War-related human rights violations fuel higher HIV burden among sex workers in conflict-affected Northern Uganda

A recent study led by SFU global health researcher Shira Goldenberg reveals a high burden of HIV and a high prevalence of undiagnosed HIV infections among sex workers in conflict-affected Northern Uganda.

The study which was conducted in partnership with The AIDS Service Organization (TASO), an indigenous HIV/AIDS service organization, as well as local sex workers, women’s sexual and reproductive health service providers, and refugee service providers, was published in the Journal of AIDS.

The researchers found that close to 34 per cent of the 400 female sex workers in Gulu, Northern Africa who participated in the study were living with HIV. “This is many times higher than the general population of women of reproductive age,” says Goldenberg, who is also a research scientist with the Gender and Sexual Health Initiative (GSHI) at the BC Centre for Excellence in HIV/AIDS. She also found the high prevalence of new or undiagnosed HIV infections among these women concerning.

The study echoes previous research which reveals that women sex workers in sub-Saharan Africa have among the heaviest HIV burden, and face severe gaps in accessing HIV testing, treatment, and care services.  

The study also reveals a strong link between experiences of incarceration and war-related human rights violations on the high HIV burden among female sex workers in this conflict-affected region. Almost 40 per cent of the sex workers who participated in the study reported having experienced war-related abduction, and these women were much more likely to be living with HIV. HIV infection could have been transmitted through sexual violence including rape and sexual slavery, and other rights violations such as forced marriages and torture.

Adds Goldenberg: “There is a critical need for initiatives which directly address conflict and gendered-violence, and which promote a rights-based approach to sexual and reproductive health, and HIV care.” Such initiatives should be led by sex workers and women living with HIV, and reinforced by programs that protect the health and human rights of marginalized women in conflict-affected settings.

Integrating HIV and sex work into humanitarian programs, providing broader social supports such as food and shelter, addressing human rights violations, and ensuring comprehensive and sustained access to HIV and sexual, and reproductive health are some interventions which may protect the health and rights of conflict-affected sex workers, suggests Goldenberg.