Reports of rape and sexual violence increased among women and girls in Uganda during the COVID-19 pandemic, while uptake of post-exposure prophylaxis (PEP) decreased. These outcomes, reported to the 11th International AIDS Society Conference on HIV Science (IAS 2021) this week, suggest that Ugandan women and girls may have had increased HIV exposure during the COVID-19 pandemic.
The COVID-19 pandemic is associated with increased gender-based violence perpetration. In Uganda, COVID-19 restrictions caused a lapse in gender-based violence services, which were not initially prioritised as essential health services during COVID-19 restrictions.
Rose Apondi of the Centers for Disease Control and Prevention and colleagues analysed routine programme data to compare outcomes of six-month periods before (October 2019 to March 2020) and during (April 2020 to September 2020) the COVID-19 pandemic. The team reviewed post-rape reports and uptake of PEP (emergency treatment to prevent HIV infection) for women and girls of all ages from routine health records, as well as reports of sexual violence and teen pregnancy among girls under 18 to the Uganda Child Helpline.
In the six months before COVID-19, 17,702 women reported for post-rape care and 3274 received PEP. During COVID-19, 22,013 women sought post-rape care and 3348 received PEP in six months. This represents a 24% increase in post-rape reports during the pandemic and an 18% reduction in PEP uptake. The odds of receiving PEP during COVID-19 were 0.79 times lower (95% confidence interval, 0.75-0.83) compared to before. Over 50% of the post-rape care reported during COVID-19 was done after the recommended 72 hours, with lockdown being cited for the delay in seeking care.
In the six months before COVID-19, 593 girls under the age of 18 reported sexual violence compared to 860 girls in six months during COVID-19. The odds of reporting sexual violence were 1.3 times higher (CI 95%, 1.12-1.51) during COVID-19 compared to the preceding six months. There was also a 17% increase in reported teen pregnancy during the pandemic; however, this was not statistically significant.
Gender-based and sexual violence often go unreported, so the actual increases may have been higher, since this study relied on reports to healthcare workers or a helpline. The authors call for flexible and adaptive gender-based violence services to be prioritised during pandemics, especially during lockdowns.
Apondi R et al. Gender-based violence shadows COVID-19: Increased sexual violence, HIV exposure and teen pregnancy among girls and women in Uganda. 11th IAS Conference on HIV Science, abstract OAD0301, 2021.