title: High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda.
abstract: BACKGROUND
  HIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour.
  
  
  METHODS
  Between September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011-January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 18-49 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models.
  
  
  RESULTS
  Overall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, p<0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR =1.50, 95%; 1.20, 1.87) and participants aged 30-39 years (adj.PPR=1.40, 95%; 1.10, 1.79) and 40-49 years (adj.PPR=1.41, 95%; 1.04, 1.92) compared to those aged 18-24 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p=0.004) and among island communities compared to lakeshore ones (90.4% vs. 85.8%, p=0.004).
  
  
  CONCLUSIONS
  The HIV prevalence in the general fisher-folk population in Uganda is similar to that observed in the "high-risk" fisher folk. FFC have very high levels of willingness to participate in future HIV vaccine trials.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. nkiwanuka@gmail.com
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Ali
authors.initials: A
authors.lastname: Ssetaala
authors.forename: Juliet
authors.initials: J
authors.lastname: Mpendo
authors.forename: Matthias
authors.initials: M
authors.lastname: Wambuzi
authors.forename: Annet
authors.initials: A
authors.lastname: Nanvubya
authors.forename: Simon
authors.initials: S
authors.lastname: Sigirenda
authors.forename: Annet
authors.initials: A
authors.lastname: Nalutaaya
authors.forename: Paul
authors.initials: P
authors.lastname: Kato
authors.forename: Leslie
authors.initials: L
authors.lastname: Nielsen
authors.forename: Pontiano
authors.initials: P
authors.lastname: Kaleebu
authors.forename: Josephine
authors.initials: J
authors.lastname: Nalusiba
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
mesh_terms: D016915:AIDS Vaccines / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012309:Risk-Taking; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016915:AIDS Vaccines; D015483:HIV Antibodies
keywords: HIV-1; Uganda; fishing communities; willingness to participate in HIV vaccine trials