Bringing HIV and AIDS prevention, treatment and care to fisherfolk, a neglected 'at risk' group
Submitting InstitutionUniversity of East Anglia
Unit of AssessmentAnthropology and Development Studies
Summary Impact TypePolitical
Research Subject Area(s)
Medical and Health Sciences: Medical Microbiology, Public Health and Health Services
Summary of the impact
Interdisciplinary research conducted in the School of International
Development (2003-4) demonstrated for the first time high HIV prevalence
and AIDS incidence among 0.5 billion people in fishing-dependent
communities across the world. Subsequent research analysed the causes and
suggested new strategies for development assistance and health service
delivery. Dissemination of these insights to stakeholders generated
significant post-2008 impacts on national government, international agency
and NGO policies and programmes, contributing to improved access to
prevention, treatment and care for hundreds of thousands of people. The
research improved HIV/AIDS mainstreaming in natural resource sector
governance and development programmes via training manuals, toolkits and
The School of International Development's (DEV) interdisciplinary
research environment facilitated the synthesis of expertise in fisheries
(Edward Allison) and HIV (Janet Seeley) to provide unique insights into
the extent and causes of HIV's impact on the fishing industry. Allison and
Seeley were the first to conduct systematic research demonstrating the
particular susceptibility of fishing communities to HIV.
a) Allison and Seeley published a paper reviewing the literature on HIV
prevalence among fisherfolk worldwide, which at the time comprised only
single case studies and scattered anecdotes [Research Reference (RR)1].
b) Allison and Seeley evaluated the underlying social and economic
processes contributing to risk and susceptibility to infection in this
group, and assessed the consequences for livelihoods and sustainable
fisheries management. This 2003-4 research was supported by Department for
International Development (DFID) grants for renewable natural resource
management science and initially targeted raising awareness of HIV/AIDS as
a fishery sector governance issue. Allison and Seeley also engaged with
the health sector to mobilize funds and expertise. A grant from CGIAR's
WorldFish Center enabled Allison and Seeley to conduct a systematic review
of epidemiological data on HIV prevalence, which established fisherfolk as
an `at risk' group worthy of targeted support, as UNAIDS had already
proposed for other, better-known vulnerable groups such as truck drivers
and drug users. This work involved a partnership including additional
members of the UEA's HIV and Development group from the Schools of
International Development (Russell) and Medicine (Bachmann, Musgrave).
Published in 2005 [RR2], the research revealed that in the 10 countries in
Asia, Africa and Latin America for which data were available, prevalence
rates in fishing communities were 5-14 times higher than corresponding
national seroprevalence estimates for the sexually active population.
Allison and Seeley highlighted the implications of these findings to
Science in response to its special report on AIDS in Asia [RR3].
c) Having contributed significantly to the epidemiological evidence base,
Allison and Seeley assessed the means of addressing the epidemic,
highlighting the difficulties of reaching mobile and vulnerable groups
such as fisherfolk with prevention, treatment and care, particularly with
anti- retroviral therapies, and set out strategies to overcome them [RR4].
With DEV research student Liz Westaway and colleagues in Uganda and
Malawi, Seeley led ethnographic research on the socio-economic impacts of
HIV/AIDs and stigma in fishing communities, strengthening the case for
policy focus on this group [RR5, RR6].
d) These research insights and supporting evidence were communicated to
key stakeholders through a variety of channels. Allison, seconded to FAO
in 2005 and to WorldFish from 2007-11, worked with these organizations to
make the case for funding HIV and AIDS-related interventions in fishing
communities in Africa. Since 2008, Seeley has headed the Social Science
Programme of the Medical Research Council/Uganda Virus Research Institute
(UVRI) Research Unit on AIDS based in Entebbe, and has been involved in
several projects on HIV among Lake Victoria's fishing communities,
including work on preparing cohorts for HIV vaccine trials.
References to the research
[all available at www.uea.ac.uk/international-development/impact]
1. Allison, E.H. & Seeley, J.A. (2004). `HIV and AIDS among
Fisherfolk: A Threat to "Responsible Fisheries?"' Fish and Fisheries
5 (3): 215-39.
2. Kissling, E., Allison, E.H., Seeley, J.A., Russell, S., Bachmann, M.,
Musgrave S.D. & Heck, S. (2005). `Fisherfolk are Among Groups Most at
Risk of HIV: Cross-Country Analysis of Prevalence and Numbers Infected'. AIDS
19 (17): 1939-46.
3. Allison, E.H. & Seeley, J.A. (2004). `Another Group at High Risk
for HIV'. Science 305: 1104.
4. Seeley, J.A. & Allison E.H. (2005). `HIV and AIDS in Fishing
Communities: Challenges in Delivering Antiretroviral Therapies to
Vulnerable Groups'. AIDS Care 17 (6): 688-97.
5. Westaway, E., Seeley J.A. and Allison E.H. (2007). `Feckless and
Reckless or Forbearing and Resourceful? Looking beyond Stereotypes at HIV
and AIDS in Fishing Communities'. African Affairs 106 (425):
6. Asiki, G., Mpendo, J., Abaasa, A., Agaba, C., Nanvubya, A., Nielsen,
L., Seeley, J., Kaleebu, P., Grosskurth, H. & Kamali, A. (2011). `HIV
and Syphilis Prevalence and Associated Risk Factors among Fishing
Communities of Lake Victoria, Uganda'. Sexually Transmitted Infections
Details of the impact
Allison and Seeley's study was the first to robustly identify a pattern
of high HIV prevalence across fishing communities, link it to an
understanding of the development context, rigorously synthesize the
epidemiological evidence, identify obstacles to addressing the problem and
suggest strategies to overcome them. Since 2008, their work has
consistently been used by a wide range of organisations to argue for and
support policy change and to obtain funds for investment in reducing
vulnerability to HIV/AIDS in fishing communities.
The research has had a significant impact on a wide range of influential
actors and in international discourse at different levels:
International agencies: The initial 2003-5 wave of research had an
immediate impact on a broad range of important international agencies,
including bilateral development agencies such as DFID and the Swedish
International Development Agency (SIDA). The research contributed to an
influential FAO Policy Brief Series and the inclusion of HIV/AIDS for the
first time in FAO's Fisheries Department's bi-annual flagship publication,
The State of World Fisheries and Aquaculture (2006). Its impact has
continued since 2008, both through these organizations' toolkits and key
resource documents [Impact References (IRs) 1, 2, 3] and via their
influence on other development actors [IR4].
This impact was facilitated by the research team's strong international
networks, including Allison's 2003-7 secondment to FAO. With FAO, Allison
and Seeley developed a partnership in 2005 with the WorldFish Center
(CGIAR) and SIDA funding Fisheries and HIV/AIDS in Africa: Investing in
Sustainable Solutions (2007-11), a USD 5 million programme of
institutional support for African fisheries agencies and health service
providers to reduce vulnerability to HIV and AIDS in fishing communities.
Allison was involved in writing the pre-proposal to secure funding for FAO
and WorldFish; Seeley was a keynote speaker at a workshop in Zambia used
to convince SIDA of the importance of investing in reducing vulnerability
to AIDS in Africa's fisheries sector. Among many other initiatives, the
programme has led to the development and implementation in Zambia of the
`Fish Trader+' intervention model to reduce female fish traders'
vulnerability to HIV through the formation of savings groups, with funding
from SIDA and the Norwegian Ministry of Foreign Affairs, [IR5].
National Governments: The research has influenced the governments
of several countries, including Kenya and Malawi to recognise fisheries
workers' vulnerability to HIV/AIDS and the need to address this in
fisheries sector policy [e.g. IR6]. It has strengthened the case for the
inclusion of fisherfolk in government HIV plans, including National AIDS
Commissions and Ministry of Health Plans [IR7].
NGOs: The research findings have also been directly taken up by
smaller, national NGOs in Kenya, Uganda, Ghana, and Indonesia to develop
specific programmes for fisherfolk. For example, HIV and AIDS awareness
raising is one of the four main focus areas of Diakonia's Lake Victoria
Livelihood Programme, [IR8]; and an Africa Social Development and Health
Initiatives (ASDHI) worker used RRs 1, 2, 3 and 4 to persuade the
organisation's management committee to extend its HIV services to fishing
communities in Uganda in 2008. This initiative grew and attracted local
government, NGO and university partnerships and funding. A daily clinic is
now held at Ssenyi fish landing site in Ssi-Bukunja sub-county in Buikwe
district, where fisherfolk are tested for HIV, treated with ARVs, can
access opportunistic infection treatment and are provided with safe male
HIV Intervention trials: Fishing communities were included in the
establishment of cohorts for HIV intervention trials for the first time in
2008, and ARV projects increased their targeting of fisherfolk in 2011.
The DEV research made an important contribution to specific interventions
by several development agencies. One of these was the Uganda Virus
Research Institute's successful bid to the European and Developing
Countries Clinical Trials Partnership to include fisherfolk in Uganda and
Malawi as key communities in intervention trials partnered by the
International AIDS Vaccine Initiative. Seeley led the social science
The ultimate impact of our work is on citizens in fishing-dependent
communities and others who benefit directly and indirectly in their
economic, social and sexual networks from improved access to
anti-retroviral therapies and basic health (including sexual health)
services [see IR8]. This has led to a significant increase in the number
of health and livelihood-focused projects and support programmes in
fishing-dependent regions, such as the Lake Victoria and Malawi fisheries.
Sources to corroborate the impact
[all available at www.uea.ac.uk/international-development/impact]
- FAO 2011 `Building Capacity for the Agriculture Sector's Response to
Aids: A Training Manual for Agriculture Sector Workers. Introduction and
Methodological Guide to the Manual', Module 5: AIDS and the fisheries
sub-sector. (A living document, most recently updated in 2011.) http://www.fao.org/docrep/013/am022e/am022e.pdf
- FAO-ILO (2011) `FAO-ILO Good Practice Guide for Addressing Child
Labour in Fisheries and Aquaculture: Policy and Practice'. http://www.fao-
- RR1 suggested as further reading in World Bank 2009 `Gender in
Agriculture Sourcebook' (Module 13: Gender in Fisheries and Agriculture)
`... intended for practical application and we hope that it will serve
to inform public discussion, policy formulation, and development
- Director, Media and Communications, Fisheries Department, FAO, Rome.
"UEA's contribution to FAO's work has been extremely valuable in raising
awareness on HIV/AIDS in a fisheries context...."
- Hüsken, S.M.C. and Heck, S. 2012. `The "Fish Trader+" Model:
Reducing Female Fish Traders' Vulnerability to HIV', African Journal
of AIDS Research 2012, 11 (1): 17-26. Cites RR 1 and 2. http://www.tandfonline.com/doi/pdf/10.2989/16085906.2012.671254
- Kenya's Office of the President, National AIDS Control Council (2011).
`Kenya AIDS Epidemic Update. 2011'. RR2 cited repeatedly in Chapter 3:
`HIV risk and vulnerability: Factors that contribute to the continued
spread of HIV'. http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012cou
- July 2011 Ugandan AIDS Commission report `HIV Sero Behavioural Survey
in Fishing Communities of the Lake Victoria Basin of Uganda' as part of
its justification for focusing on fishing communities. Supported by
AMREF, SIDA, the Ugandan Ministry of Health and the Lake Victoria Basin
- Diakonia (Swedish development NGO part-funded by SIDA), 2011, `Context
Analysis for Diakonia Programme Intervention in the Lake Victoria Region
(Uganda, Kenya & Tanzania): Results of the Terminal Evaluation of
the Lake Victoria Livelihood Programme 2006-2011' (cites RRs 1, 2 and 5)
- Founding Executive Director, Africa Social Development and Health
Initiatives (ASDHI) "In the first quarter of 2008, I was struggling to
convince colleagues at the organization where I was working to extend
HIV treatment services to the fishing communities where I was born and
raised..... Drawing on these studies [RRs 1-4], I was able to convince
my colleagues and on October 9, 2008, they sent team of counsellors,
nurses and doctors to provide services. ... Our HIV prevention program
has since attracted funding and partnerships from Buikwe district local
government, Tackle Africa, UK, PACE an affiliate of PSI, AVSI, Uganda
Cares and Makerere University-Walter Reed Project."
- European & Developing Countries Clinical Trials Partnership
(EDCTP) (2009) `Uganda and Malawi Fisherfolk Study' http://www.edctp.org/uploads/tx_viprojects/Project_Profile_-_CT_HIV_33111_Pontiano_Kaleebu.pdf