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Women and young girls confined to their homes during the COVID-19 lockdowns experienced increases in sexual violence and exposure to HIV, researchers in Uganda reported.

At a press conference at the virtual International AIDS Society (IAS) Conference on HIV Science, Rose Apondi, MPH, an HIV-prevention specialist with the CDC in Kampala, Uganda, said that when compared with the 6-month period before the lockdown in 2020, the 6 months afterward showed a 24% increase in reports of rape and a 30% increase in sexual violence experienced by teenage girls.

"This troubling study shows us there can be serious collateral damage from COVID-19," said IAS President Adeeba Kamarulzaman, MBBS, of the University of Malaya in Kuala Lumpur, Malaysia, who moderated the press conference, but was not involved in the research.

"There has been a lot of concern about the potential for COVID-19 lockdowns to fuel what [the organization] UN Women has called the 'shadow pandemic' of increased gender-based violence and unintended pregnancy," she added.

Apondi's group also reported an 18% reduction in the use of post-exposure prophylaxis, or PEP (OR 0.79, 95% CI 0.75-0.83), and more than 50% of the women who arrived at clinics for post-rape care after the 72-hour window for PEP had passed cited lockdown restrictions as the main reason for not coming earlier.

In addition, there was a non-significant increase in teen pregnancies (OR 1.121, 95% CI 0.82-1.53).

"The COVID-19 pandemic is associated with increased gender-based violence perpetration," Apondi said. "However, the COVID-19 response did not prioritize gender-based violence services, negatively impacting post-violence care service access among girls and women in Uganda."

She added that although the data analysis did not identify the perpetrators of sexual violence, "we know from other [research] that studied sexual violence against children that most of the perpetrators tended to be neighbors or other persons who live with the children in their homes."

Apondi and her colleagues analyzed routine program data from the Uganda Health Management System and the Uganda Child Helpline to correlate COVID-19 restrictions with gender-based violence reports.

The pre-COVID-19 period was defined as October 2019 through March 2020. In that period, she said, 17,702 women and girls reported for post-rape care and 3,274 received PEP. During the lockdown period of April 2020 to September 2020, 22,013 Ugandan women and girls sought post-rape care and 3,348 of those received PEP.

In the pre-COVID-19 period, 593 girls reported being victims of sexual violence, and 73 reported teen pregnancies, compared with 880 and 117, respectively, during the lockdown period.

"During Uganda's COVID-19 lockdown, sexual violence reports increased, increasing HIV exposure in national data, taking into consideration possible underestimated true gender-based violence increase associated with COVID-19 related disruptions," Apondi said.

She and her co-authors concluded in the abstract that "investment in unhindered, flexible, and adaptable [gender-based violence] mitigation is important during pandemics."

"This study confirms that HIV risk is also a major concern that should be taken into account when designing pandemic response plans," Kamarulzaman said. "This is a large study with quite striking results and I think will generate significant interest."

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