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Opinion: Road Projects Need an HIV Officer as Much as an Engineer

Asia needs roads. Roads open up markets, bring economic growth, and offer access to health care and opportunities. But new roads can also displace communities, destroy homes, and disrupt livelihoods. Countries in the region have responded to these concerns with national policies on resettlement and rehabilitation of communities displaced by infrastructure projects.

The spread of HIV/AIDS by road projects—a problem with implications even more serious than resettlement and rehabilitation—has received much less attention and action by governments in the region.

As Asia transitions from recession to recovery, many countries in the region are firming up ambitious plans to expand their road networks. Construction brings truck drivers and road workers—often male migrants, living away from home for long stretches. While many studies about HIV/AIDS and transport have flagged long-haul truck drivers as a group at risk of HIV, there has been much less work investigating HIV/AIDS prevalence and risk among road construction workers, who constitute an important risk group for the transmission of HIV.

In 2006, the World Bank, Asian Development Bank, African Development Bank, the Department for International Development of the United Kingdom, the Japan International Cooperation Agency (JICA), and German government-owned development bank KfW agreed to recommend that infrastructure construction contractors conduct HIV/AIDS awareness programs to reduce risks of HIV transmission among their workers and the local community.

Today, major donor agencies that provide loans for many of Asia’s road projects require agencies to carry out HIV prevention work as part of the agreement.

The challenge is to scale up such interventions. This requires national policies that make it mandatory for all road construction projects—whether they are donor-funded, locally resourced or use the build-operate-transfer model—to incorporate HIV information in their project design. The more daunting next step is to translate such policies into practice and to get the technical people in charge of the project talking seriously with the NGOs involved in outreach.

India, a country with 2.5 million people living with HIV/AIDS, and an emerging economic power hobbled by poor infrastructure, offers good examples of what is happening and what needs to happen. Over the next two years, the country, will build more highways than any other country in the world, according to Kamal Nath, India’s Minister for Road Transport and Highways. The ministry is working on incentives to attract developers to hit the country’s target of adding 20 kilometers a day to the national highway system. Humanitarian as well as economic reasons underpin donor interest in HIV prevention campaigns. Such programs are intended partly to be firewalls against loss of skilled workers who could be at risk of HIV. The World Bank is working on a pilot project that would target local communities and spouses of the migrant workers.

Donor involvement in India’s highway expansion has led to the National Highway Authority of India engaging NGO partners to conduct HIV/AIDS and human trafficking awareness programs. The donor-supported Delhi Metro Rail Corporation, which is responsible for building, operating, and maintaining the metro rail system, has initiated an HIV/AIDS program targeting laborers on one of the metro lines.

These examples are a good start. But merely including HIV/AIDS prevention clauses in civil works contracts does not ensure the implementation of activities. A May 2009 report by the World Bank’s Transport Unit points out that many NGOs selected to partner with the implementing agencies have experience with rehabilitation and resettlement but not HIV prevention campaigns. For better results, the capacity of such partner NGOs needs to be strengthened. Simultaneously, technical personnel overseeing road projects must be sensitized to better understand the NGOs. The third critical issue is improved monitoring mechanisms to increase the effectiveness of the interventions. The observations provide lessons for other road projects as well.

Governments in Asia need to tie effective HIV/AIDS prevention programs to all new road projects. Donors play a critical role in leading this effort. Roads should provide a path out of poverty, not a door that opens communities to disease.