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The Longest Road - Part I of III

The longest road in Africa runs from north to south, east to west and cuts through the hearts and lives of truckers and sex workers across the continent. It is a trail of tears and a trail of hope. The truck stops that were once hotbeds of AIDS/HIV and other sexually transmitted infections (STIs) have now become centers for healing thanks to the efforts of a small team of individuals that have worked tirelessly to stop the transmission of HIV in Africa. This is the story of that small team and lives of those they have impacted.

One of the most important jobs in Africa, trucking is also one of the loneliest. In the highlands of Southern Central Africa transporters will drive 18 hrs straight from Lilongwe, Malawi to Beira Port in Mozambique in order to pick up a load which they then deliver back to Lilongwe a day or so later. The cycle repeats itself and the more they drive the more money they stand to make. Transporters make good money on these runs but life on the road takes its toll.

Drivers are typically in their trucks 28 out of 30 days a month. The driving is difficult as they are forced to navigate steep grades as they climb into the highlands on moderately maintained roads. Tired and worn the drivers pull into border stations like Mwanza, on Malawi's southern end, where they will spend a night or two waiting for customs to clear their paperwork. In darkness of these highway stations the drivers seek out companionship and a bed for the night before pulling out and moving on down the road.

Also drawn to these junctions are young women who are often under educated and lured by the promise of quick money, which will enable them to pay their bills, feed their families and clothe their children. It is not a life they want to live but often it is the only option they have. Eventually, as the trucking routes move with annual changes in the seasons and crop harvests these women will migrate with the traffic and find work along the corridors that connect Malawi, Mozambique, Zambia and Zimbabwe.

These sites, with their combination of lonely men with money in their pockets and young women with beds for the night, are fertile ground for the transmission of HIV throughout Africa and it is here where our story really begins.

In the late 1990's, when Paul Matthew noticed that the transporters he was training at his center in South Africa were dying at an alarming rate, he decided to do something about it. At the time Paul ran a service, The Learning Clinic, which provided best practices training to transporters throughout South Africa. After securing a grant from the South African Ministry of Health to expand AIDS education and awareness programs throughout the country, Paul set about determining how to gain the trust of the road freight industry and work past the stigma associated with AIDS education and treatment programs. At the time there was a fear that employers would learn of their drivers using other local AIDS clinics and drop them from their payroll. This turned out to be much more rumor than fact but the damage had already been done.

After learning of the stigma associated with the clinics Paul decided on a new course of action. Since it was apparent that current AIDS prevention projects were failing to attract clientele in town Paul decided it was best to set up shop where he knew the transporters gathered. Armed with little more than his knowledge of the industry Paul set out one evening for the transport hub of Harrismith, which lies halfway between Durban and Johannesburg. Sitting in his car on the side of the road Paul simply watched, hour after hour, from early evening to midnight as truckers came and went and the sex industry flourished in small shacks near the roadside.

Eventually, after getting a sense of the established patterns Paul began speaking with the drivers and sex workers to learn more about their arrangements in order to decide how to best approach the problem. It was clear to Paul that by bringing education and treatment to the transporters and sex workers on site Paul would be able to provide a valuable service to this small community and help slow the transmission of HIV and other sexually transmitted infections (STIs) throughout the population. Every night, after hours of observation and discussion with the drivers and sex workers, Paul would take copious notes and which he would eventually use in the implementation process.  

The next iteration of the plan was for Paul to return with a nurse from a local area hospital who would accompany him on his nightly forays. They would spend their hours chatting with the men and women at the depot about best practices, all the while handing out condoms and providing basic medical services. Eventually, Paul returned with the nurse but this time driving a borrowed ambulance that enabled the team to provide better care and a bit of privacy for his roadside clientele.

The small team wasn’t just focused on AIDS awareness and education but also on treating the aches and sprains that were part of the trucker life as well as the abundance of STIs that were transmitted between truckers and sex workers. Truckers had a strong incentive to seek out treatment, as they didn’t want to pass the same disease to their wives when they returned home. While treating for STIs and general ailments the team could also educate the transporters about AIDS prevention. This package treatment approach was rapidly gaining acceptance among the transporters and sex workers but the problem for Paul was that he didn’t have the facilities to handle the increasing numbers of visitors.

It was then that Paul hit upon another idea. Most of the trucks traveling the roadway were loaded with shipping containers bound for Johannesburg. Rather than use a less than adequate mobile unit or build a permanent structure, why not modify a shipping container to serve as a portable clinic? The units could be easily transported and deposited just about anywhere. Also, there was a surplus of the containers available and so it was decided that the first semi-permanent wellness center would be built inside a 20 ft shipping container.

It was around this time, 1998, that Paul formalized his efforts and establish a new programme, Trucking Against AIDS, which would serve as the main organization for the campaign to build portable clinics in transporter depots throughout South Africa. With funding from the transporter industry and various government ministries Paul went on to establish additional clinics in the next couple of years throughout South Africa and worked to refine the treatment plan for the clinics with help of advisors from the South African Ministry of Health.  Click here for Part II of the story.