Stephen Mukasa, 23, a fisherman on East Africa's Lake Victoria, is more terrified of drowning than he is of dying from an AIDS-related illness.

"Marine accident death is more mourned than when one dies from HIV/AIDS," he told IRIN/PlusNews. "It is tragic for one to die suddenly, but AIDS death is a protracted process."

"A body recovered from water after a boat capsizes is an ugly scene that traumatises every fisherman," said Richard Kiwanuka, another fisherman.

James Kigozi, a spokesperson for the Uganda AIDS Commission (UAC), which manages the country's anti-AIDS fight, said surveys carried out in 2007 confirmed that fishermen feared the lake more than the AIDS pandemic. Up to a million Ugandans have died of it since the first case was diagnosed in Kasensero, a fishing community southwest of the capital, Kampala, in 1982.

"The nature of their work exposes them to danger," Kigozi explained. "Many have told us that they could die in the lake any time they go fishing and they find our talk of HIV ... misplaced because they believe the disease spares them for as long as five years and more."

The UAC put estimates of HIV prevalence in fishing communities as high as 38 percent in some areas - more than five times the national average of 6.4 percent.

Fishermen at most of the landing sites and islands on the lake, flush with their takings from the day's catch, engage the services of sex workers or compete for the attention of the few other available women.

"Many believe that the lake is their bank, where they go and, on a good day, replenish their wallets," Kigozi said. "Some still believe that when one sails on the lake, he or she is cleansed automatically, so those found on islands [in the lake] are free from the disease."

"I always see sex workers boarding boats heading to the islands," said Stephen Kwezi, 29, a porter at Kasenyi landing site in Uganda's central district of Wakiso. "Most fishermen - young and old - spend their free time drinking with women and end up in the many lodges available."
A survey by the Ministry of Agriculture's fisheries department blames frequent travel and separation from spouses and from socio-cultural norms that regulate behaviour in stable communities, as some of the factors driving HIV among fishing communities.

The fishermen's lifestyle also means they work in isolated environments with limited recreation but easy access to commercial sex workers, drugs and alcohol.

Kigozi noted that despite what was known about the fishermen's high-risk behaviour, there weren't enough clinics, pharmacies and non-governmental organisations supplying condoms at the landing sites and on the islands. The fishermen's high mobility also made it difficult for them to stay on antiretroviral (ARV) treatment programmes.

Turning the tide

In an effort to reverse some of these trends, the agriculture ministry has come up with a strategic plan to improve the livelihoods, social services, infrastructure, social organisation and governance of Uganda's fishing communities.

"Evidence suggests that HIV is more likely to spread in this kind of environment, and that people cannot find the kinds of health and other support they need when they become ill," said Aventino Bakunda, the focal person on HIV in the ministry.

The UAC's Kigozi said the government was also planning an aggressive outreach programme that would include mobile clinics, and recruiting 'agents of change' in communities to help promote and distribute condoms.

According to the ministry, the continued destruction of fishing communities by the AIDS pandemic could have serious repercussions in an industry worth more than US$200 million in annual export earnings, and which supports an estimated 700,000 people across the country.

"Fishermen accumulate knowledge and skills related to weather, navigation, coasts and landing sites, movement of fish shoals, techniques for handling boats and gear, maintenance and markets," the strategic plan stated. "Fathers who die young cannot train their sons. New workers take time to pick up the knowledge and skills."