As the table shows, electronic media, print media and poster/banner are the major sources of information about HIV/AIDS. Since TOs are always on the highway, most of the information they do get are from hoardings at road sides. The impact of NGO as well Government programmes is very little in increasing the HIV/AIDS awareness of TOs. It may be due to limited interventions from GOs and NGOs among Truck Operators.
This section of the analysis deals with composite indices developed to present more specific conclusions about knowledge, attitude and practices. The major indices developed are STD knowledge, HIV/AIDS knowledge, and STD prevalence.
The knowledge has been presented into three categories i.e. complete, misconceptional and incomplete for both STDs and HIV/AIDS. Misconceptional knowledge represents the complete knowledge but associated with certain misconceptions like STDs or HIV/AIDS can spread by shaking hands, eating together, exchanging clothes etc.
The STDs aspect in this study strictly covers only Bacterial STD like Syphilis, Gonorrhoea, and some vaginal infections like Gardnella and Candidiasis. The symptoms of all these STDs has not been included separately for each but broadly for all types of STDs.

The combinations used to reach these four indices are as follows:

STD like Syphilis, Gonorrhoea, and some vaginal infections like Gardnella and Candidiasis. The symptoms of all these STDs has not been included separately for each but broadly for all types of STDs.

Table 8: Composite Analysis

As the above table shows only 28% of the total TOs have complete knowledge about STDs and 13.6% have many misconceptions about this. If we see the HIV/AIDS knowledge, we find that 37.1% of TOs have complete knowledge about it followed by 10.6% with misconceptional knowledge. It is obvious that the level of complete knowledge is very low for both but it is higher for HIV/AIDS from community as well from the service side. Even the level of misconceptions is higher in the case of STDs. The STD prevalence is very high among TOs. Around three-fourth of the TOs have suffered from one or another type of STDs during the last one year. Alarmingly high prevalence of STDs among TOs is a matter of great concern. They would catch the killing virus at large in the years to come if appropriate actions are not taken in time.

Conclusions
Prevention is the only cure for HIV//AIDS. This fact necessitates for education about STDs and HIV/AIDS, motivation for attitudinal change and intervention for safe practices among TOs. Only a proper knowledge, positive attitude and safe practices can save them from the killing virus.
Truck Operators form a group of high risk behaviour involved in multi-partner sex. TOs moving on the highways are usually away from their families for long durations. This causes them to visit sex workers for their sexual pleasure and thereby falling prey to HIV transmission.
Majority of the TOs belong to the sexually active age-group of 20-30 years. Around 25 percent of TOs are literate and understands the risk of HIV infection. Most of the TOs are from joint family system and majority of them are married and have children. The knowledge of TOs about STDs and HIV/AIDS is also very poor. Around 85% of TOs are found frequently visiting sex workers. The use of condom is very low among TOs. Only 1 of them are consistently using condoms.
The very high prevalence of STDs is causing a great concern and posing great threat of wide-spread HIV infection among truckers. In different government and nongovernment activities to check the HIV infection among risk group; this group has not received proper attention. The following suggestions are made to rectify the situation.

Suggestions

1. Integrated efforts from government and non-government organisation should be initiated to provide information and knowledge about the causes and consequences of prolonged STD problem and its association with HIV/AIDS and the necessary precautions for safety.
2. Non-availability has emerged as major factor for low use of condoms. Government should take the initiative for condom promotion and free distribution of condoms from Dhabas (halt points) on major truck routes.
3. Comprehensive interventions are required for STD diagnosis and treatment and health promotion leading to safer sexual activities. These services could be provided by establishing STD and health clinics at major halt points on the highways. NGOs should be involved in a bigger way to provide this services package to truckers.

Reference

1. Kalra, R.M. and Kalra S. 1996, Adolescents and AIDS: A new generation at risk, New Delhi: Vikas Publishing House Pvt. Ltd.
2. Mishra Rajesh, 1997, Knowledge, Attitude and Practice About STDs and HIV/AIDS: A Comprehensive Study of Risk Groups and General Population, Jaipur, Rajasthan Voluntary Health Association.
3. Nag Moni, 1996, Sexual Behaviour and AIDS in India: Vikas Publishing House Pvt. Ltd.
4. Sehgal P.N., 1997, Towards Effective Policy and Strategy for HIV Infection/AIDS, New Delhi, Voluntary Health Association of India.

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