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Epidemiol Infect. 1991 Aug;107(1):69-80.

Civil war and the spread of AIDS in Central Africa.

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Department of Geography, University of Cambridge, England.


Using ordinary least squares regression techniques this paper demonstrates, for the first time, that the classic association of war and disease substantially accounts for the presently observed geographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1 infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, are shown to be significantly and positively correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA) after the overthrow of Idi Amin some 10 years earlier in 1979. This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 and underlines the need for cognizance of historical factors which may have influenced current patterns of AIDS seen in Central Africa. The findings may have important implications for AIDS forecasting and control in African countries which have recently experienced war. The results are compared with parallel analyses of other HIV hypotheses advanced to account for the reported geographical distribution of AIDS in Uganda.


Statistical analyses suggest that military involvement has substantially affected the apparent geographical distribution of reported clinical AIDS cases in Uganda. Official estimates place the number of HIV infections in Uganda at 1 million, 6% of the country's population. Using statistical regression model, the authors test the viability of 3 hypotheses in explaining the geographical distribution of the epidemic: 1) the "truck town hypothesis," which proposes that the distribution of HIV and AIDS reflects the diffusion process in which major roads act as the main corridors of virus spread; 2) the "migrant labor hypothesis," which says that HIV spread from areas of labor demand in urban regions to areas of labor supply in rural regions through return migration; and 3) the "military involvement" hypothesis, which takes into account the historical link between servicemen, prostitutes, and the spread of STDs. The military involvement hypothesis proposes that the distribution of HIV is largely due to the 6-year civil war that began in Uganda in 1979, following the overthrow of Idi Amin. As the statistical regression shows, the truck town hypothesis and the migrant labor hypothesis fail to fully explain the district to district variability in AIDS incidence. The analysis, however, does reveal a highly significant positive relationship between the ethnic composition of the Ugandan National Liberation Army and the currently reported spatial pattern of clinical AIDS in the country, which makes sense, considering that the mean incubation period for HIV is estimated at 8-10 years. The authors note that these findings may serve to in forecasting and controlling the spread of AIDS in other African countries which have recently experience war.

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