High HIV‐1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda

Abstract

IntroductionHIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour.MethodsBetween September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011–January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 18–49 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models.ResultsOverall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, p<0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR =1.50, 95%; 1.20, 1.87) and participants aged 30–39 years (adj.PPR=1.40, 95%; 1.10, 1.79) and 40–49 years (adj.PPR=1.41, 95%; 1.04, 1.92) compared to those aged 18–24 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p=0.004) and among island communities compared to lakeshore ones (90.4% vs. 85.8%, p=0.004).ConclusionsThe HIV prevalence in the general fisher-folk population in Uganda is similar to that observed in the “high-risk” fisher folk. FFC have very high levels of willingness to participate in future HIV vaccine trials.

Prevalence and Incidence of HIV Infection among Fishermen along Lake Victoria Beaches in Kisumu County, Kenya

“…This was 4 times the national HIV prevalence of 5.6% [19]. Similar high HIV prevalence (20% -28%) among fishermen, have been previously reported in Kenya and Uganda [16] [20]- [22]. In comparison to other high-risk groups such as MSM, the HIV prevalence in this study was twice that observed in bisexual MSM in Mombasa, Kenya [23].…”

An update on human immunodeficiency virus vaccine preparedness studies

“…The types of questionnaires utilized with regards to WTP were mainly interviewer-administered questionnaires, found in nine studies (Asiki et al, 2013;Deschamps et al, 2013;Kiwanuka et al, 2013;Middelkoop et al, 2008;Newman et al, 2014;Olanrewaju et al, 2014;Otwombe et al, 2011;Ruzagira et al, 2009;Suhadev et al, 2009) (Table S1). Two studies utilized a self-administered questionnaire (Chariyalertsak et al, 2011;de Bruyn et al, 2008;C.…”

“…In another study in HIV discordant couples in Uganda, the 2-year follow-up was 80.2 % (Ruzagira et al, 2011) (Table S2). In a further study, the retention rate was 76.9 % overall in a general fisher-folk population in Uganda at 12 months (Kiwanuka et al, 2013) (Table S2). With regard to factors associated with retention in these African countries, higher retention was associated with being female (Middelkoop et al, 2008;Geis et al, 2011) and being of older age (Geis et al, 2011;Ruzagira et al, 2011).…”

“…Retention was examined in five studies in African countries including South Africa (Middelkoop et al, 2008;Price et al, 2012), Kenya (Price et al, 2012), Tanzania (Geis et al, 2011) and Uganda (Ruzagira et al, 2011;Kiwanuka et al, 2013) (Table S2). The types of population enrolled in these VPSs included heterosexuals (including both adults and adolescents) (Geis et al, 2011;Middelkoop et al, 2008;Price et al, 2012), HIV discordant couples (Ruzagira et al, 2011), MSM (Price et al, 2012) and general fisher-folk communities (Kiwanuka et al, 2013).…”

“…The types of population enrolled in these VPSs included heterosexuals (including both adults and adolescents) (Geis et al, 2011;Middelkoop et al, 2008;Price et al, 2012), HIV discordant couples (Ruzagira et al, 2011), MSM (Price et al, 2012) and general fisher-folk communities (Kiwanuka et al, 2013).…”