HIV Seroprevalence, Incidence, and Viral Suppression Among Ugandan Female Bar Workers: A Population-Based Study

Prior studies have shown that some female bar workers (FBWs) may engage in sex work in Africa. However, population-level data on the HIV burden among FBWs in African settings are limited.

Data from 5 survey rounds (2011-2020) of the Rakai Community Cohort Study, a population-based HIV surveillance cohort in 36 inland agrarian/trading communities (HIV prevalence ∼12%) and 4 Lake Victoria fishing communities (∼40%) in southern Uganda, were analyzed. Women reporting bar work as a primary or secondary occupation were identified and compared with non-FBWs. Primary outcomes included HIV seropositivity, incident HIV infection, viral suppression (<200 copies/mL) among women with HIV, and population prevalence of viremia. Prevalence ratios and incidence rate ratios were estimated using Poisson regression with 95% confidence intervals (CIs).

Among 23,556 female participants contributing 52,708 person-visits, 1205 (5.1%) self-identified as FBWs, who had significantly higher baseline HIV seroprevalence than non-FBWs (51.9% vs. 18.5%; prevalence ratio = 2.81; 95% CI = 2.64 to 2.95). There were 356 incident HIV infections over 39,228 person-years. HIV incidence among FBWs was 2.49 per 100 person-years compared with 0.87 among non-FBWs (age-adjusted incidence rate ratio = 3.64; 95% CI = 2.33 to 5.42). Although HIV viral suppression was similar among participants living with HIV regardless of FBW status, the population prevalence of HIV viremia was 1.69 times higher among FBWs (95% CI = 1.38 to 2.08). Among 179 HIV-seronegative FBWs surveyed during 2018-2020, 79.9% (143/179) were aware of preexposure prophylaxis, whereas only 13.4% (24/179) had ever used it, and 2.8% (5/179) were current users.

FBWs in Uganda experience a substantially higher HIV burden and acquisition risk compared with the general population. Prevention strategies tailored to the occupational context of bar work, including prioritization of HIV service delivery and access to oral and long-acting injectable preexposure prophylaxis, may substantially reduce HIV incidence among FBWs and their sexual partners.