Accounts of migrant professionals as bridges of disease transmission in sexual networks and women’s transactional relationships with rich men are not new and have been documented across sub-Saharan Africa. However what has been missing in these reports is a consideration of how the eco-social environment can shape people’s HIV risk. Social structural processes shaped the ecological environment through rapid population growth and subsequent changing land use in wetland areas contributing to disrupted lake and fish ecology. The transformed ecological environment in turn shaped social structures, contributing to reorganized sexual, domestic and economic partnerships, and mapping on to a gendered fishing economy with problematic outcomes. The results of these interactive eco-social processes were high levels of sexual concurrency, increasing HIV risk.
Findings such as these suggest that interventions that focus solely on changing individual behavior without taking account of the eco-structural context of that behavior might have limited effectiveness. Indeed a consideration of the eco-social environment suggests different kinds of interventions to reduce concurrency. For example, educating a fisherwoman in this context to negotiate safe sex and insist on condom use makes little sense in practice when she is already at a disadvantage in terms of bargaining power and may lose business. However, coupling this intervention with ecological strategies to increase the supply of fish in the lake would reduce fishermen’s leverage for demanding risky sex from fisherwomen. This would involve promoting farming further from the lake by investing in alternative water sources to reduce sources of lake pollution, as well as curtailing water hyacinth infestations. A more stable fish eco-system might also reduce fishermen’s need for extended migration and allow for more regular returns to home beaches and partners (especially if unrelated fisherwomen were no longer necessarily available as partners).
While providing fridges might provide a good short-term solution, it could also result in longer fishing expeditions to harvest more fish, further diminishing fish supply and would have limited long-term environmental sustainability. Similarly, without more comprehensive alternative income generating solutions on land, seasonal fishing bans by the government to allow fish to restock might only exacerbate fish demand and competition during periods when fishing is allowed. A more effective solution might be directed at the gendered structure of the fishing economy. If women also fished, they could simply buy fish from other women thus removing fishermen’s leverage of sex altogether. While these are clearly retrospective interventions, they suggest the kinds of eco-social structural changes that might meaningfully alter the context of fisherfolk’s individual sexual decisions.
The magnitude of structural interventions such as cleaning up Lake Victoria, stimulating economic development, or reducing gendered work inequalities, and the difficulty of measuring their direct effect on HIV incidence might lead policy makers to leave these structural constraints untouched. It is easier to conduct discrete, measurable individual level interventions and count the number of people educated, or condoms distributed, than to measure behavior change resulting from operations to restore the lake eco-system. However, in settings such as Nyanza where individual level strategies implemented over several years have had limited success, as evidenced by persistently high HIV rates, integration of these with creative, informed and specific eco-structural interventions could improve program effectiveness. More qualitative research highlighting specific connections between the eco-social environment and sexual behavior might contribute to fresh ways of thinking about HIV prevention in high prevalence settings. It might also allow for early intervention in settings where ecological factors might be fueling an epidemic.