Fisherfolk are among groups most at risk of HIV: cross-country analysis of prevalence and numbers infected

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IntroductionHIV prevalence in some fishing communities in low and middle-income countries is known to be high relative to national average seroprevalence rates [1,2]. Most of the studies supporting this claim refer to the men involved in fish-catching operations (fishermen). However, they acknowledge that the men and women who work in associated occupations such as fish trading and processing are also vulnerable, in part because they are often within the fishermen's sexual networks [3–5]. This vulnerability stems from the nature and dynamics of the fish trade and fishing lifestyle in which a number of known or hypothesized ‘risk factors’ converge.Most people involved in fishing as an occupation are within the age groups (15 to 35 years) most vulnerable to sexually transmitted infections (STIs).Many fishing people are mobile or migratory, so the social structures that constrain sexual behaviour in home communities may not apply in the context of fishing camps or ports.Fishing is a high-risk occupation which can contribute to a culture of risk denial or risk confrontation, extending to displays of bravado and risk-taking in the social and sexual arena.Fishing people are often socially marginalized and have low status, which can cause, among men, exaggerated or ‘oppositional’ forms of masculinity that challenge norms of behaviour adopted by those in ‘mainstream’ society. Masculinity in this context often includes the expectation of multiple sexual partners.Alcohol use is widespread among fisherfolk in many parts of the world, to help cope with the dangers or stresses of their occupation. This further compounds vulnerability to HIV.In addition, fisherfolk are vulnerable to HIV and AIDS due to inadequate prevention, treatment and mitigation measures and limited access to sexual health services more generally.These points are summarized from a more detailed explanation and bibliography pertaining to HIV-related risk factors among fisherfolk, given in two of our earlier publications [2,6].The occurrence of these risk factors should not be taken as characteristic of all fishing communities but it appears, through numerous government, donor agency and non-governmental organization reports as well as recent academic studies, to be widespread enough to cause concern that fishermen, female fish traders and processors and their sexual partners are at significant risk of HIV infection. This is particularly so in the Asian, African and Latin American countries with established or emerging epidemics, where over 95% of the world's 200 million fisherfolk (men and women fish catchers, processors and traders) live [3].Thus, there is mounting evidence that fisherfolk and people living in fishing communities comprise a significant sub-population at risk. Despite this, the policy response to their vulnerability has, to date, been limited and fragmented. There is, for example, no clear targeting of fishing communities in prevention, care and mitigation guidelines issued by WHO and UNAIDS. Key national and international fisheries policies do not mention HIV and AIDS [3,7]. It was only in March 2005 that the International Labour Organisation's Governing Body was asked to consider a draft FAO/ILO/IMO ‘Fishing Vessel Safety Code and Voluntary Guidelines’ recommending that ‘those who are HIV positive, but not disabled, are not excluded from opportunities to work’ [8].There is evidence, however, that the previous neglect of HIV in the fisheries sector is changing. Recent initiatives, like those supported by the Food and Agriculture Organisation of the United Nations (FAO) and the WorldFish Center, have started to raise awareness of HIV in the sector [3]. Urgent action is still required to increase awareness and improve the response.

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