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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 26

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      Models for longitudinal data: a generalized estimating equation approach.

      This article discusses extensions of generalized linear models for the analysis of longitudinal data. Two approaches are considered: subject-specific (SS) models in which heterogeneity in regression parameters is explicitly modelled; and population-averaged (PA) models in which the aggregate response for the population is the focus. We use a generalized estimating equation approach to fit both classes of models for discrete and continuous outcomes. When the subject-specific parameters are assumed to follow a Gaussian distribution, simple relationships between the PA and SS parameters are available. The methods are illustrated with an analysis of data on mother's smoking and children's respiratory disease.
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        Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

        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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          High HIV incidence and socio-behavioral risk patterns in fishing communities on the shores of Lake Victoria, Uganda.

          We report on HIV acquisition and its associated risk factors in 5 fishing communities on the shores of Lake Victoria in Uganda. A cohort of 1000 HIV-uninfected at-risk volunteers aged 13 to 49 years were recruited in 2009 and followed up for 18 months. At enrollment and semiannual visits, socio-demographic and risk behavior data were collected through a structured questionnaire and blood samples tested for HIV and syphilis. Detailed life histories were collected from 78 volunteers using in-depth interviews. Of the 1000 volunteers enrolled, 919 (91.9%) were followed up, with 762 (76.2%) reaching the study end points (either seroconverted or completed 4 visits). There were 59 incident cases in 1205.6 person-years at risk (PYAR), resulting in an incidence rate of 4.9 (95% CI = 3.8 to 6.3) per 100 PYAR. The highest HIV incidence rates were among those working in bars (9.8/100 PYAR [4.7-20.6]), protestants (8.6/100 PYAR [5.8-12.7]), those aged 13 to 24 years (7.5/100 PYAR [5.2-11.0]), and new immigrants (6.6/100 PYAR [4.9-8.9]). HIV infection was independently associated with being young (adjusted hazard ratio (aHR) = 2.5 [95% CI = 1.3-4.9]), reporting genital sores/discharge recently (aHR = 2.8 [1.6-5.0]), regular alcohol consumption (aHR = 3.3 [1.6-6.1]), use of marijuana (aHR = 2.9 [1.0-8.0]), cigarette smoking (aHR = 3.6 [1.4-9.3]), and religion (compared with Catholics, Protestants had aHR = 2.7 [1.4-5.3] and Muslims had aHR = 2.3 [1.1-4.8]). These fishing communities experienced high HIV infection, which was mainly explained by high-risk behavior. There is an urgent need to target HIV prevention and research efforts to this vulnerable and neglected group.
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            Author and article information

            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

            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.

            Contributors
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, USA )
            1932-6203
            2014
            27 May 2014
            : 9
            : 5
            24866840 4035272 PONE-D-13-44190 10.1371/journal.pone.0094932

            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.

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            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.
            Categories
            Research Article
            Biology and Life Sciences
            Microbiology
            Medical Microbiology
            Microbial Pathogens
            Viral Pathogens
            Immunodeficiency Viruses
            HIV
            Medicine and health sciences
            Epidemiology
            HIV epidemiology
            Infectious disease epidemiology
            Social epidemiology
            Spatial epidemiology
            Infectious Diseases
            Viral Diseases
            Physical Sciences
            Mathematics
            Statistics (Mathematics)
            Biostatistics
            Research and Analysis Methods
            Research Design
            Clinical Research Design

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