Fisher-folk on Lake Victoria Find Solidarity in the Fight Against AIDS

Kenya’s fishing communities around Lake Victoria are at a greater risk of HIV infection and have a higher HIV prevalence compared to the general population. This is due to several factors, including the practice of trading fish for sex.

Deeply affected by HIV and classified as a priority population, 12 percent of the total number of people diagnosed as HIV-positive within Homabay County are from the fisher-folk community. “I have been a part of the beach community for many years. This is my third term as the chair of Kendu Bay Beach Management Unit (BMU). The community is highly vulnerable to HIV,” says Ibrahim Kasera.

Oliver Auro, a fisher folk, states that “the easiest place to get a sexual partner is at the beach. Fishermen migrating in search of better fishing areas start casual sexual relationships wherever they go.”

They affirm that fisher-folk’s vulnerability to HIV has long been compounded by risky behavior such as ‘fish for sex’, rampant substance abuse and the promotion of cultural practices centered on sexual relationships, including wife inheritance.

On the back of this scenario, EGPAF designed a fisher-folk peer model, implemented in partnership with the Ministry of Health (MoH) and BMUs in Rachuonyo North, Homabay town and Rangwe sub-counties.

Members of Maguti village BMU ( beach management unit) on boats in Maguti beach, Kendubay.

Kasera says that BMUs are the backbone of fisheries management and are registered with the Fisheries Department, Ministry of Fisheries Development.

“Homabay County hosts the highest number of fish landing sites in Kenya also known as beaches, at 158. Kendu Bay is in Rachuonyo North Sub-County and has 35 fish landing sites. Overall, EGPAF implements the fisher-folk peer model in 45 fish landing sites,” says Lucie Adagi, technical advisor in key and priority population at EGPAF.

Kendu Bay BMU has over 500 members. Membership is constituted of boat owners, boat crews, net repairers and menders as well as fish traders. The surrounding population is estimated at 8,000 to 10,000 people.

The fisher-folk model of service delivery involves the fisher-folk community identifying peer educators from the beach community who are then interviewed and approved by the Ministry of Health, working hand-in-hand with EGPAF. Approved peer educators are then linked to health facilities nearest to each of the 45 targeted landing sites.

“There is a drop-in-center (Dice) at Kendu Bay hospital where fisher-folk as a priority population receive comprehensive HIV services. A Dice is a designated room within the hospital that provides for privacy and convenience for fisher-folk in need of HIV services,” says Victor Owuor, Sub-County AIDS and STI coordinator.

A fisherman with his catch in Maguti beach, Kendubay. He has helped facilitate peer health talks among fisher folk.

Adagi says that EGPAF’s integration of the Dice model into a government facility is a first. She states that it is a major step towards ownership and guaranteed sustainability of targeted service provision for key and priority population beyond EGPAF’s support.

EGPAF supports five Dices in six sub-counties and an additional 10 fisher-folk friendly facilities with trained health providers in areas where EGPAF is yet to roll out specific sites.

Kasera says that the peer model intervention began in 2018. Then, HIV testing was an impossible task. On numerous occasions, he says MoH brought voluntary HIV counseling and testing services to the beach and that people were afraid of being tested.

“Peer educators live and work with us and are best placed to help us overcome challenges in HIV testing, prevention, care, and treatment. The initiative has changed and saved lives, says Kasera.

EGPAF’s Isaac Owino puts this success into perspective. He says uptake for viral load testing is currently at 97 percent, up from 64 percent in 2018.

Fisher folk viral suppression rate has risen to a high of 95 percent. Pre-exposure prophylaxis (PrEP) uptake is at 30 percent up from zero in 2019 across the 45 fish landing sites.

“I have seen the power of PrEP in my life. HIV prevention is a life long journey and you can meet many challenges along the way that can be overcome using PrEP,” says Mercy Atieno, a BMU member.