Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Acquired Immune Deficiency Syndromes
Abstract
As previously encamped resettle, potential for rapid
HIV transmission in post-conflict Northern Uganda is concerning.
Women in particular may be experiencing heightened vulnerability
resulting from war-related sexual violence.
Setting: Cango Lyec (Healing the Elephant) Project is a cohort
involving conflict-affected people in 3 districts in Northern Uganda.
Methods: Eight randomly selected communities were mapped, and
a census was conducted. Participants aged 13–49 years completed
questionnaires in Luo on war-related experiences, mental health,
sexual vulnerabilities, and sociodemographics. Blood samples were
tested for HIV and syphilis. Baseline data from all sexually active
participants was used to determine gender differences in HIV
prevalence. Multivariate modeling determined correlates of HIV
by gender.
Results: Among 2008 participants, HIV prevalence was higher
among women [17.2; 95% confidence interval (CI): 14.7 to 19.7]
compared to men (10.6; 95% CI: 8.0 to 13.2, ,0.001). Among
women, correlates of HIV included: war-related sexual assault
[adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable
depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable
post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84);
experiencing $12 traumatic events (AOR: 2.04; 95% CI: 1.31 to
3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in
a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first
sexual partner $10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67);
sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2
(AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65
to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95%
CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38);
active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health
without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among
men, correlates of HIV included no condom at sexual debut (AOR:
1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI:
1.35 to 14.40).
Conclusion: Women are disproportionately impacted by HIV,
trauma, and depression in this conflict-affected population. Traumainformed
HIV prevention and culturally safe mental health initiatives
are urgently required.
Description
Keywords
HIV-AIDS, Conflict-affected people, Northern Uganda, Gender, Sexual violence, Mental health
Citation
Spittal, P. M., Malamba, S. S., Ogwang, M. D., Musisi, S., Ekwaru, J. P., Sewankambo, N. K., ... & Schechter, M. T. (2018). Cango Lyec (Healing the Elephant): Gender differences in HIV infection in post-conflict Northern Uganda. Journal of Acquired Immune Deficiency Syndromes (1999), 78(3), 257.