“The Cango Lyec Project - Healing the Elephant”: HIV related vulnerabilities of post-conflict affected populations aged 13–49 years living in three Mid-Northern Uganda districts

BMC Infectious Diseases

Research Article

Eugene Kinyanda¹  Achilles Katamba²  Nelson K. Sewankambo²  Herbert Muyinda³  Patrick Odong⁴  John P. Ekwaru⁵  Martin D. Ogwang⁶  Samuel S. Malamba⁷  Paul K. Kitandwe⁸  Noah Kiwanuka⁹  Alden Blair^1,10  Martin T. Schechter^1,10  Patricia M. Spittal^1,10  Kate Jongbloed^1,10 

[1] MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda;Butabika National Psychiatric Referral Hospital, Nakawa, Uganda;Makerere University College of Health Sciences, Kampala, Uganda;Makerere University, Child Health Development Center, Kampala, Uganda;Northern Uganda Program on Health Sciences, Kampala, Uganda;School of Public Health, University of Alberta, Alberta, Canada;St. Mary’s Hospital-Lacor, Gulu, Uganda;Northern Uganda Program on Health Sciences, Kampala, Uganda;Uganda Virus Research Institute (UVRI) - HIV Reference Laboratory Program, Entebbe, Uganda;Northern Uganda Program on Health Sciences, c/o Uganda Virus Research Institute, HIV Reference Laboratory, P.O. Box 49, Entebbe, Kampala, Uganda;Uganda Virus Research Institute - International HIV/AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Program, Entebbe, Uganda;Uganda Virus Research Institute - International HIV/AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Program, Entebbe, Uganda;Makerere University College of Health Sciences, Kampala, Uganda;University of British Columbia, School of Population & Public Health, Vancouver, Canada;

关键词: HIV;    Prevalence;    Risk factors;    Post conflict;    Northern Uganda;   

DOI  :  10.1186/s12879-016-2030-0

 received in 2016-06-20, accepted in 2016-11-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe protracted war between the Government of Uganda and the Lord’s Resistance Army in Northern Uganda (1996–2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce.MethodsThe ‘Cango Lyec’ Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13–49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline.ResultsA total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31–4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06–1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28–2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34–2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive.ConclusionsHIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.

【 授权许可】

CC BY   
© The Author(s). 2016