# HIV testing and prevalence in fishing communities in rural Uganda: a cross-sectional study of 3197 individuals within SchistoTrack

## TL;DR

This study finds that fisherfolk in rural Uganda have higher HIV testing rates but similar HIV prevalence and treatment outcomes compared to the general population.

## Contribution

The study introduces a novel approach to understanding HIV dynamics in fishing communities through community-based data collection and analysis.

## Key findings

- Fisherfolk had higher odds of ever being tested for HIV compared to the general population.
- Fisherfolk showed comparable care cascade engagement and viral suppression rates to non-fisherfolk.
- Despite higher testing rates, gaps remain in recent testing and status awareness among fisherfolk.

## Abstract

To compare HIV testing coverage, prevalence and care cascade engagement between fisherfolk and the general population, and to assess the relevance of individual and community-level definitions of fisherfolk in understanding variation in HIV status and testing.

Primary data collection and cross-sectional analysis in 1 year of the SchistoTrack community-based cohort.

52 shoreline villages in Pakwach, Buliisa and Mayuge districts in rural Uganda.

A total of 3197 individuals aged 5–92 years were tested for HIV in 2024. A subset of 124 HIV-positive participants had viral load measured in 2025. Statistical analyses focused on 1931 adults aged 15 years and older.

The primary outcomes were lifetime HIV testing, testing in the past 12 months and current HIV status. Secondary measures included self-reported care cascade outcomes and viral load suppression.

Overall, 6.94% (134/1931) of adult participants aged 15 years and older were with HIV (people with HIV (PWH)), of whom 22.39% (30/134) were newly diagnosed. 6% (25/415) of adults reporting fishing activities were HIV-positive. Of those, 80% (20/25) were status-aware, 76% (19/25) were on antiretroviral therapy, and 100% (8/8) of those who knew their viral load reported viral suppression. No significant differences in care cascade engagement were found between PWH reporting fishing activities and the general population. Measured viral suppression was 70.59% (72/102) among PWH with no significant differences by fishing activities. Fishing activities were significantly associated with higher odds of ever testing for HIV (OR 1.76 (95% CI 1.22 to 2.54)), but not with testing in the past 12 months or HIV status. No consistent district-level differences were observed.

Individuals reporting fishing activities had higher lifetime testing and comparable HIV prevalence and care cascade engagement to the general population. Gaps remain in recent testing, status awareness and viral suppression for fisherfolk.