My time has been completely consumed lately by my HIV/AIDS project that I’m getting started. I’ve been attempting to link my HIV/AIDS sensitization curriculum to all the other groups I’ve created and work with on a weekly basis. I’ve been going village to village to educate people on the basics of HIV and why they should be tested; and I’ve been busy at home drawing posters, making pre- and post-test counseling sheets, and creating an HIV Support Group Curriculum and Manual for the support group that I’ll create after my testing event, but also for future PCVs to use. Needless to say, my free time that I used to spend reading, studying for the GRE, or researching PhD programs has shrunk to nearly nothing.
Thankfully, however, I love work. While I value free time, I like being busy, having deadlines, and being under a bit of pressure. I function best in that environment. I’ve been trying to delve my heart and soul into this HIV/AIDS project not only because I want to do one big project such as this during my service, but more importantly because it’s extremely needed in my community.
Ngatt, while being a mostly conservative Muslim and Fulbe small village in the Adamawa, is a bit unique in its high HIV prevalence rate. And while official figures are lacking, I’d even hazard a guess that the area around Ngatt has one of the highest HIV prevalence rates in the Adamawa, mostly likely comparable to the areas around large transit towns like Meiganga (near the border of the East Region and the Central African Republic) or Ngaoundal (the 2nd largest train stop between Ngaoundere and Yaounde).
Why is the Ngatt area so affected by HIV if it’s not a very populated area? The population of the Ngatt health area is at most 5,000, and Ngatt proper’s population is around 1,500, with half of those being children under 12. And why is the prevalence rate so high if the culture is relatively conservative? The answer lies in the area’s largest industry: Fishing. The Ngatt area has a lot of cattle, and our cattle market is well-known throughout the area, but fishing is where the real money is, where the layperson can make a good wad of cfa during a few months of the year when Lake Mbakaou is dammed and open to fishing.
Lake Mbakaou is the largest lake in the Adamawa, and it supplies fish all throughout Cameroon. Besides Kribi, Lake Mbakaou is arguably the second largest supplier of fish. From around January to end of April, Lake Mbakaou is dammed and all the fishermen (both men and women) come from around the Adamawa (and Cameroon as a whole) to catch large tilapia, mackerel, and capitaine. From August to November, fishing in the lake is forbidden so that it isn’t over-fished. When the lake is finally dammed and opened to fishing, the lakeside village’s swell with an influx of fishermen food and alcohol vendors and prostitutes.
The Ngatt health district's HIV prevalence rate is between 10-12%, around 3 times higher than the overall Cameroon average of 4.5%. Cameroon has many groups that are considered ‘high risk’ populations, including prostitutes (in many cities, prostitutes are just a dollar), military, and truck drivers (because they are often stuck en route and find comfort in the arms of a warm prostitute). What is often missing from the list of ‘high risk/at risk’ populations is fishermen, which is very relevant and important to explaining my area’s high HIV prevalence.
The link between fishermen and HIV isn’t new, but it is significantly lacking research. In fact, some of the earliest recorded HIV cases were around the Lake Victoria area in 1982. Yet despite this, many organizations have failed to consider fishermen among groups whom they consider at-risk.
While there is still much research needed to be done, many organizations have set out to begin researching the link between fishermen and HIV prevalence rates. The findings are somewhat shocking, but would explain why the Lake Mbakaou area has a high prevalence. Research has begun to show that in low and middle-income countries, fishermen are between 4-14 times more likely to have HIV than the general population. In studies conducted in Kenya, Uganda, and DRC, HIV prevalence rates among fishermen were on average 25%, which is around 5 times higher than the prevalence rates of the general population. In the same study, researchers discovered that HIV rates (in prevalence and in absolute numbers) were much larger in fishermen than in truck drivers, a well-known high risk group, and other at-risk groups including injection drug users, military, and prisoners (see graph).
According to Ann Gordon in the report “HIV/AIDS in the Fisheries Sector in Africa”, there are several reasons as to why fishermen are more at risk of HIV. A few of these reasons include:
· Fishermen are normally young adults (15-35), which is the age group most vulnerable to sexually transmitted diseases. And ISTs increase one’s chance of getting HIV.
· Fishermen are migratory, and therefore are less constrained by traditional social and family structures. For example, the Lake Mbakaou fishing season is February-June, so those who participate in fishing are away from their ‘home’ for many months and are more likely to participate in risky activities, such as prostitution.
· Fishermen are considered as having a sizable disposable income and time off, which allows for plenty of opportunities to drink alcohol and participate in risky sexual practices.
· In fishing communities, it is common for a small number of women to have sex with a large number of men, which increases ones chance of being exposed to HIV.
· In fisheries where women participating in the catch, it is not rare for women to trade fish for sex.
· Gender inequality and poverty make it difficult for women to insist on condom use.
· Given the remoteness and seasonality of fishing communities, the availability of condoms and sexual health resources in fishing communities is often limited
The effects of HIV on fishing communities are multifold. For fishermen who contract HIV, they are no longer as productive, especially if they don’t adhere to their ART treatment and fall sick frequently. For families with an HIV+ member, many of their resources will go towards the care and treatment of their sick family member. And for the country as a whole, when entire fishing communities are ravaged by HIV/AIDS and the problem is large enough, then access to fish decreases, which then increases food insecurity and hurts the national economy.
In order to lower the prevalence of HIV among fishing communities, there needs to be better prevention, more access to testing/care/counseling/and ART adherence and better mitigation of poverty. I’ve created my project to address all three of these criteria in hopes that this project will actually make a difference and be sustainable. For increasing prevention methods, I’m addressing this by educating all the fishing communities in my area during their most-active season on the transmission and prevention of HIV as well as the importance of voluntary testing. With increased education among this at-risk population, I hope they will adopt the practices of using condoms and getting tested on a regular basis.
Furthermore, the access to condoms is non-existent in my area. If you want to buy condoms, you have to travel to either Tibati or Ngaoundal, which is an expensive trip for the average person. I’ve started a small condom stock at the Ngatt health center, which they will sell at normal market price (3 condoms for 20 cents). While condoms won’t be available in all villages, it’s my goal to make them at the very least accessible in Ngatt, where everyone from all the villages come at least once a week on market day to buy food for the week, sell their fish, or go to the health center for treatment. With condoms readily available in the Ngatt health center, everyone should be able to buy them if they want them.
Secondly, to address testing/care/counseling/and ART adherence, I’m leaving my health center with a supply of HIV tests so that they can continue an annual testing campaign. Furthermore, I’m creating an HIV+ support group which will meet bi-monthly to discuss mental and physical health and to monitor their adherence to their ART. The support group manual I’m creating will ensure the sustainability of the project so that my health center staff has a list of lesson plans and resources to ensure the longevity of the group.
Finally, my HIV campaign will address the mitigation of poverty by teaching various income generating activities to my HIV+ support group. They will learn and adopt these practices and teach them to other women who work in fishing communities so that the income disparity between men and women will begin to shrink, which will allow women to turn away from prostitution and empower them to use condoms.
Addressing the problem of HIV among fishing communities in my area is imperative for the continuation of the fishing industry, and also for the continuation of a healthy population. I’ve got my fair share of work cut out for me, and the majority of it won’t be easy since it deals with behavior change and communication. By the time I leave Cameroon, my project will just be barely getting its feet off the ground, but I hope that at least the ball will be rolling and perhaps a decade down the road my health center will start noticing the positive changes.