title: Prevalence and Correlates of HIV and Hepatitis C Virus Infections and Risk Behaviors among Malaysian Fishermen.
abstract: Fishermen in Southeast Asia have been found to be highly vulnerable to HIV, with research evidence highlighting the role of sexual risk behaviors. This study aims to estimate the rate of HIV as well as hepatitis C virus (HCV) infections among Malaysian fishermen, and the risky sexual and injection drug use behaviors that may contribute to these infections. The study also includes an assessment of socio-demographic, occupational and behavioral correlates of testing positive for HIV or HCV, and socio-demographic and occupational correlates of risk behaviors. The study had a cross-sectional design and recruited 406 fishermen through respondent-driven sampling (RDS). Participants self-completed a questionnaire and provided biological specimens for HIV and HCV testing. We conducted and compared results of analyses of both unweighted data and data weighted with the Respondent-Driven Sampling Analysis Tool (RDSAT). Of the participating fishermen, 12.4% were HIV positive and 48.6% had HCV infection. Contrary to expectations and findings from previous research, most fishermen (77.1%) were not sexually active. More than a third had a history of injection drug use, which often occurred during fishing trips on commercial vessels and during longer stays at sea. Of the fishermen who injected drugs, 42.5% reported unsafe injection practices in the past month. Reporting a history of injection drug use increased the odds of testing HIV positive by more than 6 times (AOR = 6.22, 95% CIs [2.74, 14.13]). Most fishermen who injected drugs tested positive for HCV. HCV infection was significantly associated with injection drug use, being older than 25 years, working on a commercial vessel and spending four or more days at sea per fishing trip. There is an urgent need to strengthen current harm reduction and drug treatment programs for Malaysian fishermen who inject drugs, especially among fishermen who work on commercial vessels and engage in deep-sea fishing.
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Martin K K
authors.initials: MK
authors.lastname: Choo
authors.affiliation: Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Bassel
authors.affiliation: Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Australia, Sydney, Australia.
authors.forename: Philippe C G
authors.initials: PC
authors.lastname: Adam
authors.affiliation: Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America.
authors.forename: Louisa
authors.initials: L
authors.lastname: Gilbert
authors.affiliation: Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America.
authors.forename: Elwin
authors.initials: E
authors.lastname: Wu
authors.affiliation: Social Intervention Group, Columbia University School of Social Work, New York, New York, United States of America.
authors.forename: Brooke S
authors.initials: BS
authors.lastname: West
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Bazazi
authors.affiliation: Centre for Social Research in Health, Faculty of Arts and Social Sciences, UNSW Australia, Sydney, Australia.
authors.forename: John B F
authors.initials: JB
authors.lastname: De Wit
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Rusli
authors.initials: R
authors.lastname: Ismail
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005398:Fisheries; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult