title: Risk Denial and Socio-Economic Factors Related to High HIV Transmission in a Fishing Community in Rakai, Uganda: A Qualitative Study.
abstract: BACKGROUND
  In Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission is still very high with an incidence of 4.3 and 3.1 per 100 person-years in women and men, respectively, and an HIV prevalence of 44%, reaching up to 74% among female sex workers. We explored drivers for the high HIV transmission at Kasensero from the perspective of fishermen and other community members to inform future policy and preventive interventions.
  
  
  METHODS
  20 in-depth interviews including both HIV positive and HIV negative respondents, and 12 focus-group discussions involving a total of 92 respondents from the Kasensero fishing community were conducted during April-September 2014. Content analysis was performed to identify recurrent themes.
  
  
  RESULTS
  The socio-economic risk factors for high HIV transmission in Kasensero fishing community cited were multiple and cross-cutting and categorized into the following themes: power of money, risk denial, environmental triggers and a predisposing lifestyle and alcoholism and drug abuse. Others were: peer pressure, poor housing and the search for financial support for both the men and women which made them vulnerable to HIV exposure and or risk behavior.
  
  
  CONCLUSIONS
  There is a need for context specific combination prevention interventions in Kasensero that includes the fisher folk and other influential community leaders. Such groups could be empowered with the knowledge and social mobilization skills to fight the negative and risky behaviors, perceptions, beliefs, misconceptions and submission attitudes to fate that exposes the community to high HIV transmission. There is also need for government/partners to ensure effective policy implementation, life jackets for all fishermen, improve the poor housing at the community so as to reduce overcrowding and other housing related predispositions to high HIV rates at the community. Work place AIDS-competence teams have been successfully used to address high HIV transmission in similar settings.
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda; Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, 171 77, Stockholm, Sweden; School of Graduate Studies and Research Busoga University, PO BOX 154, Iganga, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors: Muhamadi
authors: M
authors: Lubega
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Neema
authors: N
authors: Nakyaanjo
authors: School of Graduate Studies and Research Busoga University, PO BOX 154, Iganga, Uganda.
authors: Sumaya
authors: S
authors: Nansubuga
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Edgar
authors: E
authors: Hiire
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Godfrey
authors: G
authors: Kigozi
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Gertrude
authors: G
authors: Nakigozi
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Tom
authors: T
authors: Lutalo
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: Fred
authors: F
authors: Nalugoda
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda.
authors: David
authors: D
authors: Serwadda
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda; Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors: Ronald
authors: R
authors: Gray
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda; Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors: Maria
authors: M
authors: Wawer
authors: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors: Caitylin
authors: C
authors: Kennedy
authors: Rakai Health Sciences Program, Old Bukoba road, P.O Box 279, Kalisizo, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors: Steven James
authors: SJ
authors: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D003717:Denial, Psychological; D005260:Female; D005398:Fisheries; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology* / Q000635:transmission*; D006798:Housing; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D000067074:Peer Influence; D036301:Qualitative Research; D012111:Residence Characteristics; D012309:Risk-Taking; D012944:Social Support; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult