Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Abstract

SummaryBackgroundUnderstanding the extent to which HIV burden differs across communities and the drivers of local disparities is critical for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda.MethodsThe Rakai Community Cohort Study (RCCS) is an open, population-based cohort surveying persons aged 15–49 in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioral, and health information. RCCS data from August 2011 to May 2013 were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). HIV prevalence was mapped using Bayesian methods, and variability across and within community classifications was characterized. Differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types were assessed.Findings17,119 individuals were included; 9215 (54%) were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. There was large variation in HIV prevalence, ranging from 9% to 43% across communities. Fishing communities had a higher median HIV prevalence (41%, range: 37–43%) compared to trading (17%, range: 11–22%) and agrarian communities (14%, range: 9–26%); ART and male circumcision coverage were significantly lower in fishing communities. Self-reported risk behaviors were significantly higher in men compared to women and in fishing communities compared to other community types.InterpretationThere is substantial heterogeneity in HIV prevalence, risk factors, and service uptake across communities within one region of Uganda. These findings underscore the need for local surveillance and have important implications for the design of targeted HIV responses. In particular, the extremely high HIV burden and risk behaviors, and low use of combination HIV prevention in fishing communities make these areas a priority for intervention.

HIV-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach

“…However, recent findings from a qualitative study on the uptake of SMC in our own study area point to continued barriers to uptake of SMC which need to be addressed if coverage is to increase [46]. While ART coverage in many fishing communities remains low (Rakai 13% in men vs 18% in women) or unknown [47]. Higher coverage of SMC and ART would greatly reduce the number of new infections.…”

Pangea-Hiv 2

“…hotspots) among larger, relatively low-risk general populations [30]. In East Africa, hotspots include Lake Victoria fishing communities, which contain disproportionate numbers of key populations at high risk of infection, such as sex workers [21,31]. In Southern Africa, similar high prevalence foci have been observed along major trading routes and close to mines [32,33].…”

Design and Implementation of a Community Health Worker HIV Treatment and Prevention Intervention in an HIV Hot Spot Fishing Community in Rakai, Uganda

“…In Uganda, the overall national HIV prevalence is ~7.4%; however, HIV prevalence is as high as 43% in some fishing communities on Lake Victoria. 1 The complex social-structural nature of these fishing communities, which includes dangerous work conditions, mobile populations, high rates of sex work, alcohol use, drug use, and fatalism, has created challenging environments in which to prevent and treat HIV. 2 …”