Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities: A Qualitative Analysis

Abstract

Among Ugandan fisherfolk, HIV prevalence (with estimates ranging from 15 to 40 %) is higher than in the general population (about 7 %), potentially due to high-risk behaviors and low access to HIV testing and health-care. We conducted semi-structured interviews on barriers to linkage to care with 10 key stakeholders and 25 fisherfolk within 1–2 months of their testing HIV-positive at clinic outreach events in Ugandan Lake Victoria communities. Interviews were recorded, transcribed, translated, and coded using grounded theory methods. Participants cited low healthcare access and quality of care, mobility, competing needs for work during clinic hours, stigma, and low social support as barriers. Over 10 % of clients screened positive for HIV at outreach events, and only half accessed care. Linkage to care issues may begin with the failure to attract high-risk fisherfolk to testing. New models of HIV testing and treatment delivery are needed to reach fisherfolk.

A Comparison of Home-Based Versus Outreach Event-Based Community HIV Testing in Ugandan Fisherfolk Communities

“…28,29,37–44 Perceived barriers to accessing healthcare were assessed with a checklist (alpha=.72), 45,46 adapted using prior qualitative data. 29 Mobility was assessed with the item, “In the past 3 months, how many times did you travel and sleep away from this community?” 47 Perceived health was assessed with a validated item.…”

“…28,29,37–44 Perceived barriers to accessing healthcare were assessed with a checklist (alpha=.72), 45,46 adapted using prior qualitative data. 29 Mobility was assessed with the item, “In the past 3 months, how many times did you travel and sleep away from this community?” 47 Perceived health was assessed with a validated item. 48 Participants completed the internalized HIV stigma scale (alpha=.63) and items from the chronic illness anticipated stigma scale (alpha=.88) at baseline, and reported whether they had experienced 5 different types of HIV-related discrimination at follow-up.…”

“…26–29 Although community-based testing may overcome some of these barriers, the most effective method of conducting community-based testing for fisherfolk has not been determined. A primary barrier to event-based testing identified by our prior research—lack of testing due to competing work needs for individuals involved in the fish trade at the same time as testing events—suggests that different community-based models of HIV testing are needed to fully reach fisherfolk.…”

“…A primary barrier to event-based testing identified by our prior research—lack of testing due to competing work needs for individuals involved in the fish trade at the same time as testing events—suggests that different community-based models of HIV testing are needed to fully reach fisherfolk. 29 For example, home-based testing may decrease barriers due to competing work needs associated with attending a public HIV-related outreach event, and therefore home-based testing (versus event-based testing) could increase the number of fisherfolk aware of their serostatus relative to event-based testing. 21,30 Home-based testing may also decrease stigma concerns among fisherfolk, as home-based testing offers the option of being tested confidentially and privately in one’s own home, rather than in a public setting.…”

Anthelminthic treatment receipt and its predictors in Lake Victoria fishing communities, Uganda: Intervention coverage results from the LaVIISWA cluster randomised trial

“…The Koome islands have a population of approximately 16,000 residents, with fishing and its related industries the main activities, and comprise the main island (Koome) and a number of smaller surrounding islands. The population of these islands is highly mobile, with much migration related to the movement of fish populations and to government policies related to these communities [ 18 ]. The islands are remote, being approximately 2–3 hours from the mainland by powered canoe.…”