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 policy briefs.

Underpinning research

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]

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 circumcision [IR9].

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 research [IR10].

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]

1. 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
2. FAO-ILO (2011) `FAO-ILO Good Practice Guide for Addressing Child Labour in Fisheries and Aquaculture: Policy and Practice'. http://www.fao- ilo.org/fileadmin/user_upload/fao_ilo/pdf/FAO- ILOGuidelines_child_labour_in_fisheries_and_aquaculture_Policy_practice_Preliminary_ve rsion.pdf
3. 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 planning'. http://siteresources.worldbank.org/INTGENAGRLIVSOUBOOK/Resources/CompleteBook.pdf
4. 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...."
5. 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
6. 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 ntries/ce_KE_Narrative_Report.pdf
7. 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 Commission (LVBC). http://www.aidsuganda.org/documents/FISHERS%20FINAL%20REPORT%20- %20SUBMITTED%20TO%20LVBC%20-%20VERSION%20OF%20JULY%2031-2011.pdf
8. 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) http://www.diakonia.se/documents/public/WHERE_WE_WORK/Africa/LakeVic/Context_An alysis_LakeVic2011.pdf
9. 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."
10. 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