HIV in Fishing Communities: Prevalence, Incidence, Risk Factors, and Interventions

As the world coalesces around achieving WHO’s 90-90-90 targets, initial steps are focused on finding and shutting down sources of new infections. We sought to describe the burden, risk factors and potential prevention interventions for HIV infections in fishing communities. This largely involves syntheses of published findings as well as findings from recent studies in the fishing communities. Some of the recent studies were conducted under the umbrella of Lake Victoria Consortium for Health Research which has a mission of improving the health of the fishing communities that inhabit the Lake Victoria shoreline and islands in Kenya, Tanzania and Uganda (http://www.wavuvi.org/about-wavuvi-concern). HIV prevalence is variable across fishing villages and gender. In Kenya, HIV prevalence range from 14.2% in Busia to 37.4% in Homa Bay. Women are more affected (37.5%) compared to men (29.4%). HIV prevalence in Uganda range from 22% to 29% with gender differences. HIV prevalence in women is reported to reach 40% in some communities. Overall HIV prevalence in Tanzania is 7.6% with gender and regional differences. The prevalence is higher in women (11%) compared to men (6.3%) and higher in Kagera region (12.5%) compared to Mwanza (7.3%) and Mara (6%).  HIV incidence is also variable across different communities. In Uganda, incidence range from 3.39 to 4.9 and seem to increase with age and alcohol consumption. In Kenya, HIV incidence vary from 4.2 to 9.3% and seem to depict regional variations. Risk factors for HIV infection include: age at sexual debut,  multiple and transactional sexual partnerships, alcohol consumption and low condom use. The risky behaviors are precipitated by high number of women in fishing villages, scarcity of fish, high cash flow, high fisherfolk mobility and culture of risk denial. Potential interventions include: reaching the fishermen with late night radio prevention messages, synchronizing opening and closing of health clinics with fisherfolk availability, targeting couples for interventions to reduce risky behaviors, and empowering women to own boats to reduce their interactions with men over fish. Fishing communities experience high HIV burden that exhibit gender and regional variations. The high burden results from personal, interpersonal and environmental factors. Identifying appropriate HIV interventions in these communities require thorough understanding of their high risk social environment.