HIV remains a public health concern (1–3). Despite, tremendous efforts made in reducing the epidemic, there were 1.7 million people living with HIV (PLHIV) in 2019 (4). Sub-Saharan Africa (SSA) is the region with the highest global HIV prevalence. Southern and Eastern SSA are the regions most burdened by the epidemic and have the largest number of people living with HIV in the world (5). UNAIDS estimates there were 20.7 million PLHIV in 2019 in the Eastern and Southern regions of SSA. The 2016–2017 Uganda Population-Based HIV Impact Assessment (UPHIA) estimated about 1.2 million adults to be living with HIV in the country (6).
HIV infection was first described in Uganda in 1985 in a fishing community (7). Since then, studies have consistently documented that fishing populations are disproportionately burdened by HIV, relative to the general population in the country (8–12). Specifically, HIV prevalence in fishing communities is estimated to be 5–7 times higher than in the general population (13). One study estimated the HIV prevalence of among people aged 18–24 years in fishing communities along the shores of Lake Victoria to be 12% in men and 26% in women (10). Despite the high burden of HIV infection in Uganda’s fishing communities, HIV prevention and treatment strategies have not effectively reached all high-risk individuals in these communities (10, 14). One of the largest barriers to HIV service access in Uganda’s fishing communities is that these areas are characterized by complex sexual networks that includes fishermen, food vendors, fish traders, alcohol brewers, and other service providers (9). The members of this network are hard to track and follow due to their inconsistent patterns of mobility, the time they spend away from home, their pursuit of a daily cash inflow, and their risky work environments.
Another defining feature of Uganda’s fishing communities is the high level of availability and use of alcohol, a well-established risk factor for HIV globally (15, 16) and among young people in fishing communities (17). Alcohol use impairs judgment, reduces one’s ability to negotiate for safer sex, and lowers inhibitions (10). Kuteesa and colleagues (2020) observe several drivers of alcohol use among fishing populations including work-related stress, mobility, geographical remoteness, and limited regulation of alcohol sales (17). Evidence from fishing communities in Koome Islands in Mukono District in Uganda indicates that lower education, smoking, and depression are all associated with alcohol misuse (17). In fishing communities in Tanzania, alcohol consumption is associated with higher odds of contracting HIV (12). Relatedly, people employed in alcohol related businesses (e.g., working in bars) in fishing communities around Lake Victoria are at greater risk of HIV infection (18).
Intimate partner violence (IPV), including physical and sexual abuse, has been found to be a risk factor for HIV acquisition (14, 19), including in fishing communities in Rakai, Uganda (20). Sexually or physically abused women are less likely to be able to negotiate safer sex with a partner and are more likely to engage in sexual relations in exchange for money or gifts (21). In the event of a divorce, Kher (2008) notes that women may become vulnerable and susceptible to violence since they lack financial independence and may need to stay in unsafe relationships for survival (14).
Several demographic, socio-economic, and behavioral factors are associated with sexual HIV risk among Uganda’s fishing communities. Asiki et al (2011) observe that age, occupation, relationship to head of household, knowledge of partner’s HIV status, alcohol consumption, inconsistent condom use, marital status, being away from home for more than two nights in a month, gift exchange for sex, multiple sexual partners and a recent history of STIs were associated with sexual HIV risk among fishing communities of Lake Victoria in Uganda (10).
Age is a key variable that is associated with sexual HIV risk behavior (13, 22, 23). Kiwanuka et al (2014) report that HIV incidence is higher among younger people (age 18–24 years) than those age 30 years and older, in fishing communities around Lake Victoria in Uganda (23). Adolescents are more susceptible to drug and substance abuse, sexual HIV risk behaviors (17). Studies that focus on fisherfolk are timely because fishing populations are more vulnerable than other risky sub-groups. Kissling and colleagues (2005) observe that sexual HIV risk infection was higher among fisherfolk than other high-risk populations in DRC, Kenya, and Uganda, including sex workers, prisoners, migrant workers, men who have sex with men, military, long-distance truck drivers and drug users. In addition, alcohol consumption is common among young people. They often use alcohol to cope with daily stresses in life makes hence becoming more vulnerable through increased sexual risk taking behaviors (10, 15).
Multiple sexual partnerships among men is a sexual HIV risk behavior factor. This is higher in fishing communities than in agrarian or trading communities in Rakai Community Cohort Study (RCCS) (24). This finding resonates with Kapesa et al (2018), who found a similar result – higher odds of being HIV infected among fishing communities around Lake Victoria, northwestern Tanzania (three times higher) than among farming communities. Sexual HIV risk was also observed to be associated with lower levels of education, inconsistent use of the condom, and being older (12). Results from eight fishing communities in Uganda also indicate higher sexual HIV risk among lower educated people, women, divorced or in multiple sexual relations, and users of alcohol or illicit drugs before sexual encounters (23, 25).
Some studies have included fishing communities in Gerenge (26), Kasenyi & Kigungu (18), and Rakai district (20, 27–29), in central Uganda and Kasensero from southwestern Uganda (30). Despite the well-established burden of HIV in this setting, there is limited research exploring the correlates of sexual HIV risk factors in fishing communities among adolescents and young people in Mukono and Namayingo Districts of Uganda (9, 10, 31). This paper fills this gap by examining sexual HIV risk factors among young people in the age group 15–24 years in fishing populations in Mukono and Namayingo districts, Uganda. Specifically, we investigate whether alcohol use and IPV influence sexual HIV risk. We focus on this specific age group because they are at the greatest risk of incident HIV (8, 32). Our contribution to the field of sexual HIV risk is that this paper utilizes data from fishing communities to shed light on the correlates of sexual HIV risk among young people (15–24 years) in Uganda.