It is well known that displaced people, particularly girls and women, are at a much higher risk than the rest of the population for communicable diseases and other health concerns including HIV/AIDS
. However, the combination of economic, social, biological, and behavioural factors that increase adolescent girls’ sexual vulnerability in times of war and render them disproportionately susceptible to HIV/AIDS is not yet perfectly understood.
In study interviews many women commented that, “we have lost control of our children” and “we are experiencing complete familial and cultural breakdown”. This research process has furthered our understanding of parental and extended family frustration and anguish regarding the vulnerability of their daughters living in squalor, impoverished and hungry. The lack of control they feel they have over the well being of the girl-child stands in stark contrast to the systems of protection in existence prior to IDP camp relocation. In many ways women – grandmothers, aunties and mothers – were the active witnesses/player/consenters in the transition of their daughters from adolescence to womanhood. However, the personal security and support offered to girls by their families was virtually extinguished upon the advent of war. Traditional mentoring systems and cultural norms that previously governed girls’ sexual behaviour and provided cultural cohesion and guidance in supporting and protecting young girls from risky behaviours, have largely been eroded by war-induced displacement. In IDP camps the mentoring systems are limited by the close proximity between families, thus restricting the traditional comfort that had been associated with the grandmother’s hut. Further, cultural norms governing girls’ sexual behaviour have disintegrated because the family unit is now broken-up and dispersed among other families. These findings demonstrate that children no longer have a culturally ‘safe’ place to go for information on sexual matters.
Research suggests that the erosion of belief systems and a shift in cultural norms governing girls’ sexual behaviour in times of conflict helps to explain their heightened sexual vulnerability during war
. This breakdown increases the likelihood of early sexual debut, unprotected sexual activity and larger numbers of sexual partners
[17, 29]. It is clear that the erosion of family and other social and cultural processes needs to be meaningfully addressed through appropriate programming if the vulnerability of girls in conflict settings is to be mitigated. The Government of Uganda is reinstating plans for ‘resettlement’ in the northern region as relative peace prevails
. Post-conflict prevention planners must recognize that the realities of girls will not necessarily change when peace ensues. Although the long-term effects of conflict on children is rarely discussed, available evidence suggests that girls’ vulnerability to sexual and intimate partner violence does not necessarily end with the cessation of armed conflict; in fact in many instances their vulnerability is exacerbated by reconstruction programmes that fail to specifically target their needs
[16, 17]. Therefore, any planning for resettlement must incorporate the adequate provision of basic humanitarian services, including HIV prevention programming, particularly for children already traumatized by war. Moreover, as people are leaving camps and moving back to their home villages there is more room to build multiple huts for one family. Hence, families should be encouraged and supported in building several huts for their homestead and resettling according to clan and/or in close proximity to members of extended families (i.e. cluster homes), as the Acholi once resided before the war. Living with and/or near family members will help reinstate traditional child protection components of the Acholi compound, family and moral value systems while also providing increased security for adolescent girls. Indeed, research suggests that in places where values and principles mirrored by familial and clan obligation remain strong despite the war, kinship-related interventions may provide the only opportunity for consistent programming in conflict settings
Devoid of any means of livelihood in the camps, a people of agriculturalists and livestock breeders have been reduced to near total dependence on donated food and other humanitarian aid. The anguish of poverty and the extreme difficulties women and girls face to provide for their families in IDP camps is demonstrated in our results. With no land to cultivate or crops to harvest the opportunities are restricted for girls who are out of school to make money to procure items that they consider important (including soap, Vaseline, panties and dresses). These results are worrisome because of the potential for girls participating in transactional or survival sex relationships and early marriages, which inherently increase adolescent girls’ sexual vulnerability
. Mothers in this study indicted selling portions of WFP food rations to buy the things they felt their daughters needed to prevent the initiation of sex for exchange relationships. It is clear that in order to alleviate the vulnerabilities of adolescent girls in times of conflict, women and girls must be supported in providing for their families. The provision of marketable skills training in camp settings is therefore very important. However, appropriate skills training relevant to the market economy and camp living must be considered. For example, training in tailoring might not be relevant because there is no one to buy new clothing; however, with a micro-credit loan girls might be able to buy a bail of used clothing and sell it in a market. By decreasing the dependence of girls on men for economic security, adolescent girls’ sexual vulnerability will intrinsically be alleviated
[17, 32]. Therefore, local and international NGOs must be encouraged to initiate and support appropriate marketable skills training (e.g., hairdressing and catering courses) to female camp residents, particularly adolescent girls who are not in school.
According to the Uganda AIDS Commission and reinforced by our study results, Ugandan youth begin sexual activity at young ages and with little information on sexuality thereby increasing their risk of contracting HIV/AIDS
. Traditionally, premenstrual sex was forbidden in Acholi culture and age of sexual debut ranged from 16–18 years. The diminishing age of sexual debut for girls observed in this study, reported by many women to be between 12–14 years old, is telling of adolescent girls’ increased sexual vulnerability in times of conflict. Often out of economic need girls are having sex earlier and with older men, and some men seek younger girls as sexual partners in the belief that they are more likely to be HIV-negative. Age disparities in sexual relationships increase the likelihood of sexual coercion and inhibit girls’ ability to control the terms of their sex lives including negotiating condom use, subsequently increasing their exposure to HIV
Furthermore, literature suggests that early sex may increase the likelihood of early marriage and pregnancy, signalling the end of education for most girls and leaving adolescent girls even more at risk of poverty and sexual exploitation
. Our study results corroborated this literature, as the primary reasons reported by girls for dropping out of school were marriage and/or pregnancy, in addition to lack of money for school-related supplies (uniforms, books, meals). Moreover, our results demonstrated that girls who were not in school were being left behind in the camps for most of the day instead of accompanying and assisting their mothers in the gardens, due to fear of abduction. These circumstances left out-of-school girls unsupervised in camps during the day increasing the potential for sexual predation by men offering food and clothing in exchange for sex. A report by UNICEF found that after families, schools are the next perimeter of a protective environment for children
. Schools can be a powerful protective force in most children’s lives, especially for girls, as schools physically remove children from potential harm for much of the day and help children learn skills and gather information to protect themselves and delay on-set of sexual activity. The longer girls are kept in school their vulnerability to HIV infection lowers by approximately thirty per cent
. Consequently, in-light of the widespread benefits of education, including the physical protection and sexual security that schools can provide to adolescents, every effort must be made to ensure displaced girls have consistent and stable access and support in their academics in times of conflict. Therefore, educational responses from the Ugandan Government and NGOs in northern Uganda must prioritize the provision of policies and programmes that support adolescent girls in attending and maintaining their in-school status, particularly young mothers with children and girls who are married. Currently, due to restrictive national policy, girls who get married or become pregnant are generally forced out of school. After substantial time away, the majority of these girls do not end up re-entering the school system, mainly due to the stigma associated with older girls re-entering school with their younger peers and, lack of childcare support for young mothers
. As such, it is imperative that the Ministry of Education in Uganda restructure current educational policy so that young girls who become pregnant or get married are not forced to leave school. Moreover, this policy change must coincide with the development of special bridging centres (attached to government schools) for young mothers where they can continue with their formal education while their children are cared for. In addition, the Ministry must ensure that older girls who drop out of school are afforded the opportunity of accessing accelerated learning programmes, complementary educational initiatives which allow young people to catch-up with their studies relative to their peers, in-turn increasing the chances of school leavers re-entering the formal education system. Finally, the Government of Uganda and the Ugandan Ministry of Education must work with the districts and sub-districts in the North, as well as local NGOs and international donor agencies, to provide funding for all the ‘extras’ that keep children from entering/re-entering school or force school-going children to subsequently drop-out (i.e. uniforms, books, meals).
Our study results demonstrated that girls were also vulnerable at night; our analysis uncovered a very concerning ‘internal’ night-commuting phenomenon whereby, due to privacy and security concerns, children moved from their family hut at night from the outskirts of camps to sleep in more central locations within their camp’s perimeters in a friend’s or relative’s hut without any adult supervision. Many parents reported the increased vulnerability of their daughters, in particular, to sexual predation during this internal nighttime movement. Unfortunately, the hundreds of children moving at night within the perimeters of the camps has not been highly recognized as a night-commuting phenomenon in and of itself, and has therefore not been properly assessed from either a research or a policy perspective. A concerted effort by researchers, policy makers and, programme planners to address these unique circumstances is urgently required.
In Northern Uganda, the Information, Education, and Communication (IEC) campaigns focused on the dissemination of HIV/AIDS information can be considered successful, as the majority of our study participants had a high awareness of HIV/AIDS and a high knowledge level of how to prevent infection. Yet what is apparent in our analysis is that girls are having difficulty translating knowledge of how to prevent infection into risk minimization practice. Many girls reported that condom availability in the camps was inconsistent or unavailable altogether. Moreover, several participants expressed the need for sexual health information and services in camps that was cognizant of the current realities and needs of adolescent girls and that would support them in the translation of HIV/AIDS awareness and knowledge to personal modification of sexual lifestyles. Combined, these findings are an indicator of the lack of appropriate sexual health programming that exists in camps and are of concern. With limited access to knowledge and means to protect one’s self, girls are inherently vulnerable to high-risk sexual activity
. It is well documented that war-related insecurity has diminished opportunities for NGOs and other organizations providing prevention programming to have a strong and consistent presence in displacement camps
[17, 39, 40]. However, research demonstrates that reduced access to reproductive and sexual health services including relevant sexual health information increases the vulnerability of adolescents in particular
. Prevention programming planners in camps must realize that early sex, early marriage, and early pregnancies are the realities of adolescent girls living in displacement camps. Appropriate responses and innovative community-driven solutions acknowledging this actuality are urgently required to ensure adolescent girls have support and access to the information and means they need to protect themselves. For example, Spittal et al. (2008) developed the Wayo Programme, a reproductive health initiative in northern Uganda that trained women from the community to assume traditional Acholi, wayo-like counselling roles for the purposes of passing on sexual education and HIV prevention information from adults to younger women
. This is a highly successful and sustainable initiative because the women themselves are chosen by the community to become trained in STI prevention, condom use and reproductive health issues. They essentially resurrect roles that carried traditional respect; roles, which have now been lost or eroded due to prolonged conflict and displacement. Similar interventions that are built solidly upon indigenous knowledge and supported by the community must be supported and expanded. Furthermore, consultations must occur between the Wayo Programme, girls at risk, and other NGO and service providers in northern Uganda, including Save the Children, The AIDS Support Organization (TASO) and Straight Talk, on ways to increase access to condoms, condom information, VCT, STI treatment and antiviral care in camp settings. Strengthening reproductive health service provision to adolescent girls in times of conflict would improve their health outcomes considerably