HIV Still Problematic In African Countries Like Uganda

Since the global HIV/AIDS epidemic reached its peak in the late 1990s, advancements in medicine and outreach have increased chances of survival and lowered the transmission rate of the virus around the world.

But in countries like Uganda, where the prevalence rate is 6.5 percent, there’s still a lot of work to be done – especially in the high-risk communities that encircle Lake Victoria.

On the shores of the largest lake in East Africa, Thursday mornings begin the same way every week. Long, colorful wooden boats queued to unload their catches of the day at the dock. Men tossed bunches of fish, strung together by rope, out of the boats and into the waiting arms of auctioneers.

Photo Credit: Emma Atkinson/for Illinois Public Media

Sitting in a plastic chair in the shade of an awning, Christine Ssentamu watched the chaos. The fish market at Ggaba Beach in Kampala is her neighborhood. And on that day, just like any other day, she worked with Ugandans to stem the rampant spread of HIV, human immunodeficiency virus, throughout the fisherfolk community.

“I move door-to-door or person-to-person, sensitizing them about HIV mostly, tuberculosis and hygiene,” she said.

She lingered at the entrance to her bar, mere steps away from the water.

Ssentamu is a community health worker, trained by the Ugandan government and other organizations to identify common illnesses and diseases and recommend treatment. Most often, this means educating people about HIV and encouraging them to get tested.

This is especially important when it comes to fishermen, among whom the HIV prevalence rate is nearly three times the Ugandan national rate. One June 2018 study from The Lancet estimated the prevalence rate of HIV among fishermen to be a staggering 42 percent.

Ssentamu said getting a fisherman to come in off the lake and talk about his HIV status isn’t easy. This is where being a bar owner comes in handy.

“They can sit here and start boozing, then I come, I sit,” she said. “‘Ey, mami,’ they call me mami. ‘Ey, mami you are here?’ Yes, I am here. Can we talk?”

Photo Credit: Cody Thompson/IU Media Center

HIV began ravaging Uganda in the early 1980s. And 28,000 people died in 2016 alone of AIDS-related complications, according to data from the global HIV/AIDS support organization AVERT.

Thanks to the success of anti-retroviral drugs (ARVs) and anti-retroviral therapy (ART), people are now able to live long, healthy lives after being diagnosed with HIV.

That’s why it’s so important for Ugandan fishermen to get tested – so they can get treatment and stop the spread of the virus.

Lake Victoria is the second-largest lake in the world. Storms on its surface are intense and can easily capsize the small boats on which fishermen spend their days.

According to the Lake Victoria Basin Commission, an East African non-governmental organization, at least 5,000 people die on the lake each year.

Most fishermen can’t swim.  

“They perceive their type of work to be a risky sort of activity,” said Yusuf Mawazo, with the Uganda Fisheries and Fish Conservation Association. “For them, they look at going fishing as much more riskier [sic] than having HIV/AIDS because you can die anytime.”

Mawazo works with the Ugandan government to implement HIV prevention and treatment programs in fishing communities.

He said fishermen are hard to reach because they’re always on the move, and sex work in the villages along the lake is common.

“If [a fisherman] moves from point X and goes to point Y and spends some three, six, five months they will forget their relationship, so they will go to other relationships,” Mawazo said. “They have multiple sex partners, so the risk of getting HIV increases.”

Photo Credit: Emma Atkinson/for Illinois Public Media

Ssentamu said she struggles to pierce many fishermen’s cocky exteriors.

“They are arrogant,” she said. “They talk anyhow. They behave anyhow. When you go near him, it feels like you are in love with him.”

But still, she persisted. She met with them, day after day, wearing them down. She asked after their children, their wives.

And slowly but surely, they began to listen to her.

“I ask them, ‘What if you don't die on the water? And you end that business on the water. You are alive – but you have HIV. How will you feel?’” she said. “Then they come to know that there is life after water.”

Photo Credit: Cody Thompson/IU Media Center

Emma Atkinson is a senior journalism student at Indiana University. She reported this story during an internship with the Daily Monitor this summer in Kampala, Uganda.