At the massive truck stop at Namakkal in Tamil Nadu, the young NGO trainer, Poornima, introduced herself with folded hands to twenty swarthy young truckers, who had been cajoled into the HIV information session by their broker. They looked bored even before she started, lounging on a hard floor covered by a thin durrie. The trainer reached into her kitbag and took out a slightly larger-than- life wooden model of a penis. She opened a packet of condoms and expertly demonstrated the right way to put on the prophylactic, using the model as a prop. She warned the truckers never to put oil on the condom, or wear two at a time, as this might cause the condom to break. She asked for volunteers to repeat the demo and the truckers demurred, suddenly bashful. Poornima smiled and turned to the next part of the lesson, a flip chart with successive charts of a lemon and a donkey, each marked with a red X. The truckers sat up and began to take notice. They were whispering.
In a concentrated epidemic, the HIV virus moves from risk group to bridge group to general population. The risk group consists of those people most exposed to the virus, and among whom HIV prevalence is high. Female sex workers are the largest segment of this group. The virus then travels to the clients of the sex worker. These clients – the men who frequently go to sex workers – are known as the bridge group. The virus then travels across the bridge into the general population, passing from the client of the sex worker to his wife, and through her to her unborn child. It is a relentless course, and HIV prevention programmes try to stop infections from happening all along the chain. Our strategy was to focus on the core risk groups. But we also had to work on the male side.
Truckers were the single largest identifiable segment of the bridge group, accounting for 10 to 16 per cent of clients of sex workers in 2001 and 2006 respectively. HIV prevalence among truckers ranged from 3 to 7 per cent.
The highway is the trucker’s home. As prime minister, Atal Bihari Vajpayee launched a massive national highway modernisation and extension programme. Running along the main north-south and east–west corridors connecting the four major cities – Delhi, Mumbai, Chennai, and Kolkata – the Golden Quadrilateral was cast in sturdy concrete and had two to four lanes. Smaller routes sprouting from these arterial roads connected with the smaller cities and towns. Vajpayee’s vision gave a huge boost to the highway system and the movement of goods across the country. The length of the national highway system was about 60,000 kilometres in 2004 when we launched our highway programme.
Despite all this progress, movement along the highways was slow, with trucks rarely crossing forty kilometres an hour. Traffic, weather conditions, local strikes, and more led to huge congestions and delays of hours.
It was a challenge to design our truckers’ programme. Intervention with truckers along highways had been tried before, but never anywhere near the scale of the Golden Quadrilateral. Most programmes had worked along strips of highway. The most ambitious so far had been the “Healthy Highways” programme, started by the Department for International Development (DFID, the UK government’s international aid agency) in 1996, covering two hundred sites in nineteen states. It yielded many learnings. Its one flaw, we felt, was that it was built around discrete intervention sites rather than a fluid highway network.
We decided to locate intervention points at truck halting stations along the Quadrilateral, and treat them like nodes on a moving network. We would provide HIV prevention services at all such points. The first service priority was to provide information on safe sex, to defuse the many myths that truckers believed, as Poornima did. The second need was reliable treatment for STIs at programme-run clinics. Our truckers’ programme partnered with brokers at each of these points; they had all lost good truckers to HIV and were willing to support any HIV prevention programme, offering their office space for information sessions.
We called our programme Kavach (meaning “armour”) and entrusted its running to the TCI Foundation (TCIF), the charitable arm of TCI. The owners of TCI, the dignified DP Aggarwal and his urbane son Vineet, took a keen interest in their foundation and it was always enjoyable dealing with them. Tarun Vij was Kavach’s programme director and had been running his family business in steering wheels. We had recommended him to TCI as programme head, even though – like us – he had no background in HIV. We thought a person experienced in the private sector would better see this as a network solution, akin to the ones many businesses face.
After a year, we saw that we had a problem. In a tearing hurry as usual, we had embarked on a plan of setting up thirty-eight nodal points and had already contracted with local NGOs and made significant investments. Now as the data was coming in we realised that many of these points just didn’t have the level of traffic we had expected.
We also discovered that long-distance truckers were the ones most at risk; the short-haul truckers got home every night and didn’t have much sex on the highway. At some points there was a lot of traffic, but not many long-distance truckers stopped there.
We took a tough call and decided to do a rapid restructuring of Kavach, working with Tarun, whose business acumen helped solve a tricky problem. We would cut the nodal points from thirty-eight to seventeen and close the points where there was neither the quantum nor the right mix of traffic. We saw this as a speedy course correction based on new data. We had done that already with some other grants. Many of our partners saw it as a refreshing and even exciting new way of working. Some partners, however, saw our approach as unfair, even unethical. There were strong feelings all around. In the end, the dust settled and Kavach ended up as a model for trucking programmes in HIV prevention.
My team spent a lot of time with truckers. We needed to understand them as people, their lifestyles, and why their condom usage was so low. Without that, we would not be able to develop a meaningful plan of action. The most learning came out of the long-distance travels we made with the truckers along the highways. The person from our team who did the most such travel was Amit Soni, a twenty-three-year-old McKinsey business analyst, who had asked to join me when I left to start Avahan.
In May 2003, Amit was at Bangalore Transport Nagar, a massive truck halting point, running a focus group discussion with a bunch of truckers. Truckers from different parts of India were present, but most were locals and they were bored. One of them suddenly said, “If you really want to understand how we live and work, why don’t you come with us?” It was then four in the afternoon, and he was set to leave no later than eight, driving north, all the way to Mumbai.
Amit called me in Delhi to ask if he could join the truckers on their journey, and I agreed immediately. By eight, he had packed a small bag and set out on the highway with Babu the leader, Gopi, his co-trucker, and Mani the helper.
Truckers have a macho image of themselves, and that was obviously a big part of who they are. Babu told Amit melodramatically, “We are always playing in the hands of death, but we don’t know fear.” They thought of themselves as real men, who put their lives on the line every time they get behind the wheel. Babu told Amit, “You are a nice guy, but for us you are always from the other side.” It was mostly bravado, and there was vulnerability just below the surface.
This macho attitude partly explained the truckers’ cavalier attitude towards sex. At the dhabas and the truck stops, many had heard of HIV, but it didn’t worry them too much.
Babu said, “HIV might kill us in ten years, but this truck might kill us the next minute.” They were more scared of STIs, especially the ones that gave them boils.
At a dhaba Amit overheard a trucker counselling the others, saying that if you applied some chuna on the boil it would go away. Amit was aghast that they believed such stuff.
Babu and Gopi explained the many myths linked with risky sex that truckers believe. One – which truckers all over India believe – was about garmi (heat), when they felt that their balls were on fire. The space below the driver’s bench was extremely hot, and they had to keep rubber chappals on always. They believe the garmi gets into their balls, and unless it is released it will harm them. They believe that they must have sex as soon as the garmi sets in, to get rid of it. They would go to the bathroom and ejaculate if they couldn’t get sex. is was one reason why truckers picked up sex workers on the highway.
They also believed that nimbu (lime or lemon) squeezed on the penis after sex will kill HIV. Amit asked them about the myth going around that you can prevent HIV by having sex with a donkey after unprotected sex. They were evasive and muttered that it didn’t happen with South Indian drivers.
Amit says, ‘Talking to Babu and Gopi, I got some insight into the relationship that truckers have with sex workers. Simply put, truckers really enjoy women. They treat the sex workers nicely. They don’t threaten; they are not aggressive. They laugh at jokes together, get into the act slowly, rather than dive right in. The sex workers seem very accepting of the situation. Joking with the drivers, they seem to trust them. One woman described the truckers as decent people.”
Possibly everyone was on their best behaviour because Amit was an outsider – but I doubt it. We ran Kavach for almost a decade, all along the highway system. We didn’t have a single bad incident and felt that by and large the encounter between the trucker and the sex worker on the highway is qualitatively different from that seen in towns, between the client and the sex worker on the street or in the brothel. It seemed almost civil in comparison.
The trucker, hurtling into pitch darkness, hundreds of kilometres ahead of him, day in, day out, is a lonely person. It may be masked by bravado, banter, or alcohol, but that loneliness is part of his life. The sex worker too is a solitary person, without real human contact. There is a strange kinship between the two. In a fleeting encounter between these two strangers, on a dark highway, there probably is an element of trust.
Excerpted with permission from Stranger Truth: Lessons in Love, Leadership and Courage from India’s Sex Workers, Ashok Alexander, Juggernaut Books.