Understanding migration patterns and their impact on the spread of HIV infection is crucial for tailoring prevention efforts. Scientists from the MRC/UVRI and LSHTM Uganda Research Unit investigated transmission linkages and networks between inland and fishing communities around Lake Victoria, focusing on seven fishing communities along its shores. The research aimed to uncover the factors driving the preferential migration of people living with HIV to these areas and to understand the low adherence to HIV treatment among these migrating populations. Village Health Teams (VHTs), as critical government-led community-based representatives providing primary health services, along with other local leaders, supported the study. Their involvement facilitated engagement between the study communities and researchers, particularly in identifying and locating study participants. 

Access to care
James[1], a 42 year old resident of one of the fishing communities along Lake Victoria, shared his story of migrating to the area while living with HIV. Initially, he moved to support his brother’s business. Drawn by the lucrative fishing industry, James decided to stay. He receives healthcare services through interventions by a non-governmental organization operating in the community, ensuring consistent access to antiretroviral therapy (ART).

He says, “Every month doctors come to this community from different organisations; Uganda Cares, Medical Research Council (MRC), The Aids Support Organisation (TASO), Kitovu mobile,(International Center for Child Health and Development (ICHAD) and so on, to test and treat people living with HIV. These have helped me with drug refills, so I have never missed my medications.”

James’ experience highlights the significant role of reliable access to HIV treatment as a key factor in making these communities attractive to some people living with HIV.

Controlling stigma and transmission
Thirty-seven-year-old Margaret is a member of a Village Health Team (VHT) at one of the landing sites. She is part of a government health programme whose role is to inform, educate and communicate to communities about HIV prevention and care in Uganda.

Like her fellow team members, Margaret engages with new in-migrants at places like restaurants, lodges and bars at the landing site, advocating for HIV testing, condom use and treatment adherence. Her compassionate approach has made her a trusted figure in the community, bridging gaps between residents and healthcare facilities.

“Because of stigma, some people on ART have given up on their medication, so I encourage them to take their medications at the right time since they are not the first to contract HIV. I urge them not to mind about peoples’ words, because on most occasions, the very people that make others feel uncomfortable while taking their medications also have HIV. This is consoling enough”, she says.

Towards tailored interventions
To address the structural factors driving migration and promoting community empowerment, multi-level collaborations that holistically represent the intersection of mobility, healthcare access and HIV prevention ought to be further strengthened.

Links between government agencies, healthcare organizations, and community leaders are essential for sustaining HIV/AIDS prevention efforts. By leveraging existing resources and community networks, stakeholders can enhance access to healthcare services and reduce transmission. For example, one of the participating organizations on this study, the Rakai Health Sciences Program (RHSP) was supported by PEPFAR through the US Centers for Disease Control and Prevention-Uganda, and it partnered with existing health facilities in the fishing communities to offer ART, which promotes adherence.

This study was funded by PANGEA Consortium, a network of 10 African, European, and American research organisations identifying individual and population-level factors that drive HIV transmission in sub-Saharan Africa by using viral genetics and epidemiology, and social science.

[1] All names are pseudonyms.

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