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High HIV Incidence and Socio-Behavioral Risk Patterns in Fishing Communities on the Shores of Lake Victoria, Uganda

Seeley, Janet PhD*,†,‡; Nakiyingi-Miiro, Jessica PhD*,‡; Kamali, Anatoli MSc*,§; Mpendo, Juliet MPH; Asiki, Gershim MSc*; Abaasa, Andrew MSc*; De Bont, Jan PhD; Nielsen, Leslie RN; Kaleebu, Pontiano PhD*,‡,§

Sexually Transmitted Diseases: June 2012 - Volume 39 - Issue 6 - p 433–439
doi: 10.1097/OLQ.0b013e318251555d
Original Study

Background: We report on HIV acquisition and its associated risk factors in 5 fishing communities on the shores of Lake Victoria in Uganda. A cohort of 1000 HIV-uninfected at-risk volunteers aged 13 to 49 years were recruited in 2009 and followed up for 18 months.

Methods: At enrollment and semiannual visits, socio-demographic and risk behavior data were collected through a structured questionnaire and blood samples tested for HIV and syphilis. Detailed life histories were collected from 78 volunteers using in-depth interviews.

Results: Of the 1000 volunteers enrolled, 919 (91.9%) were followed up, with 762 (76.2%) reaching the study end points (either seroconverted or completed 4 visits). There were 59 incident cases in 1205.6 person-years at risk (PYAR), resulting in an incidence rate of 4.9 (95% CI = 3.8 to 6.3) per 100 PYAR. The highest HIV incidence rates were among those working in bars (9.8/100 PYAR [4.7–20.6]), protestants (8.6/100 PYAR [5.8–12.7]), those aged 13 to 24 years (7.5/100 PYAR [5.2–11.0]), and new immigrants (6.6/100 PYAR [4.9–8.9]). HIV infection was independently associated with being young (adjusted hazard ratio (aHR) = 2.5 [95% CI = 1.3–4.9]), reporting genital sores/discharge recently (aHR = 2.8 [1.6–5.0]), regular alcohol consumption (aHR = 3.3 [1.6–6.1]), use of marijuana (aHR = 2.9 [1.0–8.0]), cigarette smoking (aHR = 3.6 [1.4–9.3]), and religion (compared with Catholics, Protestants had aHR = 2.7 [1.4–5.3] and Muslims had aHR = 2.3 [1.1–4.8]).

Conclusions: These fishing communities experienced high HIV infection, which was mainly explained by high-risk behavior. There is an urgent need to target HIV prevention and research efforts to this vulnerable and neglected group.

From the *Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; School of International Development, University of East Anglia, Norwich, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom; §Uganda Virus Research Institute, Entebbe, Uganda; Uganda Virus Research Institute/International Aids Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda; and International AIDS Vaccine Initiative, New York, NY

The authors are grateful for the funding given by the European and Developing countries Clinical Trials Partnership (EDCTP), Irish Aid, the Swedish International Development Cooperation Agency (SIDA), International AIDS Vaccine Initiative (IAVI), and the Medical Research Council of the United Kingdom (MRC, UK) to support this research. They also thank the field study teams, laboratory and data management staff for their contribution to this study, and to the participants for their time, information, enthusiasm, and support for this research. They thank the comments of two anonymous reviewers and Prof Jonathan Levin, Dr. Noah Kiwanuka, Dr. Stan Musgrave, and Dr. Richard White.

Correspondence: Janet Seeley, PhD, MRC/UVRI, P.O. Box 49, Entebbe, Uganda. E-mail:

Received for publication August 27, 2011, and accepted January 5, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association