Food insecurity fuels HIV among urban women — Study

Although Uganda has largely moved on from the COVID-19 pandemic, many urban poor women continue to struggle with food insecurity and joblessness. 

The pandemic and the subsequent lockdown wiped out informal jobs and disrupted livelihoods, forcing many women to adopt coping strategies that have increased their vulnerability to HIV infection. Despite efforts from the Government and development partners, women remain disproportionately disadvantaged. 

The HIV epidemic continues to affect women more than men. Last year, there were 22,000 new HIV infections among women aged 15 and above, compared to only 11,000 among men. 

In a study conducted by the Makerere University School of Public Health, University of Waterloo, Uganda AIDS Commission, and Afrislum Uganda — a non-governmental organisation, from 2022 to date, informal settlements such as Namakwekwe and Namatala in Mbale city, as well as Kagugube and Kitintale in Kampala, 65% of respondents reported a decline in income due to the pandemic. 

“When COVID-19 struck, most of their informal employment opportunities were affected, including casual jobs, many of which collapsed. Today, five years after the pandemic, while everyone else has moved on, they are still struggling with its effects,” Dr Susan Babirye, a post-doctoral research associate at MakSPH and a lecturer at the Uganda Management Institute, said.

Economic hardships, vulnerability to HIV 

Presenting the survey findings, Dr Babirye, who was one of the principal investigators, said many women engaged in transactional sex out of desperation so as to meet basic needs, which exposed them to HIV and unintended pregnancies. 

The study showed that some women also entered long-term or traditional relationships for financial stability, though these were not always beneficial or desirable. 

Others, especially those in informal employment, lost their businesses, leaving them struggling to recover. The study was titled: Socio-economic Effects of COVID-19 on HIV Vulnerability Among Urban Poor Women in Uganda.

Female vendors' experience 

“My husband abandoned his family. Things became tough for me because I was managing a vegetable stall, and my spouse used to transport me to Owino market or other markets to buy produce. When he ran away, things became difficult.” 

The study revealed that some women adapted to reduced or lost income by cutting expenses, rationing food and seeking alternative work, such as vending and domestic jobs.

Socio-economic effects 

The survey analysed how the pandemic impacted employment and economic stability. It also examined how these socio-economic challenges contributed to increased HIV vulnerability. 

According to the findings, some women displayed remarkable resilience, supporting their families despite the shifting gender dynamics. Others resorted to illegal activities to survive, bribing Police officers or using secret transport routes. 

Some scavenged for food, risking their health and safety. The long-term effects of job losses, food insecurity and housing instability continue to push many women into risky survival strategies. 

Lockdown measures affected the precarious jobs that informal settlement residents depend on, leading to widespread hunger and severe food insecurity. 

The study revealed that social networks, including family, friends, neighbours and church groups, were a source of emotional and practical support for food, childcare and work opportunities. Additionally, the study found that 19% of respondents lost their desire for sex due to unemployment-related stress. 

Dr Babirye explained: “When someone is stressed, especially due to the impact of COVID-19, they are more likely to suffer from mental health issues. In such a state, sexual interest is often the last thing on their mind.”

Integrated support 

Dr Babirye urged organisations implementing health or socio-economic programmes to focus on vulnerable sub-populations, emphasising that many people are still struggling with food insecurity and employment instability. 

The researchers recommended that health partners consider the broader socio-economic impact of pandemics. 

Babirye said: “Whenever there is a public health emergency like COVID-19, attention should also be given to non-health effects. Interventions should be integrated while health programmes should incorporate social and microeconomic enterprise components to address both health and socio-economic challenges,” the report advised.

Women empowerment 

Mondo Kyateka, the assistant commissioner for youth and children’s affairs at the Ministry of Gender, Labour, and Social Development, acknowledged that while women’s economic situation has improved compared to the past, more empowerment is still needed. 

“Economic empowerment is very important. For example, the GROW programme supports women in business to help them grow financially. However, a challenge remains in that some male chauvinists exploit women when they see them earning money, taking it and spending it on alcohol,” Kyateka noted. 

Joyce Matuka, the country director of Wise Choices for Life Uganda, a non-governmental organisation involved in women empowerment, said her organisation would use the study findings to shape project designs. 

“As we continue working in Mbale city communities, these insights will help us remain relevant and effectively address the challenges women face,” she stated.

HIV prevalence 

Based on the epi-data country estimates for the year ending December 2023, an estimated 1,492,410 people in Uganda were living with HIV as of December 2023, with women being the majority. HIV prevalence among the adult population (15-49 years) declined to 5.1% from 5.5% in 2020. 

It was 6.6% in women and 3.6% in men. Overall, there has been a declining trend in new HIV infections from 46,000 in 2020 to 38,000 in 2023. 

It’s worth noting that the majority were adolescent girls and women contributing about 30% of the new infections. Given the slow trend of indicators, it is unlikely that Uganda will meet the 2025 target of 15,000 new infections annually. 

Experts say the country is at risk of not achieving the goal of ending HIV/AIDS by 2030. Uganda achieved 92-90-94 performance against 95-95-95 UNAIDS targets by 2025. 

This means that 92% of the people living with HIV have tested and know their HIV status, 90 of those who are HIV-positive are receiving treatment and that 94% have managed to suppress the virus to undetectable levels. 

The overall UNAIDS 95-95-95 targets are that by 2030, 95% of people living with HIV know their status, 95% of those diagnosed receive sustained antiretroviral therapy, and 95% of those on treatment achieve viral suppression.