title: War and HIV: sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District, Northern Uganda.
abstract: Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15-29 years old in Gulu District. Biological specimens were collected for rapid and confirmatory HIV testing. Separate multivariable logistic regression models by sex identified risk factors for HIV infection. HIV prevalence was 15.6% (95% confidence interval [CI]: 10.8%, 21.6%) among females and 9.9% (95% CI: 6.1%, 15.0%) among males. The strongest correlate of HIV infection among men was a non-consensual sexual debut (adjusted odds ratio [AOR] 3.24; 95% CI: 1.37-7.67), and having practiced dry sex (AOR 7.62; 95% CI: 1.56-16.95) was the strongest correlate among women. Conflict-affected men and women experience vulnerability to HIV infection in different ways than may have originally been understood. Post-conflict programme planners must therefore design and implement contextualised, evidence-based responses to HIV that are sensitive to gender and cultural issues.
authors.affiliation: a School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Patel
authors.forename: Martin T
authors.initials: MT
authors.lastname: Schechter
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Stella
authors.initials: S
authors.lastname: Atim
authors.forename: Sam
authors.initials: S
authors.lastname: Lakor
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Spittal
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D015528:HIV Seroprevalence; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D012036:Refugees / Q000706:statistics & numerical data*; D012309:Risk-Taking; D017678:Sex Distribution; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult