Uganda's motorcycle taxis riders threaten to derail the country's fight against HIV because of risky sexual behaviours, including sex with clients in lieu of payment, according to a new study.
At least 12% of a sample of 281 commercial riders, a common informal job known as boda boda and dominated by young men, admitted to engaging in transactional sex with customers who failed to pay their fares; 65.7% reported having had sex with more than one partner in the past 12 months; and 23% had had multiple partners in the same period, with 57.1% reporting that they did not use a condom at all in the six months prior to the survey, conducted by Makerere University College of Education and External Studies (CEES).
"Engaging with multiple sexual partners is a high-risk sexual behaviour, especially in the absence of condom use. It leads to sexually transmitted diseases like HIV, and unwanted pregnancies," said Lillian Mbabazi, a researcher at CEES, presenting the research findings at a workshop in the capital, Kampala, last week.
"It shows a need to educate young Ugandans to understand unsafe and irresponsible sexual behaviour."
The study was conducted in the districts of Wakiso and Namayingo.
"The revelation from this study, that customers who can't afford to pay their service freely offer sex and a high proportion are actually engaging in risky sexual behaviours with multiple partners without a condom, is concerning," Daniel Byabakama, head of HIV prevention at the Uganda Aids Commission (UAC), said.
"The HIV infections will definitely go up. The boda bodas need to know that HIV is still real and people are still contracting the virus," he said. Uganda has a 5.6% HIV prevalence rate.
"This study is a wakeup call that if we keep on scaling down the targeting of these boda bodas as a high priority, then we may end up in shock," said Byabakama.
"We should continue prioritising them, helping them and offering HIV prevention services, such as free condoms, so that they don't contract or transmit the virus." Some of the boda boda riders in Wakiso said transactional sex and multiple sexual partners were occupational risks.
"What do you expect me to do with a client who can't afford to pay the fee and offers you sex instead?" said Patrick*, a boda boda rider at Kyaliwajjala. "I can't just let her go free. Of course I will have sex with her in exchange."
"Some of these clients are just stubborn and tempt us. The ladies intentionally refuse to pay and offer you a sex deal. If you are interested, you fall and go for it," said Joseph*. "Of course, most of the time you might not be having a condom. You end up having live [unprotected] sex."
Byabakama said it was a worrying picture: "We are seeing resurgence of bad sexual behaviours among this group, they are having sex with multiple sexual partners, they don't first test for HIV, and a good number of them don't use condoms. This is worrying.
"They don't care about avoiding HIV because they think there are ARVs [antiretrovirals]. It's a misconception. We continue to encourage them to practise HIV prevention measures as we have always taught them. We need to rekindle and reinvigorate the campaign."
Paul Birevu Muyinda, deputy principal at CEES, said the "nomadic" industry was booming and employed more than 50% of people aged 18-35 in the east African country, but riders face myriad health risks.
"The solution is to organise and bring order to the industry. Make it a safe and gainful industry and provide continuous professional training aimed at bringing positive behavioural change," said Muyinda.
"These project findings will go a long way in helping the government to develop scientifically proven evidence-based interventions aimed at influencing behavioural change of boda boda riders in Uganda," said James Katunguka, road safety officer at the ministry of Works and Transport.
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