AIDS is one of the growing epidemics in the world today and has been widely ascribed to be the most appalling health disaster. According to Global Health Observatory data Repository 2015, 35 million people were living with human immunodeficiency virus (HIV) worldwide at the end of the year 2013 with a mortality of 1.5 million [1].

Population groups reported 2, 3 with increased risk of acquiring the disease (HIV/AIDS) are commercial sex workers, intravenous (IV) drug abusers, and mobile populations such as military personnel, fishermen, prisoners, and truck drivers. Mobile populations are known to engage in high risk–behavior, such as having unprotected sex with multiple sexual partners. Studies in different parts of SubSaharan Africa have found strong correlations between HIV and migration status [4]. HIV/AIDS prevalence among fishermen was reported to be four to 14 times higher than the general population in a review of surveys conducted since 1992 in 10 low or middle income countries in Africa, Asia, and Latin America 5, 6. Fishermen are particularly susceptible to the risk of HIV/AIDS on account of various risk factors associated with fishing and its related lifestyles. The dynamics of the fish trade require that fishermen be mobile and stay away from their families for several days together. Fishing is considered a high-risk occupation, both in terms of the livelihood insecurity that it offers and its potential for physical injury and death. The despair of poverty and the high-levels of physical risk are believed to encourage a culture of risk-taking with respect to sexual behavior, alcohol, and drug consumption. There is evidence to show a strong culture of heavy drinking of alcohol and drug consumption among fishermen in order to deal with the stress of long working hours and exposure to danger while at sea 7, 8. Some authors contend that risk-taking among fishing communities reflects a low risk perception, a denial of risk, and fatalism 7, 9. Other risk factors include their access to cash income, demographic profile (they are often young and sexually active), low level of education (especially sex education), and readily available commercial sex hawkers in most of the fishing ports and shores of fishing grounds [10]. Also significant, are cultural factors related to fishing as a high-risk, low-status, and uncomfortable occupation, which lead to high-risk sexual behavior practices.

HIV/AIDS is largely preventable, but lack of knowledge has led to its rapid spread. Widespread ignorance, poor information, and misconceptions regarding HIV in society are responsible for causing social stigma, discrimination, and stigmatization. Therefore, understanding regarding the awareness of HIV/AIDS among high risk populations such as fishermen can help us in formulating a strategy for prevention, treatment, and improving compliance to treatment of HIV/AIDS. Therefore, the present study was undertaken to assess the knowledge regarding HIV/AIDS among fishermen population of the Kutch coast, Gujarat, India.

Table 1 depicts the distribution of study participants according to socio-demographic variables. Among all participants (n = 950), the majority belonged to the 38–47 years age group (30.2%) and were married (60.8%). Approximately 80% of the study population was illiterate. More than half of the participants worked on a contract basis. The majority (65.6%) of participants had a monthly income of ≤ 10,000 Indian Rupees (INR). Electronic media (TV, radio) was the potential source of information for the majority of participants (28.5%). Approximately 57.2% of participants had no access to any media.

The majority of the study population had never heard about HIV/AIDS (65.1%). Modes of transmission of HIV were known to approximately > 40% of study participants except mother to child transmission which was not known to 74% of participants. Only 19–25% of participants were aware of the methods of prevention of AIDS (Table 2). Among all, 23.1% of the participants had appropriate knowledge regarding HIV/AIDS. The proportion of participants with appropriate knowledge varied significantly with age (p = 0.023) and educational status (p = 0.012). The age group of 28–37 years showed the highest proportion of participants (31.3%) with appropriate knowledge regarding HIV/AIDS. Among illiterate participants, only 6.2% had appropriate knowledge as compared with 90.9% literate participants (Table 3).

Participants > 30 years of age had 2.431 times [confidence interval (CI) = 1.231–5.551; p = 0.035] greater knowledge than their younger counterparts. Literate participants had more knowledge [odds ratio (OR) = 4.551, CI = 2.314–8.982, p = 0.014] than those who cannot even read or write (Table 4).

Fishermen are considered a high risk bridging population for HIV/AIDS because of their social contacts and interactions with the general population [12]. The key components of that bridging phenomenon are they stay away from home for long periods and most people involved in fishing as an occupation are within the age groups (18–35 years) most vulnerable to sexually transmitted infections (STIs). As they stay away from home for longer durations, the chances of indulging in risky behavior such as unsafe sex with casual/commercial sex workers substantially increases. A study by Setiawan and Patten [13] (2010) reported on selected findings of a qualitative social network study investigating STI/HIV-related risk among migrant fishermen based at one of Indonesia's major fishing ports in Bali. According to this study, entertainment for all alcohol-drinking fishermen included drinking, buying sex, playing pool, and watching pornographic films. These fishermen run a high personal risk of contracting HIV due to their circular migration patterns among Indonesian and foreign ports such as Thailand and South Africa [13]. Frequent mobility and high levels of alcohol use among fishermen before and during sexual encounters may be a factor of unsafe sexual practices. The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty, and corrupt authorities. The migrant population may be subject to discrimination, xenophobia, exploitation, and harassment, and have little or no legal or social protection in the host community. Within this social context, transactional sex, sex for survival, rape, and nonprofessional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use 14, 15. In an exchange of sex for fish, fishermen get access to new sexual partners in the destination beaches and engage in risky sexual behaviors without any HIV prevention measures [16]. Therefore, the present study was conducted to witness a baseline data on knowledge of fishermen regarding the preventable disease, AIDS.

A low level of HIV/AIDS related knowledge (23.1%) among fishermen of Kutch, depicted in the present study confirm the findings of previous researches addressing the knowledge, attitude, and practices related to HIV/AIDS among fishermen of Karachi [17], North Central Nigeria [18], and Baluchistan [19]. Almost half of the population in the present study was unaware of the modes of transmission and > 25% of them did not present knowledge regarding methods of prevention of the disease. Moreover, ∼65% of the participants never heard about HIV/AIDS. Zafar et al [17] (2014) also stated that the majority of the fishermen population of Karachi did not hear about HIV/AIDS. By contrast, Olowosegun et al [20] (2009) reported a major proportion (98.4%) of the fishermen population of Kainji Lake basin had heard about HIV/AIDS, though the knowledge regarding modes of transmission and prevention was relatively low. Faye et al [3] (2013) also reported a low level of knowledge among Senegalese sailors, a similar migrant population to the present study. According to the health belief model of health behavior change, perceived susceptibility means perceived risk for contracting the health condition or disease [21]. However, when the person is unaware of the disease or never heard of the disease, perceived susceptibility for disease seems to be nil which indirectly affects the health behavior. The majority of participants at the Kutch coast never heard of HIV/AIDS implying that no prevention methods were being practiced. Only 37.3% of participants in the present study agreed to the fact that healthy looking individuals can have HIV/AIDS which implies that the remaining 63% hold the misconception that those carrying HIV virus cannot look healthy. A similar misconception was reported among commercial sex workers in a qualitative study conducted by Mah and Dibba [22] (2008) in Gambia among high risk populations. This study stated that among all high risk populations, fishermen had the lowest knowledge regarding HIV/AIDS. A common misconception stated by fishermen participants was that STIs can be contracted from urinating at a location where a dog had previously urinated [22].

The low knowledge reported in the present study is analogous to the findings among various fishermen populations of Karachi [17] and Bali [13]. However, studies eliciting knowledge among general populations reported amplified knowledge as compared with the present study. A good level of knowledge was evidenced among university students of Xinjiang [23] and among high school students of Lao People's Democratic Republic [24]. The insufficiency of knowledge among the fishermen population as compared with the general population may be ascribed to their illiteracy. Approximately 80% of the present study population could not read and write and among the meager literate population, the majority (90.9%) had appropriate knowledge regarding HIV/AIDS. Basavakumar et al [25] (2011) studied a profile of a fishing community in a village at Karnataka, India and reported that only 13.8% of fishermen participants were literate. By comparison, the literacy rate of the general population of India was found to be 74.04% [26]. The difference in knowledge regarding HIV/AIDS of illiterates and literates was found to be significant in the present study. A similar association in the literacy level and HIV related knowledge was also observed among fishermen of Baluchistan [19] and Bali, Indonesia [13]. Another major concern in the present study was that more than half of the study population had no access to any potential source of information on AIDS which might have added to their inferior knowledge. However, significant association was not elicited between source of information and knowledge which is in line with previous researches [17]. Among those, who had access to sources of information in the present study, electronic media such as TV and radio was the major source which confirms the findings of previous studies 17, 27. Limited access to sources of information in the present study might be attributed to the migrant nature of their work and less developed rural residential settings. Significant variation in the knowledge was also elicited with age in the present study which confirms the result obtained in the previous studies 13, 17.

The present study determined poor knowledge of HIV/AIDS and associated factors (age and educational status) that might have an influence on the knowledge base of fishermen. Thereby the subgroups among the highly vulnerable fishermen population which are at highest risk of getting the disease were assessed so that interventions could be planned more efficiently for preventing the disease in this population group.

This paper has highlighted knowledge regarding HIV/AIDS among fishermen of the Kutch coast. Knowledge varied with age and educational status. Therefore, it is imperative for government and other community based organizations to give the fisheries sector attention on HIV/AIDS education and prevention to help the population in the struggle against the pandemic. Urgent mobilization on HIV/AIDS information and education can be organized in the fishing communities to reduce the burden of HIV/AIDS on the national economy. Circulation of HIV/AIDS related information routinely through several means in the community is needed as many people reported lack of access to sources of information. The establishments of HIV/AIDS support organizations in enlightening the people on a broad-based community approach are required. Strengthening social capital through structural intervention programs may be important in preventing the spread of HIV/AIDS in this community.

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