Qualitative exploration of the legacy of civil war on alcohol use and its intersection with depression, PTSD, and HIV in the post-conflict populations of Northern Uganda

Background: The civil war in Northern Uganda displaced over 90% of the population and saw the dismantling of most of the regions economic and physical infrastructure. In its wake, NGOs and government agencies have reported with concern the rise of problematic substance use, especially alcohol, and concern over its impact on recovery processes.

Methods:  30 participants (15 men and 15 women) were selected from the “Cango Lyec Project,” a prospective cohort study of conflict-affected young people in Northern Uganda. Trained local staff conducted in-depth interviews in a language of participants’ choosing to explore the legacy of the civil war on the intersection of substance use, mental health, and HIV though a grounded theory approach.

Results: Narratives of personal experiences during the conflict describe a complex situation wherein abduction in many ways had a protective effect on early substance use and related sexual vulnerabilities such as transactional sex, early sexual debut, and multiple partners, risks widely reported by participants who lived in IDP camp settings. In the current post-conflict period, major themes around alcohol were; (1) widely held concerns on the increase in availability, use, and abuse in the community; (2) the loss of cultural traditions as a main driver for problematic use especially in younger generations; (3) substance use as a coping mechanism resulting from unavailable mental health services; (4) alcohol’s contribution to the rise in HIV through decreased condom usage as well as a driver of rape and transactional sex; and (5) ongoing stigma among both sexes against women partaking in alcohol.

Conclusion: The legacy of conflict in Northern Uganda is directly shaping problematic substance use patterns. While participants’ narratives show that current approaches are not effectively addressing the issue, they also show clear areas for potential culturally sensitive interventions.