1
|
Bahemuka UM, Okimat P, Webb EL, Seeley J, Ssetaala A, Okech B, Oketch B, Kibengo FM, Okello E, Kwena Z, Kuteesa MO, Price MA, Kaleebu P, Grosskurth H, Fast P. Factors Associated with Short and Long Term Mobility and HIV Risk of Women Living in Fishing Communities Around Lake Victoria in Kenya, Tanzania, and Uganda: A Cross Sectional Survey. AIDS Behav 2023; 27:880-890. [PMID: 36088399 PMCID: PMC9944640 DOI: 10.1007/s10461-022-03824-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
Mobility is linked to negative HIV care continuum outcomes. We sought to understand factors associated with short and long term mobility among women in fishing communities in Kenya, Tanzania, and Uganda. From 2018 through 2019 we conducted a cross-sectional survey of women aged 15 years and above, randomly selected from a census of six fishing villages, around Lake Victoria. Data collected included: demographics, risky sexual behaviour on the most recent trip, and travel behaviour in the previous 4 months. Mobility was recorded as any overnight trip outside the participant's village. A two-level multinomial logistic regression model was used to determine the associated factors. A total of 901 participants were enrolled, of whom 645 (71.6%) reported travelling (53.4%; short and 18.2% long term trips). Five factors were associated with long term travel: age, travel purpose, frequency of travel, sexual behaviour while travelling, and destination. Trips made by women aged 46-75 years were less likely to be long term. Long term trips were more common if the trip was to visit, rather than to trade, and more common for women who reported one or two trips rather than three or more trips. Women who made long term trips were more likely to engage in unprotected sex while on a trip. Women who travelled to a regional town/district or another town/district were more likely to take long term trips. The factors associated with travel duration among women living in fishing communities could inform planning of future health care interventions in these communities.
Collapse
Affiliation(s)
- Ubaldo M. Bahemuka
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Paul Okimat
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Emily L. Webb
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Ali Ssetaala
- grid.415861.f0000 0004 1790 6116UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Brenda Okech
- grid.415861.f0000 0004 1790 6116UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Bertha Oketch
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, KEMRI, Kisumu, Kenya
| | - Freddie M. Kibengo
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Elialilia Okello
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Zachary Kwena
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, KEMRI, Kisumu, Kenya
| | - Monica O. Kuteesa
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
| | - Matt A. Price
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
- grid.266102.10000 0001 2297 6811University of California, San Francisco, San Francisco, USA
| | - Pontiano Kaleebu
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Pat Fast
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
| | | |
Collapse
|
2
|
Bajunirwe F, Akakimpa D, Tumwebaze FP, Abongomera G, Mugyenyi PN, Kityo CM. Persistence of traditional and emergence of new structural drivers and factors for the HIV epidemic in rural Uganda; A qualitative study. PLoS One 2019; 14:e0211084. [PMID: 31693660 PMCID: PMC6837848 DOI: 10.1371/journal.pone.0211084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 10/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Uganda, the HIV epidemic is now mature and generalized. Recently, there have been reports of resurgence in the incidence of HIV after several years of successful control. The causes for this resurgence are not clear but suspected to be driven by structural factors that influence large groups of people rather than individuals. The aim of this study was to describe the structural drivers of the HIV epidemic in high prevalence regions and inform the next generation of interventions. METHODOLOGY We conducted a total of 35 focus group discussions in 11 districts in Uganda. Due to their high HIV prevalence, the districts had been selected to implement a donor supported program to scale up HIV prevention, care and treatment. Focus groups consisted of men and women including opinion leaders, civil servants including teachers, police officers, religious, political leaders, shop keepers, local residents and other ordinary persons from all walks of life. The qualitative data were transcribed and analyzed manually. Texts were coded using a coding scheme which was prepared ahead of time but emerging themes and codes were also allowed. RESULTS Our data indicated there is persistence of several structural drivers and factors for HIV in rural Uganda. The structural drivers of HIV were divided into three categories: Gender issues, socio-cultural, and economic drivers. The specific drivers included several gender issues, stigma surrounding illness, traditional medical practices, urbanization, alcohol and substance abuse and poverty. New drivers arising from urbanization, easy access to mobile phone, internet and technological advancement have emerged. These drivers are intertwined within an existing culture, lifestyle and the mixture is influenced by modernization. CONCLUSION The traditional structural drivers of HIV have persisted since the emergence of the HIV epidemic in Uganda and new ones have emerged. All these drivers may require combined structural interventions that are culturally and locally adapted in order to tackle the resurgence in incidence of HIV in Uganda.
Collapse
Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and
Technology, Mbarara, Uganda
- * E-mail:
| | | | | | | | | | | |
Collapse
|
3
|
Warren EA, Paterson P, Schulz WS, Lees S, Eakle R, Stadler J, Larson HJ. Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review. PLoS One 2018; 13:e0198680. [PMID: 29902205 PMCID: PMC6002067 DOI: 10.1371/journal.pone.0198680] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use. OBJECTIVES This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use. DATA SOURCES We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance. STUDY ELIGIBILITY CRITERIA Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included. STUDY APPRAISAL AND SYNTHESIS METHODS Included publications were quality assessed using the Hawker method and coded thematically. RESULTS 10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may-or may not-choose to use prevention interventions. LIMITATIONS This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings. CONCLUSIONS AND IMPLICATIONS When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.
Collapse
Affiliation(s)
- Emily A. Warren
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - William S. Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robyn Eakle
- Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Jonathan Stadler
- Department of Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa
| | - Heidi J. Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health, University of Washington, Seattle, United States of America
| |
Collapse
|
4
|
Michalopoulos LTM, Baca-Atlas SN, Simona SJ, Jiwatram-Negrón T, Ncube A, Chery MB. "Life at the River is a Living Hell:" a qualitative study of trauma, mental health, substance use and HIV risk behavior among female fish traders from the Kafue Flatlands in Zambia. BMC WOMENS HEALTH 2017; 17:15. [PMID: 28270127 PMCID: PMC5341354 DOI: 10.1186/s12905-017-0369-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022]
Abstract
Background In Western settings, the relationship between trauma history, posttraumatic stress disorder, substance use, and HIV risk behavior, is well established. Although female fish traders in Zambia are affected by HIV at rates estimated to be 4–14 times higher than the national prevalence, no studies have examined the co-occurring issues of trauma, substance use and HIV risk behavior among this vulnerable population. The current study examined: 1) trauma history, trauma symptoms and HIV risk behaviors and 2) the relationship between these co-occurring issues among female fish traders from the Kafue Flatlands in Zambia. Methods Twenty individual semi-structured qualitative interviews and a focus group discussion (n = 12 participants) were conducted with female fish traders in the Kafue Flatlands of Zambia. Template analysis was used to examine the data. Results The findings indicate that female fish traders in Zambia are at risk of multiple and ongoing traumatic events and daily stressors, severe mental health symptoms (including western conceptualizations of disorders such as anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief, as well as local idioms of distress), substance abuse, and HIV sexual risk behaviors. The results suggest a relationship between trauma and HIV sexual risk behavior in this population. Conclusions The indication of these co-occurring issues demonstrates the need for HIV prevention intervention efforts, which account for trauma, mobility, and psychosocial outcomes in order to reduce HIV sexual risk behavior among female fish traders in Zambia. Electronic supplementary material The online version of this article (doi:10.1186/s12905-017-0369-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lynn T Murphy Michalopoulos
- Columbia University School of Social Work, Social Intervention Group, Global Health and Mental Health Unit, 1255 Amsterdam Avenue, Room 804, Mail Code 4600, New York, NY, 10027, USA.
| | - Stefani N Baca-Atlas
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, North Carolina, USA
| | - Simona J Simona
- Department of Social Development Studies, University of Zambia, School of Humanities and Social Sciences, Lusaka, Zambia
| | - Tina Jiwatram-Negrón
- University of Michigan, Curtis Center, School of Social Work, 1080 South University, Ann Arbor, 48109-1106, Michigan, USA
| | - Alexander Ncube
- Elizabeth Glaser Pediatric AIDS Foundation, Zambia, Lusaka, Zambia
| | - Melanie B Chery
- Columbia University School of Social Work, New York, NY, 10027, USA
| |
Collapse
|
5
|
Cawley C, Wringe A, Slaymaker E, Todd J, Michael D, Kumugola Y, Urassa M, Zaba B. The impact of voluntary counselling and testing services on sexual behaviour change and HIV incidence: observations from a cohort study in rural Tanzania. BMC Infect Dis 2014; 14:159. [PMID: 24655360 PMCID: PMC3994406 DOI: 10.1186/1471-2334-14-159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background It is widely assumed that voluntary counselling and testing (VCT) services contribute to HIV prevention by motivating clients to reduce sexual risk-taking. However, findings from sub-Saharan Africa have been mixed, particularly among HIV-negative persons. We explored associations between VCT use and changes in sexual risk behaviours and HIV incidence using data from a community HIV cohort study in northwest Tanzania. Methods Data on VCT use, sexual behaviour and HIV status were available from three HIV serological surveillance rounds undertaken in 2003–4 (Sero4), 2006–7 (Sero5) and 2010 (Sero6). We used multinomial logistic regression to assess changes in sexual risk behaviours between rounds, and Poisson regression to estimate HIV incidence. Results The analyses included 3,613 participants attending Sero4 and Sero5 (3,474 HIV-negative and 139 HIV-positive at earlier round) and 2,998 attending Sero5 and Sero6 (2,858 HIV-negative and 140 HIV-positive at earlier round). Among HIV-negative individuals VCT use was associated with reductions in the number of sexual partners in the last year (aRR Seros 4–5: 1.42, 95% CI 1.07-1.88; aRR Seros 5–6: 1.68, 95% CI 1.25-2.26) and in the likelihood of having a non-cohabiting partner in the last year (aRR Seros 4–5: 1.57, 95% CI 1.10-2.25; aRR Seros 5–6: 1.48, 95% CI 1.07-2.04) or a high-risk partner in the last year (aRR Seros 5–6 1.57, 95% CI 1.06-2.31). However, VCT was also associated with stopping using condoms with non-cohabiting partners between Seros 4–5 (aRR 4.88, 95% CI 1.39-17.16). There were no statistically significant associations between VCT use and changes in HIV incidence, nor changes in sexual behaviour among HIV-positive individuals, possibly due to small sample sizes. Conclusions We found moderate associations between VCT use and reductions in some sexual risk behaviours among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT uptake. Furthermore, there were no significant changes in HIV incidence associated with VCT use, although declining background incidence and small sample sizes may have prevented us from detecting this. The impact of VCT services will ultimately depend upon rates of uptake, with further research required to better understand processes of behaviour change following VCT use.
Collapse
Affiliation(s)
- Caoimhe Cawley
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
High-risk sex and displacement among refugees and surrounding populations in 10 countries: the need for integrating interventions. AIDS 2014; 28:761-71. [PMID: 24346025 DOI: 10.1097/qad.0000000000000118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Between 2004 and 2012, the United Nations High Commissioner for Refugees conducted behavioural surveillance surveys in 27 separate communities in 10 countries. METHODS Random systematic or two-stage cluster sampling was used among participants of age 15-49 years, using a modified standard questionnaire. We conducted descriptive data analysis and multivariable logistic regression to identify factors independently associated with multiple sexual partnerships. RESULTS Of 27 sites surveyed comprising 24 219 individuals, 11 refugee and surrounding communities were paired. Recent displacement comprised less than 10% of participants. Visiting neighbouring communities varied from 8.6 to 74.4%. Multiple sexual partnerships varied from 2.7% in Sudan to 32.5% in Tanzania. Condom use during last sex was low in most of the communities (<5%). The prevalence of forced sex was similar in paired sites, with intimate partner violence being the most frequent, ranging between 1.0 and 4.6% in camps and 0.8 and 3.6% in communities, with the exception of Nepal (10.8 and 9.8%). Being away from home for more than 1 month and having lived in community for less than 12 months was associated with multiple partnerships in six and five of 16 sites, respectively. CONCLUSION In the largest study of paired sites of refugees in protracted refugee camps and surrounding nationals, data showed no consistent difference in levels of risky sexual behaviour and there was much variation among the different groups. The prevention strategies should be targeted in a highly integrated manner for both the communities. Forced sex among women was reported at similar levels among refugees and nationals, with intimate partner violence being the most common. These findings should reduce stigma and discrimination against refugees.
Collapse
|
7
|
Camlin CS, Kwena ZA, Dworkin SL. Jaboya vs. jakambi: Status, negotiation, and HIV risks among female migrants in the "sex for fish" economy in Nyanza Province, Kenya. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:216-31. [PMID: 23631716 PMCID: PMC3717412 DOI: 10.1521/aeap.2013.25.3.216] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
In Nyanza Province, Kenya, HIV incidence is highest (26.2%) in the beach communities along Lake Victoria. Prior research documented high mobility and HIV risks among fishermen; mobility patterns and HIV risks faced by women in fishing communities are less well researched. This study aimed to characterize forms of mobility among women in the fish trade in Nyanza; describe the spatial and social features of beaches; and assess characteristics of the "sex-for-fish" economy and its implications for HIV prevention. We used qualitative methods, including participant observation in 6 beach villages and other key destinations in the Kisumu area of Nyanza that attract female migrants, and we recruited individuals for in-depth semi-structured interviews at those destinations. We interviewed 40 women, of whom 18 were fish traders, and 15 men, of whom 7 were fishermen. Data were analyzed using Atlas.ti software. We found that female fish traders are often migrants to beaches; they are also highly mobile. They are at high risk of HIV acquisition and transmission via their exchange of sex for fish with jaboya fishermen.
Collapse
Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, 50 Beale St., Suite 1200, San Francisco, CA 94105, USA.
| | | | | |
Collapse
|