Background: Herpes simplex virus type-2 (HSV-2) and human papillomavirus (HPV) are common sexually transmitted infections (STIs) among fishing communities and are associated with high HIV prevalence in this underserved population. However, there is limited knowledge on HIV incidence among fishermen. This study aimed at determining prevalence, incidence and risk factors associated with HIV infection among fishermen in Kisumu Kenya. Methods: Three hundred fishermen were evaluated for baseline HIV, HSV-2, HPV infection and a structured questionnaire administered. HIV incidence was assessed after 12 months among those initially HIV negative. HIV incidence rate in person-years and prevalence were estimated. Multivariate logistic regression was used to determine factors independently associated with HIV acquisition. Results: HIV prevalence was 23.3% (95% CI: 18.5 - 28.1). Risk factors for baseline HIV prevalence were older age (aOR = 2.13; 95% CI: 1.25 - 5.07), history of STI (aOR 4.21; 95% CI: 2.07 - 9.34), baseline HPV infection (aOR 2.13; 95% CI: 1.05 - 4.77), number of lifetime sexual partners (>5) aOR = 5.76 (95% CI: 1.41 - 13.57) and transactional sex (aOR = 10.98; 95% CI: 1.86 - 19.34). Condom uses with new sexual partner (aOR 0.21, 95% CI: 0.08 - 0.55) and during most recent sexual act (aOR 0.09, 95% CI: 0.03 - 0.61), were negatively associated with HIV prevalence. HIV incidence was 4.2 (95% CI = 1.3 - 7.1) per 100 person-years with being single (aIRR = 8.32; 95% CI: 1.27 - 54.67) as an independent risk factor. Condom use with new sexual partner (aIRR = 0.11; 95% CI: 0.01 - 0.89) and recent sex with wife/regular girlfriend (compared to sex worker/casual partner; aIRR = 0.03; 95% CI: 0.01 - 0.35) were associated with reduced risk of HIV acquisition. Conclusion: Inconsistent condom use and transactional/casual sexual partnerships were the main high-risk sexual behaviors in addition to marital status explaining the high HIV acquisition rate among fishermen. Intensified safer sex promotion is urgently needed in this subpopulation to avert new HIV infections.
 Coovadia, H.M. and Hadingham J. (2005) HIV/AIDS: Global Trends, Global Funds and Delivery Bottlenecks. Globalization and Health, 1, 13. http://dx.doi.org/10.1186/1744-8603-1-13
 Agot, K.E., Vander Stoep, A., Tracy, M., Obare, B.A., Bukusi, E.A., et al. (2010) Widow Inheritance and HIV Prevalence in Bondo District, Kenya: Baseline Results from a Prospective Cohort Study. PLoS ONE, 5, e14028. http://dx.doi.org/10.1371/journal.pone.0014028
 Likatavicius, G., and van de Laar, M.J. (2011) HIV infection and AIDS in the European Union and European Economic Area, 2010. Eurosurveillance, 16, pii=20030.
 Lingappa, J.R., Lambdin, B., Bukusi, E.A., Ngure, K., Kavuma, L., et al. (2008) Regional Differences in Prevalence of HIV-1 Discordance in Africa and Enrollment of HIV-1 Discordant Couples into an HIV-1 Prevention Trial. PLoS ONE 3, e1411. http://dx.doi.org/10.1371/journal.pone.0001411
 Dunkle, K.L., Stephenson, R., Karita, E., et al. (2008) New Heterosexually Transmitted HIV Infections in Married or Cohabiting Couples in Urban Zambia and Rwanda: An Analysis of Survey and Clinical Data. Lancet, 371, 2183-2191. http://dx.doi.org/10.1016/S0140-6736(08)60953-8
 Anand, A., Shiraishi, R.W., Bunnell, R.E., Jacobs, K., Solehdin, N., et al. (2009) Knowledge of HIV Status, Sexual Risk Behaviours and Contraceptive Need among People Living with HIV in Kenya and Malawi. AIDS, 23, 1565-1573. http://dx.doi.org/10.1097/QAD.0b013e32832cb10c
 Pandey, A., Benara, S.K., Roy, N., Sahu, D., Thomas, M., et al. (2008) Risk Behaviour, Sexually Transmitted Infections and HIV among Long-Distance Truck Drivers: A Cross-Sectional Survey along National Highways in India. AIDS, 22, S81-S90.
 Stefan, B., Beyrer, C., Muessig, K., et al. (2012) Burden of HIV among Female Sex Workers in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis. The Lancet Infectious Diseases, 12, 538-549. http://dx.doi.org/10.1016/S1473-3099(12)70066-X
 Delany-Moretlwe, S., Bello, B., Kinross, P., et al. (2013) HIV Prevalence and Risk in Long-Distance Truck Drivers in South Africa: A National Cross-Sectional Survey. International Journal of STD & AIDS, 25, 428-438.
 Allison, E.H. and Seeley, J.A. (2004) Another Group at High Risk for HIV. Science, 305, 1104. http://dx.doi.org/10.1126/science.305.5687.1104b
 Allison, E.H. and Seeley, J.A. (2004) HIV and AIDS among fisherfolk: A Threat to “Responsible Fisheries”? Fish & Fisheries, 5, 215-234. http://dx.doi.org/10.1111/j.1467-2679.2004.00153.x
 Entz, A.T., Ruffolo, V.P., Chinveschakitvanich, V., Soskolne, V. and van Griensven, G.J. (2000) HIV-1 Prevalence, HIV-1 Subtypes and Risk Factors among Fishermen in the Gulf of Thailand and the Andaman Sea. AIDS, 14, 1027-1034. http://dx.doi.org/10.1097/00002030-200005260-00015
 Akumu, J., Odongkara, K., Masette, M., Khaidhiwa, M., et al. (2006) Prevalence and Impacts of HIV/AIDS and Other Diseases, Indigenous Knowledge and Nutritional Status of Fisher Communities of Lake Albert. NaFIRRI. National Agricultural Research Organisation.
 Kwena, Z.A., Bukusi, E.A., Ng’ayo, M.O., Buffardi, A.L., Nguti, R., Richardson, B., Sang, N.M. and Holmes, K. (2010) Prevalence and Risk Factors for Sexually Transmitted Infections in a High-Risk Occupational Group: The Case of Fishermen along Lake Victoria in Kisumu, Kenya. International Journal of STD & AIDS, 21, 708-713. http://dx.doi.org/10.1258/ijsa.2010.010160
 Seeley, J.A. and Allison, E.H. (2005) HIV/AIDS in Fishing Communities: Challenges to Delivering Antiretroviral Therapy to Vulnerable Groups. AIDS Care, 17, 688-697.
 Opio, A., Muyonga, M. and Mulumba, N. (2013) HIV Infection in Fishing Communities of Lake Victoria Basin of Uganda—A Cross-Sectional Sero-Behavioral Survey. PLoS ONE, 8, Article ID: e70770. http://dx.doi.org/10.1371/journal.pone.0070770
 Asiki, G., Mpendo, J., Abaasa, A., Agaba, C., Nanvubya, A., Nielsen, L., Seeley, J., Kaleebu, P., Grosskurth, H. and Kamali, A. (2011) HIV and Syphilis Prevalence and Associated Risk Factors among Fishing Communities of Lake Victoria, Uganda. Sexually Transmitted Infections, 87, 511-515. http://dx.doi.org/10.1136/sti.2010.046805
 Kiwanuka, N., Ssetaala, A., Mpendo, J., Wambuzi, M., et al. (2013) High HIV-1 Prevalence, Risk Behaviours, and Willingness to Participate in HIV Vaccine Trials in Fishing Communities on Lake Victoria, Uganda. Journal of the International AIDS Society, 16, 18621.
 Sanders, E.J., Grahamc, S.M., Okuku, H.S., van der Elst, E.M., Muhaari, A., Davies, A., Peshu, N., Price, M., McClelland, R.S. and Smith, A.D. (2007) HIV-1 Infection in High Risk Men Who Have Sex with Men in Mombasa, Kenya. AIDS, 21, 2513-2520. http://dx.doi.org/10.1097/QAD.0b013e3282f2704a
 Vandepitte, J., Bukenya, J., Weiss, H.A., Nakubulwa, S., Francis, S.C., Hughes, P., Hayes, R. and Grosskurth, H. (2011) HIV and Other Sexually Transmitted Infections in a Cohort of Women Involved in High Risk Sexual Behaviour in Kampala, Uganda. Sexually Transmitted Diseases, 38, 316-323.
 Seeley, J., Nakiyingi-Miiro, J., Kamali, A., Mpendo, J., Asiki, G., Abaasa, A., De Bont, J., Nielsen, L. and Kaleebu, P. (2012) High HIV Incidence and Socio-Behavioral Risk Patterns in Fishing Communities on the Shores of Lake Victoria, Uganda. Sexually Transmitted Diseases, 39, 433-439.
 Okuku, H.S., Sanders, E.J., Nyiro, J., Ngetsa, C., Ohuma, E., McClelland, R.S., Price, M.A. and Graham, S.M. (2011) Factors Associated with Herpes Simplex Virus Type 2 Incidence in a Cohort of HIV-1-Seronegative Kenyan Men and Women Reporting High-Risk Sexual Behavior. Sexually Transmitted Diseases, 38, 837-844. http://dx.doi.org/10.1097/OLQ.0b013e31821a6225
 Sanders, E.J., Okuku, H.S., Smith, A.D., Mwangome, M., Wahome, E., Fegan, G., Peshu, N., van der Elst, E.M., Price, M.A., McClelland, R.S. and Graham, S.M. (2013) High HIV-1 Incidence, Correlates of HIV-1 Acquisition, and High Viral Loads Following Seroconversion among Men Who Have Sex with Men in Coastal Kenya. AIDS, 27, 437-446. http://dx.doi.org/10.1097/QAD.0b013e32835b0f81
 Price, M.A., Wasima, R., Mwangome, M., Mutua, G., Middelkoop, K., Roux, S., Okuku, H.S., Bekker, L.G., Anzala, O., Ngugi, E., Stevens, G., Chetty, P., Amornkul, P.N. and Sanders, E.J. (2012) Identifying At-Risk Populations in Kenya and South Africa: HIV Incidence in Cohorts of Men Who Report Sex With Men, Sex Workers, and Youth. JAIDS Journal of Acquired Immune Deficiency Syndromes, 59, 185-193. http://dx.doi.org/10.1097/QAI.0b013e31823d8693
 Li, S.M., Zhou, Z.H., Jiang, S.L., Liu, Y.J., Li, D.L., Zhang, Z., Zhang, X.X., Luo, F.J., Ruan, Y.H. and Shao, Y.M. (2011) Incidence and Risk Factors of HIV and Syphilis Seroconversion among Men Who Have Sex with Men in Beijing. Chinese Journal of Preventive Medicine, 45, 118-122.
 Xu, J.J., Zhang, M., Brown, K., Reilly, K., Wang, H.L., Hu, Q.H., Ding, H.B., Chu, Z.X., Bice, T. and Shang, H. (2010) Syphilis and HIV Seroconversion among a 12-Month Prospective Cohort of Men Who Have Sex with Men in Shenyang, China. Sexually Transmitted Diseases, 37, 432-439. http://dx.doi.org/10.1097/OLQ.0b013e3181d13eed
 Reynolds, S.J., Risbud, A.R., Shepherd, M.E., Zenilman, J.M., Brookmeyer, R.S., Paranjape, R.S., Divekar, A.D., Gangakhedkar, R.R., Ghate, M.V., Bollinger, R.C. and Mehendale, S.M. (2003) Recent Herpes Simplex Virus Type 2 Infection and the Risk of Human Immunodeficiency Virus Type 1 Acquisition in India. Journal of Infectious Diseases, 187, 1513-1521.
 Vandepitte, J., Weiss, H.A., Bukenya, J., Nakubulwa, S., Mayanja, Y., Matovu, G., Kyakuwa, N., Hughes, P., Hayes, R. and Grosskurth, H. (2013) Alcohol Use, Mycoplasma genitaliumand Other STIs Associated with HIV Incidence among Women at High Risk in Kampala, Uganda. JAIDS Journal of Acquired Immune Deficiency Syndromes, 62, 119126.
 Mehta, S.D., Moses, S., Parker, C.B., Agot, K., Maclean, I. and Bailey, R.C. (2012) Circumcision Status and Incident Herpes Simplex Virus Type 2 Infection, Genital Ulcer Disease, and HIV Infection. AIDS, 26, 1141-1149. http://dx.doi.org/10.1097/QAD.0b013e328352d116
 Aaron, A.R.T., Victor, S., Godfrey, K., Amy, E.O., et al. (2009) Incident HIV and Herpes Simplex Virus Type 2 Infection among Men in Rakai, Uganda. AIDS, 23, 1589-1594.
 Guy, R.J., Spelman, T., Stoove, M., El-Hayek, C., Goller, J., Fairley, C.K., Leslie, D., Tee, B.K., Roth, N., Grulich, A.E. and Hellard, M.E. (2011) Risk factors for HIV Seroconversion in Men Who Have Sex with Men in Victoria, Australia: Results from a Sentinel Surveillance System. Sexual Health, 8, 319-329. http://dx.doi.org/10.1071/SH10095
 Brown, E.L., Wald, A., Hughes, J.P., Morrow, R.A., Krantz, E., Mayer, K., Buchbinder, S., Koblin, B. and Celum, C. (2006) High Risk of Human Immunodeficiency Virus in Men Who Have Sex with Men with Herpes Simplex Virus Type 2 in the EXPLORE Study. American Journal of Epidemiology, 164, 733-741. http://dx.doi.org/10.1093/aje/kwj270
 Sutcliffe, C.G., Aramrattana, A., Sherman, S.G., Sirirojn, B., German, D., Wongworapat, K., Quan, V.M., Keawvichit, R. and Celentano, D.D. (2009) Incidence of HIV and Sexually Transmitted Infections and Risk Factors for Acquisition among Young Methamphetamine Users in Northern Thailand. Sexually Transmitted Diseases, 36, 284-289. http://dx.doi.org/10.1097/OLQ.0b013e318191ba17
 Sobngwi-Tambekou, J., Taljaard, D., Lissouba, P., Zarca, K., Puren, A., Lagarde, E. and Auvert, B. (2009) Effect of HSV-2 Serostatus on Acquisition of HIV by Young Men: Results of a Longitudinal Study in Orange Farm, South Africa. Journal of Infectious Diseases, 199, 958-964.
 Glick, S.N., Morris, M., Foxman, B., Aral, S.O., Manhart, L.E., Holmes, K.K. and Golden, M.R. (2012) A Comparison of Sexual Behavior Patterns among Men Who Have Sex with Men and Heterosexual Men and Women. JAIDS Journal of Acquired Immune Deficiency Syndromes, 60, 83-90.
 Gupta, R., Warren, T. and Wald, A. (2007) Genital Herpes. Lancet, 370, 2127-2137. http://dx.doi.org/10.1016/S0140-6736(07)61908-4
 Rebbapragada, A., Wachihi, C., Pettengell, C., Sunderji, S., Huibner, S., Jaoko, W., Ball, B., Fowke, K., Mazzulli, T., Plummer, F.A. and Kaul, R. (2007) Negative Mucosal Synergy between Herpes Simplex Type 2 and HIV in the Female Genital Tract. AIDS, 21, 589-598.
 Brown, J.M., Wald, A., Hubbard, A., et al. (2007) Incident and Prevalent Herpes Simplex Virus Type 2 Infection Increases Risk of HIV Acquisition among Women in Uganda and Zimbabwe. AIDS, 21, 1515-1523. http://dx.doi.org/10.1097/QAD.0b013e3282004929
 Subramanian, T., Ramakrishnan, L., Aridoss, S., Goswami, P., Kanguswami, B., Shajan, M., Adhikary, R., Purushothaman, G.K.C., Ramamoorthy, S.K., Chinnaswamy, E., Veeramani, I.B. and Paranjape, R.S. (2013) Increasing Condom Use and Declining STI Prevalence in High-Risk MSM and TGs: Evaluation of a Large-Scale Prevention Program in Tamil Nadu, India. BMC Public Health, 13, 857.
 Baeten, J.M., Donnell, D., Ndase, P., Mugo, N.R., et al. (2012) Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women. New England Journal of Medicine, 367, 399-410. http://dx.doi.org/10.1056/NEJMoa1108524
 Cohen, M.S., Chen, Y.Q., McCauley, M., Gamble, T., et al. (2011) Prevention of HIV-1 Infection with Early Antiretroviral Therapy. New England Journal of Medicine, 365, 493-505.