Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
J Int AIDS Soc. 2013 Jul 22;16(1):18621. doi: 10.7448/IAS.16.1.18621.
HIV epidemics in sub-Saharan Africa are generalized, but high-risk subgroups exist within these epidemics. A recent study among fisher-folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person-years). However, those findings may not reflect population-wide HIV rates in FFC since the study population was selected for high-risk behaviour.
Between September 2011 and March 2013, we conducted a community-based cohort study to determine the population representative HIV rates and willingness to participate (WTP) in hypothetical vaccine trials among FFC, Uganda. At baseline (September 2011-January 2012), a household enumeration census was done in eight fishing communities (one lakeshore and seven islands), after which a random sample of 2200 participants aged 18-49 years was selected from 5360 individuals. Interviewer-administered questionnaire data were collected on HIV risk behaviours and WTP, and venous blood was collected for HIV testing using rapid HIV tests with enzyme-linked immunosorbent assay (EIA) confirmation. Adjusted prevalence proportion ratios (adj.PPRs) of HIV prevalence were determined using log-binomial regression models.
Overall baseline HIV prevalence was 26.7% and was higher in women than men (32.6% vs. 20.8%, p<0.0001). Prevalence was lower among fishermen (22.4%) than housewives (32.1%), farmers (33.1%) and bar/lodge/restaurant workers (37%). The adj.PPR of HIV was higher among women than men (adj.PPR =1.50, 95%; 1.20, 1.87) and participants aged 30-39 years (adj.PPR=1.40, 95%; 1.10, 1.79) and 40-49 years (adj.PPR=1.41, 95%; 1.04, 1.92) compared to those aged 18-24 years. Other factors associated with HIV prevalence included low education, previous marriage, polygamous marriage, alcohol and marijuana use before sex. WTP in hypothetical vaccine trials was 89.3% and was higher in men than women (91.2% vs. 87.3%, p=0.004) and among island communities compared to lakeshore ones (90.4% vs. 85.8%, p=0.004).
The HIV prevalence in the general fisher-folk population in Uganda is similar to that observed in the "high-risk" fisher folk. FFC have very high levels of willingness to participate in future HIV vaccine trials.
撒哈拉以南非洲的艾滋病毒流行呈普遍态势，但在这些流行中存在高风险亚群。乌干达最近对渔民社区（FFC）进行的一项研究显示，艾滋病毒感染率较高（28.8%），发病率（4.9/100 人年）较高。然而，由于研究人群是为高风险行为而选择的，因此这些发现可能无法反映 FFC 中的人群普遍艾滋病毒率。
2011 年 9 月至 2013 年 3 月，我们在乌干达进行了一项基于社区的队列研究，以确定 FFC 的人群代表性艾滋病毒率和参与假设疫苗试验的意愿（WTP）。在基线（2011 年 9 月至 2012 年 1 月），在八个渔业社区（一个湖滨和七个岛屿）进行了家庭普查，之后从 5360 个人中随机选择了 2200 名 18-49 岁的参与者。通过访谈者管理的问卷收集有关艾滋病毒风险行为和 WTP 的数据，并使用快速艾滋病毒检测和酶联免疫吸附试验（EIA）确认收集静脉血进行艾滋病毒检测。使用对数二项式回归模型确定艾滋病毒感染率的调整流行比例比（adj.PPR）。
总体基线艾滋病毒感染率为 26.7%，女性高于男性（32.6%对 20.8%，p<0.0001）。渔民（22.4%）的感染率低于家庭主妇（32.1%）、农民（33.1%）和酒吧/旅馆/餐厅工人（37%）。与男性相比，女性的艾滋病毒 adj.PPR 更高（adj.PPR=1.50，95%；1.20，1.87）和年龄在 30-39 岁（adj.PPR=1.40，95%；1.10，1.79）和 40-49 岁（adj.PPR=1.41，95%；1.04，1.92）的参与者。与 18-24 岁的参与者相比，其他与艾滋病毒流行率相关的因素包括受教育程度低、曾结婚、一夫多妻制婚姻、性前饮酒和吸食大麻。假设疫苗试验中的 WTP 为 89.3%，男性高于女性（91.2%对 87.3%，p=0.004），岛屿社区高于湖滨社区（90.4%对 85.8%，p=0.004）。
乌干达普通渔民人群中的艾滋病毒流行率与观察到的“高危”渔民人群相似。FFC 非常愿意参与未来的艾滋病毒疫苗试验。
