Cango Lyec (Healing the Elephant): HIV incidence in post-conflict Northern Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
EClinicalMedicine
Abstract
Civil war in Northern Uganda resulted in widespread atrocities, human rights violations, and
death, and caused millions to flee to internally displaced persons camps. War-related traumas combined
with difficulties accessing HIV prevention and health services has led to extreme HIV-related vulnerability
among conflict-affected people who survived the war. Objectives were to (1) determine HIV incidence
among conflict-affected people in Northern Uganda and (2) identify vulnerabilities associated with HIV
infection.
Methods: The Cango Lyec (Healing the Elephant) Project is a prospective cohort involving conflict-affected
populations in three districts in Northern Uganda. In 2011, eight randomly selected communities were
mapped, and a census was conducted. Consenting participants aged 13 49 years were followed over three
rounds of follow-up. Longitudinal data collected included war-related experiences, sexual vulnerabilities,
and sociodemographics. Blood samples were tested for HIV-1 at baseline and each 12-month follow-up. Multivariable Cox proportional hazard models determined factors associated with HIV incidence.
Findings: Overall, 1920 baseline HIV-negative participants with at least one follow-up contributed 3877 person-years (py) for analysis. Thirty-nine (23 female, 16 male) participants contracted HIV during follow-up.
Age- and gender-standardised HIV incidence rate was 102 per 1000py (95%CI: 72-140). Stratified by sex,
the age-adjusted HIV incidence was 110 per 1000py (95%CI: 69-166) among women and 94 per 1000py
(95%CI: 53-153) among men. Adjusting for confounders, factors associated with risk of HIV included: having been abducted (HR: 370; 95%CI: 187-734), experiencing 12 war-related traumatic events (HR: 291
95%CI: 128-660), suicide ideation (HR: 283; 95%CI: 100-803), having 2 sexual partners (HR: 468;
95%CI: 136-1605), inconsistent condom use (HR: 675; 95%CI: 249-1829), and self-reported genital
ulcers (HR: 439; 95%CI: 204-945).
Interpretation: Conflict-affected participants who had experienced abduction and multiple traumas during
the war were at greater risk of HIV infection. Trauma-informed HIV prevention and treatment services, and
culturally-safe mental health initiatives, are urgent for Northern Uganda
Description
Keywords
HIV/AIDS, Conflict-affected people, HIV incidence, Trauma, Mental health
Citation
Katamba, A., Ogwang, M. D., Zamar, D. S., Muyinda, H., Oneka, A., Atim, S., ... & Schechter, M. T. (2020). Cango Lyec (healing the elephant): HIV incidence in post-conflict Northern Uganda. EClinicalMedicine, 23, 100408. https://doi.org/10.1016/j.eclinm.2020.100408