Key populations at increased risk of HIV

The Joint United Nations Programme on HIV/Aids (UNAIDS) November 2012 report, indicates that Uganda is among 12 countries where the rate of new HIV infections among adults aged between 15 and 49 years remained stable between 2001-2011. Over the same period, HIV prevalence among 15-49 year-old Ugandans increased from 6.4 per cent in 2004/05 to 7.3 per cent in 2011, a precarious situation that calls for HIV prevention programming and intensified efforts to reverse the trend.

Although Uganda’s HIV epidemic affects all population groups, there are populations that are more at risk for HIV infection and therefore bear a disproportionate burden of HIV.

These key populations include men who have sex with men (MSM), sex workers and their clients and partners, fisher folk; and people who inject drugs.

Recent studies have found HIV prevalence (the number of people living with HIV at a given point in time) of 33-37 per cent among female sex workers, 18 per cent among partners of sex workers, and 13.7 per cent among MSM.

In Rakai District, a recent survey has found HIV prevalence of 41 per cent at Kasensero landing site and 19 per cent in the surrounding communities.

It should be recalled that the first HIV/Aids cases in Uganda were identified in 1982 at Kasensero and Lukunyu landing sites on the shores of Lake Victoria. It is therefore alarming that HIV prevalence is still as high as 41 per cent at these sites, thirty years after the first cases were identified.

Evidence shows that HIV incidence (the number of new cases of HIV infection occurring in a population that was originally not infected with HIV) is equally high among key populations than in the general population.

A recent study among the fishing communities of Lake Victoria in Uganda found HIV incidence of five new HIV cases per year for every 100 people tested, while another study done at Kasensero landing site in Rakai District found HIV incidence of four new HIV cases per year for every 100 people who were tested for HIV.

Studies conducted among female sex workers and MSM have indicated similar levels of high HIV incidence.

In Rwanda, one study found HIV incidence of four new HIV cases per year for every 100 female sex workers who were not originally infected with HIV, while a study among MSM in Mombasa found HIV incidence of seven new HIV cases per year for every 100 MSM who were not originally infected with HIV. These findings suggest that key populations have high levels of both HIV incidence and prevalence, and constitute a key population that we cannot afford to ignore in our HIV prevention efforts.

Multiple sexual partnerships
Key populations are linked to the general population and HIV prevalence in the general population cannot be successfully reduced unless interventions are also targeted at these groups. A study of MSM in Kampala, Uganda found that nearly four in 10 people reported that they have both male and female partners.

A recent study conducted jointly by Makerere University School of Public Health and Centers for Disease Control and Prevention (CDC) found that almost one-third of MSM had been married and 20 per cent were currently married.

In another study, female sex workers (FSWs) reported an average of 28 partners in the past 30 days while truckers reported an average of seven partners over the same period. Only 21 per cent of truckers and 45 per cent of FSWs reported using condoms consistently.

A study conducted in 46 fishing communities of Lake Victoria found that 11 per cent of women and 46 per cent of men reported more than one sexual partner in the past year. However, condom use was only 41 per cent among women and 47 per cent among men.

Among MSM, only 40 per cent were found to have used condoms with their female casual partners, 39 per cent with female steady partners, 43 per cent with male casual partners and 50 per cent with their male steady partners in the past three months. These findings suggest that these key populations are at an elevated risk of HIV infection.

Need for increased focus on key populations
Despite engaging in high risk sexual behaviours, key populations have been largely neglected in Uganda’s HIV prevention response. While the revised National HIV and Aids Strategic Plan (2011/12-2014/15) includes specific targets for key populations, only targets for female sex workers, fisher folk and truckers have been given attention at the expense of other key populations such as the uniformed services, injecting drug users, and MSM. Given their continuous interaction with members of the general population, interventions targeting key populations at increased risk of HIV infection can contribute to the reduction in HIV incidence by 30 per cent by 2015, as stipulated in the National HIV Prevention Strategy.