High Incidence of HIV-1 Infection in a General Population of Fishing Communities around Lake Victoria, Uganda

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Abstract

Background

High HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour. We assessed the incidence of HIV-1 and associated risk factors in a general population FFC to determine population-wide HIV rates.

Methods

A community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. At baseline and 12 months post-baseline, data were collected on socio-demographic characteristics and risky behaviors (including number of partners, new partners, condom use, use of alcohol and illicit drug use). Venous blood was collected for HIV serological testing. HIV incidence was calculated per 100 person years at-risk (pyar) and adjusted incidence rate ratios (Adj.IRR) were estimated by multivariable Poisson regression.

Results

Overall follow up at 12 months was 76.9% (1685/2191) and was significantly higher among HIV uninfected persons and those with at least 1 year duration of stay in community. Overall HIV-1 incidence was 3.39/100 pyar (95% CI: 2.55–4.49). Among the 25–29 years who drank alcohol, HIV incidence was 7.67/100pyar (95% CI;4.62–12.7) while it was 5.67/100pyar (95% CI;3.14–10.2) for 18–24 year olds who drank alcohol. The risk of HIV infection was higher among 25–29 years (adj.IRR = 3.36; 95% CI: 1.48–7.65) and 18–24 years (adj.IRR = 2.65; 95% CI: 1.05–6.70) relative to 30+ years. Compared to non-drinkers, HIV incidence increased by frequency of alcohol drinking - occasional drinkers (adj.IRR = 3.18; 95% CI: 1.18–8.57) and regular drinkers (adj.IRR = 4.93; 95% CI: 1.91–12.8).

Conclusion

HIV-1 incidence in general fisherfolk population along L.Victoria, Uganda, is high and is mainly associated with young age and alcohol drinking. HIV prevention and control strategies are urgently needed in this population.

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Most cited references 19

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Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

Matthew Chersich, Stanley Luchters, Innocent Ntaganira … (2013)

Introduction Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.

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HIV/AIDS in fishing communities: challenges to delivering antiretroviral therapy to vulnerable groups.

Kimberly H. Allison, Mark Seeley (2005)

Fishing communities have been identified as among the highest-risk groups for HIV infection in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from, the time fishers and fish traders spend away from home, their access to cash income, their demographic profile, the ready availability of commercial sex in fishing ports and the sub-cultures of risk taking and hyper-masculinity in fishermen. The subordinate economic and social position of women in many fishing communities makes them even more vulnerable to infection. In this paper we review the available literature to assess the social, economic and cultural factors that shape many fisherfolks' life-styles and that make them both vulnerable to infection and difficult to reach with anti-retroviral therapy and continued prevention efforts. We conclude from the available evidence that fisherfolk will be among those untouched by planned initiatives to increase access to anti-retroviral therapies in the coming years; a conclusion that might apply to other groups with similar socio-economic and sub-cultural attributes, such as other seafarers, and migrant-workers including small-scale miners, and construction workers.

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HIV Infection in Fishing Communities of Lake Victoria Basin of Uganda – A Cross-Sectional Sero-Behavioral Survey

Alex A Opio, Michael Muyonga, Noordin Mulumba (2013)

Background Uganda's first AIDS case was reported in a fishing village. Thereafter, due to varying risk factors, the epidemic spread heterogeneously to all regions, with some populations more affected. Given the recent rising trends in HIV infection in Uganda, it is crucial to know the risk factors in different populations. The aim of this study was to determine the prevalence and risk factors of HIV infection among fishing communities. Methodology A cross-sectional survey of 46 fishing communities was conducted in 2010. Following written consent, 911 randomly selected respondents age 15–59 years were interviewed and gave blood for HIV testing. HIV testing was conducted in the field and central laboratory according to national algorithm. Survey protocol was approved by the Science and Ethics Committee of Uganda Virus Research Institute, and cleared by Uganda National Council for Science and Technology. Data was captured by EPIINFO and statistical analysis done in SPSS. Findings Overall HIV prevalence was 22%; there was no difference by sex (x 2 test, p>0.05). Association with HIV infection was determined by x 2 test, p<0.5. Never married respondents had lower HIV prevalence (6.2%) than the ever married (24.1%). HIV prevalence was lower in younger respondents, age 15–24 years (10.8%) than in age group 25 years and above (26.1%). Muslims had lower HIV prevalence (14.4%) than Christians (25.2%). HIV prevalence was higher among respondents reporting 3 or more lifetime sexual partners (25.3%) than in those reporting less numbers (10.8%). HIV prevalence was higher among uncircumcised men (27%) than in circumcised men (11%). Multivariate analysis identified 4 risk factors for HIV infection; age, religion, ever condom use and number of lifetime sexual partners. Conclusions HIV prevalence in the surveyed communities was three times higher than of general population. This underscores the need for tailor made HIV combination prevention interventions targeting fishing communities.

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Author and article information

Contributors

Scarlett L. Bellamy: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 27 May 2014

Volume: 9

Issue: 5

Electronic Location Identifier: e94932

Affiliations

[1 ]Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda

[2 ]Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda

[3 ]International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America

[4 ]Medical Research Council/Uganda Virus Research Insitute, Uganda Research Unit on AIDS, Entebbe, Uganda

[5 ]Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda

University of Pennsylvania School of Medicine, United States of America

Author notes

* E-mail: nkiwanuka@ 123456gmail.com

Competing Interests: The authors have no competing interests to declare.

Conceived and designed the experiments: NK NKS. Performed the experiments: NK AS JM MW A. Nanvubya SS LN AB JN. Analyzed the data: NK AS A. Nalutaaya PK JN NKS. Contributed reagents/materials/analysis tools: PKK PK. Wrote the paper: NK AS JM A. Nanvubya LN PK JN NKS. Performed laboratory assays: PKK.

Article

Publisher ID: PONE-D-13-44190

DOI: 10.1371/journal.pone.0094932

PMC ID: 4035272

PubMed ID: 24866840

SO-VID: 9e9d4ddf-1d98-493b-83da-40ef4ac299ed

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 29 October 2013

Date accepted : 21 March 2014

Page count

Pages: 9

Funding

This work was made possible in part by the generous support of the American people through the United States Agency for International Development (USAID) through the International AIDS Vaccine Initiative, USA, and the Training Health Researchers into Vocational Excellence in East Africa Project (THRiVE), Grant Number 087540 of Wellcome Trust, UK, and the Canada-Africa Prevention Trials Network (CAPTN) grant number 1063357-001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

High Incidence of HIV-1 Infection in a General Population of Fishing Communities around Lake Victoria, Uganda

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Most cited references 19

Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

HIV/AIDS in fishing communities: challenges to delivering antiretroviral therapy to vulnerable groups.

HIV Infection in Fishing Communities of Lake Victoria Basin of Uganda – A Cross-Sectional Sero-Behavioral Survey

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