Agot Kawango, Ayieko Benard O, Sheira Lila A, Camlin Carol S, Kulzer Jayne, Thirumurthy Harsha, Olugo Phoebe, Charlebois Edwin D, Kwena Zachary
Impact Research and Development Organization, Kisumu, Kenya.
University of California, San Francisco, Oakland, United States of America.
BMC Public Health. 2025 May 2;25(1):1630. doi: 10.1186/s12889-025-22830-0.
Forty years into the epidemic, HIV remains a significant cause of death among migratory populations such as fisherfolk. Fishermen, in particular, face heightened HIV acquisition risk associated with their high alcohol consumption and engagement in transactional sex. Additionally, the increased risk of other life-threatening conditions among fishermen is often under-recognized. We sought to document incidents and possible causes of death among fishermen on Lake Victoria beaches in Siaya County, Kenya.
This study reports on deaths among fishermen enrolled in a randomized controlled trial testing whether using a social network-based approach to distribute HIV self-kits with financial incentives compared to counselor-led testing can increase fishermen's HIV testing, uptake of antiretroviral therapy or pre-exposure prophylaxis following testing, and virologic suppression. Eligible men were aged ≥ 18 years and primarily engaged in the fishing industry. Participants were recruited between July 2020 and February 2022 and followed up for six months post-enrolment to assess the clinical outcomes. We gathered incidents of death from beach leaders, friends, workmates, and family and summed them to compute a crude mortality rate. All cases were reported to the ethics committees of participating institutions and the study's Data and Safety Monitoring Board.
We screened 1,509 registered fishermen, of whom 934 were mapped to close social networks (the intent to treat sample), and 733 were enrolled. At baseline, participants' median age was 36 years, 78% were married/cohabiting, 68% attained primary education or below, the majority (57%) earned ≤ USD 83 a month, and all were engaged in fishing/fish-related trade. During the study period, 12 deaths occurred, resulting in a mortality rate of 1,284 per 100,000, 3.1 times higher than that of the general Kenyan male population (419 per 100,000). Primary causes of death included cancers (n = 3, 25%), cardiovascular disease (n = 3, 25%), HIV-related complications (n = 2, 17%), alcohol-related incidents (n = 2, 17%), and other causes (n = 2, 17%).
The causes of death were varied, underscoring the need for a multi-disease approach to address the health risks in high-risk occupations like fishing. Since HIV is one of several significant health threats to fishermen, efforts to end HIV must also address other life-threatening conditions.
在该流行病爆发40年后，艾滋病毒仍然是渔民等流动人口死亡的一个重要原因。特别是渔民，由于他们大量饮酒和参与交易性行为，面临着更高的艾滋病毒感染风险。此外，渔民中其他危及生命疾病的风险增加往往未得到充分认识。我们试图记录肯尼亚锡亚县维多利亚湖海滩上渔民的死亡事件及可能原因。
本研究报告了参与一项随机对照试验的渔民的死亡情况。该试验旨在测试与咨询师主导的检测相比，采用基于社交网络的方法分发艾滋病毒自我检测试剂盒并给予经济激励，是否能增加渔民的艾滋病毒检测、检测后接受抗逆转录病毒治疗或暴露前预防的比例，以及病毒学抑制情况。符合条件的男性年龄≥18岁，主要从事渔业。参与者于2020年7月至2022年2月招募，并在入组后随访6个月以评估临床结局。我们从海滩负责人、朋友、同事和家人那里收集死亡事件，并将它们汇总以计算粗死亡率。所有病例均报告给参与机构的伦理委员会和该研究的数据与安全监测委员会。
我们筛查了1509名登记渔民，其中934人被映射到紧密社交网络（意向性治疗样本），733人入组。基线时，参与者的中位年龄为36岁，78%已婚/同居，68%接受过小学及以下教育，大多数（57%）每月收入≤83美元，且均从事捕鱼/与鱼相关的贸易。在研究期间，发生了12例死亡，死亡率为每10万人1284例，是肯尼亚男性总人口（每10万人419例）的3.1倍。主要死亡原因包括癌症（n = 3，25%）、心血管疾病（n = 3，25%）、艾滋病毒相关并发症（n = 2，17%）、酒精相关事件（n = 2，17%）和其他原因（n = 2，17%）。
死亡原因多种多样，这凸显了需要采取多疾病方法来应对像捕鱼这样的高风险职业中的健康风险。由于艾滋病毒是对渔民的几种重大健康威胁之一，终结艾滋病毒的努力也必须解决其他危及生命的疾病。
