High mortality among fishermen along the beaches of lake Victoria: secondary analysis of evidence from a randomized control trial to promote HIV testing and services uptake in Siaya County, Kenya.

introductionForty years into the epidemic, HIV remains a significant cause of death among migratory populations such as fisherfolk. Fishermen, in particular, face heightened HIV acquisition risk associated with their high alcohol consumption and engagement in transactional sex. Additionally, the increased risk of other life-threatening conditions among fishermen is often under-recognized. We sought to document incidents and possible causes of death among fishermen on Lake Victoria beaches in Siaya County, Kenya.

methodsThis study reports on deaths among fishermen enrolled in a randomized controlled trial testing whether using a social network-based approach to distribute HIV self-kits with financial incentives compared to counselor-led testing can increase fishermen's HIV testing, uptake of antiretroviral therapy or pre-exposure prophylaxis following testing, and virologic suppression. Eligible men were aged ≥ 18 years and primarily engaged in the fishing industry. Participants were recruited between July 2020 and February 2022 and followed up for six months post-enrolment to assess the clinical outcomes. We gathered incidents of death from beach leaders, friends, workmates, and family and summed them to compute a crude mortality rate. All cases were reported to the ethics committees of participating institutions and the study's Data and Safety Monitoring Board.

resultsWe screened 1,509 registered fishermen, of whom 934 were mapped to close social networks (the intent to treat sample), and 733 were enrolled. At baseline, participants' median age was 36 years, 78% were married/cohabiting, 68% attained primary education or below, the majority (57%) earned ≤ USD 83 a month, and all were engaged in fishing/fish-related trade. During the study period, 12 deaths occurred, resulting in a mortality rate of 1,284 per 100,000, 3.1 times higher than that of the general Kenyan male population (419 per 100,000). Primary causes of death included cancers (n = 3, 25%), cardiovascular disease (n = 3, 25%), HIV-related complications (n = 2, 17%), alcohol-related incidents (n = 2, 17%), and other causes (n = 2, 17%).

conclusionsThe causes of death were varied, underscoring the need for a multi-disease approach to address the health risks in high-risk occupations like fishing. Since HIV is one of several significant health threats to fishermen, efforts to end HIV must also address other life-threatening conditions.