title: High HIV incidence and socio-behavioral risk patterns in fishing communities on the shores of Lake Victoria, Uganda.
abstract: 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.
authors.affiliation: Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda. janet.seeley@mrcuganda.org
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi-Miiro
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
authors.forename: Juliet
authors.initials: J
authors.lastname: Mpendo
authors.forename: Gershim
authors.initials: G
authors.lastname: Asiki
authors.forename: Andrew
authors.initials: A
authors.lastname: Abaasa
authors.forename: Jan
authors.initials: J
authors.lastname: De Bont
authors.forename: Leslie
authors.initials: L
authors.lastname: Nielsen
authors.forename: Pontiano
authors.initials: P
authors.lastname: Kaleebu
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005398:Fisheries; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D060106:Lakes; D008297:Male; D020380:Needs Assessment; D012111:Residence Characteristics; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult