Conflict in Northern Uganda in the 2000s between the government and the Lord’s Resistance Army (LRA) resulted in widespread atrocities, human rights violations and death, and saw millions flee to internally displaced people camps.

By December 2010, more than 90% of people who had been living in camps had gone home – bringing significant concerns around the potential for rapid HIV transmission in this post-war setting.

Initial results from a five-year study known as the Cango Lyec (Healing the Elephant) Project show that survivors of the Northern Ugandan war face more than double the HIV prevalence of the general population, with 14% living with HIV. Women are considerably worse affected, with 17.2% living with HIV compared to 10.6% of men.

Over 2,000 participants from the conflict-affected Nwoya, Amuru, and Gulu districts in Northern Uganda were also asked about their experiences during the war, including sexual assault, abduction and displacement.

The results that gender-specific vulnerabilities, cultural economic power imbalances between men and women in Uganda, were exacerbated in the context of war and return migration.

Many of those returning to their homes in Northern Uganda had experienced sexual assault and exploitation, with significantly more women experiencing sexual assault linked to conflict than men, although this was experienced by both genders. Sexual assault in conflict was also associated with a nearly two-fold increase in odds of HIV infection among women, providing further evidence for the role sexual violence plays in fuelling HIV epidemics in conflict and post-conflict settings.

In addition to this, more women demonstrated signs of probable depression and post-traumatic stress disorder (PTSD). Women with these mental health issues were more than twice as likely to be living with HIV compared to other women. Although many men were also living with depression and PTSD, these issues were not associated with HIV.

Other factors that increased women’s risks of HIV included living in a female-headed household, having a partner 10 or more years older, having a higher number of sexual partners, and engaging in transactional sex.

These findings underscore that people in Northern Uganda, particularly women, continue to be impacted by psychological distress, war-related sexual violence, and HIV.

Researchers comment that the results of this study highlight the complex challenges Northern Ugandans face as they rebuild their lives in their ancestral homes. They state “meaningful HIV interventions must be trauma-informed” and be “emotionally and culturally supportive and facilitate healing at individual, family, and community levels.”