Ali Ssetaala

High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda

HIV epidemics in sub‐Saharan Africa are generalized, but high‐risk subgroups exist within these epidemics. A recent study among fisher‐folk communities (FFC) in Uganda showed high HIV prevalence (28.8%) and incidence (4.9/100 person‐years). However, those findings may not reflect population‐wide HIV rates in FFC since the study population was selected for high‐risk behaviour.

Characterization of Neutrophil Subsets in Healthy Human Pregnancies

We have previously shown that in successful pregnancies increased arginase activity is a mechanism that contributes to the suppression of the maternal immune system. We identified the main type of arginase-expressing cells as a population of activated low-density granulocytes (LDGs) in peripheral blood mononuclear cells and in term placentae. In the present study, we analyzed the phenotype of LDGs and compared it to the phenotype of normal density granulocytes (NDGs) in maternal peripheral blood, placental biopsies and cord blood. Our data reveal that only LDGs but no NDGs could be detected in placental biopsies. Phenotypically, NDGs and LDGs from both maternal and cord blood expressed different levels of maturation, activation and degranulation markers. NDGs from the maternal and cord blood were phenotypically similar, while maternal, cord and placental LDGs showed different expression levels of CD66b. LDGs present in cord blood expressed higher levels of arginase compared to maternal and placental LDGs. In summary, our results show that in maternal and cord blood, two phenotypically different populations of neutrophils can be identified, whereas in term placentae, only activated neutrophils are present.

Creating an African HIV Clinical Research and Prevention Trials Network: HIV Prevalence, Incidence and Transmission

HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.

Schistosoma mansoni and HIV acquisition in fishing communities of Lake Victoria, Uganda: a nested case–control study

It has been suggested that Schistosoma mansoni, which is endemic in African fishing communities, might increase susceptibility to human immunodeficiency virus (HIV) acquisition. If confirmed, this would be of great public health importance in these high HIV‐risk communities. This study was undertaken to determine whether S. mansoni infection is a risk factor for HIV infection among the fishing communities of Lake Victoria, Uganda. We conducted a matched case–control study, nested within a prospective HIV incidence cohort, including 50 HIV seroconverters (cases) and 150 controls during 2009‐2011.

Are fishing communities another most-at-risk- population? Results of a community-based study along Lake Victoria, Uganda

Background A recent study reported HIV prevalence of 28.8% among high risk persons in fishing communities (FC) of Uganda, indicating that FC may be another most-at-risk-population (MARP). However, these findings do not reflect the population-based HIV prevalence in FC. We conducted a community-based study to determine the population representative HIV prevalence and incidence among FC along Lake Victoria shores, Uganda. Methods

Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda.

Background Although the association between alcohol consumption and HIV risk is well documented, few studies have examined the magnitude of new HIV infections that could be prevented by controlling alcohol use. We report the population attributable fraction (PAF) of incident HIV infections due to alcohol consumption among the HIV high-risk population of fishing communities along Lake Victoria, Uganda. Methods In a community-based cohort study, 1607 HIV sero-negative participants aged 18–49 years were enrolled from eight fishing communities along Lake Victoria, Uganda. At follow up 12 months later, 1288 (80.1%) were seen and interviewed. At baseline and follow-up visits, participants completed interviewer-administered questionnaires on alcohol consumption, demographics, and sexual risk behavior, and were tested for HIV infection. HIV incidence and adjusted incident rate ratios (adjusted IRRs) were estimated using Poisson regression models; the crude and adjusted PAFs of incident HIV infections associated with alcohol consumption were calculated using the Greenland and Drescher method for cohort studies. Results Among the 1288 participants seen at follow up, 53.5% reported drinking alcohol of whom 24.4% drank occasionally (2 days a week or less) and 29.1% drank regularly (3–7 days a week). Forty eight incident HIV infections occurred giving an incidence rate of 3.39/100 person years at-risk (pyar) (95% CI, 2.55–4.49). Compared to non-drinkers, the adjusted IRR of HIV was 3.09 (1.13–8.46) among occasional drinkers and 5.34 (2.04–13.97) among regular drinkers. The overall adjusted PAF of incident HIV infections due alcohol was 64.1 (95% CI; 23.5–83.1); ranging from 52.3 (11.9–74.2) among Muslims to 71.2 (32.6–87.7) for participants who reported ≥ 2 sexual partners in the past 12 months. Conclusion In fishing communities along Lake Victoria, Uganda, 64% of new HIV infections can be attributed to drinking alcohol. Interventions to reduce alcohol consumption should be integrated in HIV/AIDS prevention activities for populations in whom both HIV and alcohol consumption are highly prevalent.

Making a livelihood at the fish-landing site: exploring the pursuit of economic independence amongst Ugandan women

Qualitative life history data were used to explore the experiences of women who live at five fish-landing sites on Lake Victoria, Uganda. We explored what economic and social opportunities women have in order to try to understand why some women are more vulnerable to violence and other risks than others and why some women are able to create successful enterprises while others struggle to make a living. The ability of women to create a viable livelihood at the landing sites was influenced by a wide variety of factors. Women who had or were able to access capital when they arrived at the landing site to set up their own enterprise had a significant advantage over those who did not, particularly in avoiding establishing sexual relationships in order to get support. Being able to establish their own business enabled women to avoid lower paid and more risky work such as fish processing and selling or working in bars. The development of landing sites and the leisure industry may be having an impact on how women earn money at the landing sites, with the most desirable economic opportunities not necessarily being connected directly to fishing.

Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda.

Introduction Fishing communities (FCs) in Uganda have high HIV infection rates but poor access to health services including family planning (FP). Although FP is a cost-effective public health intervention, there is a paucity of data on knowledge and use of modern FP in FCs. This study determined knowledge and use of modern FP methods in FCs of Uganda. Methods Data were accrued from a 12-month follow up of 1,688 HIV-uninfected individuals, 18–49 years from 8 FCs along Lake Victoria, between September 2011 and March 2013. Data on knowledge and use of modern FP were collected through a semi-structured questionnaire. Prevalence Risk Ratios with corresponding 95% CIs were used to determine factors associated with Modern FP knowledge and use. Results The mean age was 31.4 years, with nearly half (48.8%) being females while more than half (58.6%) had attained up to primary education level. Knowledge of modern FP was high, 87.5% (1477/1688); significantly higher among females [adj. PRR = 4.84 (95% CI; 3.08, 7.61)], among older respondents (25–29 years) [adj. PRR = 1.83 (95% CI; 1.12, 2.99)] compared to younger ones (18–24 years) and among those conducting business [adj. PRR = 2.42(95% CI; 1.02, 5.74)] relative to those primarily in fishing. Just over a third (35.2%, 595/1688) reported use of at least one modern FP method. Use of modern FP methods was significantly higher among females [adj. PRR = 2.04 (95% CI; 1.56, 2.65, and among those reporting multiple sexual partnerships [adj. PRR = 2.12, 95% CI; 1.63, 2.76)]. Nonuse of modern methods was mostly due to desire for more children (30.6%), fear of side effects (12.2%) and partner refusal (5.2%). Conclusion Despite their high knowledge of FP, FCs have low use of modern FP methods. Key barriers to use of modern FP methods were high fertility desires, fear of perceived side effects and partner refusal of methods.

Schistosoma mansoni Infection in Ugandan Men Is Associated with Increased Abundance and Function of HIV Target Cells in Blood, but Not the Foreskin: A Cross-sectional Study.

Background Schistosoma mansoni infection has been associated with an increased HIV prevalence in humans and SHIV incidence in primate models. We hypothesized that immune activation from this gastrointestinal mucosa infection would increase highly HIV-susceptible CD4 T cell subsets in the blood and the foreskin through common mucosal homing. Methodology/Principal Findings Foreskin tissue and blood were obtained from 34 HIV- and malaria-uninfected Ugandan men who volunteered for elective circumcision, 12 of whom were definitively positive for S. mansoni eggs in stool and 12 definitively negative for both S. mansoni eggs and worm antigen. Tissue and blood T cell subsets were characterized by flow cytometry and immunohistochemistry (IHC). Th17 and Th1 cells from both the blood and foreskin expressed higher levels of CCR5 and were more activated than other CD4 T cell subsets. S. mansoni-infected men had a higher frequency of systemic Th1 cells (22.9 vs. 16.5% of blood CD4 T cells, p<0.05), Th17 cells (2.3 vs. 1.5%, p<0.05), and Th22 cells (0.5 vs. 0.3%, p<0.01) than uninfected men. Additionally, Th17 cells in the blood of S. mansoni-infected men demonstrated enhanced function (28.1 vs. 16.3% producing multiple cytokines, p = 0.046). However, these immune alterations were not observed in foreskin tissue. Conclusions/Significance S. mansoni infection was associated with an increased frequency of highly HIV-susceptible Th1, Th17 and Th22 cell subsets in the blood, but these T cell immune differences did not extend to the foreskin. S. mansoni induced changes in T cell immunology mediated through the common mucosal immune system are not likely to increase HIV susceptibility in the foreskin.

Alcohol and illicit drug use among potential HIV vaccine efficacy trial volunteers along Lake Victoria, Uganda.

Background HIV has adversely affected fishing communities (FC), with prevalence ranging between 25-30% on Lake Victoria. To better characterize the HIV prevalence among FC and explore potential for HIV vaccine efficacy trials, we conducted a pilot study on HIV prevalence, sexual risk behavior, alcohol and drug use in these communities. Methods A cross-sectional HIV prevalence survey was conducted in 8 FC over 3 months. Census and mapping to determine the average population size in each community were conducted prior to the study. After obtaining informed consent, 2,200 individuals aged 18-49 years from randomly selected households were tested for HIV and responded to questionnaires on sexual behavior, alcohol consumption and drug use. Results Fifty three percent (53.0%) had consumed alcohol in the past three months with males consuming more alcohol than females [59.0% vs. 46.8%, p<0.01].19.2% of alcohol consumers also used illicit drugs [p<0.01]. Alcohol consumption in the previous 3 months was highest among Catholics [p<0.01], those with no formal education [p=0.01], sex workers (100%), loaders/off loaders (79%), bar owners (69.7%), construction workers (66.7%), bar attendants (66.1%) and fishermen [(61.0%), p<0.01]. Daily alcohol consumption was highest among older participants (35-49years) and sex workers [p<0.01]. Alcohol consumption before sex (43.0%) was highest among youths (25-34 years), sex workers, bar owners and attendants [p<0.01]. HIV prevalence was higher amongst alcohol consumers [63.4% vs. 36.6%, p<0.01], with daily and weekly consumers having a higher prevalence [73.0% vs. 27.0%, p=0.05]. Illicit drugs like cocaine, Miraa/Khat were used by 13.8% of participants, mostly amongst sex workers [(33%), p<0.01]. Illicit drugs were used mainly on a daily basis [(44.6%), p<0.01]. Conclusion Alcohol and illicit drug use is prevalent in FC and associated with higher prevalence of HIV infection. Efforts towards controlling alcohol and illicit drug use might help control HIV in these communities