Linking anthropological analysis and epidemiological evidence: formulating a narrative of HIV transmission in Acholiland of northern Uganda.
For twenty years, a region of northern Uganda known as Acholiland has been heavily affected by war, leading to the formation of internally displaced people's camps, rape, transactional sex and child abductions. While it is clear that the war has had onerous consequences for the health of the Acholi people, the specific impact of the war on HIV transmission remains unclear, as the epidemiological evidence presents an ambiguous picture of HIV prevalence patterns. Other than a few non-governmental organization reports, very little qualitative data exists about the impact of HIV on the Acholi population. Attempting to formulate a clearer narrative of HIV transmission in Acholiland, this paper jointly analyses the historical and political context of the Acholi people and the war, the epidemiologic evidence of HIV prevalence patterns, and the ethnographic perspectives of Acholi healthcare workers and patients living with HIV/AIDS. Juxtaposing these sources of information allows for the emergence of a rich understanding of HIV in Acholiland. It is argued that three specific forms of violence--physical, symbolic and structural--create vulnerability to HIV infection in Acholiland, although to variable degrees dependent on location. The ethnographic evidence presented regarding HIV's impact on Acholiland suggests that an incorporation of historical, political, cultural and social factors must form the backbone of efforts both to understand HIV transmission and design strategies for curbing the epidemic in war settings.
Westerhaus
M
M
Global Health Equity track at Brigham and Women's Hospital in Boston, MA 02115, USA. mwesterhaus@partners.org
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000883:Anthropology; D002648:Child; D002670:Child, Abandoned / Q000706:statistics & numerical data; D054540:Child, Orphaned / Q000706:statistics & numerical data; D003466:Cultural Characteristics; D018562:Disease Transmission, Infectious / Q000517:prevention & control / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control / Q000635:transmission*; D015528:HIV Seroprevalence / Q000639:trends; D018453:Homeless Youth / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D011902:Rape / Q000706:statistics & numerical data; D012036:Refugees / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data; D014857:Warfare