PLOS Global Public Health (Jan 2024)

HIV epidemiologic trends among occupational groups in Rakai, Uganda: A population-based longitudinal study, 1999-2016.

  • Victor O Popoola,
  • Joseph Kagaayi,
  • Joseph Ssekasanvu,
  • Robert Ssekubugu,
  • Grace Kigozi,
  • Anthony Ndyanabo,
  • Fred Nalugoda,
  • Larry W Chang,
  • Tom Lutalo,
  • Aaron A R Tobian,
  • Donna Kabatesi,
  • Stella Alamo,
  • Lisa A Mills,
  • Godfrey Kigozi,
  • Maria J Wawer,
  • John Santelli,
  • Ronald H Gray,
  • Steven J Reynolds,
  • David Serwadda,
  • Justin Lessler,
  • M Kate Grabowski

DOI
https://doi.org/10.1371/journal.pgph.0002891
Journal volume & issue
Vol. 4, no. 2
p. e0002891

Abstract

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Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23-0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18-0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.