Abstract
BackgroundHigh HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour. We assessed the incidence of HIV-1 and associated risk factors in a general population FFC to determine population-wide HIV rates.MethodsA community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. At baseline and 12 months post-baseline, data were collected on socio-demographic characteristics and risky behaviors (including number of partners, new partners, condom use, use of alcohol and illicit drug use). Venous blood was collected for HIV serological testing. HIV incidence was calculated per 100 person years at-risk (pyar) and adjusted incidence rate ratios (Adj.IRR) were estimated by multivariable Poisson regression.ResultsOverall follow up at 12 months was 76.9% (1685/2191) and was significantly higher among HIV uninfected persons and those with at least 1 year duration of stay in community. Overall HIV-1 incidence was 3.39/100 pyar (95% CI: 2.55–4.49). Among the 25–29 years who drank alcohol, HIV incidence was 7.67/100pyar (95% CI;4.62–12.7) while it was 5.67/100pyar (95% CI;3.14–10.2) for 18–24 year olds who drank alcohol. The risk of HIV infection was higher among 25–29 years (adj.IRR = 3.36; 95% CI: 1.48–7.65) and 18–24 years (adj.IRR = 2.65; 95% CI: 1.05–6.70) relative to 30+ years. Compared to non-drinkers, HIV incidence increased by frequency of alcohol drinking - occasional drinkers (adj.IRR = 3.18; 95% CI: 1.18–8.57) and regular drinkers (adj.IRR = 4.93; 95% CI: 1.91–12.8).ConclusionHIV-1 incidence in general fisherfolk population along L.Victoria, Uganda, is high and is mainly associated with young age and alcohol drinking. HIV prevention and control strategies are urgently needed in this population.
Highlights
High HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour
This may not be surprising given that the first cases of HIV in Uganda were identified from a fishing community in Rakai district in 1982 [12] and since fisher folk communities (FFC) in East Africa have been disproportionately affected by the HIV epidemic [13,14,15,16]
Of the 2191 participants enrolled at baseline, 1685 were interviewed during the 12 months post-baseline visit giving a follow up rate of 76.9% (Table 1)
Summary
High HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour. A growing body of evidence from Uganda and other sub-Saharan African countries suggests that fisher folk communities (FFC) appear to have a much higher burden of HIV-1 infection than respective general populations [4,5,6,7,8,9,10,11]. HIV prevalence levels between 27–29% in Ugandan FFC and 16– 25% among Kenyan FFC [4,5,6,9,10,17,18] and an incidence rate of 4.9/100 person-years among Ugandan FFC prescreened and identified as being at high-risk of HIV infection [4,11] have been reported These figures are 3–4 times higher than respective national averages. The daily risk of drowning with immediate death appears to be a bigger concern than the risk of contracting a chronic and nowadays not necessarily fatal infection with HIV [4]
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