HIV services for fisherfolk in Sierra Leone: A formative assessment of barriers, opportunities, and community preferences.

In African fishing communities, landing sites are central to social and sexual networks, making them important areas for HIV transmission. Despite being identified as a priority group by the Sierra Leone Ministry of Health (MoH), there are limited data on fisherfolk's HIV risk or their preferences regarding HIV prevention, testing, linkage and treatment services. In May 2022, we conducted a formative assessment at two landing sites, using surveys and focus group discussions with 113 fisherfolk, including fishermen, fishmongers, fish traders, fish processors and community members, along with 17 interviews with MoH staff, fishermen union consortium, and health providers. Participants were mostly female (56%), married (70%), and middle-aged (median age 40); 64% had only primary education or less. While all had heard of HIV, 69% considered themselves at no or low risk, despite 32% having multiple recent sexual partners, 58% not knowing a partner's HIV status, and 34% not using condoms in the past month. Nearly half (48%) reported a prior STI, yet only 7% had heard of PrEP. Thirteen participants (12%) self-reported being HIV-positive, but just two were on treatment. Qualitative findings echoed low HIV knowledge and risk perception, with many noting the absence of recent condom distribution or HIV education efforts. Fisherfolk expressed a preference for receiving HIV services from nurses, ideally near landing sites. Stakeholders affirmed the need for targeted interventions. This assessment highlights a disconnect between risk behaviors and risk perception, and a lack of access to essential HIV services. To improve uptake and outcomes, it is critical to engage fisherfolk in designing community-based, differentiated HIV service delivery strategies.