It is 8:00 am at Kigungu landing site found in Entebbe, Wakiso district, and business is already bustling. Fishermen are drawing their nets to the shore and trying to sell their catch.

Not far away from them is a resident, a 19-year-old woman who is drunk and hawking her body. Her charges start from sh2,000 for what she refers to as “customer testing.”

“However, with the tough economic times, at times clients force us into sex and then we are thrown out of the lodge without receiving any payment,” the woman explains.

Transactional sex and overconsumption of alcohol are some of the prevalent activities at landing sites and the key factors fuelling the spread of HIV among fishing communities.

According to reports from the Uganda AIDS Commission, 130,000 people live in fishing communities and the estimates suggest that HIV infection rates in these communities are almost three to five times higher than the national average for adults aged 15–49 years.

The last two national surveys have documented prevalence rates at 22%–37% and as high as 40% in some fishing communities.

These communities are composed of fishermen, processors, mongers and boat-makers. The other people are repairers, shopkeepers and female sex workers, who follow the fishermen as they move in search of high yields.

These high HIV prevalence rates are the result of a complex interplay of factors, including vulnerabilities caused by the high degree of mobility.

Other factors include the failure to address the knowledge gap, attitudes and practices of these communities through HIV prevention programmes.

In a scope review conducted on the HIV epidemic in fishing communities in Uganda published in 2021, the fishermen say they often exhaust their earnings on sex workers.

Others say that idleness during the day causes them to spend their money on female sex workers.

“Most of the fishermen are not aware of the risks of HIV and AIDS,” Joseph Kato, a fisherman from Kasenyi fish landing site, says.

REMOTE LOCATIONS

Relatedly, most of the fishing communities are located in remote parts and in some villages, HIV counselling, testing and treatment are not available.

“There are also few civil society organisations and service providers prioritising service delivery in fishing communities since the fishermen keep moving from the landing site to the islands,” the programme coordinator, Family Medical Point (FMP), Polyne Nabwire, says.

She adds that when people get infected with HIV, they have to travel long distances, at least five kilometres from their villages to a hospital.

It is against this backdrop that the health ministry instituted an adaptation strategy and worked with implementing partners to modify service delivery approaches, according to the Annual Joint AIDS Review Report 2022/23.

In this regard, FMP, with partners, such as the International AIDS Vaccine Initiative, has prioritised AIDS mitigation services for fishing communities.

FMP is a non-government organisation that enhances access to lifesaving healthcare services, especially sexual reproductive health services, among key populations, marginalised communities and young people. It also empowers women and girls and promotes health.

The coalition of over 30 partners at Kasenyi and other landing sites in Entebbe offers services, like treatment and care, as well as sexual health and reproductive health (SRHR) care.

Other services offered include sensitisation talks, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) treatment, HIV testing and family planning, according to Nabwire.

One of the key services is sensitisation, which is mainly done among young people and sex workers in Kasenyi, Kigungu and Nakiwogo fishing landing sites in Entebbe Wakiso district.

They have reached 17,000 people with the correct SRHR information, trained 674 trainers and empowered community mobilisers as anti-gender-based violence champions and SHRHR ambassadors at the lake shores to sensitise the communities on the dangers of HIV.

In addition, over 32,000 sex workers were provided services in six districts by the Alliance of Women Advocating for Change, according to Macklean Kyomya, the executive director.

However, more needs to be done based on studies done by the Uganda AIDS Commission.

The 2022–2023 Annual Joint AIDS Review Report indicated an increase in multiple sexual partners, declining condom use, high-risk sex and low knowledge of HIV.

The reports indicate that the population groups with the highest HIV incidence are women who inject themselves with drugs.

In this category, at least 175 per 1,000 has HIV among sex workers, 41 per 1,000 have the virus and among the never-married females.

Thus, the epidemic remains concentrated among the key populations (5.5%), with sex workers at 31%, people who inject drugs between 11% and 34%, and men who have sex with men at 12%.

THE STATISTICS

According to reports by the Uganda AIDS Commission (UAC), key populations and priority populations are important target groups for prevention interventions since HIV prevalence is high among them.

The UAC report Acceleration of the Prevention, a road map towards zero infections by 2030, indicates that HIV rates are high among all key populations, including fishing communities, sex workers and clients of sex workers, averaging about 4,300 new infections per 100,000.

The overall positivity rate among the key populations was 1.96%. In 2022/2023, a total of 91,811 key populations were in care, increasing treatment coverage from 419,434 to 469,107, which included priority populations.

Relatedly, sex workers contribute a third of all the new HIV transmissions, with 17,037 (35.1%), followed by previously married uncircumcised men (9532, 19.6%), previously married females (5916, 12.2%), and sex workers (5344, 11%).

To avert this trend, the health ministry instituted an adaptation strategy and worked with implementing partners to modify service delivery approaches.

Consequently, over 772,755 key populations were screened, of which 726,534 (94%) were tested for HIV during the review period, achieving a coverage of 97% among sex workers, an increase from 86% in 2021/22.

Among the 11,324 that tested HIV-positive, 11,071 (98%) were linked to ART.

KASENYI’S NEED FOR HELP

On why putting the focus on Kasenyi landing site is important, HIV focal person, Harrison Mbowa, says it is the busiest on Lake Victoria, with a daily population of 7,000 people and 84 islands surrounding it.

“There is still a need to do more HIV counselling and testing in these communities. We also need to make it easier for those who are HIV-positive to get treatment,” Mbowa revealed.

Another challenge, he added, is that HIV-positive sex workers come from elsewhere and carry out their trade on the island.

“We have 30 sex workers who have come out openly and of these, 28 have HIV,” he noted.

Mbowa disclosed the fact that since Kasenyi was listed as one of the landing sites with the most at-risk population, some organisations have taken the lead towards treatment.

“We used to prevent the sex workers, but when we discovered that they were engaging school-going youth into sex, we gazetted them in the Kabati area in order to reduce the spread,” he explained.