Editor’s note: This is a guest post by Savannah Russo and Heather Zimmerman, reporting on their work with the Global Health Corps in Uganda. See below for more info. Russo and Zimmerman examine the social, economic and political reasons why men who fish for living in Uganda are at especially high risk for HIV infection.
By Savannah Russo and Heather Zimmerman, special to Humanosphere
Ask a group of Ugandan fishermen about their risks, and you are sure to get a lively response.
From attacks by crocodiles and hippos to the dangers of fishing at night, these men have experienced firsthand the risks of this profession. As one fisherman from Rwenshama told us, “sometimes, when we remove the nets, we find bodies of fishermen who have died.”
“I know my life is at higher risk because I am always in water,” said one of the fisherman we met while conducting interviews for the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in the lakeside town of Rwenshama. All seven men expressed similar fears. In addition to the threats posed by the water, many of them complained of low wages and the struggle to support themselves.
“I know my life is at risk, but I have no choice because I have no money,” said another fisherman, while the other six nodded in unison.
But these fishermen face an even greater risk, HIV, which disproportionately affects fishing communities. According to the International Organization for Migration (IOM) Uganda, the HIV infection rates of fishing communities are as much as four times higher than the national average. With a national HIV prevalence rate of 7.2 percent this puts HIV rates for fishing communities at 20 percent to 30 percent, according to the International Organization of Migration.
Fatalistic attitudes feed higher HIV rates
To better understanding the attitudes and cultural factors that have led to an increased prevalence within fishing communities, we have been interviewing fisher folk. Through these conversations it has become clear that fatalistic attitudes play a major role in HIV infection rates among this population – and addressing those attitudes will play an important role in prevention strategies and health-care outcomes.
All seven fishermen agreed that they fear the dangers of being on the water far more than contracting or spreading HIV within their community.
In a Fish and Fisheries article focused on HIV/AIDS, Edward H. Allison and Janet A. Seeley explain that the “vulnerability to HIV/AIDS stems from complex, interacting causes that may include the mobility of many fisher folk, the time fishermen spend away from home, their access to daily cash income in an overall context of poverty and vulnerability, their demographic profile, the ready availability of commercial sex in fishing ports and the subcultures of risk taking and hyper-masculinity among some fishermen.”
Six of the seven men also said that they hire sex workers. For most fishermen, nights are spent on the water while time on land is often spent resting, consuming alcohol, and purchasing sex before they head back out on the water. Despite high HIV rates, most sexual encounters happen without the protection of a condom because of hyper masculine behavior and prevailing myths about the spread of HIV/AIDS.
HIV-positive sex workers have explained that even when they disclose their status to potential clients, fishermen often respond that they will use their penises to “beat the HIV away.”
“Women don’t mind if you use a condom or don’t,” said one fishermen, “They are after money. So long as you have money, you do what you want.”
Most of the sex workers we interviewed in Rwenshama said that they do fear contracting sexually transmitted infections (STIs) and, thus, often seek services at the local health center. Although they are aware of the risks of unprotected sex, concerns about their health are trumped by high payouts for “live sex,” which is sex without a condom, and their need to provide for themselves and their families.
“Yes, we always get health education on condom use,” said one sex worker. “The men sometimes refuse. They want to feel the ‘sweetness’ of the sex because they have paid money. We always talk to them, [but]you don’t have food so you find yourself accepting.”
Increased access to health services and education programs provide a solution
In some rural fishing communities, consistent access to health services, on-site HIV testing and counseling, condoms and peer support groups have been inconsistent. However, through the promotion of such services, pervasive fatalistic and masculine attitudes can be tempered and eventually eradicated. And that is exactly why partnerships with civil society organizations and work with community health centers to reach most-at-risk communities has been a major focus of EGPAF in Uganda.
The message is starting to get through in Rwenshama.
“We get ARVs [antiretroviral medication]from the health facility and other drugs for illnesses,” affirmed one of the fishermen.
This article has been supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of funding provided to the Elizabeth Glaser Pediatric Aids Foundation (EGPAF) in the implementation of the USAID Strengthening TB and HIV AIDS response in the South Western Region of Uganda (STAR-SW project). The contents are the responsibility of the Elizabeth Glaser Pediatric AIDS Foundation and do not necessarily reflect the views of USAID or the United States government.
Heather Zimmerman is a Global Health Corps Fellow working as the advocacy and communications manager at Alive Medical Services in Kampala, Uganda.
Savannah Russo is a Global Health Corps Fellow working as the research and documentation officer for the Elizabeth Glaser Pediatric AIDS Foundation in Mbarara, Uganda.