HIV epidemic and cascade of care in 12 east African rural fishing communities: results from a population-based survey in Uganda

Abstract

Background In East Africa, fishing communities are considered most-at-risk populations for the acquisition of HIV. We estimated HIV prevalence and assessed progress towards the UNAIDS 90–90-90 targets along the HIV treatment cascade in 12 fishing communities surrounding Lakes Edward and George, Uganda. Methods We conducted a cross-sectional household-based survey between September and November 2016. All adults between 15 and 69 years old were eligible to participate. Children below 15 years old were eligible for HIV testing if either parent was HIV-positive. Viral load testing was done for all HIV-infected individuals. Logistic regression models adjusted for sociodemographic-behavioral variables were used to assess the association between occupation and HIV positivity. Results Overall, 1738 adults (959 women, 779 men) and 148 children were included. Adult inclusion rate was 96.0%. Of the men, 58% reported to be fishermen. The HIV-prevalence among adults was 17.5% (95%CI: 15.8–19.4) and 6.1% (95%CI: 3.1–11.4) among HIV-exposed children. HIV prevalence was higher among women than among men (20.9% vs. 13.5%, p < 0.001). Among men, fishermen had a higher HIV prevalence (18.7%; 95%CI: 15.1–22.3) and a higher risk of being HIV-positive (aOR: 4.2; 95%CI: 2.0–9.1) than men of other occupations (p < 0.001). Progress towards the UNAIDS 90–90-90 targets was as follows: 86.5% (95%CI: 82.3–90.1%) of the HIV-positive participants were diagnosed, 98.7% (95%CI: 96.1–99.6%) of those aware were on antiretroviral therapy (ART), and 87.3% (95%CI: 82.3–91.0%) of those on ART were virally suppressed. Overall, 73% of all HIV-positive individuals were virally suppressed. Viral suppression was lower among individuals 15–24 years (45.5%) than among those 25–44 years (74.0%) and 45–69 years (85.0%), p < 0.001. Fishermen did not to have significant differences in the HIV cascade of care compared to men with other occupations. Conclusions HIV prevalence was high in these fishing communities, particularly among women and fishermen. Important progress has been made along the HIV treatment cascade, and the UNAIDS goal for viral suppression in population was achieved. However, gaps remain and HIV care strategies focusing on young people are urgently needed. HIV preventive interventions should target particularly women, young people and fishermen though HIV preventive and care services should remain available to the whole fishing communities.

HIV epidemic in fishing communities in Uganda: A scoping review

“…The proportion of respondents aged 18–24 years old in this review ranged from 19% to 44.9% [ 25 – 33 ]. In other studies, 33.8% of the respondents were 15–24 years old [ 9 ], 14.9% were 15–19 years old, [ 34 ] and 31.5% [ 35 ] and 41.3% were 13–24 years old [ 28 ]. Pearson et al [ 36 ], describe how many of the fish landing sites along Lake Victoria have grown rapidly over the past 30 years, attracting many young people in search of income from fishing, fish trading or other related activities.…”

“…As illustrated in Fig 4 , HIV prevalence in fishing communities is very high, however, it varies greatly by study ranging from 22%–37% [ 9 , 17 , 18 , 27 , 29 , 33 , 35 , 47 , 49 ] to as high as 40% in some communities [ 17 ]. These figures are 3–5 times higher than the national average prevalence for adults aged 15–49 years documented in the last two national surveys.…”

“…Evidence from prior studies suggests a high prevalence of unprotected sex among the fisherfolk. One of the lowest proportions of consistent condom use was found in a study by Burgos-Soto et al that included 1738 adults (959 women, 779 men) in which only 5.6% of men and 4.6% of women reported always using a condom during sexual intercourse [ 9 ]. In a study by Pickering et al, women reported condom use in 93% of the 982 contacts with casual partners and never with their 689 regular contacts.…”

“…Male circumcision was strongly protective, decreasing the risk of HIV acquisition by around 54.0% [ 53 ]. Burgoso et al documented a circumcision prevalence of 56% among 779 males in a cross-sectional household-based survey in 12 fishing communities surrounding Lakes Georges and Edward [ 9 ]. Mafigiri and al.…”

Peer-leaders’ experiences and challenges in distributing HIV self-test kits in a rural fishing community, Rakai, Uganda

“…Fishing communities in sub-Saharan have been identified as areas with the highest HIV incidence and prevalence amidst low coverage of HIV services [ 5 – 7 ]. In Uganda, HIV prevalence in the fishing communities remains high, ranging between 17.5 to 37% [ 8 – 10 ] and is almost 3–6 times higher than the national average for adults which stands at 6% [ 11 ]. The high HIV prevalence in the fishing communities is as a result of an interplay of factors ranging from vulnerabilities caused by the high degree of mobility and the failure to address the low HIV knowledge, attitudes and practices that are prevalent in these communities [ 12 , 13 ].…”