By Henry Neondo
A comparative study of fishing communities around Lake Victoria and Thailand reveals that mobility of fishermen and fish traders, long absences from home, gender inequality and a masculine culture that condones or encourages casual sexual encounters affects attitudes and access to treatment of HIV/Aids as well as increasing vulnerability to infection by the scourge.
The study also found that access to health care was difficult for fishermen not only while they were away in the Lake waters or at sea, but also when they came on shore.
According to Janet Seelie and Edward Allison, lead researchers in this work, "because of their mobility, fishermen and fish traders do not know what services are available in the places they stay".
Difficulties in accessing healthcare services were even greater for migrant fishermen, because of language and cultural barriers or their status as illegal workers.
The study shows that either as sex workers, girl-friends, partners or as wives, women in developing countries’ fishing communities that have high HIV and AIDS prevalences are generally in a subordinate social position to men.
This limits their ability, for example, to negotiate for the use of condoms for sex but also limits their access to treatment and care.
Access to HIV/AIDS testing and treatment facilities may be difficult for mobile populations. Mobility coupled with irregular working hours poses an even greater hindrance to adherence to treatment regimes.
There is also a problem for poor patients who cannot afford the time off from wage-earning to attend appointments, particularly because of the long wait for treatment in busy health centres.
The study of communities around Lake Victoria, for example, found that the distance from hospitals of the 21 fishing communities studied was up to 67 km and the journey could take up to six hours.
A fisherman told the researchers: "I went to be tested but they said when I got there that it was the wrong day. I can’t fish for another day, and I don’t have Sh3000 to go again".
Possible failure to take all doses of antiretroviral drugs is of concern to experts because adherence to therapy is essential for successful management of HIV.
The WHO guidelines, Scaling up antiretroviral therapy in resource-limited settings recommend treatment for people diagnosed with AIDS and people with HIV who have a CD4 cell count below 200.
Because of concerns about the ability of health services to meet demand as well as ensure adherence,further criteria such as catchment area to define the population served and assessments of a person’s ability to keep in regular contact with the antiretroviral therapy (ART) provider have been introduced in some places.
Criteria based on length of residence, a minimum of three months, and ability to keep booked appointments, were instituted because of the highly mobile nature of the population using the Médecins Sans Frontières (MSF) programme clinic in Khayelitsha (South Africa).
In addition, the WHO guidelines suggest "continuous involvement of relatives, friends and/or community support personnel."
People who are mobile cannot keep regular appointments, or fulfil residence requirements and they do not always have family and community members on hand to provide support.
The high degree of mobility among fisherfolk can affect the nature of the communities in which they reside.
In communities around the Lake Victoria for example, "fishing communities tend to lack any form of resilience to AIDS impacts due to the lack of community initiative to offer counselling and support or health care".
Fishing may require being out at sea or on a lake for long periods of time, which means meals may be scanty and irregular.