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. 2024 Oct 11;19(10):e0293711.
doi: 10.1371/journal.pone.0293711. eCollection 2024.

Impact of natural disasters on HIV risk behaviors, seroprevalence, and virological supression in a hyperendemic fishing village in Uganda

Hadijja Nakawooya  1 , Victor Ssempijja  1   2 , Anthony Ndyanabo  1 , Ping Teresa Yeh  3 , Larry W Chang  1   3   4   5 , Maria J Wawer  1   5 , Fred Nalugoda  1 , David Serwadda  1   6 , Ronald H Gray  1   5 , Joseph Kagaayi  1   6 , Steven J Reynolds  1   6   7 , Tom Lutalo  1   8 , Godfrey Kigozi  1 , M Kate Grabowski  1   9 , Robert Ssekubugu  1
Affiliations

Impact of natural disasters on HIV risk behaviors, seroprevalence, and virological supression in a hyperendemic fishing village in Uganda

Hadijja Nakawooya et al. PLoS One. .

Abstract

Background: Understanding the impact of natural disasters on the HIV epidemic in populations with high HIV burden is critical for the effective delivery of HIV control efforts. We assessed HIV risk behaviors, seroprevalence, and viral suppression in a high HIV prevalence Lake Victoria fishing community before and after COVID-19 emergence and lockdown and a severe lake flooding event, both of which occurred in 2020.

Methods: We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, an open population-based HIV surveillance cohort in south-central Uganda. The data were collected both prior to (September-December 2018) and after (October-December 2021) COVID-19 emergence and a severe flooding event. Households impacted by flooding were identified via drone data and through consulting village community health workers. The entire study population was subject to extensive COVID-19-related lockdowns in the first half of 2020. Differences in HIV-related outcomes before and after COVID, and between residents of flooded and non-flooded households, were assessed using a difference-in-differences statistical modeling approach.

Findings: A total of 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding. HIV seroprevalence in the initial period was 37% in flooded and 36.8% in non-flooded households. After the COVID-19 pandemic and lockdown, we observed a decline in HIV-associated risk behaviors: transactional sex declined from 29.4% to 24.8% (p = 0.011), and inconsistent condom use with non-marital partners declined from 41.6% to 37% (p = 0.021). ART coverage increased from 91.6% to 97.2% (p<0.001). There was 17% decline in transactional sex (aPR = 0.83, 95% CI: 0.75-0.92) and 28% decline in the overall HIV risk score (aPR = 0.83, 95% CI: 0.75-0.92) among HIV-seronegative participants. We observed no statistically significant differences in changes of HIV risk behavior, seroprevalence, or viral suppression outcomes when comparing those affected by floods to those not affected by floods, in the periods before and after COVID-19, based on difference-in-differences analyses.

Interpretation: Despite a high background burden of HIV, the COVID-19 pandemic, and severe flooding, we observed no adverse impact on HIV risk behaviors, seroprevalence, or virologic outcomes. This may be attributed to innovative HIV programming during the period and/or population resilience. Understanding exactly what HIV programs and personal or community-level strategies worked to maintain good public health outcomes despite extreme environmental and pandemic conditions may help improve HIV epidemic control during future natural disaster events.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig 1
Fig 1. Timeline of key events.
Events include RCCS survey rounds, Lake Victoria flooding, COVID-19 emergence, and intensified implementation of differentiated HIV service delivery models.
Fig 2
Fig 2. Map of flooded households following a mass flooding event in spring of 2020 in Kasensero, Uganda.
Map adapted from open-source shapefiles obtained from Stanford University Library’s search tool for GIS datasets [27, 28].
Fig 3
Fig 3. Comparison of HIV risk behaviors and HIV outcomes by sex and COVID exposure.
Fig 4
Fig 4. Comparison of overall HIV risk scores among females and males, by exposure to flooding and COVID.
See this image and copyright information in PMC

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