Cango Lyec (Healing the Elephant): Gender differences in HIV infection in post-conflict Northern Uganda.

BACKGROUND: 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 three 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 socio-demographics. 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%CI:14.7-19.7) compared to men (10.6; 95%CI:8.0-13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault (AOR:1.95; 95%CI:1.16-3.26); probable depression (AOR:2.22; 95%CI:1.46-3.37); probable PTSD (AOR:2.03; 95%CI:1.45-2.84); experiencing ≥12 traumatic events (AOR:2.04; 95%CI:1.31-3.18); suicide ideation (AOR:1.67; 95%CI:1.22-2.28); living in a female-headed household (AOR:2.76; 95%CI:1.70-4.49); first sexual partner ≥10 years older (AOR:1.69; 95%CI:1.07-2.67); sex exchange (AOR:5.51; 95%CI:1.76-17.31); having 2 (AOR:2.54; 95%CI:1.23-5.23) or 3+ (AOR:4.65; 95%CI:2.65-8.18) sexual partners; inconsistent condom use (AOR:0.40; 95%CI:0.29-0.57); genital ulcers (AOR:3.08; 95%CI:2.16-4.38); active syphilis (AOR:4.33; 95%CI:1.22-15.40); and ill health without medical care (AOR:2.02; 95%CI:1.22-3.34). Among men, correlates of HIV included no condom at sexual debut (AOR:1.92; 95%CI:1.30-2.83) and genital ulcers (AOR:4.40; 95%CI:1.35-14.40).

CONCLUSION: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally-safe mental health initiatives are urgently required.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.