HIV / STI
Intimate Partner Violence, Food Insecurity, and HIV Incidence Among Women Aged 15–49 Years in Wakiso and Hoima, Uganda: A Population-Based Longitudinal Cohort Study (2018-2023) Alex Daama* Alex Daama Daama Daama Daama Daama Daama Daama Daama Daama Daama Daama Daama Daama Daama San Diego State University
Intimate Partner Violence, Food Insecurity, and HIV Incidence Among Women Aged 15–49 Years in Wakiso and Hoima, Uganda: A Population-Based Longitudinal Cohort Study (2018-2023)
Background
Sub-Saharan Africa accounts for nearly two-thirds of global HIV incidence, with women disproportionately affected. Despite Uganda’s progress in HIV prevention, recent community-based estimates of HIV incidence remain scarce. Previous research has largely emphasized individual-level factors, overlooking broader socio-ecological determinants. We examined interpersonal, community, and structural determinants of HIV incidence among women in two Ugandan districts.
Methods
We analyzed data from the Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (PHS) longitudinal research cohort, between 2018 and 2023. Participants were HIV seronegative women aged 15–49 years .Person-time was calculated from baseline to follow-up HIV testing to estimate incidence per 100 person-years (PY). Poisson regression models were used to compute incidence rate ratios (IRR) and 95% confidence intervals (CI) for primary exposures: intimate partner violence (IPV), district of residence, food insecurity and water insecurity.
Results
Among participants (N=3,603), median age was 29 years [IQR 23- 37]. Over 54 sero-conversions occurred over 3,608 PY, yielding an incidence rate of 1.50/100 PY, with higher incidence observed in the Hoima district (1.61/100 PY) vs. Wakiso (1.38/100 PY). In separate adjusted models, IPV was significantly and strongly associated with HIV incidence (Adjusted Rate Ratio (aRR)=3.25; 95% CI: 1.10, 9.56, as was food insecurity (ARR= 3.43; 95% CI: 1.10, 10.67). Both water insecurity and residing in Hoima (vs. Wakiso) were associated with a higher HIV incidence, rate though these associations were null (aRR= 1.56, 95%CI: 0.44-5.46 and adjusted RR= 1.01; 95% CI: 0.45, 2.24, respectively).
Conclusion
Despite declining HIV incidence in Uganda, persistent interpersonal and structural vulnerabilities faced by women, including those related to both gendered violence and food insecurity, may act as critical drivers of new infections amongst women. IPV and food insecurity substantially elevate the risk of HIV among women, underscoring the need for integrated prevention strategies addressing gender-based violence and resource insecurity.
