Grant: Doctoral Research Award - Priority Announcement: HIV/AIDS Research (SHOPP)

Hindered by social stigma and lack of access to health resources, sex workers experience inordinate amounts of gender-based violence (GBV) and represent the group with the highest rate of new HIV infections in Africa. Young women remain educationally and economically disenfranchised, increasing their risk of exchanging sex for survival. Elevated rates of HIV infection commonly accompany the post-conflict phase, emphasizing the need for evidence-based strategies to intervene as Northern Uganda transitions to post-conflict after 20 years of war. Within a longitudinal study of HIV prevention and care among female youth who exchange sex for survival in Northern Uganda, this proposal aims to: 1) Estimate the prevalence of historical GBV among youth and relationship to HIV prevalence; 2) Examine how historical violence shapes patterns of condom use with clients and incidents of interpersonal violence; 3) Estimate the incidence of HIV infection among youth mediated by historical and current experiences of GBV. Methods: Participants (n = 500 women engaged in sex for survival; 14-29 years) will be recruited through The AIDS Support Organization (TASO), the most well-established indigenous AIDS organization in Africa. This study will use participatory mapping and time-location sampling to identify young women and the places where they congregate. We will use Logistic regression to examine the relationship between violence and the biological and socio-cultural associations with HIV status. Survival analysis will be used to determine the gendered predictors of sero-conversion over a 2-year follow-up period. Outcome: The post-conflict moment in Uganda is a critical time to address the needs of young women and combat the further escalation of Uganda's HIV epidemic. Results from this research will inform evidence-based HIV prevention among one of the most at-risk groups and contribute to TASO's intervention efforts, both in Northern Uganda and other branches across Uganda.