Transactional sex work and HIV among women in conflict-affected Northeastern Uganda: a population-based study

Jennifer J Mootz,Milton L Wainberg,Milena Mello,Omolola A Odejimi,Aishwarya Bhattacharya,Bianca Kann,Julia Ettelbrick,Kaveh Khoshnood

doi:10.1186/s13031-022-00441-5

Jennifer J Mootz, Milton L Wainberg + Show 6 more

Open Access

https://doi.org/10.1186/s13031-022-00441-5

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Abstract

BackgroundArmed conflict and the HIV pandemic are significant global health issues. Evidence of the association between armed conflict and HIV infection has been conflicting. Our objective was to examine the role of mediating risk factors, such as engagement in transactional sex work, to elucidate the relation between armed conflict and HIV infection.MethodsWe used multistage sampling across three Northeastern Ugandan districts to randomly select 605 women aged 13 to 49 to answer cross-sectional surveys from January to May of 2016. We used multivariate logistic regression model with R 4.0.3 to examine if exposure to armed conflict has an indirect effect on reporting having an HIV-positive serostatus through engagement in transactional sex work. Age and district residence were included as covariates.ResultsExposure to armed conflict β = .16, SE = .04, p < .05, OR = 1.17, 95% [CI .08, .23] was significantly associated with reporting a HIV-positive serostatus. For each 1-unit increase in exposure to armed conflict (i.e., additional type of armed conflict exposure), there was a 17% increase in the odds of reporting a HIV-positive serostatus. Engagement in transactional sex work was not associated with reporting a HIV-positive serostatus β = .04, SE = .05, p = .37, 95% [CI − .051, .138]. We found district of residence, age, and interaction effects.ConclusionsAlthough exposure to armed was associated with reporting an HIV-positive serostatus, this relationship was not mediated by engagement in transactional sex. Further research is needed on risk factors that mediate this relationship. The likelihood of reporting a HIV-positive serostatus increased with each additional type of exposure to armed conflict. Thus, screening for exposure to multiple traumatic stressors should occur in HIV prevention settings. Healthcare services that are trauma-informed and consider mental distress would likely improve HIV outcomes.

Highlights

Armed conflict and the HIV pandemic are significant global health issues
While a global analysis found no direct association between HIV disability adjusted life years (DALYs) and armed conflict among WHO member states, this study demonstrated that risk factors such as illicit drug use and increased alcohol consumption moderated the conflict-HIV infection pathway [13]
We examined an indirect pathway mediated by transactional sex work between women’s exposure to armed conflict and reporting a HIV-positive serostatus in rural communities within the Katakwi, Amuria, and Kumi districts of Teso subregion in Northeastern Uganda

Summary

Introduction

Armed conflict and the HIV pandemic are significant global health issues. Evidence of the association between armed conflict and HIV infection has been conflicting. Our objective was to examine the role of mediating risk factors, such as engagement in transactional sex work, to elucidate the relation between armed conflict and HIV infection. Armed conflict can result in large-scale population displacement across borders [1, 2], and lead to violations. Conflict-related increase in prevalence of HIV infection prevalence has been theorized to occur through a number of mechanisms. Violent conflict leads to the deployment of soldiers as well as displacement of civilians which can increase contact between populations [16]. Armed conflict displaces the local population creating a group of asylum seekers that are vulnerable to HIV infection [19, 20]. 60–80% of survivors of rape during the Rwandan genocide were estimated to be seropositive for HIV compared to 13.5% of the general population [4, 23, 24]

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