HIV epidemic in fishing communities in Uganda: A scoping review

Abstract

Background: Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. In Uganda, literature on HIV in fishing communities has grown extensively since the first country's documented case of HIV in a fishing community in 1985. The current study describes the status of the HIV burden, prevention, and treatment in Ugandan fishing communities.

Method: This scoping review was conducted based on the York Framework outlined by Arksey and O'Malley. We searched the PubMed, Embase, and Web of Science databases to identify relevant quantitative and qualitative studies on HIV incidence, HIV prevalence, HIV-related risk factors, HIV testing, antiretroviral therapy coverage and adherence, and interventions to improve treatment outcomes and reduce HIV risk factors.

Results & conclusion: We identified 52 papers and 2 reports. Thirty-four were quantitative, 17 qualitative, and 3 had a mixed-methods design. Eleven studies reported on the prevalence of HIV and 8 on HIV incidence; 9 studies documented factors associated with HIV incidence or HIV positive status; 10 studies reported on HIV testing coverage and/or associated factors; 7 reported on antiretroviral therapy coverage/adherence/outcomes; and 1 study reported on the impact of combination HIV interventions in fishing communities. This scoping review revealed a significant lack of evidence in terms of what works in HIV prevention and for improving adherence to ART, in contrast to the relatively large amount of evidence from observational quantitative and qualitative studies on HIV prevalence, incidence and related risk factors in Ugandan fishing communities. Intervention studies are urgently needed to fill the current evidence gaps in HIV prevention and ART adherence.

Fig 1. Conceptual framework.

ART: antiretroviral therapy.

Fig 2. Study selection.

Fig 3. Comprehensive knowledge of HIV/AIDS.

DHS: Demographic Health Survey. The numbers represent the prevalence reported as percentage (%).

Fig 4. Prevalence of HIV in fishing communities.

AIS: AIDS Indicator Survey (national data from the general population); UPHIA: Ugandan Population-based HIV Impact Assessment 2016–2017. The numbers represent the prevalence reported as percentage (%).

Fig 5. Prevalence of HIV among young people in fishing communities.

AIS: AIDS Indicator Survey (national data from the general population); UPHIA: Ugandan Population-based HIV Impact Assessment 2016–2017. The numbers represent the prevalence reported as percentage (%).

Fig 6. HIV incidence in fishing communities.

RCCS: Rakai Community Cohort Study; UPHIA: Ugandan Population-based HIV Impact Assessment 2016–2017. The numbers represent the incidence reported as percentage (%).

Fig 7. Multiple sexual partnership in selected studies.

IOM: International Organization for Migration. Kamali et al. (2015): more than 2 partners in the past 12 months. Abaasa et al. (2015): more than 2 partners (no time line provided). The numbers represent the prevalence reported as percentage (%).

Fig 8. Prevalence of high risk sex and condom use at last high risk sex.

IOM: International Organization for Migration. MOH: Ministry of Health. The numbers represent the prevalence reported as percentage (%).

Fig 9. Commercial/Transactional sex in the past 12 months.

IOM: International Organization for Migration. DHS: Demographic Health Survey. The numbers represent the prevalence reported as percentage (%).

Fig 10. Change in HIV incidence in the RCSS.

RCSS: Rakai Community Cohort Study. The numbers represent the incidence reported as percentage (%).

Fig 11. Risk factors for HIV infection in Ugandan fishing communities based on the socio-ecological model.