We explored the social contextual factors for the high HIV transmission at Kasensero to inform future policy and preventive interventions. We conducted 20 in-depth interviews, including both HIV positive and HIV negative respondents, and 12 focus-group discussions involving a total of 92 respondents from the Kasensero fishing community from April-September Content analysis was performed to identify recurrent themes.
The current combination HIV prevention services by the RHSP need to be enhanced with more government involvement including ensuring sustainable supply of ART and circumcision services since they are reportedly highly demanded. Community involvement through the engagement of popular peers could also help in the campaign to change the HIV predisposing culture, misconceptions and risky social norms of the population.
Like other key populations, fishing communities contribute disproportionately to the national HIV burden and are at greater risk of infection than the general population. They also play a leading role in spreading the infection to the general population [ 5 , 6 ]. The government of Uganda is providing combination HIV prevention CHP biomedical, behavioral and social-structural services to reduce the new HIV infections in fishing communities and other key population [ 7 ].
The persistent high HIV prevalence and incidence in the Kasensero community is, however, still a cause for great concern and a clear contextual understanding of the status quo is required for generation of more enhanced approaches to improving the current CHP services to the community.
Research in settings similar to Kasensero fishing community in Malawi, Tanzania, Zambia, and other sites around lake Victoria basin has shown that contextual vulnerabilities to HIV acquisition lack of HIV awareness, transactional sex and health system deficiencies among others are a function of the social and cultural norms, values, networks and structural settings of a particular community [ 8 β 10 ]. The socio-ecological model SEM is based on the intertwined relationship between the individual and the environment.
