title: Understanding the socio-structural context of high HIV transmission in kasensero fishing community, South Western Uganda.
abstract: BACKGROUND
  In Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission remains 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 the social contextual factors for the high HIV transmission at Kasensero to inform future policy and preventive interventions.
  
  
  METHODS
  We conducted 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 from April-September 2014. Content analysis was performed to identify recurrent themes.
  
  
  RESULTS
  Our findings suggest that the high HIV transmission in Kasensero is a complex function of eight themes including; positive/negative attitudes about HIV and combination HIV prevention such as the demand for services versus ART/circumcision disinhibition; HIV depository; Multiple partners; Frequent unprotected sex; Clothing; Parental behaviors; Pressure within the sex industry; and Cross generational sex.
  
  
  CONCLUSIONS
  The current combination HIV prevention services by the RHSP need to be enhanced with more government involvement including ensuring sustainable supply of ART and circumcision services since they are reportedly highly demanded. Community involvement through the engagement of popular peers could also help in the campaign to change the HIV predisposing culture, misconceptions and risky social norms of the population. Social Context HIV Transmission Fishing Community.
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. dlmuhamadi@yahoo.co.uk.|Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinsika Institutet, PO Box 1717007, Stockholm, Sweden. dlmuhamadi@yahoo.co.uk.|School of Graduate Studies and Research Busoga University, PO Box 154, Iganga, Uganda. dlmuhamadi@yahoo.co.uk.|Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. dlmuhamadi@yahoo.co.uk.
authors.forename: Muhamadi
authors.initials: M
authors.lastname: Lubega
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. neema@rhsp.org.
authors.forename: Neema
authors.initials: N
authors.lastname: Nakyaanjo
authors.affiliation: School of Graduate Studies and Research Busoga University, PO Box 154, Iganga, Uganda. ksum44@yahoo.com.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Nansubuga
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. hire.edgarj@gmail.com.
authors.forename: Edgar
authors.initials: E
authors.lastname: Hiire
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. gkigozi@rhsp.org.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. ftrude@rhsp.org.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. tlutalo@rhsp.org.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. fnalugoda@rhsp.org.
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. dserwadda@rhsp.org.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. rgray4@jhu.edu.|Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA. rgray4@jhu.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Gray
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. mwawer1@jhu.edu.|Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA. mwawer1@jhu.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.affiliation: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA. caitlinkennedy@jhu.edu.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: Rakai Health Sciences Program, Old Bukoba road, PO Box 279, Kalisizo, Uganda. sreynol6@jhu.edu.|Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. sreynol6@jhu.edu.|Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA. sreynol6@jhu.edu.
authors.forename: Steven James
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D000328:Adult; D000818:Animals; D044966:Anti-Retroviral Agents / Q000600:supply & distribution / Q000627:therapeutic use; D002944:Circumcision, Male; D032882:Comprehension; D003469:Culture; D005260:Female; D005399:Fishes; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics; D012747:Sexual Partners; D014454:Uganda / Q000453:epidemiology; D047568:Unsafe Sex; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents