Counties bordering Lake Victoria have the highest adult HIV prevalence in Kenya. Within the region, fisherfolk (FF) who catch, sell, or process fish and their spouses are considered a priority population in HIV transmission. We asked if FF differ from their immediate non-fishing neighbors (non-FF) in terms of HIV prevalence, risk behaviors and health service utilization in Siaya county, western Kenya.
A cross-sectional bio-behavioral household survey was conducted at beaches and adjacent villages in the Kenya Medical Research Institute Health and Demographic Surveillance System from August 2014-March 2015. The survey collected demographics, HIV risk behavior and service utilization and offered HIV testing. Bivariate comparisons were used to examine factors of interest, evaluated by Pearson’s chi-square, with stratification by sex as appropriate.
Of 3462 participants aged 15-64 years, 940 (27.2%) were FF. Of 3344 respondents with HIV status, 17.1% were HIV positive; prevalence was higher among FF (24.1%) than non-FF (14.7%), p<.001. Most HIV-positive respondents (77.0%) self-reported their status. HIV prevalence was significantly higher among women (20.1%) than men (11.8%, p<.001), with a greater difference by sex among non-FF. HIV prevalence was highest among FF aged 30-49 years (34.4%) with a similar pattern among non-FF, peaking at 28.4% among the same age group. More non-FF men were circumcised than FF men (61.9% vs. 51.9%, p<.001). Among the sexually active, FF men were more likely than no-FF men to report two or more sexual partners in the past 12 months (34.9% vs. 25.9%, p<.006), and all FF were more likely to report no condom use with at least one sexual partner in past 12 mos. (77.2% FF vs. 46.8% non-FF, p<.001). Most respondents had previously tested for HIV (95.2% FFX vs. 92.2% non-FF, p<.001). Among 446 total respondents self-reporting as HIV positive, 78.0% reported taking anti-retroviral therapy (ART), with no significant difference by FF status. When accounting for all HIV positives, ART coverage was 56.9% among FFX and 62.9% among non-FF.
HIV prevalence was higher among FF than among non-FF. FF reported higher HIV-related risk such as non-circumcision, more sexual partners and sex without condoms. While ever-testing rates were high, just over half of FF were on ART, suggesting that aggressive scale-up of testing, treatment and prevention interventions targeted for FF are required to meet the needs of this priority population.