Assessing the Impact of Mass Rape on the Incidence of HIV in Conflict-Affected Countries

The study investigators sought to quantify the potential impact of mass rape on HIV incidence in seven conflict-afflicted countries in sub-Saharan Africa with severe AIDS epidemics using an uncertainty analysis of a risk equation model.

Using a mathematical model, the potential impact of mass rape on increasing HIV incidence in women and girls in Burundi, Democratic Republic of Congo (DRC), Rwanda, Sierra Leone, Somalia, southern Sudan, and Uganda was evaluated. The model was parameterized with data from UNAIDS, the World Health Organization and the US Census Bureau's International Database. Incidence data from UNAIDS/WHO were used for calibration.

Mass rape could result in approximately five HIV infections per 100,000 females per year in the DRC, Sudan, Somalia, and Sierra Leone; double the number in Burundi and Rwanda; and quadruple the number in Uganda. The number of females infected annually due to mass rape is likely to be relatively low in Somalia (127, [median (interquartile range 55-254)]) and Sierra Leone (156, [median (IQR 69-305)]). In the DCR and Uganda, figures could be high: 1,120 [median (IQR 527-2,360)] and 2,172 [median (IQR 1,031-4,668)], respectively. In Burundi, Rwanda, and Sudan the numbers are likely intermediate. Under extreme conditions, 10,000 females in the DRC and 20,000 in Uganda could be infected per year. "Mass rape could increase annual incidence by approximately 7 percent [median (IQR 3-15)]," study results showed.

"Interventions and treatment targeted to rape survivors during armed conflicts could reduce HIV incidence," the investigators concluded. "Support should be provided both on the basis of human rights and public health."