HIV/AIDS in fishing communities: Challenges to delivering antiretroviral therapy to vulnerable groups

Abstract

Fishing communities have been identified as among the highest-risk groups for HIV infection in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from, the time fishers and fish traders spend away from home, their access to cash income, their demographic profile, the ready availability of commercial sex in fishing ports and the sub-cultures of risk taking and hyper-masculinity in fishermen. The subordinate economic and social position of women in many fishing communities makes them even more vulnerable to infection. In this paper we review the available literature to assess the social, economic and cultural factors that shape many fisherfolks’ life-styles and that make them both vulnerable to infection and difficult to reach with anti-retroviral therapy and continued prevention efforts. We conclude from the available evidence that fisherfolk will be among those untouched by planned initiatives to increase access to anti-retroviral therapies in the coming years; a conclusion that might apply to other groups with similar socio-economic and sub-cultural attributes, such as other seafarers, and migrant-workers including small-scale miners, and construction workers.

Acknowledgments

We are grateful for comments and advice from Prof. Tony Barnett, Dr. Catherine Locke, Dr. Roy Love, Dr. Stan Musgrave, Dr. Steve Russell and Prof. Alan Whiteside. Earlier versions of this paper were presented at a seminar at the School of Development Studies, University of East Anglia and at the 2^nd African Conference on the Social Aspects of HIV/AIDS Research in Cape Town, South Africa, both in May 2004. Edward Allison's research on poverty in small-scale fisheries is currently supported by the FAO/DFID Sustainable Fisheries Livelihoods Programme.

Notes

1. In this paper the term ‘fishing communities’ is used to mean all those who live in communities where the main livelihood activity is fishing, ‘fisherfolk’ – men and women engaged in fishing, fish processing and trading and ‘fishermen’ – men who take to the water to catch fish.

2. It must be stressed that not all fishermen conform to the image of hard-drinking, sexually promiscuous risk-takers suggested by Hiemrich & Topouzis (2000) and others. Thompson's (1985), Tunstall's (1963), Tietze, Groenewold, & Marcoux, (2000) and our own work in East Africa provide an alternative image (which can of course coexist with ‘hypermasculine’ one) of fisherfolk as hardworking, adaptable, innovative and forward-thinking, using fishing as a means to ensure security and a better standard of living for themselves and their families. Nevertheless, the scattered data on HIV seroprevalence rates (Allison & Seeley, 2004, p. 219) suggest a high-risk subculture exists among some of the world's fishing communities and the consequences of this behaviour may be far reaching, not only for the fisherfolk themselves, but the communities they interact with, the economies they contribute to, the consumers they supply and the conservation of the fish resources they harvest.

3. Patients must live in Khayelitsha and patients must have regularly attended the clinics for at least three months.

4. Acheson (1981) reviews a cultural theory literature that identifies a ‘macho complex’ and displays of ‘supermasculinity’ in North Atlantic fishermen.

5. See w.ww.aidsinfonyc.org/hivplus/issue7/soc/inter.html (accessed 18^th March 2004), www.acas.org/treatment/dru_info/rti/combivir.html (accessed 18^th March 2004) and www.acas.org/treatment/drug_info/rti/nevirapine.html (accessed 16^th March 2004)

6. See www.wfp.org(accessed 16^th March 2004).

7. In March 2003 the National Institute on Alcohol Abuse and Alcoholism of the US Government issued a call for research on ‘Alcohol and HIV/AIDS in Resource-Poor Societies’, in the call they observe that ‘In addition to being a risk factor in the contraction and progression of HIV disease [sic], alcohol misuse affects adherence to complex HIV medication regimens and to physician advice. […] carrying out research on the effects of alcohol consumption and drinking behaviors on HIV-related health outcomes is challenging. […] many questions about the relationship between alcohol consumption, increased susceptibility to HIV infection and accelerated progression to AIDS remain unanswered’. www.grants.nih.gov/grants/guide/rfa-files/RFA-AA-03-009.html (2003, p. 2).

8. Paper by Ken Shadlen ‘International Trade and HIV Treatments’ LSE workshop on HIV/AIDS and Policy, 14^th February 2004.

9. ‘Lives at risk as HIV drug runs out’. http://www.guardian.co.uk/international/story/0,3604,1140306,00.html

10. For example, problems with supply to former bank employees who have been retrenched are reported in www.procaare.org/archive/procaare-art/200401/msg00005.php accessed 11^th April 2004.

11. This not only applies to fishermen, their wives and other sexual partners may be even less likely to gain access given existing gender disparities in access to treatment (Fleischman, 2004).

12. The Poor Law Act of 1601 in England categorized paupers into three categories: the able-bodied poor for whom work would be provided, the old, children, the handicapped or sick and those who were thought able but unwilling to earn a living for themselves.