Forced displacement exposes communities to potential risks of HIV transmission, both during flight and when they are negotiating alternative forms of settlement. The available multiple histories of sexual violence during and after conflict highlight the fact that young refugee women are often victimized and thus bear the brunt of consequences in their sexual and reproductive lives.
This study explored the contextual and structural factors that shape the resilience and vulnerabilities of young refugee women to HIV and AIDS in Uganda. Fieldwork was conducted by a research team for six months between April 2010 and January 2012 in three main refugee settlements in Western Uganda, based in Kiryandongo, Oruchinga and Nakivale. Data collection triangulated ethnographic participant observation, individual in-depth interviews, focus group discussions, stake holder analysis, participatory rapid assessments, particularly transect walks and social mapping exercises, legal review and a mini-questionnaire survey. Quantitative demographic data were analyzed using EPI Info. Qualitative data were analyzed using Atlas.ti software based on the grounded theory and designed for the manipulation of large volumes of textual, pictorial and sound data.
The Uganda National Council for Science and Technology (UNCST) reviewed and approved the science and ethics of the study. Young refugee women are exposed to high risks of sexual transmission of HIV during flight from home, when crossing borders, negotiating asylum, applying for and processing refugee status, in settlements and as they attempt to access the best durable solution – particularly the option of resettlement in a third country based in the West. Narratives of rape were abundant, even in the refugee settlements. Sexual partners included fellow refugees, family and friends, members of the host communities in neighbouring areas, humanitarian officials, nationals working in the immigration, asylum and refugee systems, border guards, soldiers and vigilante rebel group members. When the sexual intercourse with these young refugee women was non-consensual and/ or violent, protection for safe sex (such as condoms, contraceptives and lubricants) was hardly used. Beyond the dominant discourse that characterizes the sexual activities of refugee women as always and only violent and non-consensual, the young refugee women in this study reported having empowering partnerships including platonic relationships with members of the opposite sex, as well as loving, romantic, pleasurable, and fulfilling sexual relationships with boy friends, lovers, regular partners, cohabitants and husbands. Transactional sex was common as a survival strategy in order to avail access to provisions for self, children and other dependants. It was also a regular form of work, used to gain and maintain access to scarce employment opportunities, for pleasure, to maximize gains, to obtain food aid or other humanitarian commodities that are supposed to be distributed free, and also while bargaining for the processing of resettlement. Generally in the settlements, non-numerated sex was widely disparaged by young refugee women. Romantic relationships involved gift-giving and the provision of services by boyfriends and lovers; marriages involved mutual support of the spouses, and commercial sex was variously rewarded with cash, food and alcohol or other impersonal gifts. While commercial sex work without condoms was more expensive, young refugee women were sometimes forced to have unprotected sex out of desperation for food, clothing or other basic needs. In the absence of many other viable resources, the sexual capital of some young refugee women was peddled, exchanged and wielded to the advantage of individuals. Akin to transactional sex, many families exchanged the sexual and reproductive abilities of their refugee daughters for bride wealth received from the families of (often refugee) bridegrooms. Early marriages to both older and more youthful men were commonly arranged in the refugee settlements. However, while transactional sex was framed as the modern degeneration of the younger generation, bride wealth arrangements and arranged early marriages were constructed as ‘our customs,’ ‘our traditional practices,’ and ‘our rights to practice our culture.’ The safer sex interventions promoted in Uganda, i.e. Abstinence from Sex, Being faithful to sexual partner(s), and Condom use (ABC) were inappropriate and potentially unsafe for married young refugee women whose marital conjugal duties demanded that they have regular and relatively more frequent sexual intercourse which was more likely unprotected because of the desire or the pressure to conceive and bear children for the husband and his kinsmen. The socio-cultural context coupled with the structural infrastructure of the refugee settlements were important socializing factors for many young refugee women who entered puberty and adolescence while living in these settlements. Attitudes towards, knowledge of and values about sexualities were all shaped by the settlement environment. Hence, the sexual practices and praxis in the settlements were reference points from which young refugee women drew their knowledge gained through exposure. School sex education programmes were an important source of information about safe sex. However, because many young refugee women did not go to school, alternative modes of sexuality education included peers, observing adults in shared accommodation, popular culture such as music and drama, the public media and internet for those in the upper classes. Posters, bulletins, bill boards and information disseminated at hospitals and offices were an important source of information for literate individuals. Churches, mosques and ethnic customary values provided rituals of passage that shaped the moralities of young refugee women concerning the sexual rights and reproductive health terrains. In addition to all the above, the availability of programmes, services and policies on sexual and reproductive health and rights in the settlements influenced the imagined and real possibilities for safety from sexual transmission of HIV among young refugee women. Partnerships between the government of Uganda through the Office of the Prime Minister (OPM) as the designated agency in charge of refugees, the United Nations High Commissioner for Refugees (UNHCR), and several implementing partners that were local, international and other bi-lateral organizations offered a range of sexual and reproductive health rights (SRHRs) services and programmes in the settlements. These enhanced the resilience and reduced the vulnerabilities towards HIV/AIDS among young refugee women. The legal regime governing refugees in Uganda is comprehensive and offers a strong framework for protecting the SRHRs of young refugee women. Unfortunately, the laws and regulations are often rendered impotent to address the violations of the SRHRs of young refugee women by the complicity and complacency of the implementers and enforcers of the provisions therein. Furthermore, the heterogeneity of contexts, needs and strategic manipulations of the individual young refugee women and their communities further complicate the attainment of their SRHRs within the settlements. Details of earlier HURIPEC Working Papers can be accessed at: http://www.huripec.mak.ac.ug/publications.html