HIV and the fisherfolk communities in western Kenya
Our characterisation studies show that key fish-landing sites/beaches in western Kenya have high traffic in terms of human population, with sites such as Dunga and Uhanya in Kisumu and Siaya counties, respectively, occasionally serving up to 3500 people a day. Occupational categories in these sites include fishermen and crew, boat owners, traders-fish, vegetables and other commodities, service providers including boat repairers, transporters, shopkeepers, hoteliers, and sex workers.
There is high mobility of fisherfolk communities in search of fish. Our studies indicate a trend in movement of other occupational groups as well. There is thus a need to map movement patterns, together with health seeking behaviour, as well as social networks to guide tailoring of interventions.
Common social/health problems include HIV, stigma and lack of knowledge due to minimal interventions at the beaches. Malaria, typhoid and other water-borne diseases (and open defecation) are common. Alcohol and substance use is also common; the substances are sold in the neighbourhoods of beaches, and aggravated by a general lack of enforcement systems.
Key challenges to HIV care and treatment
Our studies reveal that key barriers to effective HIV prevention, care and treatment service delivery among the fisherfolk communities in western Kenya include
- Poverty is a major driver of transactional sex, with women being mostly affected (sex-for-fish)
- Mobility: high mobility of these communities is a major challenge to access to, and retention in, HIV services, including prevention, care and treatment.
- Limited health facilities and services: There is shortage of health clinics in most fish landing sites. Even where there are, a number of services, including HIV self-test are mostly unavailable. The fisherfolk are therefore forced to travel long distances (in some cases up to 11km) to access HIV services.
- Unfavourable clinic hours and services: The clinic operating times and availability of fisherfolk to attend clinic are at variance. They also mentioned unfriendly health care providers as well as long queues at the health facilities.
- Alcohol and substance use: this was seen as a driver of risky sexual behaviour and barrier to retention in care, with a number of myths including not taking ARVs with alcohol.
- Stigma and poor social support were the key psychosocial barriers mentioned. Notably, members of the community decried lack of confidentiality from health care providers.
PHIS is working with partners to adapt HIV services to lifestyle and occupational realities of the fisherfolk communities, including innovating delivery of ART services to ensure prevention, care and treatment services are within their reach; that they can continue with the services wherever they go (in response to their mobility); building capacity of health care providers to understand uniqueness of the fisherfolk and to ensure patient-centred service delivery; addressing stigma and other psychosocial challenges; and deliberately tackling poverty and other inequalities as a way of empowering vulnerable segments of the communities, including women and adolescent girls.