MRC grant awarded to project investigating Ugandan women’s increased vulnerability to HIV as a result of genital inflammation

12 April 2018
Sephy Valuks

The three-year study, led by Tara Beattie at the London School of Hygiene & Tropical Medicine, will explore the physical causes of genital inflammation and investigate which behaviours put women at risk. Genital inflammation strongly increases the risk of HIV infection, as HIV infects activated immune cells. This project will investigate if structural factors (violence and alcohol use) increase risk of genital inflammation through a mental health/immunological pathway.  

STRIVE evidence about violence and alcohol as structural drivers of HIV have fed into the planning of the project, along with analysis and exchange at STRIVE's Greentree meeting. We welcome the news that further investigation will continue after the end of STRIVE.

Study design

The study will be conducted with Ugandan women at high risk of HIV infection who are already enrolled in a long-term study called The Good Health for Women Project (GHWP). Of these women approximately:

  • half will have experienced physical or sexual violence in the previous six months;
  • half are problem drinkers, and
  • 45% are living with HIV.

The first 750 HIV uninfected women who attend the clinic in October 2018, and who consent to the study, will be enrolled. Women will complete a behavioural-biological survey when they enrol in the study (baseline), and again at a follow-up visit, 6-12 months later. Two qualitative interviews (one at baseline and one 6-12 months later) will be conducted with 25 of the enrolled women. These interviews will build on the GHWP clinic questionnaire to gather further key information such as:

  • Have they experienced physical, sexual or emotional violence and who the perpetrator was?
  • Do they have symptoms of a mental health illness (such as depression, anxiety or PTSD)?
  • Are they feeling suicidal?
  • What are their vaginal washing and cleaning practices?

The research team will provide a dedicated counselling service as well as testing for a wide range of sexually transmitted infections, HIV and genital inflammation.

Analysis

After collecting all the data, statistical analyses will be used to answer the following questions:

  1. Which behavioural and biological factors cause genital inflammation and how do they cause it?
  2. Does genital inflammation remain stable in women or does it change over time?
  3. What does the violence landscape look like for women in this population? What kind of violence do they experience, how frequently and who are the perpetrators?
  4. How many women have a mental health illness?
  5. How many women have genital inflammation?

Implications

The research findings will be used to design interventions to address women's multiple needs. These might include clinical (e.g. anti-inflammatories), behavioural (e.g. alcohol prevention) and empowerment (e.g. violence prevention) components, to complement existing HIV services.