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Gender-based violence shadows COVID-19: Increased sexual violence, HIV exposure and teen pregnancy among girls and women in Uganda

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BACKGROUND: The COVID-19 pandemic is associated with increased gender-based violence (GBV) perpetration. However, the COVID-19 response did not prioritize GBV services, negatively impacting post-violence care service access among girls/women in Uganda. We analyzed routine program data to correlate COVID-19 restrictions with GBV violence reports, post exposure prophylaxis (PEP) uptake and teen pregnancy among Ugandan females.
METHODS: Violence data from the Uganda Health Management System (HMIS) and Ministry of Gender Labor and Social Development reports (Uganda Child-Helpline (UCHL)) were analyzed. Analysis included reports involving females (all ages) from HMIS and females aged <18 years from UCHL. Two 6-month time periods were compared: October-2019 to March-2020 (pre COVID-19 period) and April-2020 to Septempter-2020 (COVID-19 period). From HMIS, selected outcome variables for sexual violence were post-rape reports and PEP uptake; from UCHL selected outcomes were sexual violence (SV) reports and reported teen pregnancy. Frequency distributions to measure prevalence and chi-square statistics were calculated to assess significant differences and computed odds of occurrence associated with time period.
RESULTS: In pre COVID-19 period, 17,702 females reported for post-rape care and 3,274 received PEP compared to 22,013 and 3,348, respectively, during COVID-19 period. This translates to a 24% increase of post-rape reports and 18% reduction in PEP uptake between two periods. The odds of receiving PEP during COVID-19 period was 0.79 times (95% CI 0.75-0.83) lower compared to pre COVID-19 period. Over 50% of those who reported for post-rape care after the recommended 72-hour intervention timeframe cited lockdown restrictions as the main reason for coming late.
In pre COVID-19 period, 593 girls reported SV, and 73 reported teen pregnancy compared to 860 SV and 117 teen pregnancies in COVID-19 period. The odds of reporting SV during COVID-19 period was 1.30 times (95% CI: 1.12-1.51) higher compared to pre COVID-19 period. There was a 17% increase in teen pregnancy between two periods, not statistically significant (OR 1.121, 95% CI, 0.82-1.53).
CONCLUSIONS: During Uganda's COVID-19 lockdown, sexual violence reports increased, increasing HIV exposure in national data, taking into consideration possible underestimated true GBV increase associated with COVID-19 related disruptions. Investment in unhindered, flexible and adaptable GBV mitigation is important during pandemics.