Abstract
Female bar or sex workers (FBSWs) in Eastern Africa experience a high burden of HIV, but population-level data on HIV seroprevalence, incidence, and viral suppression among their male partners are limited. We identified 2,420 men who had ever reported sex with FBSWs in the past year among 17,438 male participants through longitudinal population-based HIV surveillance in southern Uganda (2013-2020), spanning four surveys in four Lake Victoria fishing communities (HIV seroprevalence ~40%) and 37 inland agrarian and trading communities (~12%). Primary outcomes were HIV seropositivity, incident infection, and viral suppression (< 200 copies/mL). Prevalence and incidence rate ratios (PR, IRR) were estimated using Poisson regressions with 95% confidence intervals (CIs). Among 17,438 male participants (35,273 visits), 2,420 (13.9%) reported FBSW partners at ≥ 1 study visit, who were generally older, less educated, had lower incomes, and were more likely to be previously married. Men with FBSW partners had significantly higher HIV seroprevalence than those without (32.6% vs. 10.3%; PR=3.16, 95% CI=2.93-3.40). Overall, 154 incident HIV infections occurred over 27,396 person-years of follow-up, with men with FBSW partners having higher incidence than those without (1.93 vs. 0.44/100 person-years; IRR=4.37, 95% CI=3.04-6.16). Viral suppression among men with HIV was similar between groups, but population-level HIV viremia was 1.6 times higher (95% CI=1.41-1.84) among men with FBSW partners due to their higher background seroprevalence. Men in Uganda frequently report sex with FBSWs, which is associated with a significantly higher risk of HIV acquisition. Tailored HIV prevention strategies, including approaches to promote PrEP uptake, may help reduce the HIV burden in this population.