“The Cango Lyec Project - Healing the Elephant-”: Women at Risk – HIV Risk Differences between Men and Women in Post-Conflict Northern Uganda

Background: War-related violence in Northern Uganda is well documented and may be accelerating HIV spread. We studied the differences in prevalence and risk factors for HIV infection between men and women in this post-conflict region.

Methods: The “Cango Lyec Project” is a prospective cohort study in Northern Uganda. We randomly selected study communities and mapped and enumerated the entire population. 2448 residents aged 13-59 consented to participate in the survey. Trauma, depression and sociodemographic-behavioural surveys and HIV testing were conducted.

Results: Of 2448 participants, 58.2% were females; 24% had been abducted, and 23% sexually-assaulted in captivity. HIV prevalence was 14.4% in women vs. 7.9% in men (p< 0.001), reaching 19.77% among women in one community. PTSD was observed in 13.9% of women compared to 8.6% of men and depression was reported by 19.9% and 8.2%  respectively (p< 0.001). Among sexually-active men, HIV positivity was associated with never using condoms with most recent sex partner (AOR: 2.03, 95% CI: 1.09-3.78); history of genital ulcers in last year (4.64, [2.2-9.4]); and residing in Gulu district (1.83, [0.98-3.42]). For sexually active women, HIV positivity was associated with never use of condoms with most recent sex partner in last year (1.83, [1.28-2.62]), history of genital ulcers in last year (2.51, [1.65-3.82]), war-related sexual violence (1.80 [1.19-2.73]), depression (1.82, [1.26-2.64]) and residing in Gulu district (1.45, [1.04-2.04])

Conclusions: Women are disproportionately impacted by HIV, trauma and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health care initiatives are urgently required.