“The Cango Lyec Project – Healing the Elephant”: Comparisons of HIV, PTSD, and depression between former abductees compared to their non-abducted counterparts in post-conflict Northern Uganda

Background:Experiences of abduction continue to have a profound impact on the mental and physical well-being of of survivors of the conflict in Northern Uganda. Despite the pervasiveness of the conflict into every level of society, relief and recovery efforts lack a sound evidence base in program design and implementation, often mistakenly targeting perceived ‘at-risk’ groups.

Methods: This prospective cohort study examines 2500 participants age 13-49 in three districts of Northern Uganda who consented to complete trauma (HTQ), depression (HSCL-25) sociodemographic surveys, and provide blood samples for HIV testing. Three separate multivariable logistic regressions examine a history of abduction and the likelihood of HIV positivity, PTSD, and depression.

Results: Of included participants, 27.4% of men (n=271) and 22.9% of women (n=319) experienced abduction. Among women, abductees faced more HIV risk factors including sexual abuse (34.2% vs. 7.15%), participation in sex work (2.2% vs. 0.5%), syphilis (7.2% vs. 4.4%), and experienced more traumatic events (32.9% vs. 1.8%). Among men, abductees were more likely to report inconsistent condom use (6.3% vs. 15.6%), to have experienced more traumatic events (33.1% vs. 1.84%), and to have abused their current sexual partner (19.6% vs. 8.9%). After adjustment for potential confounders, history of abduction was significantly associated with depression (AOR: 1.89; 95%CI 1.43-2.49) and PTSD (AOR: 2.10; 95%CI 1.56-2.83), but was notsignificantly associated with HIV infection (AOR: 1.08, 95%CI 0.80-1.47).

Discussion:HIV is not confined to easily defined groups in Northern Uganda, requiring a crucial rethinking of treatment and prevention programs. Trauma informed HIV prevention and culturally safe mental health care initiatives are urgently required.