UBC Theses and Dissertations
The intersection of conflict, substance use, trauma, and HIV : exploring their complex interplay among conflict affected populations in a rapidly changing northern Uganda Blair, Alden Hooper
Background: Epidemiologists have long noted a paucity of research addressing the role of substance use in conflict and post-conflict settings especially as it interacts with mental health and HIV vulnerability in affected populations. Such is the case in northern Uganda where after two decades of conflict the region is rapidly changing, and where community leaders are expressing concerns as to perceived rapid increases in substance use and its impact on the population and growing HIV epidemic. Methods: This multidisciplinary research explored the intersection of mental health, substance use, and HIV in the context of conflict. This project was conducted in partnership with the “Cango Lyec Project” a five-year cohort project exploring HIV risk among Acholi people aged 14-49 in the Gulu, Nwoya, and Amuru districts of northern Uganda. The quantitative analyses began with a confirmatory factor analysis of the structure and underlying validity of the AUDIT alcohol scale. Next, multivariable regressions explored factors associated with hazardous drinking in the population. Qualitative analyses used an interpretive and interpretive description (ID) thematic approach to analyze 30 in-depth interviews and explored within the context of the quantitative analyses. Results: Quantitative findings indicated strong validity for the AUDIT scale. Overall, rates of drinking were much lower than the rest of Uganda, and women were significantly less likely than men to consume alcohol or have hazardous use behaviors. After adjustment neither post traumatic stress disorder (PTSD), depression, nor HIV were significantly associated with problematic drinking though there were significant associations with many sexual behaviors, and abduction was protective against problematic drinking among men. Qualitative findings highlighted participants’ views that substance use remained a large and growing problem in the region that was closely tied to HIV. Use was highly stigmatized especially as it pertained to perceptions that it constituted a rejection of Acholi traditions. Conclusion: This research highlights the need to integrate rigorous and population-level epidemiological evidence within community perspectives and understandings of risk. While at times the results appeared to contrast, underlying both were clear areas for intervention that acknowledge the profound trauma inflicted by the conflict and areas to support community- driven change.
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