Arts and Sciences
Social dynamics, HIV risk, and use of HIV services in high-prevalence fishing communities in Rakai, Uganda
In Rakai DIstrict, Uganda, fishing villages on Lake Victoria have been identified as settings with extremely high HIV incidence and prevalence, risk behaviors and mobility. Recent surveillance of 2,500 individuals in 3 Rakai fishing communities showed an HIV prevalence of 35-43% and incidence of ~3.9/100 person-years. Preliminary evidence from Rakai and similar settings indicates these rates may be driven by complex dynamics of sex work (often related to the fishing economy), high rates of sexual risk behaviors, low priority accorded to HIV prevention, extensive networks of inter- and intra-community relationships, high rates of mobility and seasonal migration, and suboptimal interactions between health workers and key populations. The objective of this study is to use mixed methods research to better understand HIV transmission and potential prevention dynamics in high-prevalence fishing villages in Rakai, Uganda. The project is conducted in collaboration with the Rakai Health Sciences Program (RHSP), an organization with a longstanding collaboration with Johns Hopkins. A substantial qualitative component will include: (a) in-depth interviews with local fishermen, female fish traders/sellers, sex workers/bar girls, bar/venue owners, and HIV-related service delivery providers, (b) focus group discussions with men and women in the local community, and (c) unstructured observations in fishing markets and beaches, drinking establishments and sex work venues (bars, lodges), and HIV-related services. Qualitative findings will be triangulated with existing data from quantitative surveys and clinical data sources, and results will be used to develop additional quantitative measures that can be included in the Rakai community cohort study. Findings from this study will be used to tailor existing PEPFAR-supported combination HIV prevention, care and treatment programs, as well as demand generation to optimize uptake, for these settings.
Global Health Mentor/PI: Caitlin Kennedy, PhD, MPH
I’ve always wanted a career in global health, but I had very arbitrary reasons as to why. I wanted to help people, but had no real understanding of how to go about doing so. My Global Health and Field Placement Experience solidified my desire to do international work by giving me concrete reasons through experiences. I was placed in the rural area of Rakai, Uganda, when I first arrived in Uganda I stayed in the main city of Kampala. Neither Rakai, nor Kampala, were exactly what I was expecting; this was because they were far more “westernized” than I imagined. We’re led to believe Africa is one big bush-land, but this was the furthest from the truth. This awareness isn’t what made Uganda feel like home, but rather, what brought me the most sense of security and support during my time in this vast country. What made Uganda feel like home were the people - whether at work, in the city, or at church, there seemed to be a sense of communal support that I had never encountered before. In Uganda, most of the people who are considered middle or upper class have “house help”. Having “house help” is seen as a way to employ people in the local community, which in turn, helps to boost the economy. It is seen as greedy (or selfish) not to have house help because you’re not adding to the local economy. The mindset in Uganda is “we” not “me”. People are not expected to be able to do it all – with many household members working full time, trying to maintain their home alone is considered illogical. This what of thinking and being is completely different from the US Western culture of what it means to have a “nanny” or a “maid” and I loved it.
There were numerous cultural differences that I witnessed in Uganda which gave me a new perspective to how to view the world. With this insight came additional motivation as to why I wanted to study and have a career in global health. Being exposed to other cultures, how the communities were developed and formed as well as how the population treated each other, gave me a powerful perspective on what’s needed to ensure a healthy populace. The US is always revered for being an amazing place, but when I was in Uganda, I felt like it had just as much to offer, if not more, than the US in the sense of culture, and community.
I went into my Global Health and Field Placement program with the mindset that I was going to learn about HIV and get experience with working internationally. I learned this, but I also learned about the multiple factors and situations that go into the HIV epidemic. One of these factors being the power dynamic between men and women, that make is so that women are left in a moral vulnerable position, both physically and financially. Another factor being the high occupational risk of fishing that affects the lifestyle and sexual practices of fisherman in the area. I learned about different fields of public health that I had not known about much before, such as public health communications. I had seen health campaigns before, but had never seen or noticed them on such a large scale as I did in Uganda. At RHSP, they had a health campaign going on for male circumcision. This campaign was called “Stylish Man” and persuaded men to get circumsized, with the jargon that a cirumsized man is a stylish man. Outside of RHSP, I saw UNAIDS campaigns throughout the village and main city about condom usage, family planning and prenatal care. These campaigns where in differet languages depending on where in Uganda they were. As I pondered about how UNAIDS would decide in which area to choose which language, I got to see first hand how a public health organization collects scale data with the RHSP Cohort Study. I also saw first hand how a “focus group” is conducted and the different protocls for waivers depending on the language and writing barriers. Overall, I got much more from my Global Health and Field Placement then I anticipated, as I grew both emotionally, mentally and professionally. This experience helped me grow my network, as I met more people at Bloomberg, but also meet new community members and different clinicians. This created a sense of individual growth, but an additional feeling of subtle collective community gains.