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ARE FISHERFOLK AT HIGHER RISK THAN THEIR NEIGHBORS: FINDINGS FROM WESTERN KENYA, 2015
Sifunjo F. Odongo1, Daniel Kwaro1, Kennedy Mutai1
1Kenya Medical Research Institute, Kisumu, Kenya
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.