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Mobile populations such as fisherfolk show high HIV incidence and prevalence. We pilot-tested implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake and adherence in the context of healthcare outreach events in two mainland fisherfolk communities on Lake Victoria, Uganda from September 2021 to February 2022. The implementation strategies included PrEP adherence supporters (selected from PrEP users' social networks), community workshops (to address misconceptions and stigma, and empower PrEP advocacy), and check-in calls (including refill reminders). PrEP medical records data were collected from 6-months pre-intervention to 6-months post-intervention. Qualitative interviews with 20 PrEP users (10 who continued, 10 who discontinued), 9 adherence supporters, and 7 key partners (providers, community leaders) explored acceptability. Percentages of PrEP initiators (of those eligible) were significantly higher during the intervention (96.5%) than 6-months before the intervention (84.5%), p < 0.0001; percentages of PrEP users who persisted (i.e., possessed a refill) 6-months post-initiation (47.9% vs. 6.7%) and had at least 80% PrEP coverage (based on their medication possession ratio) from the initiation date to 6-months later (35.9% vs. 0%) were higher during versus pre-intervention, p < 0.0001. A comparison fisherfolk community with better healthcare access had lower uptake (78.3%; p < 0.0001) and persistence at 6-months (34.0%; p < 0.001), but higher coverage during the intervention period (70.4%; p < 0.0001). Qualitative data suggested the strategies promoted PrEP use through reduced stigma and misconceptions. The intervention bundle cost was $223.95, $172.98, and $94.66 for each additional person for PrEP initiation, persistence, and coverage, respectively. Enhanced community-based PrEP implementation that fosters a supportive community environment can improve PrEP use in mobile populations without easy access to healthcare. (NCT05084716)., (© 2024. The Author(s).)

Introduction: Non-Communicable Diseases (NCDs) place a significant burden on India's healthcare system, accounting for approximately 62% of all deaths in the country in 2017. The southern Indian state - Kerala - has some of the highest rates of NCDs. Within the state, the fisherfolk community has a high prevalence of risk factors such as tobacco use and alcohol consumption. Working in the fisheries industry demands physical exertion, night shifts alongside extended periods of time at sea (for seafaring fisherfolk). Evidence is scant on how these conditions relate to the health-seeking experiences of fisherfolk, particularly in the context of NCDs. We conducted a qualitative study in two districts of Kerala to fill this gap., Methods: In-depth individual and small group interviews- as per participant preference -  with male and female fishing community members living with NCDs were conducted between October 2022 and February 2023 in two districts of Kerala. Interviews were conducted to explore community members' experiences with health-seeking for NCDs. Transliterated English transcripts were coded using ATLAS.ti software and analysed using thematic analysis with inductive generation of codes, with indexing against Levesque, Harris, and Russell's 2013 access to healthcare framework., Results: Thirty-three interviews with 42 participants were conducted. We found that NCDs were usually diagnosed late- either when admitted/consulted for other illnesses or when the symptoms became unbearable. Health-seeking patterns differed between seafaring and inland fishing subgroups, who were sampled from two districts in the state. Seafaring fisherfolk preferred public facilities for regular checkups and medicines while in-land fisherfolk relied on private facilities, although it was considered expensive. Ability to seek care was impacted by the working hours of the health centre which did not suit their working hours. Health constaints and related expenses also impacted their financial status and occupation, with some opting for less strenuous jobs., Conclusion: This study highlights the NCD-related health-seeking experiences of the fisherfolk community in Kerala, India. Fisherfolk reported self neglect, delayed diagnosis, cost and livelihood constraints owing to the onset of NCDs, even as dual practice and medicine access in the public sector were appreciated. Overall, larger studies and policymaking processes should consider in depth the experiences faced by particular economic groups like fisherfolk, who may face unique health and care-seeking challenges., (© 2024. The Author(s).)

Background: Preexposure prophylaxis (PrEP) reduces new human immunodeficiency virus(HIV) infections by up to 96% and is recommended for key populations by the World Health Organization. Understanding the knowledge and willingness to use PrEP is essential for effective implementation. This study assessed these factors and identifiedcharacteristics associated with differences in knowledge among key populations in Kampala, Uganda., Methods: We administered a cross-sectional survey to a systematic sample of 497 participants from fisherfolk (283, 56.9%), men who have sex with men (MSM) (93, 18.7%), and female sex worker (FSW) (121, 24.4%) communities in Kampala Central, where PrEP had not yet been rolled out. Data on sociodemographic characteristics, PrEP awareness, and HIV-related behavioralfactors were collected. Knowledge about PrEP was measured using an adopted questionnaire comprising five key questions about PrEP knowledge, graded as no knowledge, some knowledge and good knowledge. Ordered probit regression models were used to analyze the associations of independent factors with PrEP knowledge levels., Results: Participants had a mean age of 29±7.6 years. Ofthese, 257 (51.7%) reported having sex with women, 157 (31.6%) with men and 83 (16.7%) with both men and women. Self-reported HIV-positive status was 6.4% in fisherfolk, 11.8% in MSM and 27.3% in FSW. PrEP awareness stood at 62.4% overall, with the highest awareness in FSW (73.6%) and the lowest in fisherfolk (54.1%). Willingness to use PrEP was high across all groups (77.7%), although it was lower among FSW (66.9%). Multivariate probit analysis highlighted key independent factors associated with PrEP knowledge among fisherfolks and HIV-related concerns (Adj. Coeff = 0.54, 95% CI: 0.11, 0.97) and lack of PrEP awareness (Adj. Coeff = -0.99, 95% CI:-1.28, -0.70); among MSM, lack of PrEP awareness (Adj. Coeff = -1.74, 95% CI:-2.38, -1.10); and in FSW, tertiary education (Adj. Coeff = 1.53, 95% CI: 0.07, 2.99) and marital status (Adj. Coeff = 0.57, 95% CI=0.09, 1.05). MEshighlighted the influence of these independent factors at each knowledge level., Conclusions and Recommendations: Despite the high willingness to use PrEP, significant knowledge gaps exist, particularly concerning dosage and use duration, which are influenced by factors such as HIV concern and educational attainment. Tailored educational initiatives may bridge these gaps and enhance willingness to use PrEP., Competing Interests: Competing interests The authors declare no conflicts of interest.

Conflicts between human populations and Nile crocodiles are widespread with crocodiles posing significant threats to fisherfolk and riverine communities across r-Saharan Africa. Hundreds of deadly attacks take place annually, and mortality rates may range from 50% to 100%. Attitudes and perceptions towards crocodiles were studied using structured questionnaires among fisherfolk along the River Nile and the Sudd wetlands in South Sudan. Local communities used crocodiles for their meat and skin/leather trades. The meat is regarded to enhance longevity, sexual potency, and protection against witchcraft. Crocodiles are perceived as a main threat to lives and livelihoods as they restrict people's freedom of movement along water bodies, attack livestock and humans, and devastate fishing equipment. To assess whether responses were influenced by the intensity of crocodile threats, published data on fatal crocodile attacks on humans and livestock were analysed using Generalised Linear Models (GLMs). This analysis indicated a direct link between the number of crocodile attacks and human attitudes. Crocodiles were generally feared and hated, and there was the agreement of the need to destroy breeding habitats. However, some attitudes were complex and nuanced as highlighted by the agreement of local communities on the need to destroy Nile Crocodile breeding habitats on the one hand and the need to establish crocodile sanctuaries as the the preferred strategy to mitigate risks and conflict on the other hand. There is a need for the creation of a crocodile sanctuary in the Sudd wetlands to minimise the risks of illegal hunting and to buffer the increasing pressure on crocodiles due to human population growth and economic upturn after the civil war.

Background: HIV is hyperendemic among fisherfolk in Sub-Saharan Africa, especially around Lake Victoria, Uganda. Purpose/Research Design: We conducted cross-sectional semi-structured interviews about oral pre-exposure prophylaxis (PrEP) implementation with 35 Ugandan fisherfolk (15 women, 20 men) and 10 key stakeholders (healthcare providers, policymakers, community leaders). We used a directed content analysis approach based on implementation science and social marketing frameworks. Results: Participants showed high acceptability for PrEP. Anticipated barriers among fisherfolk included stigma (due to similar medications/packaging as HIV treatment); misconceptions; mobility, competing needs, poverty, and partner conflict. Anticipated provider barriers included insufficient staffing and travel support. Recommendations included: change PrEP packaging; integrate PrEP with other services; decrease PrEP refill frequency; give transportation resources to providers; train more healthcare workers to provide PrEP to fisherfolk; and use positively framed messages to promote PrEP. Conclusions: Results can inform policymakers and healthcare organizations on how to overcome barriers to PrEP scale-up in most at-risk populations with poor healthcare access., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ethnobotanical knowledge about the role of plants in fisheries provides valuable ecological information vital for sustainable management of local resources; however, it is diluted and understudied globally. This literature review aims to map the knowledge of plant use within traditional fishing communities., Methods: Through the PRISMA method, we identified and selected 34 articles reporting the use of plants in fisheries, and including 344 taxa of plants and algae. Uses of plants and algae were grouped into different categories., Results: In the novel categorization of fishery-related uses we proposed, the most mentioned were for fishing and building/repair of fishing artifacts and habitat-related uses, while the records of plants related to fiber uses, providing aid in fishing management and species causing problems, were among the least mentioned. Semi-structured interview is most commonly used with local resource users, especially fishery experts, in exploring perceptions on plant use within traditional fishing communities. Diversity was high in all the recorded families, but most were reported locally., Conclusion: Ethnobotanical studies with fishers are not common in the documented literature but they provide a large number of use reports. On the basis this review, in most of the world, the information is of a casual and sporadic nature. Fishers can provide information on aquatic plants and algae that create problems and aid in fishing management, which are crucial in understanding the ecosystem of a region experiencing environmental challenges. This knowledge is greatly understudied globally and undergoing a rapid decline, as highlighted in several of the reviewed articles. Thus, further systematic research on fishery-related uses of plants by fisherfolk is needed considering its potential contribution to the sustainable management of fishery resources., (© 2023. The Author(s).)

Background: East Africa's fishing communities experience a high burden of two interrelated and frequently co-occurring health issues: HIV and hazardous alcohol use. Nearly two-thirds of Ugandan fisherfolk men meet the criteria for harmful alcohol use. We developed a multilevel intervention to reduce hazardous alcohol use and improve HIV care engagement among fisherfolk men living with HIV (LWHIV) in Wakiso district, Uganda., Methods: This is a qualitative study of stakeholder perspectives on the appropriateness, acceptability, and feasibility of a multilevel intervention for fisherfolk men LWHIV. The proposed intervention, Kisoboka ("It is possible!"), combines a structural component [changing the mode of work payments from cash to mobile money] with a behavioral component [motivational interviewing-based counseling combined with content using behavioral economic principles to promote behavior change]. We conducted one focus group (n=7) and eight in-depth interviews with fisherfolk men LWHIV and 19 key informant (KI) interviews with health workers, employers, and community leaders. These explored the appropriateness, acceptability, and feasibility of specific key intervention components., Results: Overall, stakeholders' perspectives supported high intervention acceptability and perceived appropriateness of the proposed intervention. It was perceived to be feasible with some caveats of recommendations for overcoming potential implementation challenges identified (e.g., having a friend assist with documenting savings and alcohol use if an individual was unable to write themselves) which are discussed., Conclusion: This work highlights the potential of the Kisoboka intervention and the importance of early engagement of key stakeholders in the intervention development process to ensure appropriateness, acceptability, feasibility, and socio-cultural fit., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Fishing communities are a subpopulation burdened by human immunodeficiency virus (HIV), mainly due to their mobility and cash income access. Strategies to mitigate the spread of HIV in fishing communities have varying outcomes. We conducted a study to determine the prevalence of HIV, recent infection and associated factors among fishing communities at Lake Victoria in Tanzania., Methods: We conducted a cross-sectional study in the first quarter of 2019. The participants' information was collected using a structured questionnaire. Blood samples were screened for HIV infection; the positive samples were tested for avidity and viral load to determine the recent infection. Logistic regression analysis was used to determine the factors associated with HIV infection., Results: A total of 1048 individuals were included with a mean age of 34 years (SD ± 11.5). The overall prevalence of HIV was 9.1%, while 7.4% had a recent infection. Lack of formal education, being separated/divorced/widowed, transactional sex, history of sexually transmitted infections, not tested for HIV in the last 12 months had 1.7 to three times more odds of contracting HIV., Conclusion: A proportion of HIV recent infection among the fisherfolks was relatively high, signifying the continuous spread, which is predisposed by some demographic and behavioural characteristics., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: fisherfolk play a major role in emerging economies such as Ghana. While many fishing communities are noted to be underdeveloped, fisherfolk are considered to neglect their oral hygiene, while being prone to certain conditions due to peculiar risks. The purpose of this study was to determine the periodontal health status of adults in a selected fishing community in Ghana., Methods: a descriptive cross-sectional study was carried out to assess the periodontal status of adults in Jamestown, a peri-urban area in Ghana. Data acquisition was by means of a structured questionnaire and periodontal examination. Information obtained consisted of demographic data (age, sex, education and occupation category) oral hygiene practices (type of teeth cleaning materials, methods of tooth cleansing, frequency of dental visits and reasons for the visit) and periodontal clinical parameters (plaque index, and community periodontal index of treatment needs)., Results: a total of 276 participants were included in the study, with ages ranging from 21 to 70 years. The participants were made up of 138 fisherfolk and 138 non-fisherfolk. Males had worse scores for periodontal disease compared to females. Plaque score did not vary among age groups, but changed significantly between educational level and occupational categories. CPITN varied significantly between educational levels, age categories and occupational categories., Conclusion: the study found inhabitants of the fishing community of Jamestown to have a generally unsatisfactory periodontal status, but worse for the fisherfolk in the community., Competing Interests: The authors declare no competing interests., (Copyright: Daniel Tormeti et al.)

Background: The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence., Objective: To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV., Methods: We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members in which PrEP had not been rolled out yet by the time of we conducted the study. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP., Key Results: We enrolled 283 participants with a mean age of 31 ± 8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6, 95%CI 75.5-85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31-3.02, P = 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24, P = 0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P < 0.001). In focus group discussions, participants described pill burden, side-effects and drug safety as potential barriers to PrEP use., Conclusions and Recommendations: Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also increase means of awareness of PrEP as an HIV preventive strategy ., (© 2022. The Author(s).)

The Sudd in South Sudan, formed by the White Nile's Baḥr al-Jabal section, is one of the largest and most important wetlands in the world. Communities in the region almost exclusively depend on fisheries for food and livelihoods. Although threatened by over-exploitation and habitat changes, fish populations are also affected by climate change. Using semi-structured questionnaires, we assessed fisherfolk's opinions of how recent variation in climate affected their livelihoods and the environment. Fisherfolk perceived that climate had changed in the past decade and were negatively impacted by this. Interviewees reported average higher temperatures, a greater frequency of floods and droughts, unpredictable timing of seasons, and erratic rainfall. Destruction of fishing villages/camps, loss and damage of fishing equipment, shifts in the fishing calendar, reduction of fish trade, and fish catch declines as well as psycho-social problems were given as the major consequences of climate change. Causes of climate change and variability were perceived to be linked to uncontrolled harvest of forest resources, anger of God and ancestors, and natural variability in climate. Most respondents expressed a desire to adopt more responsible behavior such as planting trees and establishing community nurseries, being educated on climate change risks, and sustainable fisheries management. Our results show that fisherfolk in the Sudd are troubled by climate change impacts on their livelihoods and on fish populations. In South Sudan, climate change has been reported from hydroclimatological data but concrete impacts on people remain largely unknown and of little concern because of recent wars and the poor economy. Our study provides an example of how fisherfolks' local ecological knowledge (LEK) can be used as an early warning system of the negative impacts on livelihoods and fish populations and support adaptation to the changing climate., Supplementary Information: The online version contains supplementary material available at 10.1007/s10113-022-01928-w., Competing Interests: Conflict of interestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022.)

Men's engagement in the HIV care continuum may be negatively affected by adherence to inequitable gender norms, which may be exacerbated by HIV stigma. This cross-sectional study with 300 male fisherfolk in Uganda examined the independent and interacting effects of inequitable gender norm endorsement and HIV stigma on men's missed HIV care appointments and missed antiretroviral (ARV) doses. Greater gender inequitable norm endorsement was associated with increased odds of missed HIV clinic visits (adjusted odds ratio [AOR)] 1.44, 95% CI 1.16-1.78) and a statistically significant interaction between internalized HIV stigma and inequitable gender norms on missed ARV doses was identified (AOR 5.32, 95% CI 2.60-10.86). Adherence to traditional gender norms reduces men's HIV appointment attendance, and among men with high internalized stigma, increases the likelihood of poor treatment adherence. These findings point to the need for HIV interventions that reconfigure harmful gender norms with a focus on stigma reduction., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Background: Fisherfolk have been identified as a key population in the HIV response in Uganda due to high HIV prevalence and low engagement in HIV services. While studies have examined lifestyles and risk, much remains to be understood about help and health seeking experiences, including the combined use of biomedical and traditional health care., Objective: To examine the use of biomedical and traditional health care in two fishing communities around Lake Victoria in Uganda., Methods: Exploratory, in-depth qualitative study involving semi-structured interviews with 42 HIV positive fisherfolk., Results: Prior to HIV diagnosis, participants who described becoming ill sought different forms of help including biomedical treatment prescribed by health workers or self-prescribed; biomedical and herbal medicines together; herbal medicines only; or no form of treatment. Following HIV diagnosis, the majority of participants used ART exclusively, while a smaller number used both ART and traditional care strategies, or reported times when they used alternative therapies instead of ART. Prior to HIV diagnosis, fisherfolk's health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. After HIV diagnosis, most resorted only to using ART., Conclusion: Study findings provide insight into how fisherfolk's use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Efforts are needed to reach fisherfolk through everyday health seeking networks to ensure HIV is diagnosed and treated as early as possible., (© 2021 Tumwine C et al.)

Available guidance to mitigate health risks from exposure to freshwater harmful algal blooms (HABs) is largely derived from temperate ecosystems. Yet in tropical ecosystems, HABs can occur year-round, and resource-dependent populations face multiple routes of exposure to toxic components. Along Winam Gulf, Lake Victoria, Kenya, fisher communities rely on lake water contaminated with microcystins (MCs) from HABs. In these peri-urban communities near Kisumu, we tested hypotheses that MCs exceed exposure guidelines across seasons, and persistent HABs present a chronic risk to fisher communities through ingestion with minimal water treatment and frequent, direct contact. We tested source waters at eleven communities across dry and rainy seasons from September 2015 through May 2016. We measured MCs, other metabolites, physicochemical parameters, chlorophyll a, phytoplankton abundance and diversity, and fecal indicators. We then selected four communities for interviews about water sources, usage, and treatment. Greater than 30% of source water samples exceeded WHO drinking water guidelines for MCs (1μg/L), and over 60% of source water samples exceeded USEPA guidelines for children and immunocompromised individuals. 50% of households reported sole use of raw lake water for drinking and household use, with alternate sources including rain and boreholes. Household chlorination was the most widespread treatment utilized. At this tropical, eutrophic lake, HABs pose a year-round health risk for fisher communities in resource -limited settings. Community-based solutions and site-specific guidance for Kisumu Bay and similarly impacted regions is needed to address a chronic health exposure likely to increase in severity and duration with global climate change., Competing Interests: Conflict of Interest: The authors declare they have no conflict of interest.

Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen ( n  = 25) and female sex workers ( n  = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.

In-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers to identify experiences of social support and its influence on access to and use of HIV testing, treatment, and care. Fisherfolk participants reported receiving support at some point. Prior to HIV diagnosis, this usually took the form of advice on what illness they were dealing with and remedies to use. After HIV diagnosis and disclosure to friends or family, emotional support enabled fisherfolk to come to terms with an HIV diagnosis, informational support offered guidance on how best to live with HIV, while instrumental support enabled access to relevant HIV services. Finally, affiliative support, in the form of new friends met through HIV clinic visits, provided a sense of belonging. Each of these different kinds of support assisted fisherfolk to respond positively to HIV with important consequences for secondary and tertiary prevention.

Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk ( n  = 4) or sex workers ( n  = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings.

Background: We determined the prevalence of and risk factors for alcohol misuse and illicit drug use among young Ugandans in fishing communities, a recognised "key population" for human immunodeficiency virus (HIV) infection., Methods: We conducted a cross-sectional survey among young people (15-24 years) in fishing communities in Koome, Uganda, in December 2017-July 2018. Using Audio-Assisted Self-Interviewing, we collected data on socio-demographic characteristics and alcohol use, including the Alcohol Use Disorders Identification Test (AUDIT) and timeline follow-back calendar (TLFB). Blood samples were analysed for HIV, herpes simplex virus 2 (HSV2), and Phosphatidyl ethanol (PEth 16:0/18:1). Urine samples were analysed for illicit drugs., Results: Among 1281 participants (52.7% male, mean age 20 years), 659 (51.4%) reported ever drinking alcohol, 248 (19.4%) had 12-month-AUDIT ≥ 8, and 261 (20.5%) had whole-blood PEth 16:0/18:1 concentration ≥ 20 ng/mL, indicating significant consumption. In multivariable analyses, PEth 16:0/18:1 ≥ 20ng/mL, AUDIT ≥ 8 and binge drinking (≥6 standard drinks per drinking occasion in the previous month from TLFB) were all strongly associated with older age, low education, smoking, and HSV2. Illicit drug use prevalence was 5.2% and was associated with older age, low education, being single, and smoking., Conclusion: Levels of alcohol misuse were high among young people in fishing communities and associated with HSV2, a proxy for risky sexual behaviour. Alcohol and illicit drug harm reduction services and HIV prevention programs in Uganda should prioritise young fisherfolk.

Background: Depression is a prevalent and serious mood disorder and a major source of disability adjusted life years (DALY) in Uganda. Furthermore, evidence from Uganda and other countries throughout sub-Saharan Africa suggests that nearly a third of persons living with human immunodeficiency virus (HIV) suffer from depression and it adversely affects healthcare seeking behavior. The high burden of disease attributable to depression makes data on the prevalence of depression in Uganda, a country with a generalized HIV epidemic, a public health priority. This paper describes the psychometric properties of the Center for Epidemiologic Studies-Depression (CES-D) measure when administered to men and women residing in three fishing communities along the shore of Lake Victoria., Methods: We applied methods based on item response theory and classical test theory approaches to assess individual item characteristics, conducted exploratory factor analysis and assessed internal reliability, and construct and content validity of the measure. All analyses were performed in R Studio., Results: The study sample consisted of 300 residents of fishing communities in Wakiso District, Uganda. Fifty-six percent of the sample was female and 19.7% reported being HIV positive. Seven items of the measure that did not perform well, either because they could not differentiate between levels of the latent trait or because they did not map onto the primary factor, were removed from the scale. A single factor structure best fit our final set of 13-items and we found an overall coefficient alpha of 0.89, indicating high internal consistency in this population., Conclusions: Based on our findings, we recommend that future use of the CES-D in this population utilize our revised scale with the final set of 13-items. The addition of other measures that can improve the rigor of CES-D validation efforts, such as inclusion of a clinical depression measure and administration in both a clinical and a general population sample in this setting are needed.

HIV fatalism, or the belief that HIV acquisition and mortality is out of one's control, is thought to contribute to HIV risk in fishing populations in East Africa. The objective of this cross-sectional study was to investigate the association between fatalism and sexual risk behaviours (unprotected sex, engagement in transactional sex), beyond the influence of other known HIV risk factors (e.g. food insecurity, mobility), and identify demographic, psychosocial, and structural correlates of HIV fatalism. Ninety-one men and women living in fishing villages on two islands in Lake Victoria, Uganda completed an interviewer-administered questionnaire after testing HIV-positive during home or community-based HIV testing between May and July 2015. Multivariate logistic regression was used to test the association between HIV fatalism and transactional sex and multivariate linear regression was used to identify demographic, psychosocial, and structural correlates of HIV fatalism. HIV fatalism was significantly associated with a greater likelihood of transactional sex (AOR = 3.07, 95% CI = 1.02-9.23, p = 0.04), and structural barriers to HIV care (e.g. distance to clinic) were significantly associated with HIV fatalism (β = 0.26, SE = 0.12, p = 0.04). Our findings highlight HIV fatalism as a contributor to transactional sex in Ugandan fishing communities, and as a product of broader social and contextual factors, suggesting the potential need for structural HIV interventions in this setting.

Globally, almost 2.78 million deaths that occur annually are attributed to work-related health risks. Worldwide and, especially, in developing countries, about 20% to 50% of the workers are exposed to health risks. Fishing is an ancient occupation, and like many others, it is characterized by numerous health risks and hazards. This study sought to understand the exposure of fisherfolk to human health risks, through fish handling and processing in Lake Baringo, Kenya. The study adopted a cross-sectional social survey design. A systematic random sampling technique was used to select respondents for this study. A semi-structured questionnaire was administered to the respondents to collect data on risks involved during the handling and processing of fish. Key informant interviews and observation checklists were also used to collect more information. Both descriptive and inferential statistics were used to analyze data. Inferential statistics included Pearson χ 2 test, which was used to test the association of various factors on the encounter with occupational health risks. The level of significance was tested at α = 0.05. The study findings reveal the fisherfolk-encountered risks such as cuts, eye irritability, sunburns, skin burn, cold, falls, and musculoskeletal injuries during their work. The results showed that only 12% of the fisherfolk use personal protective equipments (PPEs) at work. Pearson χ 2 test analysis showed there was an association between gender and gender roles (χ 2  = 39.517, P  < .05). In addition, an association was revealed between occupational health risks and gender (χ 2  = 16.283, P  < .05). There was also an association between occupational hazards and gender (χ 2  = 21.352, P  < .05). However, there was no association revealed between occupational health risk and marital status (χ 2  = 1.305, P  > .05) and PPEs (χ 2  = 1.089, P  > .05). Furthermore, results indicate that 61% of the fisherfolk who suffered from occupational health risks missed work. The study concludes that all the fisherfolk at Kampi Samaki are exposed to various health risks while working, which is thus likely to affect their health. We recommend public health campaigns to sensitize fisherfolk on the associated risks in fish handling and processing. There is also a need for health campaigns for the fisherfolk to appreciate the need for First Aid Kits during the fishing operations., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

We used a discrete choice experiment to assess the acceptability and potential uptake of HIV pre-exposure prophylaxis (PrEP) among 713 HIV-negative members of fishing communities in Uganda. Participants were asked to choose between oral pill, injection, implant, condoms, vaginal ring (women), and men circumcision. Product attributes were HIV prevention effectiveness, sexually transmitted infection (STI) prevention, contraception, waiting time, and secrecy of use. Data were analysed using mixed multinomial logit and latent class models. HIV prevention effectiveness was viewed as the most important attribute. Both genders preferred oral PrEP. Women least preferred the vaginal ring and men the implant. Condom use was predicted to decrease by one third among men, and not to change amongst women. Oral PrEP and other new prevention technologies are acceptable among fishing communities and may have substantial demand. Future work should explore utility of multiple product technologies that combine contraception with HIV and other STI prevention.

Qualitative research exploring the influence of community-level factors on access to and use of HIV treatment and care services among people living in fishing communities is limited, especially with respect to those already in receipt of HIV care and on treatment. To enhance understanding of these issues, semi-structured in-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers from two HIV clinics located in two fishing communities in Uganda. Fisherfolk's mobility and poor transport systems were significant barriers to access to and use of HIV treatment and care. Mobility, which involved regular movement between communities, sometimes led to fisherfolk's inability to access HIV treatment and care. A poor transport system in fishing communities - characterised by irregular transport services and boats in a poor condition - was reported to force both fisherfolk and health care providers sometimes to cancel journeys to centres providing treatment and support. Community-level factors such as these, which relate to the organisation and provision of transport in local community settings, are significant influences on access to HIV treatment and care. Interventions that address these challenges are needed to improve access to and use of HIV treatment and care in fishing communities.

Fishing communities are a most-at-risk population for HIV in Uganda. Alcohol use and abuse and economic vulnerability fuel risky sexual practices and lead to increased risk of HIV infection in these communities. Economic strengthening is an emerging intervention approach and interventions promoting saving money via mechanisms with a "soft commitment" in the form of restricting or charging small fees for withdrawals, may serve to reduce spending on alcohol and spending that leads to HIV risk behaviors in cash-based economies. However, little research has been conducted to explore the potential for commitment savings-led economic strengthening interventions to address alcohol use and sexual risk behavior among fisherfolk. This cross-sectional study explored the associations between commitment savings, HIV sexual risk behavior, and problematic alcohol among fisherfolk. We also determined whether commitment savings moderated the associations between problematic alcohol use and risky sexual behaviors. 300 (132 male, 168 female) residents of fishing communities on Lake Victoria, Uganda completed a structured interviewer-assisted interview. Over half (55.3%) used commitment savings by saving money in a bank or savings cooperative or via mobile money. Having problematic alcohol use increased the rate of risky unprotected sex with: all partners (adjIRR 6.08, 95% CI 4.30-8.60) and with casual partners and CSWs/clients (adjIRR 4.90, 95% CI 3.09-7.78), and increased the odds of having met a sex partner at an alcohol venue (adjOR 2.84, 95% CI 1.46-5.51) compared to those without problematic alcohol use. Commitment savings was associated with lower odds of: problematic alcohol use (adjOR 0.50, 95% CI 0.26-0.96), meeting a sex partner at an alcohol venue (adjOR 0.43, 95% CI 0.24-0.78), as well as lower rates of risky unprotected sex with all partners (adjIRR 0.68, 95% CI 0.48-0.96), and with causal partners, CSWs/clients (adjIRR 0.38, 95% CI 0.17-0.85). Use of commitment savings moderated the associations between problematic alcohol use and unprotected sex. However, the moderating effects of commitment savings varied by gender. These findings suggest that promoting saving money in savings mechanisms which involve a commitment may be a potentially viable avenue for HIV prevention among fishing communities and may be particularly helpful for those who have problematic alcohol use.

This study explored the intersection of masculinity and HIV care engagement among fishermen and other male fisherfolk on antiretroviral therapy (ART) in Wakiso District, Uganda. We conducted 30 in-depth interviews with men on ART recruited from HIV treatment sites and used a thematic analysis approach. Since HIV diagnosis and ART initiation, men had adopted masculine identities more conducive to HIV care engagement. The masculine roles of worker and provider, husband and sexual partner and the appearance of physical strength were compromised by HIV, but restored by ART's positive effects on health. Peers also emerged as facilitators to HIV care, with men supporting each other to seek testing and treatment. However, structural and occupational barriers to HIV care associated with the masculine role of worker remained a barrier to care engagement. Findings suggest that emphasising the benefits of ART in bolstering men's ability to fulfil the roles important to them may improve the effectiveness of HIV testing and treatment messaging for men. Differentiated care models that address structural-level barriers to care, and community-level gender-transformative programming to help fishermen engage in HIV care, may be beneficial.

This cross-sectional study assessed determinants of HIV clinic appointment attendance and antiretroviral treatment (ART) adherence among 300 male fisherfolk on ART in Wakiso District, Uganda. Multi-level factors associated with missed HIV clinic visits included those at the individual (age, AOR = 0.98, 95% CI 0.97-0.99), interpersonal (being single/separated from partner, AOR: 1.25, 95% CI 1.01-1.54), normative (anticipated HIV stigma, AOR: 1.55, 95% CI 1.05-2.29) and physical/built environment-level (travel time to the HIV clinic, AOR: 1.11, 95% CI 1.02-1.20; structural-barriers to ART adherence, AOR: 1.27, 95% CI 1.04-1.56; accessing care on a landing site vs. an island, AOR: 1.35, 95% CI 1.08-1.67). Factors associated with ART non-adherence included those at the individual (age, β: - 0.01, η 2  = 0.03; monthly income, β: - 0.01, η 2  = 0.02) and normative levels (anticipated HIV stigma, β: 0.10, η 2  = 0.02; enacted HIV stigma, β: 0.11, η 2  = 0.02). Differentiated models of HIV care that integrate stigma reduction and social support, and reduce the number of clinic visits needed, should be explored in this setting to reduce multi-level barriers to accessing HIV care and ART adherence.

Fishing communities in Uganda have high rates of excessive alcohol consumption and negative health outcomes related to alcohol consumption, such as HIV acquisition and transmission and intimate partner violence victimization and perpetration. Research lacks understanding of alcohol use in Ugandan fishing communities, underlying reasons for excessive drinking among fishermen or how their community perceives negative health outcomes linked to excessive alcohol consumption. This qualitative study was conducted among Ugandan fisherfolk to determine why excessive alcohol consumption has overtaken their communities. Through analyzing in-depth interviews and focus group discussions, reasons for drinking and community perceptions of drinking were explored using the Socio Ecological Model and the Time Perspective Theory. Interviews were coded into two content themes: social influences on drinking and using alcohol to cope with stress. Participants acknowledged links between excessive alcohol consumption and negative health outcomes within their families and communities. These findings highlight the need for alcohol-related reduction interventions that are sensitive to contextual factors and self-identified contributors to problematic alcohol use within individuals and their communities. Such interventions must consider the social, ecological and economic conditions within fishing sites, focusing not only on individual-level behavioral change but also challenging the underlying structures that foster excessive alcohol consumption.

Ugandan fishing communities are dually burdened with high rates of HIV and alcohol use. This qualitative study explores context and motivation of alcohol consumption, and alcohol's effect on antiretroviral treatment (ART) adherence, among male fisherfolk living with HIV in Wakiso District, Uganda. We conducted in-depth semi-structured interviews with 30 men in HIV care and on ART, and used a thematic analysis approach for analysis. Alcohol use was identified as a major barrier to ART adherence through cognitive impairment and the intentional skipping of doses when drinking. Men reportedly reduced their drinking since HIV diagnosis - motivated by counseling received from providers and a newfound desire to live a healthy lifestyle. However, social, occupational, and stress-related influences that make alcohol reduction difficult were identified. Our findings suggest alcohol use may pose a challenge to ART adherence for fishermen living with HIV - and has implications for the tailoring of screening and brief intervention for alcohol reduction in HIV care for this population.

Background: New HIV infections in Tanzania have been decreasing, however some populations remain at higher risk. Despite of that, evidence on the magnitude of HIV infection and the associated factors and HIV/AIDS services uptake among fisherfolk in Tanzania are inadequately explored. This study therefore aimed at determining prevalence of HIV infection and utilization of HIV/AIDS services among fishfolk in selected Islands of Lake Victoria for evidence-based interventions., Methods: Cross-sectional study determining status of HIV infection among fisherfolk (n = 456) and retrospective review of voluntary counselling and testing (VCT) registry (n = 1744) were done in Buchosa and Muleba districts. Structured questionnaire and HIV rapid test kits with the standard testing protocol were used as research tools., Results: A total of 269 (58.9%) male and 187 (41.1%) female fisherfolk were recruited during the community survey. Prevalence of HIV infection was 14% in all surveyed landing sites with a site variation from as low as 7.2% to as high as 23.8%. Participants employed in fishing related employment had higher odds of being HIV infected (5.4 times) than those who practiced fishing and partly farming [OR = 5.40; 95%CI 1.88-15.61; p < 0.001]. Participants employed in fishing related employment had higher odds of being HIV infected (5.4 times) than those practiced fishing and farming [OR = 5.40; 95%CI 1.88-15.61; P < 0.001]. Lack of formal education [aOR = 3.37; 95%CI 1.64-6.92; p < 0.001], being older [aOR = 1.06; 95%CI 1.03-1.09] and using alcohol [aOR = 2.26; 95%CI 1.23-4.15] predicted the likelihood of contracting HIV infection. Approximately three quarters (76%) of respondents had ever tested for HIV infection within past 1 year. Moreover, about half of the study participants had used condom inconsistently and 5 out of 14 (37.5%) of participants who knew their status had never started treatment. Despite the low uptake of most HIV preventive services, majority (88%) of male fisherfolk were circumcised., Conclusion: The magnitude of HIV infection among fisherfolk was up to 3 times higher than that of the general populations in Muleba and Buchosa districts. Higher age, using alcohol and lack of formal education predicted increased likelihood of HIV infection. The uptake of key HIV/AIDS curative and preventive services was generally low.

We compared two community-based HIV testing models among fisherfolk in Lake Victoria, Uganda. From May to July 2015, 1364 fisherfolk residents of one island were offered (and 822 received) home-based testing, and 344 fisherfolk on another island were offered testing during eight community mobilization events (outreach event-based testing). Of 207 home-based testing clients identified as HIV-positive (15% of residents), 82 were newly diagnosed, of whom 31 (38%) linked to care within 3 months. Of 41 who screened positive during event-based testing (12% of those tested), 33 were newly diagnosed, of whom 24 (75%) linked to care within 3 months. Testing costs per capita were similar for home-based ($45.09) and event-based testing ($46.99). Compared to event-based testing, home-based testing uncovered a higher number of new HIV cases but was associated with lower linkage to care. Novel community-based test-and-treat programs are needed to ensure timely linkage to care for newly diagnosed fisherfolk., Competing Interests: COMPLIANCE WITH ETHICAL STANDARDS: There are no conflicts of interest to disclose. All human subjects procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Among Ugandan fisherfolk, HIV prevalence (with estimates ranging from 15 to 40 %) is higher than in the general population (about 7 %), potentially due to high-risk behaviors and low access to HIV testing and healthcare. We conducted semi-structured interviews on barriers to linkage to care with 10 key stakeholders and 25 fisherfolk within 1-2 months of their testing HIV-positive at clinic outreach events in Ugandan Lake Victoria communities. Interviews were recorded, transcribed, translated, and coded using grounded theory methods. Participants cited low healthcare access and quality of care, mobility, competing needs for work during clinic hours, stigma, and low social support as barriers. Over 10 % of clients screened positive for HIV at outreach events, and only half accessed care. Linkage to care issues may begin with the failure to attract high-risk fisherfolk to testing. New models of HIV testing and treatment delivery are needed to reach fisherfolk.

In Uganda, elevated HIV prevalence in fishing communities along Lake Victoria have been attributed in part to heavy alcohol use, but qualitative research is needed to understand the contextual factors influencing alcohol and sexual risk. Eight focus group discussions were conducted (n = 50; 23 male, 27 female) in Gerenge, Uganda with five occupational groups: fishermen, fishmongers, alcohol-sellers, commercial sex workers, and restaurant owners. Data was analyzed using content analysis. Alcohol use was prevalent and said to influence risky sex. Sex-related alcohol expectancies and occupational factors influenced individuals to drink during sex and structural factors related to the built environment, economy, and policy were identified as key contributors to both alcohol use and sexual risk in general. The findings highlight alcohol reduction as an important component of HIV/AIDS prevention and suggest structural interventions should be prioritized in this context.

The study describes the nature, context and implications of a unique form of transactional sexual relationships in the fishing communities along Lake Victoria in Kisumu County, Kenya. We conducted 12 focus group discussions and 17 key informant interviews among fishermen, fishmongers and fish transporters in Kisumu. Women fishmongers in the fishing communities commonly form relationships with fishermen, which are often sexual, as part of the jaboya system, wherein women who wish to sell fish in the market secure the rights to purchase the fish caught by the fishermen. Due to the nature and context of the sexual intercourse, sex typically occurs in a hurried manner, often without preparation or protection. Thus, by engaging in a web of these relationships, conducted in contexts that compromise their ability to practice safer sex, men and women in these fishing communities are at increased risk of HIV.

Analysis from research and practice in Africa shows that fishing communities are hardly reached by HIV-related services, education, and business services, partly because of the efforts and costs involved and a lack of good practice in reaching out to these often remote areas. At the same time, fish traders, especially women, travel regularly to remote fishing camps to purchase fish. Although female fish traders may be exposed to HIV, violence and abuse in their interactions and relationships with fishermen, economic necessity keeps them in this trade. Good health among fisherfolk is a basic mainstay of productive and sustainable fisheries, providing food and income to fishing communities and the nation at large. However, these benefits are severely at risk as per-capita fish supplies in several African countries are declining, and fisherfolk are among the populations most vulnerable to HIV and AIDS. Under the regional programme 'Fisheries and HIV/AIDS in Africa: Investing in sustainable solutions,' the WorldFish Center conducted a socioeconomic assessment in the Kafue Flats fishery in Zambia to identify factors related to HIV/AIDS vulnerability among people in the fishing communities, particularly female fish traders. The study identified a variety of factors, hence the 'Fish Trader+' model of intervention was developed to reduce female fish traders' vulnerability to HIV by building on their economic rationale through the formation of savings groups. This article outlines the implementation of the Fish Trader+ model in Zambia and examines its potential to empower female fish traders so as to reduce poverty and vulnerability to HIV in fishing communities.