Exposure to Armed Conflict and HIV Risk Among Rwandan Women

Abstract

This article focuses on the link between past exposure to violence and a critical public health issue in sub-Saharan Africa: HIV-positive status in women of repro­duc­tive age. Specifically, we use bio­so­cial data from the Rwandan Demographic and Health Survey (2005‒2014) to assess how the tim­ing and inten­sity of women’s expo­sure to the war and geno­cide in Rwanda (1990‒1994) may be asso­ci­ated with their HIV sta­tus. We find sig­nifi­­cant dif­fer­ences in risk across age cohorts, with the late ado­les­cence cohort (women born in 1970‒1974, who were aged 16‒20 at the start of the con­flict) hav­ing the highest risk of being HIV pos­i­tive 10‒20 years after the vio­lence, even after con­trol­ling for cur­rent socio­eco­nomic and demo­graphic char­acter­is­tics. Women who reported two or more sib­ling deaths, exclud­ing those related to mater­nal mor­tal­ity, dur­ing the con­flict years also had higher odds of being HIV pos­i­tive, net of cohort and con­trol var­i­ables. Age at first sex­ual inter­course and num­ber of lifetime sex­ual part­ners par­tially—but not fully—explain the asso­ci­a­tions between cohort and sib­ling deaths and HIV. These find­ings advance research related to armed con­flict and pop­u­la­tion health and indi­cate that expe­ri­enc­ing con­flict dur­ing key stages of the life course and at higher inten­sity may affect women’s long-term sex­ual health.