Exploring the HIV epidemic in the lakeshore communities of Uganda and Malawi 

Life on Africa’s great lakes has never been easy. Aside from the dangers of trawling the lake for a living, the fishermen and other folk  in these areas must contend with the countless debilitating bacterial and parasitic diseases—from malaria to cholera to schistosomiasis—that thrive around tropical and subtropical waters. But today, in addition to these threats, the largely impoverished communities around Lake Victoria in Uganda and the eponymous Lake Malawi are threatened by a pathogen more insidious than any they have yet encountered: HIV.

These fishermen and their neighbours, including fishmongers, bar workers and sex workers, are being recruited into the global battle to end the AIDS pandemic. In a joint collaboration led by the Uganda Virus Research Institute (UVRI), and supported by the International AIDS Vaccine Initiative (IAVI) and the European & Developing Countries Clinical Trials Partnership (EDCTP), as many as 2,000 fishermen in Uganda and Malawi will ultimately be enrolled in a fisher folk study that has three major goals. The first is to map the prevalence of HIV and track its transmission through the lake-shore towns and island villages. Such data will provide critical guidance to AIDS prevention efforts in these communities. UVRI researchers will also evaluate the strains of HIV circulating in this population to ensure that HIV vaccine candidates that are currently in the earliest stages of development are designed from the outset to prevent HIV infection here as much as anywhere else.

Finally, researchers will analyse the early-stage immune responses of individuals who become infected with HIV during the study. This information could provide important clues about the appropriate design of AIDS vaccines, which, if successfully developed, would contribute significantly to ending the AIDS pandemic.

The study will also cast the net of HIV prevention efforts over a particularly vulnerable and hard-to-reach population. Although it was on the shores of Lake Victoria that Uganda identified its AIDS epidemic, people in the fishing industry have long been without basic health care services and have eluded the nation’s rollout of increased access to HIV services, such as HIV testing and counselling, prevention of mother-to-child transmission and HIV treatment. There are many reasons for this. For one thing, fishing communities tend to be far flung and difficult to reach, and thus difficult to target in public health efforts. Second, as several fishermen have told IAVI researchers, given the dangers associated with their livelihood, they tend to worry a lot more about surviving the dangers of the lake than about contracting HIV. When they do worry about disease, it is usually the water-borne varieties that leap to mind. The lack of awareness about HIV accounts, in part, for the high rates of HIV observed in the lakeshore communities. So does the frequency of transactional sex, which is often paid for with fish.

UVRI will share its immunologic data, as well as the samples it collects, with other laboratories around the world that are working to develop an AIDS vaccine, including those of the three research consortia it oversees. It will also collaborate with the Centre for HIV-AIDS Vaccine Immunology (CHAVI), and the Collaboration for AIDS Vaccine Discovery (CAVD).

A sub-Saharan network for HIV/AIDS research

UVRI has a wealth of experience in infectious disease and HIV vaccine research. Its researchers are, further, committed to forging partnerships with colleagues in other African countries and helping other sub-Saharan research institutions build their scientific and technical capacity. The current project establishes a pioneering collaboration between researchers in Uganda and Malawi, another link in a critically important network for health-related research that has grown across the region over the better part of the past decade. The establishment of this network, in which IAVI has played a key role, enables African researchers to benefit from the experience of colleagues who must often overcome similar challenges.

By the time the study ends in 2010, it will have contributed to strengthening access to healthcare facilities for fishing communities, and amassed critical data on the risks of acquiring HIV. This information will be provided to the Ministries of Health in Uganda and Malawi as well as the Uganda AIDS Commission, and will provide important guidance on approaches to the control of HIV infection in these communities.

This news item was adapted from the orginial story featured on SciDev Net, 20 May 2009.