School of Population and Public Health, University of British Columbia, Vancouver, Canada.
BC Children's Hospital Research Institute, Vancouver, Canada.
J Acquir Immune Defic Syndr. 2018 Jul 1;78(3):257-268. doi: 10.1097/QAI.0000000000001671.
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.
Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda.
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.
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).
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.
随着之前的难民重新安置，在乌干达北部冲突后，艾滋病毒快速传播的可能性令人担忧。由于与战争有关的性暴力，妇女可能面临更高的脆弱性。
Cango Lyec（治愈大象）项目是一个涉及北部乌干达 3 个地区受冲突影响人群的队列。
对 8 个随机选择的社区进行了绘图，并进行了人口普查。年龄在 13 至 49 岁之间的参与者用卢奥语完成了有关战争经历、心理健康、性脆弱性和社会人口统计学的问卷。采集了血液样本进行艾滋病毒和梅毒检测。所有活跃的性参与者的基线数据用于确定艾滋病毒患病率的性别差异。多变量模型确定了按性别划分的艾滋病毒相关因素。
在 2008 名参与者中，与男性（10.6%；95%置信区间：8.0%至 13.2%，<0.001）相比，女性的艾滋病毒患病率更高[17.2%；95%置信区间：14.7%至 19.7%]。在女性中，艾滋病毒的相关因素包括：与战争有关的性侵犯[调整后的优势比（AOR）：1.95；95%置信区间：1.16 至 3.26]；可能患有抑郁症（AOR：2.22；95%置信区间：1.46 至 3.37）；可能患有创伤后应激障碍（AOR：2.03；95%置信区间：1.45 至 2.84）；经历≥12 次创伤事件（AOR：2.04；95%置信区间：1.31 至 3.18）；自杀意念（AOR：1.67；95%置信区间：1.22 至 2.28）；生活在女性主导的家庭中（AOR：2.76；95%置信区间：1.70 至 4.49）；第一个性伴侣年龄大≥10 岁（AOR：1.69；95%置信区间：1.07 至 2.67）；性交换（AOR：5.51；95%置信区间：1.76 至 17.31）；有 2（AOR：2.54；95%置信区间：1.23 至 5.23）或 3+（AOR：4.65；95%置信区间：2.65 至 8.18）性伴侣；避孕套使用不一致（AOR：0.40；95%置信区间：0.29 至 0.57）；生殖器溃疡（AOR：3.08；95%置信区间：2.16 至 4.38）；活动性梅毒（AOR：4.33；95%置信区间：1.22 至 15.40）；以及未经治疗的疾病（AOR：2.02；95%置信区间：1.22 至 3.34）。在男性中，艾滋病毒的相关因素包括初次性行为时没有使用避孕套（AOR：1.92；95%置信区间：1.30 至 2.83）和生殖器溃疡（AOR：4.40；95%置信区间：1.35 至 14.40）。
在这个受冲突影响的人群中，妇女不成比例地受到艾滋病毒、创伤和抑郁症的影响。迫切需要进行以创伤为导向的艾滋病毒预防和文化上安全的心理健康干预措施。
