Leaning against his brightly painted truck, Muhammad Rafiq, 30, looks furtively at the two condoms he holds in his hand. "I plan to use these soon, but I hope I can remember to do so when the time comes," he says, a little shyly.
Rafiq, from the town of Kohat in Pakistan’s North West Frontier Province (NWFP), is an exception. A long-distance truck driver who regularly transports goods from the southern port city of Karachi to Lahore and up to Peshawar along thousands of kilometres of highway, he says he "quite often" uses a condom, and generally only has sex with women.
There are thousands of truck drivers like him, many of them young men from northern parts of the country. Displaced from their home, families and social environments, they are one of the groups most vulnerable to HIV/AIDS, mainly because of the dangerous behaviour they engage in, including multiple sex partners and drug use.
The huge truck terminal at Mauripur in Karachi, one of the busiest in South Asia, sees 20,000 trucks pass through it each day. The terminals in Lahore, including the ones located at Badami Bagh in the congested heart of the city where Rafiq parks his truck, are less busy, but still accommodate thousands of the giant, rumbling vehicles, gaudily decorated with lights, coloured paper and mobiles that spin in the slipstream, arriving from destinations outside the city each day.
According to limited research carried out on the subject, very few among the thousands of long-distance truck drivers in the country are as cautious as Rafiq, who says he picked up information on HIV/AIDS from television, and is anxious to protect his wife from the "incurable illness."
Others among the small gang of truck drivers who Rafiq hangs out with while in Lahore generally confess they do not use any protection. "It is all in Allah's [God's] hands anyway. Besides, a condom is not always available," says Dilshad, from the Attock area of northern Punjab.
He adds that he knows a former truck driver who now has AIDS, but refuses to provide details as this man has sworn him to secrecy. "He was diagnosed by a doctor in Karachi, but he has not told anyone, not even his wife, because of the stigma," explains Dilshad.
"We are aware that long-distance truck drivers are among the groups most at risk from HIV/AIDS," said Raza Hussnain, coordinator of the Islamabad-based Amal Human Development Network, an NGO which since 1994 has been working on raising awareness about HIV/AIDS.
Talking to IRIN, Hussnain explained that the organisation worked with "marginalised communities, and aimed to raise awareness and change the lives of affected people."
The task is not an easy one. There seems, in the minds of many of the truck drivers, to be a strong association of condoms with contraception, but not with protection against sexually transmitted diseases (STDs) including HIV/AIDS.
These gaps in knowledge are largely due to limited official awareness-raising efforts. Categorised by the World Health Organization (WHO) and UNAIDS as a low prevalence, but high-risk country with regards to HIV infection, Pakistan has recently witnessed a rapid rise in rates on infection, mainly among injecting drug users.
According to UNAIDS, about 85,000 people in Pakistan, or 0.1 percent of the adult population, are infected with HIV/AIDS. Heterosexual transmission (52.55 percent) and contaminated blood or blood products (11.73 percent) are the most commonly reported modes of transmission for HIV/AIDS in Pakistan.
This is one of the reasons why the country's long-distance truck drivers are seen as a group particularly at risk. Away from home for prolonged periods of time that sometimes stretch into months, most truck drivers are believed to engage in regular sex with both female and male sex workers, including 'hijras' or transvestites.
The limited studies carried out indicate HIV infection stands at around 1 or 2 percent among female sex workers and long-distance truck drivers.
Among injecting drug users, the rate is much higher. According to a 2004 UNAIDS study, 10 percent of injecting drug users in the town of Larkana, in Sindh province, tested positive for HIV/AIDS.
Ministry of Health findings have found that over 20 percent of female sex workers in Karachi and Lahore had sold sex to injecting drug users and condom use was very low during those encounters.
High intravenous drug use among truck drivers means that the unsafe sexual practices they routinely engage in make them extremely vulnerable to infection.
"Most of us smoke 'charas' [marijuana] or other substances. It is essential if we are to survive the long, relentless hours of monotony on the roads. But now more and more of the truck drivers have also started injecting drugs," says Rafiq. He believes the use of injected drugs is most common among "the younger drivers, some just out of their teens."
While the drivers often seem to be at least vaguely aware of AIDS, they have little real idea of how they can protect themselves from the virus. Many argue that their way of life - the sex with both women and men and the drugs - are a part of a culture of migrant workers in the country that has "been just the same for decades."
"We need some recreation, something to do to relax – otherwise how would we be able to continue with the work we do? Women, sometimes 'hijras' or drugs offer us this relaxation," says Asif Jan, a 25-year-old trucker from Lahore.
Many also confess that rather than doctors, they turn to traditional healers, or 'hakeems', when they are ill or suspect they have contracted an STD. Several hakeems based at tiny clinics on the Grand Trunk Road that winds its way up to Peshawar are well known to the truck-drivers, who depend on their powders and potions.
The lack of interaction with orthodox medical practitioners, coupled with a somewhat confused understanding of the HIV/AIDS issue, means the truck drivers, regularly seen gathered at roadside cafes near the truck terminal in Lahore, are at high risk of infection.
Observes say an awareness programme targeting the group and its specific culture is desperately needed to help reduce their vulnerability and save them and their families from the dangers they face from HIV/AIDS.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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