Grant: Project Grant

With HIV vaccines unlikely to be available for years, marginalized populations in low income countries represent "hotspots" where specialized interventions are required to prevent transmission and support engagement in care. Four million young people aged 15-24 living with HIV globally are a critical group experiencing multiple barriers to care, however few studies have provided evidence for development of interventions. Acholi young women impacted by Northern Uganda's civil war are among the most neglected populations in East Africa. Complex societal processes contribute to vulnerability in this post-conflict environment and can drastically escalate susceptibility to HIV, other sexually transmitted infections (STIs), and early death. Young women in Northern Uganda are faced with the challenges of return migration, poverty, mental health, lack of health infrastructure, and insufficient services. They also experience increased opportunities for HIV exposure via untreated STIs, sexual violence, and sex work. Epidemiological data that characterizes the impact of war and the post-conflict environment on both vulnerability and resilience of young women in Northern Uganda are scarce. Little is understood about how to support young women's access to HIV care: treatment retention, adherence, and viral suppression. We will initiate a study addressing HIV vulnerability among young conflict-affected women aged 13-24 years in 3 Northern Ugandan districts - the areas most severely impacted by the protracted war between the Government of Uganda and the Lord's Resistance Army. Using ethnographic and epidemiological methods over 3 years, we will: 1) estimate prevalence/incidence of HIV and syphilis and identify risk factors; 2) investigate associations between post traumatic stress, resilience, and depression with HIV incidence, and; 3) pilot the feasibility and acceptability of using mobile phones to support engagement in HIV care.