A FORGOTTEN WAR WITHIN A WAR: An Examination of Sexual and Gender-Based Violence in the Conflict-Affected Districts of Kitgum and Pader, Northern Uganda

by

Lahoma Thomas

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at

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Appendices Copyright Releases (if applicable) Table of Contents

ABSTRACT vii LIST OF ABBREVIATIONS USED viii DEDICATION ix ACKNOWLEDGEMENTS x CHAPTER ONE: INTRODUCTION 1 Formulation of the Problem 4 Purpose of the Study 6 Contribution of Knowledge 7 Research Questions 9 Definition of Terms 10 Summary 11 CHAPTER TWO: THEORY 13 Introduction 13 Feminists Perspective on Violence Against Women 13 Gender Relations & Patriarchy 14 Cultural Dimension 16 Militaristic Masculinity 18 Rape as a Method of Male Bonding 20 Male-to-Male Sexual Violence 22 The Political Economy of Rape 23 Summary 25 CHAPTER THREE: SEXUAL VIOLENCE AND THE SPREAD OF HIV/AIDS IN CONFLICT SITUATIONS 26 Introduction 26 The Relationship Between Conflict and Sexually Transmitted Infections 26 Evidence of the Relationship 29 Disagreement on the Relationship 30 The Role of Sexual Violence in Sexually Transmitted Infections 30 The Risk of HIV Transmission During Rape 32

IV HIV/AIDS Prevalence Among Armed Combatants 33 Summary 34

CHAPTER FOUR: CASE STUDY OF UGANDA .. 35 Introduction 35 Post-Independence: Political Transitions 35 Armed Conflict in Northern Uganda 36 Impact of the Conflict 37 Documentation of HIV/AIDS in Uganda 39 Impact of HIV/AIDS on Women 40 Sexual and Gender-Based Violence 41 Patterns of Sexual Assault 43 Summary 44 CHAPTER FIVE: METHODOLGOY & STUDY SETTING 45 Introduction 45 Methodological Framework 45 Rationale for Choosing a Qualitative Method 45 The Influence of Participatory Feminist Methodology 46 Data Collection 47 Study Setting 47 Study Procedures and Process 48 Focus Group Discussion 48 In-Depth Interview 50 Data Analysis Strategy 50 Ethical Considerations 51 Dissemination Plan 53 Limitations of Study 54 Summary 55 CHAPTER SIX: FINDINGS 56 Introduction 56 Methodological Insights Gathered During Interviews.... 56

v Findings of Study 58 Motivations of Rape 59 Increase in Incidences of SGBV Post-Conflict 63 Identified Perpetrators .64 Causes Attributed to Violence 67 Lack of Livelihood Opportunities 67 Changing Gender Roles 69 Pre-Existing Violence in the Culture 73 Inadequate Laws & Policies 76 Communitarian Approach to Addressing SGBV 81 Inadequate Health-Care Services 82 Intentional HIV Infection 85 Summary 88 CHAPTER SEVEN: CONCLUSION 89 Introduction 89 Reflections on the Findings 89 Recommendations 90 Inclusion of SGBV in HIV/AIDS Programmes 90 Improved Criminal Justice System 91 Improvement in the Measurement of SGBV 91 Improved Healthcare System 92 Enforcement of Resolutions and Legislation on SGBV 92 Reintegration 93 Final Remarks 93 BIBLIOGRAPHY 95

VI ABSTRACT

It is difficult to imagine a time in human history when a country or region in the world was not engulfed in conflict. Twenty-four hour news channels are now available to remind us that conflict and violence are impacting every corner of the planet. Sexual violence is one of the most common and, yet, unspoken features of war. The twenty-one year conflict in northern Uganda is a prime example. Drawing insights from ethnographic research conducted in the districts of Kitgum and Pader, this thesis examines how sexual and gender-based violence (SGBV) and its health implications is understood and articulated by a range of primary stakeholders, representing the state and civil society, including local governmental authorities, university faculty, and representatives of local and international non-governmental organizations (NGOs) working in the area of women's rights. More concretely, this thesis explores the relationship between conflict and HIV/AIDS; provides insight into how women continue to be subjected to SGBV after the conflict has ended; sheds light on how a community responds to sexual violence in the post-conflict setting; as well as, how families negotiate justice for the victim in the absence of an effective criminal justice system within the IDP camp setting.

vii LIST OF ABBREVIATIONS USED

The following acronyms are used at various points throughout the thesis.

AIDS: Acquired Immune Deficiency Syndrome

ANC: Antenatal clinics

ART: Anti-retroviral therapy

CBOs: Community based-organization

HIV: Human Immunodeficiency Virus

IDP: Internally displaced person(s)

INGOs: International non-governmental organizations

LRA: Lord's Resistance Army

NGOs: Non-governmental organizations

PEP: Post-exposure prophylaxis

SSA: Sub-Saharan Africa

SGBV: Sexual and gender-based violence

STI: Sexually transmitted infection

UNAIDS: The Joint United Nations Programme on HIV/AIDS

UNDP: United Nations Development Programme

UNHCR: United Nations High Commissioner for Refugees

UN-OCHA/IRIN: United Nations Office for the Coordination of Humanitarian Affairs> Integrated Regional Information Network

VAW: Violence against women

WFP: World Food Programme

WHO: World Health Organization

viii DEDICATION

To the steadfast gentle soul in my life, my glorious mother Jennifer Thomas, thank you for never letting me think that there was anything in this life I could not achieve. Truly, there has been no greater joy in my life than being your daughter.

To my 'MAMA' who taught me that the strength of the feminine is reflected in everyday acts of resistance. Your struggles and sacrifices have not been in vain. I hope to one day impact the life of my granddaughter in the same way you have defined mine.

IX ACKNOWLEDGEMENTS

I wish to thank my thesis supervisor, Dr. Rebecca Tiessen, I am enormously grateful for her constant feedback, encouragement, and reminders that this research is, indeed, relevant and I should push through the process. Her proofreading, countless suggestions, and thoughtful comments were invaluable in strengthening my writing. I also wish to thank Dr. Jacqueline Gahagan for being a committee member; our discussions always gave me great insights into my research.

It is imperative that I extend my thanks to the staff of KIWEPI, who embraced me with open arms. To Mrs. Gladys Canogura, your vision and efforts to achieve social justice leaves me in awe. Thank you for taking me into your heart. I would also like to give a huge thank you to the staff of the Ugandan Cooperative Alliance.

I owe a great deal of thanks to the many people in my life who assisted me in getting through this process. So here goes...

The cornerstone of BSAC: Barbara Hinch-Hamilton and Keslyn Adams, thank you for providing me a space in which I could be authentic and free. To the wonderful staff at Avalon, many thanks for reminding me of my clinical roots and assisting me in gaining a better perspective on my academic endeavours. To my friends: JJ, KW, JC, HM and CB I am finally done!

To Ben-jah-la, thank you for taking all of my calls in UG! Your kindness, support and love in the face of my tears, frustration and plain moodiness still has me speechless.

Last but certainly not least, I would like to thank one of my favourite people in this whole entire world, my 'sister' Stefanie Crispino, thank you for ALWAYS standing with me in the peaks and valleys.

Finally, I thank the James Robinson Johnston Chair, Social Sciences and Humanities Research Council and the Students for Development Programme for providing financial support.

x 1

CHAPTER ONE: INTRODUCTION

Women's bodies have long been used as a battleground for competing ideologies, procurement of resources, ethnic cleansing, and genocide. The appropriation of the female body as a symbol of conquest has held a ubiquitous feature in the history of humankind; however, it is a crime that has long been dismissed as one of the casualties of war. History is replete with accounts of male victors defeating their enemy and abducting 'their women'. This practice dates back to ancient Greek, Roman and Hebrew wars. Accounts of rape in war can even be found within biblical scriptures (Gordon, 1995).

War rape has also been documented in art. The most recognizable image is Poussin's, Rape of the Sabine, in which he captures an episode from early European history of the Romans 'conquering' the women of Sabine (Bryson, 1986). In this painting, the eye is drawn to the women captured by the Romans. The women are depicted as anguished, reaching out for help as they are seized against their will by the Roman invaders. This painting is illustrative of how women are construed as reproductive property; necessary for the future prosperity and building of a nation. Artists, throughout history, have depicted similar images of rape in war, allowing their canvasses to serve as immortalized testaments to the violence women experience in war.

Sexual and gender-based violence (SGBV) as a method of warfare is well documented. Rape has been employed as a weapon of genocide, ethnic cleansing, domination and humiliation. Examples of rape as a weapon of war can be traced back to the systematic rape in War World I (WWI), most notably by German soldiers. During World War II (WWII), the pattern of German military violence continued with the sexual torture of women including forced sex work in brothels and the common practice of tattooing the inscription 'Whores for Hilter's troops' on the bodies of captured partisan women. During this same period the Japanese military sanctioned the sexual enslavement of thousands of 'comfort women'; following WWII more than 100,000 women were raped in Berlin by retreating troops. Hundreds of thousands of women were raped during the 1971 Bangladeshi war of secession. 2 In the Vietnam War, American soldiers were known for gang raping suspected civilians, as well as fuelling and sustaining the extensive prostitution ring that emerged. The American military has also been linked to other acts of sexual violence in military bases in the Philippines and Korea (Brownmiller, 1975; Seiffert, 1996; Card, 1996; Watts & Zimmerman, 2002; Kien & Diehl, 2005). More contemporary examples of violence against women (VAW) as a weapon of war can be found in the civil wars in Bosnia, Rwanda, Sierra Leone, Liberia, Colombia, Iraq, Sudan, Haiti, Indonesia, Mozambique, and Democratic Republic of Congo among others (UNIFEM, 2005). One of the common features among these conflicts is the use of women's bodies as sites of violence for socio­ political purposes; whether it is to displace a population, demoralize a community or assert one's group dominance over another.

The recent emergence of feminist analysis on war rape was precipitated by two crucial events in the early 1990s. The first occurred in January 1992, when a Japanese professor found documents that revealed the Japanese government's implicit involvement in the establishment of 'comfort stations' during WWII (Seaton, 2006). This publicized revelation forced the Japanese government to issue an apology to the survivors. The second event involved the strategic and systematic execution of sexual violence in the former Yugoslavia and Rwanda in the form of mass rape, forced impregnation, sexual mutilation and the intentional transmission of the Human Immunodeficiency Virus (HIV) through rape. These events coupled with the cumulative impact of the advocacy efforts of human rights activists has thrust the issue of sexual violence in the war zone into the public discourse of war. The exposure and international outcry to these violations has spurred critical examination on the gendered nature of war, as well as the specific health implications for women (Halim, 1998; Pankhurst, 2004; Oosterveld, 2005).

Within the past two decades, a significant amount of research has been garnered on the vulnerabilities of women in wartime (Enloe, 1987, 1988, 1989, 1993, 2000; Copelon, 1995; Barstow, 2000; Russell-Brown, 2003). More specifically, researchers have focused their attention to sexual violence committed against women and young girls (Aafjes, 1998; Turshen, 2000; Skjelsbaek, 2001; Onyejekwe, 2005) and to the relationship between sexual violence and sexually transmitted infections (STIs) (Kennedy et al., 1998, 3

Kimerling et al., 1999; Maman et al., 2000; Wyatt et al., 2002; Fawzi et al, 2005). There is agreement amongst researchers and practitioners in the field that STIs are one of the major health risks for women in war-affected regions and have reached epidemic proportions world-wide (United Nations Development Fund for Women, 2001). However, due to the inherent challenges of the temporal relationship between sexual violence and STI occurrence it has been difficult to produce a causal relationship (Halim, 1998; Oosterveld, 2005; Pankhurst, 2004). Despite these limitations, there are a number of well documented studies that have demonstrated a consistent association between a history of sexual violence and the increased risk of STI transmission, including HIV infection in non-conflict settings (Kennedy et al., 1998; Kimerling et al., 1999; Wyatt et al., 2002; Fawzi et al., 2005). The results of these studies suggest that in settings of conflict, where we know sexual violence is high, there will be an increased prevalence of STIs.

In a literature review of 29 studies on the intersection between HIV and violence in the United States and sub-Saharan Africa (SSA), authors Maman et al. (2000) discuss a bi-directional relationship between the two: (1) women who experience violence are at an increased risk of HIV transmission; and, (2) women living with HIV are at increased risk of experiencing violence. In line with this finding, a recent publication on the impact of conflict on young girls conscripted to fight in the wars in Sierra Leone, Mozambique and northern Uganda, researchers Mackay & Mazurana (2004) documented a high incidence of STIs among victims of rape and sexual slavery, ranging between 70 to 90 percent. In Sierra Leone, for example, it was found that 10 out of 17 women who had been raped during the conflict were HIV positive (McKay and Mazurana, 2004). In northern Uganda, where children were forcibly conscripted to fight for rebel groups, HIV rates were also high with 15.66 percent of these children testing positive for HIV (McKay and Mazurana, 2004). Similarly, studies conducted in Rwanda, Tanzania and South Africa reveal that the risk of HIV infection for women who have experienced violence are three times more likely than women who have not (UNIFEM, 2005). Thus, it is no longer enough to frame our conversation of the HIV pandemic in terms of race, class and gender; it is imperative that we begin to examine the synergistic relationship between conflict, SGBV and its impact on the spread of this lethal virus. 4 The portion of the literature that focuses on the link between sexual violence in war and HIV/AIDS is small but growing. The 1994 genocide in Rwanda serves as a poignant illustration of the relationship between war rape and the transmission of HIV. It has been estimated that close to seventy percent of female rape survivors were infected with HIV (African Rights, 2004). These findings indicate that sexual violence in conflict-affected regions poses a significant risk in the transmission of HIV, adding a grave new dimension to military conflict. Drawing on insights gained from ethnographic research conducted in the Kitgum and Pader districts of northern Uganda, this thesis examines SGBV in the conflict and post-conflict setting and its impact on the spread of HIV/AIDS.

Formulation of the Problem

Uganda has had a long-standing conflict in the northern region of the country that began in 1986. Cited by the United Nations as one of the world's worst forgotten crises, it has been marked by countless human rights abuses, including killings, sexual violence against women girls, abductions and the use of child soldiers. Throughout the twenty-one year conflict, there have been numerous reports of sexual violence occurring at the hands of Uganda's military-Uganda People's Defence Forces (UPDF), other government agents, rebels of the Lord's Resistance Army (LRA) and non-combatants (LIU Institute of Global Issues, 2004). The conflict has led to the breakdown of traditional social, economic and familial networks that were tied to a woman's well-being. The subsequent displacement of the population has posed a particular disadvantage for women as it has reduced their access to important life sustaining resources for themselves and their children. Consequently, this has created a context of increased poverty, marginalization and vulnerability to physical and sexual exploitation.

To begin, however, we need to better understand the terminology used in discussing SGBV. Scholars (Schwendinger, J.R. & Schwendinger, H., 1983; Card, 1996; Nordstrom, 1996; Skjelsbaek, 2001) caution a discussion that qualitatively distinguishes between 'war' rape and 'genocidal' rape to 'everyday' rape, because the very nature of the brutality associated with rape in war may portray rape in times of peace as less significant. The distinguishing feature between the two is the socio-political motivations 5 that underpin rape within the context of armed conflict. Rape within war is executed with the intent to communicate the dominance of one group over another.

Rape in war serves as an instrument for terrorizing a population, dominating an ethnic group, defiling an enemy, seeking vengeance, and suppressing a community. Documented reports and personal narratives tell of women who have been raped, mutilated, tortured and murdered in the presence of their family and community members. Whereas interpersonal rape, whether by a stranger or those known to the survivor is generally motivated by the perpetrator's selfish, sadistic aims, in this way the act is personal. It is this socio-politically charged element of rape in war that distinguishes it from interpersonal rape in the civilian context.

It is important to note that the intent of this research is not to place a hierarchical classification on women's experience of trauma; rather, it is an effort to position rape in the appropriate context in order to better understand the underlying causes (Milillo, 2006). Although the focus of this research is on SGBV and its implications on women's health, this author recognizes that sexual violence is only one way women experience war and conflict in their lives. In times of war women are not always the victims; they also engage and benefit from the conflict. The most notable example of this is the prosecution of Pauline Nyiramasuhuko1, the first woman to be tried for rape as a crime against humanity and genocide in an international court (Landesman, 2002). A failure to acknowledge that women also actively support one side over another, participate as combatants, protect and feed fighters, and provide medical assistance homogenizes and reduces women's experiences in conflict to that of a victim; thereby hindering an authentic telling of the range of women's experiences as victims, fighters, beneficiaries and survivors.

Pauline Nyiramasuhuko, is the first woman to be prosecuted in the United Nations International Criminal Tribunal for Rwanda. She was charged with orchestrating the mass rape of Tutsi women who had taken refuge in a stadium under the false pretence that Red Cross would be providing humanitarian services. She is said to have instructed the Interhamwe militia to 'rape the women before you kill them.' 6

For the purpose of simplification, this author uses the terms victim and survivor interchangeably. The choice to focus on women stems from the author's strong belief that additional consideration on women's experiences in conflict needs to be better understood in relation to the gendered norms and practices within society which perpetuate violence against women. Studies examining the impact of war and violence on men are necessary to better understand the role of masculinity in the gendered power relations and violent interactions that surface in war beyond the sex differentiation of male and female. However, a study on the impact of sexual violence in war on men is beyond the scope of this thesis.

Purpose of the Study

The genesis of this study lies in an article that I read in 2006 by authors Mills et al. that discusses the allegations made by the government of the Democratic of Republic of Congo (DRC) against the governments of Uganda, Rwanda and Burundi. In this report, the government of the DRC alleges that military soldiers known to be HIV positive from these three neighbouring countries were intentionally engaging in acts of rape with the intent to transmit HIV. With this in mind, the purpose of this study was two-fold, to investigate the perceptions of key stakeholders on the alleged practice of intentional HIV transmission through rape, and to examine the relationship between sexual violence and HIV transmission in the context of conflict and post-conflict settings.

The existing literature on SGBV in times of conflict has in large part been produced by researchers working in non-academic institutions, such as the United Nations, non­ governmental agencies and community-based organizations.

2 The terms victim and survivor refers to individuals or groups who have suffered sexual and gender-based violence. The word victim often denotes a sense of powerlessness and stigmatisation, whereas referring to them as survivors recognises their strength and resilience. However, the term victim is used in this thesis to conform to the legal terminology used in discussions of the judicial system. Also, there are instances when a victim of sexual and gender-based violence remains a victim due to lack of external support, and in such cases, the term victim is used to emphasis the continued victimization survivors experience after the abuse (UNHRC, 2003). 7

The anecdotal stories collected by humanitarian and development agencies have provided documentation on the scope and pervasiveness of violence against women, and has been successful in shinning a spotlight on the violations women and young girls experience in war. However, these reports provide little in terms of deepening our theoretical understanding of the hierarchical power dynamics within gender relations that foster the targeting of women in war or what barriers hinder their access to justice. The purpose of this study is to build on our theoretical understanding of the SGBV that occurred in the districts of Kitgum and Pader, northern Uganda, during the conflict, and how/why it continues as this region of the country transitions into peace.

This thesis describes a qualitative inquiry into the experiences of Acholi Women living through and beyond the conflict in northern Uganda. Although an extensive amount of literature has been written on conflict, HIV/AIDS and sexual violence in conflict separately, little research has been produced that examines the complex and dynamic relationship between all three issues. A literature review of studies that examine the intersection between these variables showed no more than 15 results. Thus, the primary objective of the research is to examine the meaning and impact of SGBV, and its associated health risks as understood and articulated among the key stakeholders that advocate, represent and legislate on behalf of the women in these districts.

Contribution of Knowledge

The thesis will build upon theories from feminist literature with particular attention to the construction of militaristic masculinities. Within feminist literature, the underlying theoretical explanation of war rape is patriarchy. Patriarchal cultures, it is asserted, foster a socio-cultural environment in which women are subordinate. In turn the subordination and devaluing of women provides a space in which VAW is committed, condoned and granted impunity. Sexual violence is ascribed meaning because it is the manifestation of the patriarchal power relationships between men and women (Skjelsbaek, 2001). Simply put, women are raped because they are women. Further, a discussion on patriarchy sheds light on how SGBV against women is exacerbated during the emergence of a conflict. An essentialist discourse, it offers a wealth of insight into why women in general are victims 8 in the war zone. The limitation of this explanation is that it universalizes the motives of rape and negates how religion, ethnicity and political affiliations, to name a few, interact with gender relations between men and women. A second failing of the explanation is that it does not provide insight into why some women are more disproportionately affected than others, as was the case in the selective targeting of women in the former Yugoslavia and Rwanda

Filling this gap, the structuralist epistemology offers a more comprehensive understanding of the nexus between conflict and sexual violence since it recognizes that war rape can be a politically-oriented violation committed against women in relation to their other identities, and it is the interaction of these identities that can place women in more vulnerable positions than others.

Women's vulnerability to sexual violence and exploitation is heightened with the emergence of a militaristic culture during war. It is with this panoramic perspective that feminist discourse on SGBV enables a better conceptual understanding of the instrumental and culturally significant use of SGBV in the conflict zone. Feminist discourse illustrates how sexual violence against women is employed to physically terrorize the body of the woman and symbolically terrorize her family, community and larger culture (Seifert, 1996). It is in this way that SGBV functions as a tactical weapon of intimidation and humiliation of the enemy. Feminist scholars also provide insight into acts of war rape that does not fall into the aforementioned categories, but rather the raping of a woman serves as a reward to the victors and demonstrates his masculinity among his peers and over his enemy.

This thesis makes four significant contributions to the study of SGBV in conflict and post-conflict affected areas. First, it explores the association between sexual violence and the spread of HIV/AIDS. Second, it provides insight into how women continue to be subjected to SGBV after the conflict has ended. Third, the research sheds light on how a community responds to sexual violence in the post-conflict setting, as well as how families negotiate justice for the victim in the absence of an effective criminal justice system within the IDP camp. Lastly, it postulates that the culture of militaristic 9 masculinity and the ever present threat of losing one's masculinity undercut SGBV in the post-conflict environment.

This examination will be complemented by a case study of northern Uganda. The twenty-one year conflict is of particular interest because unlike neighbouring conflicts, mass rape has not been committed along ethnic, religious or political lines, nor does it agree with the socio-political motives of war rape most commonly discussed in the literature. In fact, the vast majority of the atrocities the LRA (predominantly made up of members of the Acholi ethnic group) have committed have been inflicted upon the Acholi civilian population.

With respect to the methodological design, a qualitative approach was adopted in researching this topic. In-depth interviews were conducted with a range of primary stakeholders, representing the state and civil society, including local governmental authorities, university faculty, health personnel, and representatives of local and international non-governmental organizations (NGOs) working in the area of women's rights. The technique for sampling in this research was purposive. Two to three participants from each sector were invited to participate, and a total of 14 interviews were conducted. In addition, two focus group discussions were conducted with residents from the IDP camps in the Kitgum and Pader districts of northern Uganda. The thematic analysis approach, involving coding and counting of trends and themes, was used to derive patterns in the participants' responses.

Research Questions

The primary objectives of my research are to provide a more in-depth understanding of the motivations of SGBV; the implications of sexual violence on the transmission of STIs, including HIV/AIDS; and, how medical and judicial services address SGBV. The thesis addresses the following questions:

• How does the community understand and articulate the relationship between sexual violence and HIV? 10

• What is the perception among the key stakeholders on the alleged practice of intentional HIV infection through rape by military and LRA fighters?

o Have they encountered similar reports?

• What measures and systems are in place to address the medical and judicial needs of survivors of SGBV?

o Have these measures been effective?

o How can these measures be improved upon?

• What new insights does this study generate on our understanding of SGBV in the conflict and post-conflict setting?

• Are the findings in line with the current feminist analysis on human security during conflict?

Definition of Terms

A variety of concepts will be introduced and discussed throughout this thesis. In order to develop a shared understanding between the researcher and the reader, the next section will discuss the five terms that play a central role in this discussion.

Armed conflict: Any difference between two states or parties that leads to the intervention of members of the armed forces. A formal declaration of war, warning, ultimatum or recognition of a conflict is not necessary. (UNHCR, 2003)

Post-conflict: The restoration of peaceful relations between two states or parties who were previously in conflict with one another.

Gender: is not about biological sex differences but is a socially constructed definition of women and men and the relations between the sexes.

o Is determined by the combination of shared expectations and norms concerning appropriate behaviours, characteristics, attitudes and roles for women and men.

o Is learned, culturally specific, and varies from one culture to another and over time. It is influenced by different variables, such as religion, sexual orientation, location, race, ethnicity, socio-cultural norms, economics and political contexts. 11 Sexual and gender-based violence: is sometimes referred to by other names including gender-based violence (GBV), gender sexual violence (GSV) and gender-related violence. SGBV is an umbrella term for any harm perpetrated on a person against her/his will that has a negative impact on the physical or psychological health, development, and identity of the person.

o It is the result of gendered power inequities between males and females, among males and among females

o Violence may be physical, sexual, psychological, economic or socio-cultural

o The term is used throughout the thesis because it reflects the current UNHCR terminology

Violence against women: Any act of sexual gender-based violence that results in, or is likely to result in physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life (UN, 1993).

Summary

The purpose of this chapter has been to introduce the reader to the basic questions that are addressed in this thesis, explain how the research was carried out, establish the potential significance of a feminist approach to those questions, and provide an introduction to the key concepts. The next chapter will review and analyze the existing literature and theories on SGBV during war. The discourse reveals the symbolic and tactical function of SGBV. The chapter will conclude with a discussion on how and why militarized masculinities shape violence in the war zone. In chapter 3, I begin with a historical review of the relationship between STIs and conflict. I, then, examine the relationship between sexual violence and the transmission of HIV in settings of conflict. Chapter 4 is a case study of Uganda. This chapter provides the reader with a brief historical overview of the violent conflicts that have followed Uganda since independence; the genesis and impact of the conflict in northern Uganda, and the emergence of HIV/AIDS. Chapter 5 describes the measures and methods used to conduct this study. In Chapter 6,1 discuss the results of the study. Finally, Chapter 7 presents the 12 key conclusions drawn from my analysis. I conclude with an exploration of alternative approaches and recommendations that may better address and respond to the SGBV women experience during and beyond a conflict. 13

CHAPTER TWO: THEORY One set of fundamental functions of rape, civilian or martial, is to display, communicate, and produce or maintain dominance, which is both enjoyed for its own sake and used for such ulterior ends as exploitation, expulsion, dispersion, and murder. (Card, 1996, p.7)

Introduction

The main objective of this chapter is to present a review of the literature and theoretical background that serves as a framework for understanding issues related to SGBV in the conflict and post-conflict affected areas of northern Uganda. Sexual violence in the war zone is comprised of a complex set of interactions between gender, patriarchy, ethnic, religious, and socio-cultural norms. Each brings a wealth of understanding into the motivations of war rape that can easily be lost if not sufficiently examined. A comprehensive and multi-faceted framework that fuses all of these realities is best reflected in a feminist analysis of women's lived experiences. In this chapter, I discuss concepts related to conflict, SGBV, patriarchy and militaristic masculinity from a gender perspective. This review is not intended to be exhaustive, but rather to provide the reader with an understanding of the key arguments and critiques in feminist literature that explains the high prevalence of rape during war.

Feminists Perspective on Violence Against Women

The dominant theorizing of mass rape rests within a feminist analysis of human security, which historically has examined and exposed the gendered nature of war. Radical and post-structuralist feminist scholars, such as Brownmiller, 1975; Ellis & Beattie, 1983; Hall, 1983; Ball, 1986; Enloe, 1987, 1988, Copelon, 1994; Bunch, 1995; Seifert, 1996; Allen, 1996; Card, 1996, were the first to systematically investigate violence against women, engaging in extensive inquiry into the patterns of male VAW in the public and private spheres. As a result, for the first time, sexual violence and its impact on the lives of women was defined from a survivor's perspective. 14

Gender Relations & Patriarchy

Feminists such as Brownmiller, 1975; Ball, 1986; Enloe, 1987, 1989, 1993, 2000; Seifert, 1993, 1996; Copelon, 1994, 1995; Stiglmayer, 1994; Card, 1996; Nordstrom, 1997; Halim, 1998; Donat & D'Emilio, 1998; Turshen, 1999, 2001; Barstow, 2000; Garcia, 2000; Kelly, 2000; Skjelsbaek, 2001; Gotschall, 2002; Russell-Brown, 2003; Cockburn, 2004; Dahrendorf & Shifman, 2004; Farwell, 2004; Pankhurst, 2004; Oosterveld, 2005; and Milillo, 2006 urge that sexual violence in times of conflict needs to be understood in the wider socio-cultural dynamics among women and men, beyond the time limited and location specific context of war. The increase of SGBV within the context of armed conflict is an extension of the pre-conflict gender inequality, and an intensification of pre-existing patriarchal attitudes and practices.

In the 'power hypothesis', Brownmiller (1975) articulates that wartime rape is the result of the systematic male desire to exhibit dominance over women. Men, she posits, use their genitalia as a weapon to control and inflict fear on women. Through this act of aggression, "the collective spirit of women and of the nation is broken..[she becomes] a symbol of her nations' defeat, a pariah" (p.181). The act of rape and the fear it invokes is a means of enforcing and maintaining the hierarchical gender roles within society to which men benefit, more so than women.

Women and girls are subordinated, devalued and discriminated against, to varying degrees, in all societies. As a group, they are more marginalized, oppressed and exploited than men. The power imbalance between women and men is framed by practices that limit, restrict and exclude women's access to social, economic and political power.

Cockburn (2004) writes that:

The power within gender shapes the dynamics within all human interactions. It has expression in physique: how women's and men's bodies are nourished, trained, and deployed, how vulnerable they are to attack, what mobility they have. It has expression in economics: how money, property and other resources are distributed between the sexes. It structures the social sphere: who has initiative in the community and authority in the family, who is dependent (p. 28-29). 15 This attitudinal norm has far reaching impact on the treatment of women in any given society, embroiled or not in conflict. Within the ideological framework of patriarchy; women are defined by their reproductive capacities. As a result, women's value is tied to their family; thus, their identity is limited to the role of daughter, wife and mother. Within this one-dimensional space, a woman's importance becomes intimately tied to her sexual purity and reproductive abilities. Therefore, any perceived violation to their sexual purity, such as rape results in great dishonour to the woman, her family, community and culture (Copelon, 1994; Stiglmayer, 1994; Skjelsbaek, 2001; Farwell, 2004; Oosterveld, 2005). It is here that one can see how the socio-cultural value placed on women's reproductive abilities and sexual purity makes them especially vulnerable to sexually-oriented violations. Rape, then, is a tactic simultaneously used to terrorize a woman, demoralize a community and emasculate men within the community. Through forced pregnancies, physical injury, and psychological trauma, rape is designed to violate women and effectively destroy familial bonds, and by extension the cohesion of the community.

Patriarchy provides a good but still partial explanation of war rape. The limitation of patriarchy is it focuses solely on men's affirmation of power and neglects seeing how and why gender shapes violence. This prevents a deeper understanding of the ways in which gender is used as a weapon through the subordination of the feminine. One of the critiques with the patriarchal explanation is it lends itself to cultural determinism, by arguing that the culture creates an environment in which men possess a social propensity to be violent and use violence against women because women are culturally constructed as territories and/or bodies to be controlled. Ultimately, this explanation provides an ideological justification for SGBV and is hauntingly reminiscent of the belief of the inevitability of men committing acts of sexual violence (read: 'boys will be boys') found in biological determinism. Nonetheless, the cultural dimensions of war rape cannot be discounted. The 'power hypothesis' corresponds with the examination of cultural traditions and societal expectations that construct men as dominant and powerful male warriors and females as fertile grounds. 16

Cultural Dimension

In this section, I examine three core ways in which SGBV is rationalized, justified, understood in gendered terms. These rationalizations uncover the gendered nature of the discourse and draws attention to masculinities and femininities. The first rationalization is that women should not have full control over or decision-making power in reproduction; second, women are equated with a territory to be taken or controlled; and third, masculinity is challenged when men are unable to 'protect' their 'women' and must be re-gained through violence.

1. Women as reproductive producers of a nation

As those holding the potential for biological reproduction, women are metaphorically constructed as the life force of the culture, the locus of the nation. This construction of procreation, within the woman's body and the man's relation to it, structures the gender social dynamics within a society. Thus, sexual violence against women serves as a form of suppression and control of women's life giving-capacity. In societies where ethnicity is inherited through the paternal line, there have been cases of women being held captive, raped and forced to bear children in order to ethnically cleanse and destroy one group and further the proliferation of another. This is best highlighted in the forced impregnation camps in Bosnia-Herzegovina (Stigmyaler, 1994). This practice has also occurred during the conflicts in Bangladesh, Liberia and Uganda (UNIFEM, 2002).

Feminist scholarship on women's experience during conflict posit that this positioning of women is reflective of the larger underlying issue of women's low socio­ economic status, and speaks to the primary perception of women as reproductive units and carriers of culture or ethnicity, rather than independent agents in society (Allen, 1996; Copelon, 1994; Turshen, 2000, 2001). In many societies women have limited decision-making power over their reproductive capacity as evidenced by the policies and practices related to the availability of contraception, the accessibility of abortion and the customary laws on the custody of children. In addition, there are serious negative social 17 consequences for women who cannot bear children (Kemmann et al., 1998; Papreen et al., 2000; Matsubaayashi et al., 2001; Dyer et al., 2002).

2. Women as symbols of a territory

As the locus of the culture, women have become symbolically linked to land, territory and cultural traditions. According to Diken and Laustsen, (2005) war rape is carried out with the indirect 'aim of holding or taking a territory' (p. 117). Rape is therefore a manifestation of power over women, as well as power over territory,

[A solider] rapes because he wants to demonstrate his power. He rapes because he is the victor. He rapes because the woman is the enemy's woman, and he wants to humiliate and annihilate the enemy. He rapes because the women is, herself, the enemy who he wishes to humiliate and annihilate. He rapes because the acquisition of the female body means a piece of territory conquered (Brownmiller, 1975, p. 84).

The symbolic association of women with territory further reinforces their limited control over reproduction. Their bodies are controlled by men's decision making power and their bodies are treated as territory owned by men. This mindset of 'women as property' is reinforced by practices such as bride wealth, which has fostered the view that marriage is based on property and the wife is part of the property. According to Davies (1999), in Uganda there is a link between payment of bride wealth and the status of women in the home; the larger the bride wealth payment the lower the wife's decision making power including the ability to exercise family planning and child spacing (p. 13).

Salzman (1998) describes a "model of masculine-feminine relations where men possess rather than relate, with women" (p. 371). This attitudinal perspective on women derives from the protectionist values that are inherent in the patriarchal relations that construct women as men's property that need to be protected and guarded (Farewell, 2004). Specifically, they need to be protected and guarded only in so far as they are an investment (after paying bride wealth) and necessary for the survival and development of the nation's future: its children. 18 3. Masculinity is challenged when men are unable to 'protect' their 'women'

The perpetuation of sexual violence against women of one group also serves to convey messages of masculinity to the opposing group that they are weaker and inferior because they failed in their ability to protect 'their' women, and by extension 'their' nation. It is in this way that sexual violence against women is fused with the cultural conceptualization of nation. Women, in this case, become weapons of the military opponent, pawns if you will, to be used as each group fights for dominance, subjugation and control of the other.

A second important set of feminist literature that has added to our understanding of societal and cultural norms that leads to the occurrence of rape in war is the feminist writing on militaristic masculinity.

Militaristic Masculinity

In the vast majority of cultures, a distinction is made between 'masculine' and 'feminine' identities; each is associated with a set script of gender appropriate behaviours. Most commonly, the male is characterized as strong, dominant and aggressive and the female is represented as weak, vulnerable, and passive. In circumstances of war, this binary opposite is accentuated; men who engage in fighting are seen as the strong protector (masculine); whereas, it is presumed that women will remain at home and be in need of protection (feminine) Enloe (1987, 1988, 1993, 2000).

The very nature of war requires combatants to engage in human rights violations that would otherwise not be permissible in times of peace. Armed conflict fosters behaviours of a repugnant nature; the environment itself promotes violence as a means of displaying power and establishing control. Soldiers are trained and rewarded when they hinder, incapacitate or kill the enemy. The fact that violence is committed against the civilian population (by both fighting factions) with impunity normalizes the occurrence of day-to­ day violence, which encourages the adoption of violence as a pervasive and legitimate system of control and suppression. 19 Military policy and propaganda creates a very polarized and violent gender ideology (Hague, 1997). Within military language, bravery is synonymous with the suppression of feelings of fear, gentleness and sympathy. Gill (2000) cites that verbal degradation within the military is common. Superiors, she observes, refer to recruits with feminine gendered characterizations and slurs such as 'whore', 'bitch', and homophobic comments like 'faggot' and 'little ladies'. This, she argues, is illustrative of the "symbolic debasement of women and homosexuals" that colours military institutions. In an examination of Western military discourse, procedures and practices, French (1992) found that many of the military tunes sung by soldiers used lyrics 'explicitly' linked to the mutilation of women and male prowess. In one case, the recreational song book used by the 77th Tactical Squadron of the US Air Force contained lyrics about sadistic sexual violence. It is the combination of these factors that foster a psychological acceptance and tolerance of violence among military personnel.

In addition, the militaristic culture is infused with reconstructed polarized gender identities, nationalistic glorifications of manhood, and the 'ideological gravitations to military solutions for social problems' (Cuomo, 1996, p. 32). Emotive qualities that are perceived to divert a soldier's objective of destroying the enemy are considered, 'unsoldier-like', 'unmasculine', and 'feminine'- labels that denote passivity, subjugation and worthlessness (Enloe, 2000). Overall, the military environment mandates a compliance with a masculine identity that is defined by aggression, violence and power; and enforces a militarized (read: hyper-masculine) identity that is tied to beliefs and practices that demonstrate bravery, fearlessness, competence, and domination (Gill, 2000). This is in large part because the construction of the 'hyper-masculine' fighter is essential in the creation and effectiveness of the 'perfect masculine' soldier who is required to participate in, and be vulnerable to, extreme levels of violence.

This conflated sense of masculinity also becomes a unifying identity among combatants that fosters a sense of a fraternity among men that is not just about a shared 'hyper-masculine' identity but includes a soldier's survival. This sentiment is reflected in an interview Gill (2000) carried out with a soldier, 20

You learn how to survive in the barracks, because there is no help from your family. You only get help from yourself and those who live with you. It's a really beautiful experience, because you are isolated with others who become even more than your brothers because they share everything with you. The guy who is beside you is more important than your own family (p. 112).

In this comment, it is clear that for some soldiers the relationships among one's fellow combatants can replicate a familial relationship. The emotional connection among military units is cultivated during training and heightened in the combat zone. Because one's life is in large part dependent on the members of one's military unit, the formation and maintenance of a cohesive social identity becomes an important feature of a combatant's day-to-day life and survival. In times of war, the expression of a male group identity is reflected in a number of practices and behaviours, including rape (Milillo, 2006).

Rape as a Method of Male Bonding

Gang rape has been used as a method of strengthening interpersonal ties among combatants, as well as, a method to reaffirm their masculinity to themselves and other men through the subordination of the 'other', in this case the 'other' being women. Sanday (1990) posits that gang rape is best understood as a group bonding ritual that is framed by the discriminatory and patriarchal assumptions about women's sexuality that operate in the broader heterosexual culture.

Gang rape in times of peace is not uncommon and has been documented in other groups that promote hyper-masculinity, dominance and power such as all-male college fraternities and sport teams in the United States (Sanday, 1990; Ehrhart & Sandler, 1992; Bart, 1994; McCormick, 1995; Boswell & Spade, 1996; Porter & Laurence, 2001). Both examples of rape in times of peace and conflict reinforce the value of this act for the promotion of male bonding, group solidarity and the objectification of the 'other'.

This explanation has been, arguably, supported by narratives of women who described their sexual abuse as being committed by groups of men, more so than men in 21 solitude. For example, in 1937, during the first month of Japanese occupation in Nanking, China, at least 10 cases of gang rape were reported daily (Seifert, 1996). American soldiers frequently engaged in gang rape during the Vietnam War (Brownmiller, 1975), and gang rape was also a feature of the conflicts in the former Yugoslavia and Rwanda. Currently, reports of gang rape are surfacing from the DRC (Levett, 2008) and female employees working for US defence contractors in Iraq are slowly coming forward with their experiences of sexual violence, including gang rape, at the hands of American soldiers (Houppert, 2008).

The occurrence of gang rape has received limited critical examination by researchers in peacetime (Ulman, 1999, 2007) and even less investigation in times of conflict. The very nature of gang rape requires a degree of planning and premeditation, demonstrating that it is more than just a sexual act; it is a phallocentric ritual._Further attention on this complex crime is required to determine the motivations and characteristics of the offenders, how it is negotiated among them and carried out. One possible speculation on the cause of gang rape is it provides men a space to perform their heterosexual hyper-masculinity for other men; while simultaneously displaying their superiority over the victim and the group to which they belong. Another speculative feature of gang rape is it permits the participants to demonstrate their loyalty to the male- group and a willingness to take part in any group activity irrespective of the criminality, consequences or dehumanizing quality. Gang rape, then also becomes the ultimate form of group initiation and cohesion and less about the sexual act. One of the falsities surrounding sexual violence in war has been the generalized representation of sexual violence being conducted by males on females. This characterization has encouraged the view that sexual violence is grounded in the act of sex itself. Consequently, less attention has been paid to what the act tells us about the perceptions and expression of gender identities. The emergence of reports on the occurrence of male-to-male sexual violence requires us to assess the relationship between sexual violence and gender norms and expectations. 22

Male-to-Male Sexual Violence

There are distinct and consistent differences in how men and women experience violence in conflict settings. This is in part due to the physical differences between the sexes, but it is primarily the result of the cultural meanings ascribed to the male and female body. During a conflict, both men and women are subject to acts of physical violence, including abductions, killings, torture, displacement and other forms of violence; however, the ways in which the violence towards them is expressed and experienced can be quite different, but also the same.

There is a long held recognition that women often experience sexual violence during a conflict; in contrast, it is believed that the violence men experience is limited to direct physical attack. By casting the experience of violence in war in this way, the discourse on conflict studies has cast women solely as victims, never active agents in the conflict or heroines; while men are represented solely as heroes, warriors, and defenders, never as victims themselves. Researcher Zarkov (2001) challenges this long held assumption. Sexual violence against men, he tells us, has been a hidden feature of war for hundreds of years . During his research on the conflict in the former Yugoslavia, the Bassiouni Report revealed the systematic sexual violence and humiliation endured by men and adolescent boys in detention facilities. The "sexual abuse ranged from beating men across the genitals, rape and assault by foreign objects, forcing prisoners to sexually assault one another, castration and the severing of testicles" (p. 71). In this act of male- to-male sexual violence the symbolic meaning remains the same: the emasculation, control and degradation of the 'other' or the opponent.

The penis represents the ultimate symbol of masculinity and male power. Through castration, a man is symbolically and anatomically divested of that power. Likewise, the act of sexually assaulting another male is perceived as asserting one's male dominance, power, and authority over another male. Unlike the expression of male dominance over a

Anecdotal evidence from Save the Children (2002) also indicates that boys are targeted for sexual violence more so than previously recognized; however, feelings of shame, stigma and gendered sexual expectations discourage males from coming forward. 23 female, male dominance over another male demonstrates the perpetrator's (read: penetrator's) heightened strength, and sexual dominance. In short, he becomes a 'super male'; whereas, the male survivor simultaneously loses his masculinity, because he was a victim, and his heterosexuality, because he was penetrated. Interestingly, this 'super male' power is intimately linked with the identity of the 'penetrator'. In acts of male-on- male rape the perpetrator retains his power (read: heterosexual identity) and the victim undergoes a homosexualization (read: feminization). In so doing, the man who is raped is equated with a woman, and likewise is treated as a territory to be controlled and conquered.

Zarkov (2001) noted that in cases where one in-mate was forced to engage in a sexual act with another, the act of violence was framed not as sexual violence but as sex between prisoners; thereby, 'feminizing' both men by casting them as engaging in a homosexual act. Zarkov (2001) highlights that messages of sexuality were reinforced by the media's representation and discourse around sexual violence against men. Male survivors were, generally, framed as agents in their own victimization.

The analysis of male-to-male sexual violence in times of conflict is essential to this study because it enables us to advance our understanding of the gendering of men and women beyond the sex differentiation of male-female. The sexual violence of men tells us that, the ultimate aim of rape is to deride the masculinity of the opposing group; whether it is by threatening his role as protector or feminizing him through a sexual assault. The fact that SGBV is predominantly the experience of women is demonstrative of the way in which masculinities are asserted and the hierarchical gender structures are entrenched through acts of violence.

The Political Economy of Rape

Moser (2001) expands the definition of SGBV and allows for an understanding of rape as an economic and political form of violence. In her article, "The political economy of rape: an analysis of systematic rape and sexual abuse of women during armed conflict in Africa", Turshen (2001) argues that the "systematic rape and sexual abuse are strategies men use to wrest personal assets from women" (p. 55). Turshen identifies 24 women's assets as their reproductive and productive labour power and "in their possessions and access to valuable assets such as land and livestock" (p. 56). Productive labour includes activities such as cooking and farming. This type of labour, she emphasizes, is particularly crucial in guerrilla warfare, as these groups are mostly dependent on the agricultural production of the land. In her examination of the conflicts in Rwanda, Mozambique and northern Uganda, she found that armies and combatants employed rape as a means to strip women of their reproductive and productive power.

Recognizing the value of women's productive labour, Turshen (2001) found that in an effort to deny the enemy the benefit of women's productive contributions, attacks against women included the amputation of women's arms, legs and feet. With respect to reproductive labour, she highlights two aspects for consideration: (1) rape to impregnate, making women bear children for the 'enemy' community; and, (2) rape to prevent women from becoming mothers in their own community or by so injuring them physically that they are unable to bear children. The damage of a women's reproductive capacity prevents her from bearing son's which jeopardizes a woman's land rights under customary law.

In her analysis, she also explores the relationship between the rape of women and the theft of their property. Women who had legal access to land were targeted and in some cases weddings were performed to legitimize the seizure of their land. Due to the socio-cultural beliefs and taboos on sexual violence some women were shunned and alienated from their communities (particularly if a child was born of a rape) which prevented them returning to their land. Thus through rape the assailant is able to sever the woman's connections to her land and farms. Rape, Turshen (2001) argues, is used to displace people, and shift land access and food production primarily to men in countries where agriculture is the primary economic endeavour. 25

Summary

Post-modern and transnational feminist research on sexual violence in war has helped to generate a substantial body of literature to draw on. Within the literature there are three common themes that emerge to inform us on the influence of masculinities/gender and war rape. Rape communicates a myriad of symbolic statements including the masculine dominance of one's group over another and the ability to control and suppress women's (read: nation's) capacity to reproduce. In addition, rape is utilized as a means to strengthen interpersonal ties among combatants, as well as affirm masculinity. 26

CHAPTER THREE: SEXUAL VIOLENCE AND THE SPREAD OF HIV/AIDS IN CONFLICT SITUATIONS

Introduction

To understand the synergistic relationship between conflict, sexual violence and HIV/AIDS one must, first, examine the relationship between conflict and STIs; conflict and sexual violence; and sexual violence and STIs. This chapter will begin with a review of the literature that has found a correlation between war and increased prevalence of STIs among military personnel and conflict-affected civilian populations. The chapter then presents the research findings concerning the relationship between sexual violence and STIs. The research findings are taken from various academic and non-academic sources and are based on studies that were conducted in different conflicts in the world.

The Relationship Between Conflict and Sexually Transmitted Infections

Historically, conflict has played an instrumental role in the transmission of STIs. For example, during WWI there was an elevated prevalence of syphilis and gonorrhoea among the soldiers and nearby civilian population; from 1914-1917, there were over a million syphilis and gonorrhoea cases recorded among civilians in France; in 1917, 23,000 British soldiers were hospitalized with STIs (Hankins et al., 2002); and in WWII an estimated 750, 000 American military personnel contracted syphilis. Several decades later, a study conducted in a Rwandan refugee camp in Tanzania showed that over half of the women receiving prenatal care were infected with an STI, three percent testing positive for gonorrhoea and four percent with syphilis. The report also revealed that more generally, women and men within this community frequently reported experiencing a STI (Rehn & Sirleaf, 2002).

The rising rate of STIs needs to be considered in relation to the increasing number of conflicts that have multiplied in the last decade. In the last 20 years, no region in the 27 world has been more affected by violent conflict than sub-Saharan Africa (SSA); armed conflicts have doubled from 11 in 1989 to 22 in 2000 (Save the Children, 2002). A 'conflict belt' has been said to stretch across Angola to the Horn of Africa (Mock et al., 2004). Nearly all of the countries in this region have been directly (in country conflict), or indirectly (bordered a county in conflict), affected by the ravages of war. Conflict produces conditions of political and economic insecurity, ruptures the social fabric of a society, and all but halts the functioning of essential infrastructures such as the local economy and healthcare system; conditions, that have long been identified as risk factors for HIV/AIDS.

An additional factor that needs to be considered in an analysis of sexual violence in conflict, especially in SSA is the HIV/AIDS pandemic. In SSA, AIDS has become the single leading cause of death, killing 1.6 million people in 2007, with an estimated 1.7 million newly infected people (UNAIDS, 2007). The spread of the disease has been profound, indiscriminately affecting women, men and children from all segments of society and regional boundaries. In SSA the scope and impact of the disease is marked; HIV/AIDS has struck the most productive members of society, between the ages of 15 and 45 years old, creating labour shortages in key areas that are fundamental to development such as education, healthcare and agriculture. The burden of the disease has strained already fragile healthcare systems, reduced economic output, and eroded familial networks and social capital. In the coming years, HIV/AIDS is projected to kill ten times more people than conflict (Save the Children, 2002). Researchers have concluded that the destabilizing effect of HIV/AIDS on human capital, economic productivity, and social political institutions will set the stage for increased conflict on the continent (Smallman- Raymor, 1991; Mock et al., 2004).

The relationship between conflict and HIV/AIDS is complex; literature on conflict- affected countries in SSA has pointed to a bi-directional causal influence on one another. For instance, in conflict increased HIV risk is associated with sexual bartering, sexual violence, increased rates of partner change, low awareness about HIV, the erosion of health and education services and the breakdown of social support networks (Hankins et al., 2002; Mock et al., 2004). This scenario has been described by Save the Children 28

(2002) as a 'double emergency' because food and economic insecurity lead to increased HIV transmission through the increased engagement of survival sex (commercial sex trade and material needs based sexual relationships) and HIV transmission further leads to food and economic insecurity as the health of the population declines causing the collapse of key development sectors.

In 2000 the UN Security Council, recognizing the increased risk of exposure to HIV infection in settings of conflict, humanitarian emergencies and natural disasters, adopted Resolution 1308 which acknowledges that "HIV/AIDS is exacerbated by conditions of violence and instability; and...the HIV/AIDS pandemic, if unchecked, may pose a risk to stability and security" (UN Security Council Resolution 1308, 2000). Echoing the same concern, UNAIDS noted in a 2003 report that:

Conflict and displacement is associated with increased risk of HIV transmission among affected populations because of behavioural change due to interruption of social networks and economic vulnerability (particularly among women and adolescents), as well as sexual violence and the disruption of preventive and curative health services. [Further] in circumstances of war and conflict, the vulnerability of women and young girls particularly rises as economic and social structures are weakened and violence, including sexual abuse increases.

There are few and conflicting epidemiological studies on the relationship between conflict and HIV/AIDS (Smallman-Raynor et al., 1991; Cossa, et al., 1994; Maman, et al., 2000; Amowitz, et al., 2002; Hankins et al., 2002; Mock, et al., 2004; Mulanga, et al., 2004; Fabiani, et al., 2006; Jansen, 2006; Aniekwu,et al., 2007; Westerhaus et al., 2007). Anecdotal reports and the intuitive appraisal of the vulnerabilities in the war zone have led many researchers, activists and international institutions alike, to conclude that conflict acts as a vector for HIV/AIDS. Issues of security, the mortality and mobility of a conflict-affected population and the diversion of government resources to military spending make the accurate assessment of HIV surveillance extremely difficult. Complicating matters further, many countries in SSA possess already strained and overwhelmed healthcare infrastructures raising questions on the reliability of pre-conflict HIV prevalence estimates. 29

Evidence of the Relationship

Within the available research, conflict has been linked to the spread of HIV in a number of countries. For example, it is hypothesized that the armed conflict in Uganda (1978-79) seeded the dissemination of HIV infection throughout the country (Fabiani et al., 2001; Changalucha et al, 2002; Mock et al., 2004; Aniekwu & Atsenuwa, 2007; Westerhaus et al., 2007). The spread of HIV infection in the 1980s and the geographical distribution of AIDS during the 1990s showed to be significantly and positively correlated with the ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA) after the overthrow of Idi Amin (Smallman-Raynor & Cliff, 1991).

Other examples can be found in the 1987 conflict in Angola where HIV is believed to have spread from the northern areas of Angola to the central and south-eastern regions through war-induced population displacement (Santos-Ferreira et al., 1990, p. 786). In East Timor a spiked increase in the HIV prevalence has been associated with the high incidences of sexual violence during the war, and the new patterns of commercial sex relationships between East Timorese women and foreigners, peacekeepers, businesspeople, and aid workers (Rehn & Sirleaf, 2002, p.52). A high HIV prevalence rate among soldiers was also linked to the risky sexual behaviour and prostitution centres surrounding military posts in the 12 year conflict in El Salvador (Wollants, 1995, p. 1292). HIV prevalence rates in rural areas of Rwanda increased from lpercent before the start of the 1994 conflict to 1 lpercent in 1997. A survey, conducted by the Rwandan Association for Genocide Widows (AVEGA) revealed that close to 70 percent of the women raped contracted HIV (WHO, 2004). In Sierra Leone, Save the Children (2002) found that girls were infected with HIV after being raped by rebels terrorising civilians. In 2003, health clinics in Monrovia, Liberia reported that most of the female patients who said they had been raped by former government soldiers or armed opposition fighters tested positive for at least one STI (Amnesty International, 2004). 30

Disagreement on the Relationship

It is important to note that there has been a recent study that has challenged the veracity of the HIV and conflict association. Spiegel et al. (2007) analysed various data on the prevalence of HIV infection in conflict and refugee settings. They concluded that there is insufficient data to support the assertion that conflict and forced displacement increase HIV prevalence. In response to this report, Jewkes (2007), a gender and health research officer at the Medical Research Council in South Africa, challenged that the study went against conventional wisdom. The study, she argues, did not capture "the prevalence of HIV infection in people who spend little time in camps, or those who are internally displaced and do not enter a [refugee] camp" (p.2140). In addition, she highlights that the assessments referenced by Spiegel et al., were "made several years after the conflict and the lower than expected prevalence of HIV infection could have reflected an effect of conflict on disease progression and death" (p. 2140).

The critique offered by Jewkes (2007) reiterates the point made earlier about the extreme methodological challenges of accurately assessing the relationship between conflict and STI transmission. However, for practitioners and researchers in the area of human security this is a relationship that is hard to ignore when we know the social and biological vulnerabilities of women in the war zone. The following section will expand on these vulnerabilities.

The Role of Sexual Violence in Sexually Transmitted Infections

Haunting images, from place to place after place, of adolescent victims of rape, which has become as much a weapon of warfare as bullets and machete. Armed conflicts also increasingly serve as vectors for the HIV/AIDS pandemic, which flows closely on the heels of armed troops and in the corridors of conflict. Former UN Secretary General, Kofi Annan (2006).

In spite of the limited empirical evidence demonstrating a relationship between sexual violence and HIV, there has been a growing recognition of the link (Garcia & Watts, 2001; Rehn & Sirleaf, 2002; Jansen, 2006). It is understood among researchers, 31 activists and humanitarian workers on the ground that conflict fuels HIV/AIDS; furthermore, sexual violence is one of the methods by which the virus is spread. Recent reports from the United Nations have confirmed that the common occurrence of SGBV carried out in the scope of armed conflict considerably increases women's vulnerability to HIV/AIDS (United Nations Economic & Social Council, 2003). Several studies have found that women who experience intimate partner violence, male control in relationships and adult sexual assault by a non-partner are associated with increased risk of HIV infection (Maman et al., 2002; Gielen & O'Campo, 2002; Dunkle et al., 2004). For example, a report by the World Health Organization (WHO) (2003) found that among the proportion of Nigerian women testing HIV positive, 31 percent were raped compared with 11 percent of women who were not.

One of the challenges of obtaining reliable information is that the scope of sexual violence in the war zone is hard to assess, mainly because of the erosion of the criminal and judicial system and the underreporting of rape. Faced with the threat of retaliation, fear of stigmatization, familial and community rejection, and feelings of shame, survivors in war are far less likely to report. Underreporting is not uncommon; a 2001 study from Timor-Leste found that only seven percent of women who had experienced physical or sexual violence during the 1999 crisis ever reported their victimisation to local authority (Hynes et al., 2004). In Rwanda, a survey concluded that only six percent of respondents who had been raped during the genocide ever reported it or sought medical treatment (AVEGA, 1999). In Mozambique the rate of reporting was marginally higher at 8.4 percent (Cossa et al., 1994). In Sierra Leone, only eight percent of women reported war- related sexual assault (Amowitz et al., 2002), and during the Liberian civil war only 15 percent reported either being raped, subject to attempted rape or sexual coercion (Swiss et al., 1998).

What we do know is that there are certain social and biological factors that make women more vulnerable to HIV infection. One of those risks is that women are biologically more susceptible to HIV transmission than men; this issue is explored further in the following section. 32

The Risk of HIV Transmission During Rape

Women are physiologically more vulnerable than men to HIV infection during unprotected heterosexual vaginal sex; the data estimate that women are twice as likely to become infected as men. Factors that contribute to this increased risk include the larger surface area of the vagina and cervix and the high concentration of HIV in the semen of an infected man (UNIFEM, 2005).

Due to the violent nature of rape, it is associated with a higher risk of HIV transmission because of the elevated exposure of non-intact mucosa caused by vaginal and anal wounds through which the virus can enter the blood stream. War rape, generally, encompasses acts of extreme brutality such as insertion of foreign objects such as rifles, genital mutilation, sexual enslavement and gang rape, and with multiple assailants comes increased sources of HIV exposure.

Another key factor in the conflict-HIV nexus is the impact of military and armed combatants; both are considered a high-risk group for both infection and transmission. As discussed earlier, within war there is the frequent disassortive mixing of the military and civilian population, and this relationship has been correlated with increased prevalence of STIs for both populations (Mock et al., 2004). In addition, during wartime, militaries commit higher rates of rape and sexual violence compared to the general population. Examples of military involvement in sexual violence during conflict abounds; for instance, during WWII the U.S. military's rape rate was 260 percent of the U.S. civilian rape rate (Morris, 1996). Consequently, a discussion on the association between conflict and HIV would be remiss without an examination of the impact and role of military and armed combatants. In the following section, I discuss the STI prevalence rate among these groups. 33

HIV/AIDS Prevalence Among Armed Combatants

UNAIDS has stated that, on a whole, military personnel have a higher risk of STIs, including HIV. In times of peace, the STI prevalence rates among military personnel in some countries have been documented to be two to five times greater than the civilian populations, and the difference can be upwards of 50 times higher in times of conflict (UNAIDS, 1998; Radhika, 2003). Findings from comparative sexual health studies conducted in the USA, United Kingdom and France reveal that soldiers from these countries have a much higher risk of HIV infection than those in the civilian population of the same age and sex group (Radhika, 2003).

Similarly, African military personnel have higher HIV prevalence rates than the general civilian population (Rehn & Sirleaf, 2002). Figures from Zimbabwe and Cameroon show that the rate of HIV infection among the military is three to four times higher than the civilian population (UNAIDS, 1998). A study among the Ugandan military in the 1990s revealed that soldiers had a HIV prevalence rate of 27 percent compared to the national adult prevalence of 9.5 percent (Save the Children, 2002). In Angola the HIV prevalence among the military was 40-60 percent to the national rate of 5.5 percent, in the Congo the prevalence was 10-20 percent to 7.2 percent, in Nigeria it was 10-20 percent to 5.8 percent, in Tanzania it was 15-30 percent and 7.8 percent, in Eritrea it was 10 percent and 2.8 percent, and in Cote d'lvoire it was 10-20 to 9.7 percent (Radhika, 2003).

In June 2001, a report from International Crisis Group estimated that HIV prevalence in the South African military to be as high as 40 percent. High HIV prevalence trends were also found among other African militaries including Chad with 10.1 percent; Cameroon at 14.7 percent; and, Gabon at 5.8 percent (US Census Bureau Population Division International Program Centre, 2003). In the Democratic Republic of the Congo, where rape by combatants continues to be widespread it has been reported that 60 percent of the combatants are HIV positive (United States Institute for Peace, 2001). As for non-state combatants the risk of HIV infection is estimated to be even 34 higher, in part because they possess little military discipline, engage in high risk behaviour and have no access to health information or services (Rehn & Sirleaf, 2002).

The reasons for the high HIV prevalence rate among the military include the age group of soldiers, the deployment of military personnel far from their homes and families, a high stress environment, and a disposal income. Conditions that facilitate an environment in which soldiers may engage in causal sex with multiple partners and engage in the commercial sex trade (Radhika, 2003). The extended periods away from home also plays a key role, studies examining populations with similar occupational travel, such as truck drivers, have also been linked to the spread of STIs including HIV. This has been documented in several countries including Thailand (Podhisita, et al., 1996); Brazil (Lacerda et al., 1997), South Africa (Ramjee & Gouws, 2002), Bangladesh (Gibney et al., 2002), and China (Chen et al., 2006).

Summary

The purpose of this chapter has been to establish the relationship between conflict, sexual violence and HIV/AIDS. The chapter began with a discussion on how conflict has played a key role in the transmission of STIs. Following this, the discussion focused on the complex relationship between conflict and HIV/AIDS, highlighting the evidence that has supported and refuted the link. The chapter then discussed the risk posed by sexual violence in the transmission of HIV. The chapter concluded with a discussion on the high HIV prevalence rate among armed combatants.

Overall, data collection during conflict needs to be interpreted with caution because it is fraught with difficulties and limitations, poor survey methods, and restricted access to communities. In addition, generalizations on a whole should be avoided because each conflict is unique and every situation should be examined on a country case per case basis. I have attempted to address these challenges in my own research and in the chapters that follow. The next chapter introduces the case of Uganda. 35

CHAPTER FOUR: CASE STUDY OF UGANDA

Introduction

The main objective of this chapter is to provide an examination of the synergistic conditions that fuel conflict and STIs in northern Uganda. This chapter begins with a brief historical overview of the turbulent political transitions Uganda has experienced since its independence. The discussion is followed by an analysis of the conflict in northern Uganda and the impact it has had on the population in this region. The discussion then centers on the impact of HIV/AIDS. The chapter concludes with a discussion on the occurrence of SGBV during the conflict.

Post-Independence: Political Transitions

The Republic of Uganda is a landlocked country located in Eastern Africa, bordered by Sudan to the north, Kenya to the east, Rwanda on the southwest, Tanzania to the south and the Democratic Republic of Congo to the west. Uganda has an estimated population of more than 28 million.

Since its independence Uganda has experienced a series of violent conflicts. This time has been described as one of the bloodiest and politically turbulent periods of Uganda political history with several changes of government taking place, four of which were military regimes. Beginning with the first republican government of Sir Edward Mutesa, overthrown in 1966 by Milton Obote, each successive government has faced a wide range of dissident groups (Republic of Uganda, 2007). In 1971, Obote was deposed by General Idi Amin who then led the country into 8 years of socio-political repression and economic mismanagement. This period has been characterised as causing a 'great haemorrhage of human lives' (Museveni, 2005). During Amin's rule, Uganda was subjected to a failed economy, food shortages, an eroding transportation system, and a growing illegal trade. In January 1979, a pro-Obote rebel group supported by the Tanzanian army overthrew the Idi Amin regime (Republic of Uganda, 2007). 36 The year following Amin's exile was politically unstable because the country was being managed by the exiled Dr. Obote. In the absence of Dr. Obote, Uganda saw a number of short-term, stand-in presidents: Yusuf Lule - 68 days; Godfrey Binaisa - 8 months, and Paulo Muwanga who set the first elections since 1962 for December 1980. A few months prior to the election, a new party was formed: the Uganda Patriotic Movement (UPM) led by Yoweri Museveni. In the 1980's elections Obote was re­ instated as President and Muwanga served as Vice-President. However, the elections took place in an atmosphere of corruption and intimidation. Opposition parties charged that the people had been cheated by the election. In 1982, Museveni formed the National Resistance Movement (NRM), which waged a guerrilla war against the Obote government. The Obote government responded with brutality and mass killings, most notably the Luwero Triangle massacre where thousands of civilians were murdered (Republic of Uganda, 2007).

The Obote government ruled until July 27 1985, when it was again toppled for the second time in 1985 by its own army (primarily Acholi) headed by Lt. General Tito Okello who captured Kampala and proclaimed a military government. In August 1985, Okello and NRM entered talks of co-operation, but the talks broke down in December of 1985, and Museveni returned to the insurgent camps. On 26 January 1986, the NRM, headed by Museveni, entered Kampala and assumed power. Museveni was sworn in as the seventh President of Uganda and continues to hold the Presidency today (Republic of Uganda, 2007).

Armed Conflict in Northern Uganda

Uganda has had a long-standing conflict in the northern region of the country. The conflict started in 1986 with the fall of General Tito Okello, an Acholi from Kitgum district. After the government was deposed some of his soldiers fled to Sudan, while others agreed to surrender to the National Resistance Army (NRA), under the promise that if they laid down their arms they would be permitted to integrate back into their communities. However, en route to report to the authorities at the District Headquarters in Omianyima, 28 soldiers were ambushed and killed (Republic of Uganda, 2007). 37

Upon hearing this news, those who had fled to Sudan convinced those still in Uganda that the government was conspiring to kill all of them. Consequently, many of the remaining 'Obote' soldiers fled to Sudan, where they re-organized and started infiltrating back to Uganda. In response, the NRM government met the popular rebellion with brutal force. A battalion of the NRA was posted in Acholiland region and deployed in Gulu and Kitgum among other districts. This battalion has been depicted as deploying extreme brutality which fuelled further resentment among the population.

That same year, a young woman, Alice (Auma) Lakwena, started a rebellion against the government, called the Holy Spirit Movement (HSM). In October 1987, the 'Holy Spirit Mobile Forces' (HSMF) were defeated by Museveni's military and Lakwena went into exile in Kenya. Following her defeat, her cousin, Joseph Kony, re-organized the defeated group into the Lord's Resistance Army (LRA) and continued her struggle in northern Uganda until the current ceasefire was signed in August 2006.

Impact of the Conflict

For the past 21 years, the war raged between the rebels of the LRA and the Ugandan People's Defence Forces (UPDF) impacting almost eight percent of the Ugandan population (Isis-WICCE, 2006). The situation has been further complicated by the influx of refugees from neighbouring conflicts in Democratic Republic of Congo, Rwanda, Somalia and Kenya, as well as unrest in Karamoja, a region in eastern Uganda where violent raids by nomadic pastoralists often cross over to both Kenya and northern Uganda.

The majority of the people affected by the conflict in northern Uganda have been forced to flee their homes. Others were forced to move into IDP camps by government soldiers as a strategy to isolate the rebels from the civilian population, as well as to cut­ off the rebels from food supply lines. Due to the forced migration, the districts making up the Acholi Regions (Gulu, Kitgum and Pader) have an estimated 1.7 million people, approximately 80 percent of the population in this region living in IDP camps. With scarce agricultural opportunities the community has been forced to be heavily dependent on humanitarian aid for their survival (Isis-WICCE, 2004, 2006). 38

In mid-2002, the fighting intensified and Uganda once again drew international attention for gross human rights violations. LRA attacks in northern Uganda, during this period have been described as at their most 'brutal and destructive'. The number of Ugandans displaced from their homes more than tripled, increasing from 450,000 in early 2002 to over 1.6 million in 2006 (Isis-WICCE 2002, 2004, 2006).

The conflict has resulted in internal displacement, destruction of homes, the abduction of over 25,000 children, torture, rape, deprivation, and erosion of the social and economic infrastructure of the region. A 2006 journalistic report found that death rates in the camps averaged 1000 deaths per week, resulting from the combination of disease, poor sanitation, lack of adequate healthcare and violence (Otunu, 2006). Additionally, though often given little attention, the conflict itself and the associated erosion of socio- cultural norms has generated a series of micro but potentially dangerous conflicts within the community that include inter-family and inter-clans, generational, and gender tensions.

Peace negotiations between the LRA and Ugandan government began in Juba, South Sudan, in July 2006, and a cessation of hostilities was established on August, 25 2006. The peace talks have recently become strained with the rumour that Joseph Kony ordered the killing of Vincent Otti, Kony's second of command and the chief LRA peace negotiator (New Vision, April 14 2008). As a result, the people of northern Uganda continue to live in fear of the renewed violence between the LRA and the Ugandan Government.

During the course of my research, a promise was made during the LRA consultations that the peace agreement would be signed by the end of March. To date, a peace agreement has yet to be signed. Local papers in Uganda have identified that Kony is stalling this process, initially citing an ailment as preventing him from signing the agreement; and more recently, to his ignorance on the terms of the agreement. Peace talks appear to have stalled in April when Kony failed to appear at the final signing of the peace agreement in Ri-Kwangba (Sudan/DRC border) on April 10, 2008 (New Vision, April 14 2008). Current local newspaper reports state that the UPDF is set to launch a 39 major onslaught against the LRA who are reportedly abducting children in neighbouring countries to serve as fighters, porters and sex slaves. Reports suggest that some LRA fighters are moving towards the Ugandan border and others have already crossed the Nile to retrieve their buried weapons in northern Uganda. Army Chief General Aronda Nyakairima, stated in an interview that he suspects that Kony was "duping the world into believing that he was interested in peace to take advantage of the process to rebuild his forces through abductions in Sudan, Congo, and the Central African Republic" (New Vision, June 15 2008).

At the moment, it remains to be seen if the people of northern Uganda will see sustained peace.

Documentation of HIV/AIDS in Uganda

HIV/AIDS was first documented in Uganda in the early 1980. Since then it is estimated that 1 million Ugandans have died from ADDS related illnesses (International Crisis Group, 2004). Uganda is regarded by UNAIDS and the WHO as one of the 'first counties in sub-Saharan Africa to experience the devastating impact of HIV/AIDS and to take action to control the epidemic, [it] is one of the rare success stories in a region that has been ravaged by the HIV/AIDS epidemic" (WHO, 2004). Praised for its economic development and progressive stance on HIV/AIDS prevention and awareness campaigns, Uganda is often mentioned in reference to stability and progress in the region.

One of the key methods adopted to monitor the HIV epidemic is the sentinel surveillance of pregnant women attending antenatal clinics (ANC) (Fabiani et al. 2006). This method of assessment has its strengths and weaknesses: data obtained from this type of surveillance provides important indicators on the trend and the geographical differences in HIV prevalence at the national level. The two key limitations of ANC surveillance is it does not inform us on how a woman acquired HIV, nor does it reflect an accurate estimate of the HIV prevalence rate among the general female and male population. For instance, HIV-positive women have a reduced fertility compared with HIV-negative women because of biological and socio-behavioural factors, and as a result 40 they are under-represented in ANCs (Fabiani et., 2006; Gray et al., 1998; Changalucha et al., 2002).

In Uganda, there are 20 ANCs that have provided sentinel surveillance systems for more than 10 years; however, because of the insecurity in the North, few ANCs are located in this region of the country. A study that analysed the sentinel surveillance (1993-1999) of an ANC located in the Gulu district, northern Uganda, observed that the trend and prevalence of HIV infection decreased from 25.9 percent in 1993 to 12.1 percent in 1999 (Fabiani et al., 2001; STD/AIDS Control Programme, 2003). Despite the marked decrease in 2002, the ANC in Gulu continued to have the highest prevalence at 11.9 percent of all the sentinel sites in Uganda (Spiegel et al., 2007). Westerhaus et al., (2007) found that the HIV prevalence rate in northern Uganda to be nearly double that of the rest of the country. The higher prevalence rate has been associated with the increased collective violence, lack of adequate health structures, equipment, and trained staff, insecure conditions and subsequent population movements associated with conflict.

Impact of HIV/AIDS on Women

The vast majority of countries in SSA that are embroiled in conflict are among the hardest hit with the HIV/AIDS epidemic and the poorest in the world. Decades of economic crises, cuts in public social welfare funding allocation, healthcare sector reform, structural adjustment programmes and growing debt have severely undermined the capacity of the healthcare systems to adequately handle the treatment and care of its HIV infected population.

What is incontestable is the reality in rural parts of Central Africa that to be HIV infected is tantamount to a death sentence. Few people have access to antiretroviral (ARV) medication; consequently AIDS-related deaths are alarmingly high. Studies have shown that the health risks of poverty are generally greater for women than men. Women are far more likely than men to be poor consequently, and women often receive less medical treatment than men (Yamaskai-Nakagawa et al., 2001, Holmes et al., 1998; Doyal, 1995). 41 To be a woman who is HIV positive and a survivor of sexual violence in an impoverished post-conflict country entails managing one's health within a resource strained healthcare system and coping with the social stigma attached to being a rape survivor. The combination of these factors can further marginalize women and place them at an increase risk for exploitation and other high risk activities. For example drug use, or sex work which may lead to HIV re-infection or other blood-borne infections which may further compromise their health. Additional health complications that have lasting effects, but receive little attention, are post-traumatic stress disorder, depression and other trauma related illnesses which have serious effects on women's overall health and well-being. In the absence of effective intervention, it is projected that the life expectancy for women who are HIV positive will drop from fifty-two years to thirty-seven by 2010 (United Nations Department of Economic and Social Affairs Population Division, 2004).

Sexual and Gender-Based Violence

In the eight short years since the turn of the twenty-first century, sexual violence in the context of war has affected almost every corner of the globe (Human Rights Watch, 2004). Uganda is one of those conflicts. During the conflict, various forms of SGBV occurred including rape, sexual slavery, forced marriages and physical disfigurement through the cutting of facial and other body parts (Parliament of Uganda, 2004; Isis- WICCE, 2006). The main perpetrators identified are LRA rebels, government soldiers, police and prison officers and the local defence forces.

Forcible abductions of young children were a systematic strategy of the LRA to sustain their forces. The younger boys who were abducted helped in the camp until they were old enough for military training; similarly, younger girls were allocated to commanders to assist in domestic duties until they were deemed old enough to sexually serve the commander. Rape and sexual enslavement was sanctioned through the labelling of female abductees as 'wives'.

In a 2004 study conducted in Pabbo IDP camp, the largest camp in Gulu district (a district located in northern Uganda with a population of 63,000 people) it was found that 42 SGBV occurred on a daily basis (Okot et al., 2006). Similarly, an additional study conducted in 2005, with internally displaced youth in Gulu district found that 70 percent of the respondents stated that SGBV occurs on a regular basis and was identified as one of the major threats they face (Liu Institute for Global Issues and Gulu District NGO Forum, 2005). According to a study conducted by Isis-WICCE in 2006, more than a quarter of the female respondents of a sample size: 810, of whom 570 were female reported having been subjected to various forms of sexual torture. Almost 20 percent of the women described violent penetrative sexual abuse (rape: 3.8percent; gang rape: 0.9 percent, and defilement: 15.1 percent). 14.6 percent reported suffering daily sexual abuse such as incest (1.8 percent), sex slavery (8.3 percent), and forced marriages (4.5 percent).

The sexual violence in northern Uganda, particularly in the Kitgum and Pader regions often involved multiple levels of violence and humiliation. Rape by rebel forces were often committed in public before family and community members. In a number of cases, reports indicate that women and young girls were forced to have intercourse with their male family members, including children, siblings and fathers (Isis, 2006). Acts of rape were also about silencing the victim. The atrocities committed in the district of Pader were the most grievous, as one of the rebel strongholds, women were systematically raped, held in captivity as sex slaves and, in hundreds of cases, women had their mouths, ears and noses cut off after being raped. This practice has been described to serve two purposes: 1) it was a physical attempt to silence a woman's voice; and, 2) a symbolic and visual statement of the rebel's power and command over the community.

At first glance, the sexual violence women experienced within the conflict, the generalized dehumanizing and egregious nature of the violence emotively clouds the patterned feature to the sexual violence women experienced. In his analysis of rape camps in the former Yugoslavia, Salzman (1998) cites five patterns of sexual violence documented by the United Nations that exemplify the various contexts in which sexual violence is carried out. In the first pattern, sexual violence occurred in conjunction with looting and community intimidation before the intense fighting broke out. The second pattern took place during the fighting-in the process of attacking a town or village, the 43 combatants would sexually assault women. After an attack, the forces would select women for rape and transport them to detention facilities. The third pattern of sexual violence occurred in the detention facilities and other sites captives were held. A fourth pattern of sexual violence transpired in designated rape camps established in buildings such as hotels, schools, and restaurants. The fifth pattern of sexual violence occurred in "bordello" camps, here, women were held for the specific purpose of providing sexual services for returning soldiers. In the following section, I examine the patterns of sexual assault that took place in northern Uganda.

Patterns of Sexual Assault

In northern Uganda, there are three distinguishable patterns of sexual violence. In the first pattern, sexual violence occurred during the fighting; as the LRA fighters would attack a village or town, they would sexually violate females irrespective of their age etc. Generally, these sexual assaults occurred in front of family members and entailed numerous assailants. The second pattern of sexual violence occurred in the LRA camps; in most cases young girls were assigned to soldiers and commandeers. The more beautiful girls, it has been described, would be given to the commanders of high ranking. The primary function of women and young girls in the camp was to provide their productive labour to the overall functioning of the camp; as well as, sexually serve their assigned male 'husband'. The third pattern of sexual violence noted took place within the IDP camps. In this context, the majority of the perpetrators were military soldiers, paramilitary and other government agents, assaults occurred as women and young girls went to collect water, firewood and en route to school or food distribution pick up centres. The fourth pattern is occurring, presently, within the IDP camps. As this region transition into peace, the women of northern Uganda continue to experience sexual violations; however, the primary perpetrators identified are not LRA rebels or UDPF. Instead they make up a constellation of males in the community, including government agents, paramilitary, camp leaders, school teachers and family members.

As of July 2008, a review of the literature did not find a published study that has examined the issue of SGBV in post-conflict Uganda. However, we know that the 44 violence women experience in conflict has implications for them well after the conflict has ended. Research has shown that women who are known to have been raped are often ostracized from the community and marked as unmarriageable. For others, they are at risk of experiencing continued violence at the domestic level. Salzman (1998) offers, in way of explaining domestic violence , that it is difficult for a man to accept the humiliation of his 'woman' being raped because it means he has failed to live up to his masculine duty and obligation to defend and protect his 'woman'. "This belief translates into alienation or violence directed toward the only one whom he can punish, the woman" (Salzman, 1998, p. 371).

The occurrence of increased domestic violence post-conflict demonstrates the connectivity of violence within the larger society (public sphere) to the household level (private sphere). In her discussion on political violence in Colombia, Moser (2001) highlights how different types of violence are interrelated on a continuum. Through this framework, Moser presents the connectivity of violence through demonstrating how macro political violence expressed on the civilian population, leads to social conflict between neighbours, which lend itself to intra-household violence including spousal abuse. This point will be further explored in the findings section.

Summary

The purpose of this chapter has been to present the reader with a brief historical overview of the conflict experienced in Uganda, generally, and northern Uganda, specifically. The chapter then discusses the impact of HIV /AIDS in Uganda, highlighting the impact and consequences for women. This chapter also reveals that the patterns of sexual abuse women experienced during and beyond the conflict. The chapter that follows describes the approaches taken in the collection of data. Included in this discussion is an explanation of the approaches used in the study. 45

CHAPTER FIVE: METHODOLGOY & STUDY SETTING

Introduction

The primary objective of this chapter is to explain the methods that were employed in this study. This chapter begins with an explanation of the reasons why a qualitative methods approach was used and the influence of a feminist lens. That discussion is followed by a description of the approach adopted in analyzing and drawing conclusions from the data that was collected. The goal of this research is to deepen our understanding to the experiences of Acholi women in the conflict-affected regions of northern Uganda.

Methodological Framework

Rationale for Choosing a Qualitative Method

This study examines the experiences of women living through and beyond the conflict in northern Uganda. A qualitative approach was utilized in the gathering and analysis of the field material because only a narrative-based approach could give the deepest understanding of women's experiences of SGBV. Qualitative methods are best suited for research of this nature because it places particular importance on the voices of the individual and strives to stay in tune with how one's perceptions, ideas and behaviours are influenced by their particular socio-cultural context that could not be adequately captured in a quantitative analysis (Allen & Walker, 2000). With respect to capturing an emotionally sensitive subject matter such as sexual violence, the qualitative approach provides greater insight into the meanings attached to this experience and the impact it has on the survivor (WHO, 2005). Unlike the use of written data collection, methods which may restrict the respondent depending on their literacy level this approach allows the respondents to share their opinions and perceptions in their own voice. 46 Further, the openness of qualitative inquiry allows the researcher to observe and participate in events, practices and behaviours within their natural setting as they occur.

The Influence of Participatory Feminist Methodology

Through the adoption of the feminist lens, this study highlights the widespread violence women experience in the conflict and post-conflict setting. The two commonly held principles of participatory feminist research that makes it best suited to address the current study is that it rejects the standard academic research methodology that makes a distinction between the research and the researched, and it is 'grounded in women's experience'. Participatory feminist research attempts to erase any power imbalances between the researcher and the researched, and encourages the involvement of the participants in the development, collection and interpretation of data. Irrespective of the research tools feminist methodologies favour methods that reflect the experiences of women, 'rather than distorting them' (Skinner et al, 2005, p. 17).

In an effort to engage the community at the grass-root level, I worked with Kitgum Women's Peace Initiative (KIWEPI), a community-based organization that provides psychosocial, material and vocational support to former female abductees. Drawing on an egalitarian feminist discourse, a significant feature of my research was working in collaboration with, and advocating beside the women of KIWEPI (Lennie et al., 2003). This relationship allowed me to have intimate discussions with activists in the community on their experiences and work with women affected by the war.

While in Uganda, one of the critiques I heard about early in the research process was the exploitative qualities of 'foreign research initiatives'-the foreign researcher arrives, conducts research [re: extracts information], returns home, and uses the information for their academic advancement; a process candidly described as reminiscent of the colonial experience. Another critique raised was that foreign researchers investigating the conflict rarely left Kampala to venture into Acholiland (Gulu, Kitgum, and Pader districts) to talk to the people affected by the conflict. It was clear through this expression of concern that some of the previous research experiences for the respondents 47 was disempowering. This research legacy, of sorts, made me far more cognizant of my work and the power dynamics inherent in my identity, as a Canadian-born woman of color, graduate student and researcher.

Keeping in tune with the feminist praxis, I attempted to develop a bi-directional communication in which research interests, clinical work and personal experiences occurred between the researcher, KIWEPI staff and the participants. A less hierarchical research relationship was developed through working collectively with the organization to learn more about women's experiences during the conflict. In my opinion, the working relationship was based on reciprocity, mutual discourse and shared concern for the circumstances of the women in IDP camps in Kitgum and Pader (Gatenby & Humphries, 1996). I attended talks, rallies, debates and LRA peace negotiators - national government community consultations which allowed me the opportunity to hear women discuss their frustrations and optimism for the future.

Data Collection

Study Setting

Data collection was carried out in the conflict-affected districts of Kitgum and Pader. Kitgum district is located in northern Uganda and borders the Republic of Sudan to the north, Kotido district to the east, Pader district in the south and Gulu district in the southwest. Much of Kitgum and Pader district (Acholiland) has experienced prolonged conflict for the last 21 years. As a result of the forced migration the districts comprising the Acholi regions have approximately 80 percent of the rural population living in IDP camps (Isis-WICCE 2004). Kitgum and Pader districts were selected for this study because the districts have been severely affected by the conflict. 48 Study Procedures and Process

The process consisted of the recording and documenting of the researcher's interpretations, reflections and observations. The observations in this study encompassed the daily activities of the researcher and the members of KIWEPI. Such activities included: (1) the researcher's entry into the community; (2) discussions with NGO workers and women's rights activists; (3) the body language and participation of interviewees during interviews; and, (4) the interactions among the staff, the staff and the members of the organization, and the staff and the researcher.

Early on in the field research process, it became clear that the respondents perceived the association between sexual violence and the transmission of HIV as a forgone conclusion; moreover, I noted an interest among respondents to discuss the increased prevalence in SGBV currently taking place in the IDP camps. After consultation with the staff of KIWEPI, I expanded my interview question guide to include questions that examined the current trend of SGBV in the IDP camps.

Three focus group discussion (FGDs) and fourteen in-depth interviews were conducted over a three-month period during September to December 2007. In light of the delicate nature of the research and the concern for confidentiality, particularly in the close knit communities in the North, verbal consent was acquired. Data was stored in accordance to the Dalhousie Ethics Board Guidelines.

Focus Group Discussion

Sample

Participants of the focus group were recruited through KIWEPI and the Local Council Commander of the IDP camps. The three FGDs consisted of 107 community members, 72 females and 35 males. 49

Procedure

The three FGDs were carried out in partnership with KIWEPI. Prior to entering the IDP camps in Kitgum and Pader districts, the researcher requested permission from the Local Council Deputy in both districts. Prior to going to the IDP camps KrWEPI informed their field coordinator of our visit, the field coordinator then announced the objectives and date of our visit in a camp meeting. Individuals were invited to attend if they were interested in participating in the discussion. In addition, a letter was sent to the local government camp councillors informing them of the purpose of the research and requesting permission to enter the camp and conduct FGDs. Upon arrival, the investigator and representatives from KIWEPI officially introduced themselves to the local government councillor.

FGDs were conducted in the community meeting area, generally located near the office of the Local Council representative. FGDs were conducted in the local language, Acholi and the discussion between the community members and the researcher was facilitated by a project officer provided by KIWEPI. The field officer informed the participants of the research objectives. Due to the semi-literacy of the majority of the participants verbal consent of participants was obtained. The participants were verbally assured that their participation was voluntary and refusal to answer questions would have no negative consequences for them. FGDs lasted for approximately 60 minutes. The focus group facilitators (comprised of two field officers from KIWEPI) used a semi- structured discussion guide (the same for all groups) to ensure coverage of all research questions. The identity of respondents and their specific location of their camps have been kept strictly confidential for security reasons and do not appear in this study.

One of the field officers also provided the Acholi to English translations. The field officer who provided the translations was from the region, fluent in the local language and knowledgeable about the local culture. In order to ensure the accurate translation significant attention was paid to paraphrasing and reiteration during the FGDs. In addition, audio recordings of the FGDs were reviewed against the written translations by an additional staff member of KIWEPI to verify the accuracy of the translations. 50 In-Depth Interview

Sample

Fourteen interviews were held with eleven women and three men. A purposive sample method was utilized to select participants. A variety of primary stakeholders, representing state and civil society were included, such as local governmental authorities, university faculty, United Nations personnel, and representatives of local and international NGOs. Inclusion criteria included individuals who currently work on projects and/or research related to the conflict and women's rights. The researcher made arrangements with the interviewees directly, in some cases approval had to be sought from executive directors of organizations.

Procedure

At the beginning of the interview, the purpose of the study, methods of data collection, including audio taping, estimated time involvement, and benefits of the study were explained. The interview was audio-taped with informed consent. All interviews were conducted solely by the researcher in English. The interviews were conducted in a private room to ensure privacy and at a time convenient to the participants. Interviews lasted 45 to 60 minutes.

The interviews provided the researcher contextual information that offered an understanding about issues of SGBV and its associated health implications. Questions were drafted to gain insights and assess the respondents' perceptions on the motivations, prevalence and impact of SGBV on women and how these issues are being addressed.

Data Analysis Strategy

Collection of data and primary data analysis occurred simultaneously. My analysis proceeded in several steps. Each interview and FGD was audio-taped. The audio taped sessions were transcribed verbatim and all transcripts were reviewed against the tapes to establish accuracy of transcription. Transcripts were analysed to identify themes among participants' responses by utilizing the Ulin et al. (2006) qualitative analysis framework 51 which comprises of four separate flows of activity - data reading, coding, reducing and displaying. I did not use a qualitative data management software program in part because the instruction I received in my graduate research methods course was in the traditional format of reviewing one's data on paper. Also, on a personal level I felt more connected with the narratives one paper than I did when I was reviewing them on a computer screen, and being most at ease was essential in the data analysis process as I read through the emotionally charged transcripts. Throughout this process, the investigator was the sole person engaged in the analysis process of the in-depth interviews, with intra-rater reliability addressed through a consistent approach to reading and evaluating each text. With respect to the FGDs, throughout the process I called upon the director of KIWEPI to confirm the overall adequacy of the research process to ensure that they were rooted in the data collected during the field visit in the IDP camps and not in my construction of the issues.

Ethical Considerations

Data collection began only after approval from Dalhousie University's Health Sciences Ethics Board was obtained. The following ethical considerations were addressed in this study.

Issues of Re-Traumatization

Due to the delicate and traumatizing nature of the experience of sexual violence I decided not to include survivors of sexual violence into the study sample because of issues of re-traumatization. In the absence of direct psychosocial support and follow-up, as a social worker, I felt it would be unethical to interview survivors of sexual violence without the assurance that these services would be made available to them. None of the questions in the interview guide were about one's personal experience of violence during the conflict. That being said, it is important to acknowledge that in order to be excluded from the study survivors would have to self disclose their experiences or voluntarily opt out of the study. Therefore, within the sample it is possible that there were women who 52 had a history of sexual violence and chose to continue to participate in the study. With this in mind, at the end of all interviews and FGDs a list of psychosocial services were made available to participants.

Vicarious Trauma

Conducting research of this nature can be a very emotionally taxing and draining experience and raises the salient concern of vicarious trauma for the researcher. Despite being a trained social worker with three years of experience providing counselling to survivors of sexual violence in Canada, I was not prepared for the emotional demands of this research process. The level of trauma women experience in conflict and post-conflict setting is magnified because of the generalized humanitarian crisis associated with a conflict-affected region. As researchers we are the primary research tool, so it is imperative that I was cognizant of my emotional state and well-being throughout this process. Among some of the techniques I used to keep myself emotionally grounded were daily mindfulness meditative practice, the journaling of my experiences and feelings, cognitive reminders that 'I am one person doing my part to address the difficult realities women experience in conflict-affected environments' and maintaining regular communication with my loved ones at home.

Informed Consent

All the in-depth interviews and FGDs began with the researcher reading the study information letter that outlined the purpose of the research, the interview process, the subject matter to be covered, the concepts of anonymity and confidentiality and how these would be achieved, potential risks posed to participants and potential benefits. Participants were informed that their participation was voluntary and that at any stage in the process they could stop the interview or FGD and ask that their response not be included in the study. Following this participants were given an opportunity to ask questions and address any concerns they may have had concerning the study. It was 53 anticipated that some of the research participants would have relatively low literacy levels in English therefore all informed consent was obtained verbally.

Confidentiality

Confidentiality and anonymity were extremely important issues in this study. The issue of intentional HIV infection is a controversial and politically charged issue that could have serious vocational and personal security consequences for respondents. Therefore, during the interview process no identifying information was noted the only distinguishing feature between the transcripts was the number they were assigned in the numerical order they were conducted. All interviews were conducted in private rooms, in most instances selected by the participant. Confidentiality was ensured by keeping all research notes, audio-tapes and transcriptions in a locked case while in Uganda and in a locked drawer in my office in Canada. All the audio-tapes were erased once an accurate transcription was completed. All transcripts will be safely stored for five years and will be properly destroyed (shredded) when no longer in use.

Dissemination Plan

The narratives collected during my field research are not my own, they belong to the women in this community and should be used to facilitate the implementation of services and programmes that will assist in their psychosocial healing process, medical services and access to justice.

To ensure that all can benefit from the research conducted, the findings of this research have been shared with KIWEPI. It is important that this research is disseminated back into the community because one of the challenges the Board of Directors of KIWEPI identified is there is little documentation capturing women's experiences of SGBV during and post the conflict or highlights the gaps in women's access to essential healthcare services. Naturally, during the conflict security issues hampered research in this area and now in the post-conflict period one can see that issues such as the demobilisation of former rebel fighters, food security and land rights are given 54 considerably more priority than the issue of SGBV. Furthermore, in the absence of documentation the policies and programmes discussed, designed and implemented do not adequately reflect the challenges and experiences of women in these communities. Therefore, the dissemination of research of this nature is imperative so that organizations like KIWEPI may be in a position to offer consultation or lobby for policies and reconstruction strategies that mirror the concerns and needs of women in this region.

In the coming weeks I will be returning to Kitgum to resume my work with KIWEPI. Among the projects we will be working on is a documentary in which the women of KIWEPI will have an opportunity to share their stories in their own voice. In addition, the research findings of this study will be incorporated into a book chapter that examines issues of human security for women in settings of conflict and post-conflict. It is hoped that the research will serve as an advocacy tool for the implementation of programmes targeted at assisting survivors of SGBV and serve to build awareness on the vulnerabilities of women in the conflict and post-conflict environment.

Limitations of Study

There were two primary limitations identified throughout this study. First, the highly cultural sensitive nature of issues related to sexuality, coupled with an absence of well-established cultural definitions about what constitutes sexually coercive behaviour within domestic partnerships may have posed a barrier to in-depth discussions on the meaning attributed to and experiences of SGBV during the FGDs. The second limitation was the limited amount of time to collect data. More time within the community and strengthening relationships may have been more fruitful in terms of gaining additional knowledge on how SGBV is defined, understood, and discussed among women in these two communities. 55

Summary

The purpose of this chapter has been to describe the approaches used in collecting data. In this chapter I have discussed my own position as a researcher, emphasizing my attempt to address the field research process in a manner that was reflective of reciprocity and collaboration. In addition, I have sought to explain my selection of qualitative methods and described the approach taken with respect to the two selected methods: key informant interviews and focus group discussions. The chapter concluded with a description of the approach used to analyse the collected data and the limitations of the study. In the following chapter I present the findings of the study. 56

CHAPTER SIX: FINDINGS

Introduction

This chapter presents the findings and analysis of this study. The chapter begins with a discussion on some of the insights gathered during the course of my field research; followed by a detailed description of the findings, interpretations and analysis of these observations.

Methodological Insights Gathered During Interviews

From the onset of this study, one of the research questions I was seeking to answer pertained to the relationship between HIV transmission and sexual violence in the conflict-affected districts of Kitgum and Pader. During the course of my field research it became apparent to me that in the eyes of the stakeholders I was interviewing, particularly those who worked with women in the North, the association between sexual violence and HIV transmission was a forgone conclusion.

A number of factors could explain this view. One, HIV/AIDS is a well-known health issue in Uganda. HIV/AIDS has been a part of the Ugandan national health discourse since the late 1980's; due to the government's extensive efforts at sensitizing the nation through HIV/AIDS awareness programmes and campaigns. As a result, the vast majority of Ugandans know the risk factors of increased HIV exposure include unprotected sex and multiple partners. In fact, it is the understanding of this relationship that contributes to the HIV stigma that is attached to women and young girls who have returned from captivity; because it is presumed that if one was a 'bush wife' she experienced multiple rapes, by multiple assailants without the use of a condom.

The pressing issue identified by the stakeholders was the 'increasing' sexual and domestic abuse, currently, occurring in the conflict-affected communities. In a number of interviews, I was encouraged to explore this issue, more so, than the 'obvious' HIV 57 question. Therefore, during the course of my research I decided to expand the thesis focus to include the SGBV at the domestic level in the context of a transitional/post- conflict community.

It is also important to note that during the data collection process an accomplished feminist Ugandan scholar drew my attention to the appropriateness of using 'Western' defined terms like rape, sexual assault and violence. Posing to me one of the most important questions of an interviewee, she asked 'How effective and appropriate is your [Western] understanding and framework on what constitutes sexual violence working for you as you communicate with women in the IDP camps?', and 'Are these terms compatible with how women within the community describe violence in their lives?'

At the time of our discussion, I didn't yet grasp the breadth of the methodological challenges she was suggesting. As my days in northern Uganda turned to months, I increasingly understood the validity of her questions. For instance, largely in part to the efforts of various international development programs in northern Uganda, women living in the larger and accessible IDP camps have been informed of their 'rights', including as it pertains to their sexuality. During the focus groups and informal conversations in the community, when the question posed was 'Are there acts of rape within the IDP camp?' the question, generally, was answered with examples of cases in which the perpetrator was a government agent or a rebel. However, if the question framed was 'Is it common for a man to continue to have sex when a woman has expressed not wanting to?' the question was always answered in relation to their own experience or a female they know, with a male acquaintance or partner. These shared accounts also indicated that refusal of sex often lead to conflict and violence within the relationship. This issue of 'what constitutes sexual violence' became increasingly blurred, I observed, in discussion between NGO workers and the 'bush wives' who had escaped (referred by some women as a 'return') from the LRA camps.

The overall methodological questions this posed were 'is this due to the distinction made between rape by a stranger and someone intimately known?' Is this a reflection of cross-cultural differences in the understanding of what constitutes sexual and gender- 58 based violence? Is the articulation of sexual violence found in feminist literature an adequate universal definition? Is it fair to assume that the women in northern Uganda would be willing acknowledge an abuse that carries with it shame, stigma, and social isolation? Transitional feminists like Mohanty (1995) argue as the primary referent in theory and praxis. Western feminist discourse has a tendency to not fully grasp the racial, cultural, sexual, regional or class realities of the subaltern woman. Furthermore this, more generally, speaks to the hierarchal structures present in development practice which is reflected in the power imbalances between who is researched and who creates the knowledge.

In order to capture how women within the IDP camps articulate their experiences of violence; as well as, to avoid the monolithic representation of the subaltern woman in a victimology narrative Mohanty (1995) suggests that "male violence must be theorized and interpreted within the specific societies in order to both understand it better and to organize effectively to change it" (p. 24). In this study, I have attempted to analyse and present women's experiences of violence within the conflict as understood and related to me by the respondents. Although, this is not the focus of the study, I think the methodological issues raised could benefit from further investigation and calls for a deeper examination on how we (read: Western researchers) engage in feminist research in the Global South.

Findings of Study

In seeking to explore the questions of this study, during the process of transcription and analysis I identified a number of recurring themes concerning women's experiences with SGBV in the districts of Kitgum and Pader. Those themes were 1) rape; 2) impoverished conditions within the IDP camps; 3) alcoholism; 4) shifts in traditional culture and gender roles; 5) female-headed households; 6) domestic violence; 7) HIV/AIDS; 8) harm to women's reproductive health; 9) psychological stress and trauma; 10) justice; and finally, 11) the lack of health-care services. These themes are not mutually exclusive and often overlap in reflecting women's lived realities. 59 For the purpose of the study, I have combined these mini themes into broader themes: 1) perceived motivations of rape; 2) increased prevalence of SGBV: perpetrators and causes 3) failing criminal justice system; 4) communitarian approach to addressing SGBV; 5) inadequate health facilities; and, 6) intentional HIV transmission.

Motivations of Rape

In support of the literature, the assault of women and young girls was understood by most respondents to derive from the patriarchal social structures within Ugandan culture. Rape was also referred to as a 'tool' used to communicate the LRA's power over the community; to 'attack and frighten' members of the community into subjugation in order to ensure that the community would withhold their location and movements from the military, or to coerce the community into providing them with agricultural supplies.

In one interview, a women's rights activist describes the important symbolic messaging of rape, she states

/ think that it (rape) was the highest level of mockery to the women and entire community. It is an insult in our culture. It is the biggest insult. It tells the men they are weak, tells the community that they are helpless and powerless. (P-l)

One of the salient aspects of this statement is the absent commentary of sexual assault as a woman's personal experience. Rather, rape is articulated in relation to the impact on the community, which supports the analysis that a woman's identity and experiences are intimately tied to the community. Further, the use of the words 'mockery' and 'insult' emphasize how rape functions to debase and humiliate the cultural and moral integrity of a community.

There was also the perception among respondents that rape was carried out as a reward to soldiers, reinforcing the notion of the 'spoils of war'. In my only interview with a government official who acknowledged the ongoing occurrence of SGBV in the DDP camps, this was said about the motivations behind rape, 60

Rape was just rape in its own context. For the rape being done in the camp it was for self- pleasure and power. For the rebels - it was just about a girl being allocated to a rebel and her being his property so he would do what he liked. I don't know if it was a way of dealing with sexual appetites. You know the rebels would look for a virgin, they would check to make sure she was a virgin, she would be used, then she would be given to a rebel. (P-8)

The suggestion that rape occurred in the context of men seeking 'pleasure' offers an interesting perspective on the use of rape in this conflict. Again, we see that the traditional analysis of rape as simply being a 'by-product' of war, remains to be the mindset held at the governmental level, at least within the Kitgum and Pader district. The danger of this analysis is it depicts rape as a sexual (personal) crime, negating the deeply embedded meaning the act communicates about the status of women and how violence is manifested and expressed through gender. This comment also offers insights into the policy and procedural gaps in ensuring women's protection within the IDP camps. For example, if rape is perceived as an inevitable feature of war, the efforts to mitigate it are given low priority. Lastly, the comment highlights that survivors of rape are ALL females irrespective of their ethnic membership or political affiliation, they are subjected to widespread rape simply because they are women. Reminding us again, that the underlying causes of VAW is the subordination of women and the construction of women as not having the same rights as men.

As mentioned earlier, abduction of young girls was a common feature of this conflict. Young girls who have managed to escape captivity have shared their experiences of sexual enslavement, providing us with a look into some of their experiences of violence within the LRA camps. In one interview, a United Nations official elaborates on the sexual initiation and humiliation young girls would undergo at the hands of camp commanders, she states

In the bush it was not even rape it was seen as normal. Now the process was that when you are abducted and they come they chose the most beautiful ones. The ones that look most palatable according to them and then they are allocated to the commanders. Now, the balance that has remained are then given to the other members of the low- ranking officers and the very very young ones 9-10 years old are then 61

assigned to one of the wives of the rebel commander. But when she would come of age like turned 12 or 11 years old then she [is] given her own house, meaning the rebel commander begins to sleep with her.

So their first night or the first one week in the bush, which is terrible because, the man you don't want, older than you, you are not use to the sex, probably your first time and he sleeps with you. The boy children are given to commanders for guarding [them], so they would tell you how they enjoyed hearing the girls cry. How when it would come to about 7 in the evening you would hear all cries in huts because the commanders would sleep in this small small hut and the boys would guard outside. That you would hear in all huts wailings and wailings and wailings because the girls are crying, it is too much.

So that night you can be raped about 3 times and tomorrow morning you cannot walk, your private parts are paining too much. Maybe that night he will come back and rape you, and the third day you develop some pus like pus comes out of you.

In the meantime your fellow women, the older wives are mocking you because they have already outgrown it. Telling you 'hey put water on you and wash yourself with hot water, you will heal that is the way it is, Dear'.

So, one week past and then you heal eventually. You heal from the rape, because you are tight and young at the time that he wants to come back again and again and again and again, unless he sees blood he won't stop. So on the issue if it was used as a weapon, I don't know. I felt that more or less they were used for pleasure to satisfy I don't know, for the relaxation. (P-10)

This quote highlights the brutality and demoralising quality of sexual enslavement within the LRA camps. According to the accounts provided by the respondent's the sexual violation of women was frequently publicly witnessed and met with apathy. 62

Although, I would argue that what was described as apathy was in fact cognitive dissonance4 (Festinger, 1957; Harmon-Jones,et al., 1999). Another, point this description touches on is how the witnessing of violence became normalized. The reference to young boys enjoying young girls crying raises a lot of speculation on how there is a gradual process in which 'moral' behaviours begin to devolve and dehumanising treatment becomes more acceptable. It is clear from the comments made by the young boys and fellow women that an emotional hardening to the suffering of others develops. Although, only speculative, I interpreted this to be the result of the emotional disconnect many captives develop in order to survive the trauma of captivity.

The UN official further adds, that gang rape was used as a form of punishment.

In cases where you maybe try to escape or you do something wrong, it would be an isolated case, then many rebels would rape these girls. The girls subject to this [gang rape] would be as a result of a punishment, because you tried to escape or you ate food which you were not meant to eat, any offence. (P-10)

Many respondents were seasoned professionals having worked with survivors for more than 10 years; thus, most descriptions of the atrocities committed during the conflict had an underlying tone of frustration and exacerbation. Each telling of women's experiences of sexual violence was told with a range of emotions among respondents including anger, disgust and sadness. All the respondents, however, expressed a shared feeling of resignation to varying degrees, which many directly attributed to the feeling of a never-ending quality associated with a war that has dragged on for twenty-one years. An additional finding is that sexual violence against women continues to be a feature of women's lives even after the conflict has ended.

4 Dissonance refers to the personal tension and stress experienced when an individual's actions contradict or are inconsistent with their values or beliefs. Cognitive dissonance theory proposes that people are motivated to maintain consistency between their attitudes and their behaviours - they want their behaviours to match what they believe. Dissonance is reduced by 1) changing the behaviour to match one's attitude; 2) changing the attitude to match one's behaviour; and, 3) cognitively minimizing the degree of inconsistency or its importance. For example, LRA abductees witnessed and were forced to engage in egregious acts of violence, possessing little control over their environment and participation in violence an attitudinal shift took place to alleviate the tension between their belief systems and behaviours. 63 Increase in Incidences of SGBV Post-Conflict The victims who mostly are women and girls, have been abducted, have their bodies and spirits tortured, mutilated, broken, traumatized and for survival purposes end up living with their abusers as their 'wives'. (Uganda: Stop Impunity for Sexual Violence Now campaign, 2007)

The conflict in northern Uganda was marked with extreme acts of violence committed against the civilian population; with much of the atrocities committed being attributed to the LRA rebels. With respect to sexual violence, the perpetrators were commonly thought to be rebels and government agents. With the establishment of the ceasefire, there was a decrease in military presence in the IDP camps and the LRA rebels retreated into their 'safe camps' in bordering Sudan and DRC. Because of the decreased presence of both primary perpetrators, NGO workers and government officials, alike, anticipated a decrease in the incidences of sexual assaults. Although those interviewed included individuals from different sectors, and, in some cases, held professional posts with separate interests and agendas, all interviewees unanimously expressed their surprise and shock at the high prevalence of SGBV taking place even after the conflict had ended.

Conversing informally with government officials, I noted that for the most part they provided conservative estimates on the current level of SGBV taking place within the camps. Thus, it was very significant when a high ranking government official shared that the current levels of violence taking place in the IDP camps is the highest he has witnessed since he was appointed to government.

First of all, what I have witnessed in 1999 during the conflict which received most cases, men were the first to runaway to safe areas leaving behind women and children and they were exposed to the violence, including sexual violations. Girls from the age of 9 years old were being attacked. What I mean to say, the attacks taken place then were less than now, to what we are being exposed to now. (P-8)

In one interview, with a local government official I was told that sexual violence no longer continues to be an issue. His response was simply, "the government has addressed the problem." Although, this government official was the only individual to take this position, his response lends support to the criticism various NGO workers and local 64 activists shared with me in reference to the governments disconnect from the violent realities and trauma women continue to experience within the IDP camps. The response also emphasizes the gendered view of sexual violence

One of the primary interpretations I derived from the denial among civil servants legislating and working on behalf of women in what seems to be an otherwise accepted reality is that the characterization that no problem exists, excuses the local council's lack of appropriate criminal and medical services for survivors in the district. Once again, his denial glaringly points out that the violations experienced by survivors are not only perpetuated on their bodies but their rights to judicial justice and medical treatment.

Identified Perpetrators

In this study, four primary perpetrators of VAW were identified: 1) Members of the paramilitary anti-stock theft unit - primarily stationed along the Ugandan border, they fall under the jurisdiction of the Resident District Commission Office but operate under a loose command structure. One group in particular the Kalangala Action Plan (KAP), is headed by the senior presidential advisor Kakooza Mutale, engage in harassment and unauthorized arrests (Human Rights Watch, 2003). All levels of government deny that they control the KAP and other paramilitary groups making accountability almost impossible. In one interview a government official admits that,

No one is clear on who they answer to. They do not answer to the military and you don't take them to the police. (P-8)

This lack of clarity has facilitated an environment in which the paramilitary can operate with impunity. 2) Males in the community who hold positions of authority, for example teachers, camp leaders and local police; (3) Adolescent males; and, (4) Male family members. The last group, male family members, has been linked to the vast majority of cases of SGBV. A researcher conducting surveys on VAW in the conflict- affected districts of Lira, Gulu, Kitgum and Pader, shared with me his preliminary research findings on the extent of SGBV at the family level, 65

The data I have... at least of three percent of soldiers are committing this [rape] and fifty-one percent in the household by relatives.... our work revealed we have very high incidence now, defilement and rapes go on. (P-10)

A representative from the United Nations agreed with these findings, and added that the issue of SGBV at the family and community level is being neglected at the national level, specifically in the current discourse around the peace and reconciliation process.

She states

This is something that people are not talking about. Because now, even the people who are involved in the reconciliation process when they talk about sexual violence they are basically looking at the LRA rebels and there are many cases of SGBV they are not looking at. For example, this girl who is being frequently abused by her teacher in school, the camp commander, the husband, by any member of the family and community. (P-10)

The increase of SGBV within the family and extended family structure was a recurrent issue raised throughout the study. Of particular concern was the increased incidence of sexual violence committed against young girls. A NGO worker who works with young girls in the district had this to say on the issue,

We have heard rampant cases of sexual violence at the family level You will find cases of defilement, an old man of about 50 years defiling a three year old kid. It is sad. It is really rampant, really rampant. Last week, when this happened, like 500 metres away from here a man of 25 years defiled a kid of 3 years... So the perpetrators of sexual violence are not just armed forces it is happening at home level. It is happening and it is rampant. (P-5)

As discussed earlier, SGBV during conflict has primarily been discussed as being executed by males external to the war-affected community; the key perpetrators identified have, generally, been soldiers of the national armies, rebel forces, peace-keepers, community leaders and police forces (Amowitz et al. 2002; Hynes & Cardozo, 2000; Enloe, 1993, 2000; Copelon, 1995). Similarly, the international media coverage of conflict 66 situations often portrays these actors as the sole perpetrators. As a result, the discourse of sexual violence during conflict has confined the identity of perpetrators of violence to the sphere of external forces. Consequently, this leads to the erroneous assumption that in the absence of conflict, specifically in the absence of the primary perpetrators, VAW decreases.

The focus on SBGV during conflict and the limited perspective of the perpetrators of VAW has resulted in what Haynes & Cardozo (2004) describe as a dearth of data on sexual violence and a lack of standard measure to assess the levels and types of sexual violence in conflict and post-conflict settings. In response to this gap, researchers have begun to examine the rise in VAW in the post-conflict periods; researchers have generally attributed this increase to the socio-economic and security crisis women and young girls find themselves in after conflict (Korac, 1998; Rehn & Sirleaf, 2002; Dahrendorf & Shifman, 2004; Zicherman, 2007).

The influence of militaristic culture extends well beyond the active fighters and is present in the everyday lived experience of civilians. The culture of violence and masculinity fostered during conflict does not dissipate when the conflict is 'over'. The masculinised aggression that was acceptable on the battlefield, or used for community survival, is transferred into the home in the form of escalating SGBV (Jok, 1999, 2000).

Rehn & Sirleaf (2002) documented reports of domestic violence within post- conflict settings. They found that contributing factors include the availability of weapons, the violence male families members experienced and witnessed, and deprivation. The following are examples they found in 2002, four Special Forces soldiers from the American military killed their wives within a period of six weeks, three of whom had recently returned from overseas duty in Afghanistan. A survey of occupied Palestinian territories found that some men detained by Israelis were using the same interrogation tactics against their wives and family members that were used against them. Moreover, since the issuance of the second Intifada, which led to increased unemployment, and overcrowded living conditions, there has been an increased level of domestic violence, incest, rape and suicide. In one study, that examined an NGO that operates a hotline on 67 domestic violence in Ramallah, it was estimated that 70 percent of the calls they received were concerning rape within the family (Rehn & Sirleaf, 2002).

One of the questions that needs additional investigation, is why is there an increase of violence within the household? In the following section, I discuss some of the reasons offered by the respondents.

Causes Attributed to Violence

There are several explanations provided for the increase in violence and I cover these in the section that follows.

Lack of Livelihood Opportunities

Lack of livelihood sources and an income have caused women and men to become heavily reliant on the food and shelter provided by humanitarian organizations such as the World Food Programme. In response to the limited economic opportunities coupled with the responsibilities of caring for children and other dependents, women have been forced to engage in transactional (survival) sex with men who can provide food, money, shelter and offer protection.

In the absence of economic alternatives, a report from Save the Children (2000) found that sex is widely used as a trading commodity in refugee camps in West Africa; where young girls are sometimes supporting themselves, their parents and siblings (p.9). Children in one refugee camp in Liberia said that sexual bartering increased since the war (McCauley, 2002). Widespread sexual bartering has also been documented in Sierra Leone, Liberia, Burundi, DRC and Sudan (Save the Children, 2002). Without access to income-earning activities and the loss of extended social networks that previously offered social and economic support and security, women and young girls are vulnerable to abuses. 68 In some cases, an NGO worker noted, a mother will encourage her daughter(s) to engage in a sexual relationship with military officers based in and around the Kitgum area; because as the only individuals in the community receiving salaries, soldiers are able to offer shelter, food and, importantly, physical safety to future assaults. A practice that researcher Kelly (2000) describes as an "example of the 'patriarchal bargains' women make in circumstances not of their choosing" (p. 53). In short, the benefit to women in this relationship translates into a position of decreased vulnerability even if it is short term.

A researcher highlights how the impoverished conditions within the IDP camp contribute to women negotiating their survival through sexual relationships.

[Sexual violence] increases because in the conflict area you see a breakdown in the way people negotiate well-being and livelihood survival. So there is always a demand for food or basic life necessities among others. So these ones make women vulnerable to different forms of violence.... Go to an IDP camp and people are depending on food rations. You are depending on the next food, to wait for the World Food Programme for food distribution.

So what do you do in between if you cannot access your farm, you cannot move out of the camp your travel is restricted. What do you do during that time? Let's us look at how they negotiate survival - how do you negotiate?

You do that through transactional sex for instance because you need money, or you need clothes, and the person taking care of you cannot take care because they do not have money to do that. So you organize to go with this person in your village or camp... and then you can get what you need for your own support. (P-ll)

It is through this bartering that woman unwittingly put themselves in vulnerable positions where they are at risk for physical and sexual abuse and exploitation. 69

Changing Gender Roles

When asked 'what they perceived to be the primary factors that contributed to the increase in violence against women?' all the respondents attributed the occurrence to the deculturalisation of Acholi culture due to the sustained and prolonged conflict. By deculturalisation, they were referring to the changes in family spatial living patterns, livelihood, security, and relationships with community members, the practice of traditional ceremonies, and changing gender roles and behaviours that define masculinity and femininity.

Traditional Acholi concepts of masculinity placed great emphasis and value on a man's function as the provider and protector of the home. Respondents in the focus group defined manhood on two dimensions: (1) a man's ability to provide for his family; and, (2) a man's capacity to physically protect his family. Before the conflict and in areas of the country that have not been affected by the conflict, the primary source of income generation for men was agricultural production; however, issues of security placed restrictions on the community's mobility so men were no longer able to access their fields. In addition, the common problem of camp overcrowding inhibited agricultural opportunities within the camp and paid employment opportunities are practically non­ existent. Quite simply, there is nothing for men to do. Within the camp, the community's security and food is provided by humanitarian agencies and the national government. The dependency on humanitarian agencies for food supplies and shelter has had profound implications on the gender dynamics, expectations and roles previously prescribed, sustained and carried out by men; and more importantly, the power these roles provided men within the family unit.

One researcher explains how life in the camp has changed the role of men within the family structure, and suggests that this has led to a feeling of alienation among men.

At the end of the day it is the man who is traditionally associated with power in the household, to make decisions, to provide for the household and to also protect the household. But in the IDP setting the problem is that men end up being the receivers of humanitarian aid, so they can no longer exercise their power over provisions for the household. And then 70

the decisions are being made by the head of the agencies or by the camps themselves, so that means they can no longer make decisions on behalf of the household. The other aspect is the protection is being taken over by the soldiers and by the others within the camps, so the men are greatly greatly limited in these kind of aspects. (P-l 1)

The insights gathered here demonstrate that the conditions in the camp have created an environment in which men's traditional responsibility within the family and the associated power has diminished. These findings are consistent with those of researchers (Koss et al., 1994; Gutmann, 1996; Watts et al., 2002) who emphasize the concept that men will use violence to demonstrate and enforce their position as head of a household or relationship.

Another important gender shift that warrants consideration is the emergence of the female-headed household. The killings, displacement and abductions brought on by the war resulted in a significant number of female-headed households which demanded that women assume more responsibility and decision making roles. Freed to some extent, by the political and economic dependence on men, women's life choices still remained to be constrained economically. Nonetheless, the new roles women found themselves in allowed them to challenge and renegotiate their place in the family structure and society, to some extent. This of course has created disruptions in the existing social structure and has created relational tensions between men and women. This was evidenced in the informal discussions with men in the HDP camps who shared their perception that women are no longer fulfilling their domestic duties, and are using 'the excuse' of 'women's rights' to be dissolved of their domestic and marital (read: sexual) responsibilities.

Gutmann (1996) explains that as women transition into increasingly more economically, politically and socially autonomous roles, it will challenge and threaten men's roles. He writes,

The probable rise in domestic violence against women is linked to an intensified gendering of aggression as some men seek to 'resolve' the contradictions and confusion in their masculinities resulting from women increasingly declaring their independence from men (p. 224). 71 It is here that feminist discourse on sexual violence can offer some insights into the shift in gender roles and the increased VAW in the post-conflict setting. Feminist scholars have cautioned that women's growing independence and distancing from traditional female roles will create a transitional period of misunderstanding and hostilities between the sexes. As women attempt to assert themselves in new ways and roles, it will threaten the male ego. This tension, it is suggested, will elicit a 'backlash effect' among some men.

Cockburn points out that any increase in inequality, any widening gap between nations and classes, between men and women weakens the inhibitions against aggression. Further, as the roles of women change and women receive more attention from development programs, men will feel marginalized, and in some cases "those who are made to feel of scant value sometimes resort to violence to gain self-respect or power" (Cockburn, 2004, p. 44). Along the same lines, Koss et al., (1994) posit that sexual harassment and rape are an expression of defence of the masculine gender role, which surfaces because men perceive inadequacy in some other area of their lives (p. 14).

Card (1996) adds that rape is also used to send the message to women that they need protection from men which can only be provided by men.

She writes that

The ever present threat of rape from childhood through old age produces a society of females who [are] generally oriented toward male service—females animated by the hope of securing male protection as a reward for such service - females who often feel bound to those they serve through misplaced gratitude for a 'protection' that is mostly only a withholding of abuse" (P. 7).

Here we see how rape (and the threat of it) can be used by men to situate women in a position of dependency, or at least give the perception that women's safety is dependent on the presence of a male figure in their lives, thereby maintaining the current gender hierarchies (Russell, 1975; Williams & Holmes, 1981; Messerschmidt, 1993). Although the issue of VAW in the post-conflict setting is a complex one, the 'black lash hypothesis' provides insight into the tensions that exist in the current gender relations in the IDP camps. 72

This analysis finds support in a number of examples in which sexual violence, and the threat of sexual violence is used by men to exert control and curtail the activities of women. An illustrative example, is the rape of a prominent Indian female activist in the early 1990s, Heise & Germain (1994) found that her gang rape was motivated by male community members' disapproval of her organizing efforts to stop child marriage. After her rape, her husband was cautioned to keep his wife 'in line' or she would be assaulted again. This case is a clear illustration of how women's adoption of a new gender role or attempt to change them, can be perceived as a threat to male dominance, and sexual violence is utilized to maintain the gender order.

Much like most feminist analysis on VAW patriarchy is at the cornerstone of the explanation. However, caution is needed when drawing too direct a relationship between the ideology of patriarchy and VAW. Although, patriarchy is insightful into the subordination of women and how and why some men feel as though they are justified/ allowed/given as space to are socially permitted to commit acts of violence against women. This argument is insufficient, particularly when we acknowledge that there are men in patriarchal societies who have experienced a loss or threat to their masculinity, and yet do not engage in acts of violence against women. In order to explore this gap I would like to draw on the example of South Africa, an African country which has experienced an unquestionable rise in VAW since post-apartheid. Although, Uganda and South Africa have quite uniquely different histories, I think important insights can be gleaned from the extensive body of literature that has examined the spike of VAW in post-apartheid South Africa.

In post-apartheid South Africa, there has been a noted increase in crime, particularly in the area of sexual violence. The South African Law Commission estimates that 1.7 million cases occur each year, which translates into every third woman being raped during her lifetime (Hirshmann, 2005). The political change of apartheid challenged and shifted gender roles. The 'backlash hypothesis' has also been attributed to the rising violence against women. Hirschmann (2005) contends that the violence is a 'socio-cultural induced coping-strategy' to compensate for the sense of loss of power and control men are feeling. 73

In an analysis of the rise of sexual violence in South Africa, author Moffett (2006), argues that the western discourse on sexual violence revolves around "the anger, fear and inadequacy of individual men or the monstrosity of patriarchy"; and fails to provide a comprehensive explanation or analytical framework for the current experience of pervasive sexual violence. According to Moffet (2006), an examination of colonialism is also needed to provide a clear cultural and historical contextualization of sexual violence in current Africa.

Colonialism operated on the principle that the 'other' was inferior and the status quo was maintained through the regular and excessive use of force. The ethos of colonialism was violence and produced a culture of violence at multiple levels (institutional, community and home); thus, violence was a feature of everyday life. The patriarchal element in colonialism monitored and controlled the category of gender along racial and ethnic lines. For the colonized man, the only sphere in his life in which he could maintain and assert his masculinity was in the family domain (Wood, 2005).

One of the psychological legacies of colonialism is the hierarchical class and gender stratification of society; with gender now replacing the racial subclass. The parallel of the racial subclass under colonialism and of gender in post-colonialism is telling with the continued acceptance and practice of violence as a means to force the subclass to comply with their subordinate status in society. This analysis is helpful because it offers an additional lens in which to understand how and why violence is used as a mechanism of control. In the following section, I discuss the use of violence within pre-conflict Ugandan society.

Pre-Existing Violence in the Culture

Earlier the discussion on patriarchy demonstrated how beliefs on gender identities, generally, and women's value, specifically, construct a space in which sexual violence against women during conflict transmits messages of masculinity (read: superiority) and femininity (read: inferiority). The practice and use of violence prior to a conflict also offers great insight into the scope and use of violence during a conflict. 74

The question then becomes what were the levels of VAW in Acholiland prior to the conflict? In the absence of data on the national levels of VAW in the pre-conflict setting, it is helpful to compare the levels of sexual violence in non-conflict affected areas of Uganda to get a generalized sense of the issue. A survey of small scale studies demonstrate that 'SV represents a common reality for many, if not the majority, of Ugandan women' (Koenig et al., 2004, p. 798)

In this interview excerpt, a researcher offers insight into how violence has been used within Uganda culture as a means of social control, specifically within the marital relationship. She states,

Really the socialization process here is like most of the Africans, but let's talk about the Acholi and Bugandan tribes because that is what I know best. They have been violent in itself in the socialization process. Like you bring up children through beatings, so this is something that you grow up with in the social system, in the institutions you know and even in marriage.

Men must control the women or otherwise you know, 'they get out of hand'. And what is the nature of control? How do they do the control? They beat them, and when you are beaten you actually know you have done something wrong and they may even ask you to go back to your home, your native place where you were born and come back with a relative and then you go through the reasons you were beaten. And sometimes, you, the woman who was beaten are asked to recall it "Ucongo" in Luganda, to appease or to say give a goat, so that you are actually forgiven your sins. You know maybe you left the children at home and went to the well and spent a long time there drawing water and the kids were crying unattended.

When a girl is getting married the type of advice or counselling she is given, you know, one of them is that when a man beats you it is not a strong reason for you to leave your home. You know it is not a strong reason for you to leave your children. And the men use it as a control you know and the woman also use it as a control for the younger ones....it is not necessarily sexe specific or whatever.

So I think before we go into the sexual and gender-based violence in conflict situation it is important that we get to know what was there before., What was there before? Was violence there before? What level was it? Because you see there has been a tendency to actually highlight these issues because of the war you know. Actually these things use to be there before in the first place, maybe right now they are just 75

accelerated and intensified because of the war and the confusion and the destruction. (P-12)

VAW during the conflict cannot be understood without recognition of broader attitudes of violence in the society. In this statement, violence was tolerated, if not an accepted, practice used to communicate gender norms to women. This means that if we are going to attempt to really delve into SGBV in conflict the focus of our analysis must include an examination of violence prior to the conflict and how it is manifested in gender relations.

Supporting the idea that levels and expression of violence before the conflict is essential in understanding the present levels; one researcher has this to add,

It goes back to the social structure, it goes back to the moral structure, to the various ways people view the female body. It goes to the construction of women as sex objects and other things so you have to look at that bit and not just confine it to the conflict zone. (P-l 1)

A male NGO worker illustrates his point on the role of culture in the following statement,

/ want to add something on the perpetrators. You know one day I was chatting with friends and we were linking it to the change of culture, but I concluded that all our mothers were raped and because according to our culture [when] somebody is 14 •• 15years old, those ages they are forced to marry. It is of late that people realizing we all have a choice. My mom was 10 and my dad was I think 15 years old.. And if you have been in Uganda for long and you have read the newspaper it is not only in northern Uganda where you will see an old man going with a child of three months. (P-3)

Although, there were those who argued that the existing levels of violence taking place in the North are linked to the patriarchal ideology that cast women as objects as well as the larger cultural practices in which violence is used as a social mechanism. There were those who also argued that the present levels of violence taking place in the North are a deviation from the pre-conflict culture.

Before the war our northern culture was sacred really a sacred thing. The kids wouldn't even know about it [sex]. And there were few cases of defilement or rape apart from maybe marital rape in the houses. 76

But now since the war came things have changed. I don't know maybe because of the camps as they claim, because they are packed together and they lack what to do so they are bored. So maybe your mind turns to sex. I feel really different. I think maybe it is the effect of the war because our culture is no longer there. What our people considered sacred, now, can be done anywhere. That is why cases of sexual violence is rampant, especially in our community. It didn't use to be, we were really peaceful but no longer. (P-5)

Although, there was acknowledgement that the present violence is a continuation of the on-going VAW in the larger context of Ugandan society; it was also highlighted that the destructive impact of the conflict, has destroyed the socio-cultural mechanisms that offered women some form security in the pre-conflict context.

Another respondent illustrates how the social mechanisms present in pre-conflict northern Uganda, offered women a form of protection.

For instance, a young man does something, like spoiling a young girl, before the norm was if she was not your relative you would marry her because that was that. ..but now because of the confusion there is the destruction in the arrangement patterns of people and the living arrangement of people, that one is dying out. So the lack of social control mechanism if anything is accelerating something that was there before. Because we are not seeing anything new it is just an acceleration of something that has been there. (P-12)

Although the social mechanisms described above did not offer women formal justice, as we know it, perpetrators were at least held accountable for their actions affording victims a sense of justice. The absence of these social mechanisms and a severely under-resourced criminal justice system does not offer effective protection to women and allows men to act with impunity.

Inadequate Laws & Policies

During a visit to one of the IDP camps in Kitguim district, a camp commander confirmed that there has been a marked increase in cases of SGBV within the camp since the signing of the ceasefire between the government and the LRA forces. The camp 77 commander was unable to give me an exact figure on the prevalence because 'his office did not have the capacity to stay up on these things'; this limitation was attributed to the 'severe' under-funding of his department. Although true, restricted finances hampers the operations of the police force in the camp, there also appears to be a lack of political will that can be found in the local, district and federal levels of government. To provide me a 'feel for the problem' he shared that during Independence Day weekend (the course of three days) his office received over 9 complaints of defilement (sexual assault of a minor). All the victims, he stated, were under the age of 10 years old.

In my discussions with community members and local officials I noted that the age of the survivor and the context of the assault greatly influenced how the community construed violence against women; but also determined if the assault would be reported so it may be handled by the criminal justice system in the camp. The cases of sexual violence that were universally perceived to be egregious acts of sexual abuse were incidences of gang rape carried out by LRA rebels during the conflict, and the rape of prepubescent girls, biologically determined to 'not yet be ready for sexual activity'. It would be these cases that, I observed, during informal conversations with community members, respondents were more inclined to discuss and clearly expressed their anger, dismay and repudiation of the act and the perpetrator. Further, individuals more readily expressed deep sorrow and sympathy for the survivor. This reaction is in part because the sexual violation of a young girl produced a clear sense of right/wrong, good/evil dichotomy. The survivor in these cases is perceived to be unambiguously morally innocent and vulnerable and the perpetrator is unequivocally violent and heinous.

In cases where the survivor was 'of age' which generally referred to young girls who reached menstruation, the discussion would sometimes be framed with a question on 'how the victim knew the perpetrator?', speculation on 'her inability to protect herself and queries on whether she was a willing participant and then 'changed her mind'. Thus the resulting discourse of sexual violence at the community level is restricted to rape involving multiple assailants, sexual abuse occurring outside the home and assaults experienced by young pre-menstrual females. Of course, this construction of legitimate, less legitimate and illegitimate 'victims' has important implications for survivor in terms 78 of how they internalize and interpret the abuse they experience, along with their efforts to seek justice. Additionally, it raises issues on whether cases that do not subscribe to this narrow construction of a legitimate 'victim' will be adequately pursued by the police. Lastly, this framing of sexual violence and who are and are not 'victims' has important methodological implications for researchers who attempt to gain understanding of the scope of VAW in this community.

The limitations as expressed by the camp commander, to properly investigate and document the egregious violence women experience within the IDP camps is symptomatic of a larger national and international ambivalence to and disconnect between the policy and practice of safeguarding women and children in areas of political and civil unrest.

The problematic features of the judicial system include inadequate laws and policies addressing sexual violence, poor coordination on the part of law enforcement officials and healthcare personnel, and limited awareness and sensitivity among law enforcement officials. The erosion of the legal and health system leaves the population with insufficient aid to address issues of SGBV. According to the focus group, the most common reasons cited as to why women did not follow through with legal action was due to a deep-seated distrust of the legal system, fear of reprisal from the perpetrator, fear of stigma and concern for the marriage-ability of the survivor. Several factors help us understand the challenges of the legal system and these challenges were highlighted during the in-depth interviews.

In addition, the cases of sexual violence that would universally be perceived as a violation against young girls were cases in which the victim was a prepubescent girl and socio-biologically determined to 'not yet be ready for sexual activity'. It would be these cases that, I observed, during informal conversations with members of the community that respondents were more inclined to discuss and clearly expressed their anger, dismay and repudiation of the act and the perpetrator; further express sorrow and sympathy for the survivor. This is because in cases where the survivor was 'of age' which generally referred to young girls who reached menstruation, the discussion would be framed with a 79 question on 'How the victim knew the perpetrator?'; and speculation on 'Her inability to protect herself and inquiries on whether she was a possibly being a willing participant and then changed her mind'. Thus, the resulting discourse of sexual violence at the community level is restricted to rape involving multiple assailants, occurring outside of the home and experienced by a young pre-menstrual girl.

The common occurrence of blaming the victim, is suggested by a NGO worker, to be the primary reason women do not report or seek judicial justice,

They do not have trust in the system, any time women report to authorities or the government they, first don't believe them. Second of all, they ask for evidence or proof and a lot of times they accuse them, and they say what were you wearing? Where was your husband at the time? So it is always on the woman, the woman's onus to prove that, yes she was raped and this is why she was raped. So they do not feel comfortable. (P-2)

What this suggest is the way a family, and the greater community responds to a girl who is sexually assaulted is intrinsically tied to her perceived sexual 'innocence' and the identity of the perpetrator. Equally important is the fact that this attitude then determines which cases of sexual assault are construed as criminal acts and receive investigation. In my interviews with camp leaders and local officials, the cases cited as pending investigations were cases of defilement and sex with a minor.

Another key issue that hinders women from accessing justice is their inability to afford the fees associated with filing a criminal complaint. One of the outcomes associated with the conflict is the increased levels of poverty within the community. Very few individuals have access to currency. A researcher in the North contends that the resources required to process a case of SGBV prohibits women from reporting.

When it comes to the case of gender-based violence, for example, you are going to meet the local district who is going to assert the morale authority of the woman. And then they will tell you if you want to report the case it will cost you 20,000USH ($11.63 USD) or 30, 000USH ($17.06USD) to take up your case. Now some will have the resources and others won't have the resources. So, that means... some people will not be able to access the justice. (P-l 1) 80

A government official viewed the lengthy 'bureaucratic' process, limited healthcare facilities and medical personnel as key barriers to women filing legal complaints of SGB V. He offers a more detailed look at the process of reporting a sexual assault,

It is first reported to the Block Leader who is in charge of a designated portion of the camp, the block leader then reports the case to the camp commander, they are then directed to the hospital, then it is referred to the police. Once the police process it, there is a mandatory year that the perpetrator spends in jail (before they are found guilty or innocent) then they appear before court. This system is very bureaucratic and there is a gap in terms of when the woman actually gets to the hospital.

Once at the hospital, a Health Form 3 must be completed before going to the police. The Health Form 3 is completed after a medical examine and evidence is collected, but there is only one government health doctor in this district (Pader) of 348, 000 people. There is also a missionary hospital where this procedure and form can be obtained but they charge, 12,000Ush ($7USD) which most people cannot afford. So as you can see there is a gap between the hospital and the police. (P-8)

In the eyes of one scholar, the legal systems current process of reporting SGBV itself is an abuse of the survivor's rights, she contends that

It is the system; it is not therefor the woman. This is the problem, even that is gender- based violence against girls because they are not being rightly treated they are not getting the justice they deserve. (P- 12)

The findings indicate that the lack of reporting can be attributed to the weak functioning of the law enforcement and judicial institutions. The process of reporting, as described earlier, is costly, time consuming and requires the acknowledgement of several government personnel. The manner in which the current legal system operates reflects minimal consideration for the interests of the survivor. It does not reflect an understanding of the psychological trauma a survivor is experiencing after a sexual assault, nor does it take into consideration the financial limitations of the survivor. By failing to recognize the practical realities and constraints that confront survivors of sexual violence, the system deters individuals from coming forward. Therefore, rather than 81 proceeding through the conventional judicial system, most families rely on a communitarian approach to justice.

Communitarian Approach to Addressing SGBV

Due to the difficulties associated with filing a criminal complaint of sexual assault, families are more likely to resolve cases of sexual violence through the informal traditional justice system - highlighting that again VAW continues to be construed as a 'private matter'. This process often entails negotiations between the families of the perpetrator and the victim and the local leader or elder.

According to an NGO worker, a resolution to the sexual assault may take the form of financial compensation,

A young girl will be raped, defiled and her parents now will compromise with the perpetrator. Maybe now he will give the family an animal or some money, like that. The rights of our girls are not being respected. (P-4)

The most common resolution is that the forced union of the survivor and the perpetrator, and the perpetrator is required to provide the female's family with financial compensation, in the form of a bride wealth payment. Research offers insight into a woman and/or family's decision to address an incidence of sexual violence outside the legal system,

Women go the family first...in the reporting of something happened, the issue is what are the implications?

We have a legal system, the person has been arrested, then there is a court looking at what are the facts. But on this side of the continent, it is the other way around. Something happens, it is going to be what are the implications? Where do I go first? Someone has to decide whether it is important to our daily survival or not. How long is going to take me to report, go to the court and what is going to be the result of the court? When somebody is raped instead of addressing the urgency and going to get PEP, it is available in some of the areas but is limited, you find that because of that kind of construction people are 82

more willing to stick to the legal interventions than rather the health interventions.

So if somebody is violated, a young girl, and the family finds out about it then they try to sit down and address it with him, the family will decide what do we do with the perpetrator , court or whatever. Sometimes if they don't agree at the family level, they will go to the community level, once they go to the community leader, he [the perpetrator] will be fined and asked to pay up. If they fail to pay up, this case can be forwarded to the police station. fP-11)

From the perspective of the victim's family, the benefit of this process is the family receives reparations, the knowledge of the assault is discreetly held between the two families, and in many cases the perpetrator marries the victim. The perceived benefit to the perpetrator and his family is no formal criminal charges will be laid against the accused. As highlighted by a government official earlier, sexual assault cases that are processed through the courts hold the accused in custody for a minimum of a year.

Inadequate Health-Care Services

In cases of SGBV, particularly those that involve a minor, the focus of the criminal justice system and that of the family is on the punishment of the perpetrator, and as a consequence the health implications for the survivor are not given a priority. Consequently, many women and young girls are not receiving the medical and/or psychosocial counselling needed after a sexual assault. This inversion of priorities is not only at the family or community level but mirrors the policies and programmes that can be seen at the local, national and international level. Hospitals in the conflict-affected communities in the North are ill equipped, understaffed and difficult to access. These findings are consistent with those from the report conducted by the Ugandan Ministry of Health (2007).

Offering insight as to why women do not access health facilities an NGO worker states,

Well, what we found in our work is that they don't seek it right away. But when complications are so severe, like we had one woman who 83

had vaginal discharge for two to three years., and she would not even go outside because she was constantly leaking / think it depends how far into the bush you get. In Gulu and Kitgum town, in communities where there are infrastructures but in IDP camps., first of all, the facilities are not there...they don't seek help because they know they can't get it.(V-2)

A researcher, concludes that the reason women are not receiving appropriate medical care post sexual violence is two-fold; first, the shortage of medical facilities, and second, from the perspective of the family the detention of the perpetrators takes priority over the health and welfare of the victim, he states

Medical interventions are the last thing on the agenda. When it happens where are they suppose to go? Where are the institutions?

One of the problems you are going to see in northern Uganda, I always like NGOs they offer a clear picture but if you look at the NGO sector and try to look at gender-based violence from a realistic aspect, GBVfor NGOs is to identify the perpetrator, arrest him, put him in prison, and that is the best solution.

Ok so somebody has a problem and they go to the police, get the Police Form 3 so the perpetrator is arrested and once they are arrested they (family) can get whatever they want from the perpetrator. He has this kind of reparation obligation, so that kind of mindset has sidelined the importance of health interventions. So when even somebody is raped instead of addressing the urgency and going to get PEP-HIV, it is available is some of the areas but is limited, you find that because of that kind of construction people are more willing to stick to the legal interventions rather the health interventions.^- 10)

In a discussion on the constraints that prevent women who have experienced sexual violence from accessing medical services, an NGO worker identifies the following as primary barriers,

The healthcare system has collapsed a long time ago. Many in the camp do not have access to doctors There is a lot of bureaucracy. Like we are all aware of SGBV but you will find that for you to successfully handle a defilement case, if you are not literate [it] is not very easy for you to pass. In terms of finance, time and maybe your knowledge about where to go, ah, there is not efficiency in those 84

procedures...For example, when a girl is raped a doctor has to come in, there has to be a second witness, a medical certificate has to take place. A doctor has to approve that so and so has had penetration. Now if you are in Mucwini [IDP camp], there is no health centre for you to do that. (P-4)

Moreover, the NGO worker expands on this point, asserting that lack of knowledge of medical interventions such as PEP-HIV, a shortage of the medication and limited finances prevent victims of sexual violence from accessing this treatment; thereby increasing their chance of acquiring HIV after potential exposure.

Some of them do not know about the knowledge of PEP-HFV but the knowledge is getting out there, to stop the entrance of this virus. But it is a challenge because knowing about it is one thing and then accessibility. And that is not only about the time it is about getting it...even if they have a health facility in a camp is it working, they don't have workers.(P-3)

Overall, according to a report by the Ministry of Health on SGBV in war affected communities in northern Uganda (2007), it was found that the majority of healthcare centres lacked the basic services to manage cases of SGBV. Effective responses to SGBV was constrained by limitations in the healthcare system including, too few healthcare facilities, lack of functioning health facilities, lack of training of health workers to respond to SGBV and lack of effective referral and follow up services.

In the same study, a random survey of eight hospitals in the war affected districts of Gulu, Lira, Apac, Kitgum and Pader, found that only five healthcare centres provided PEP- HIV services; however, they were made available only to health workers because of their cost, and only two hospitals provided emergency contraception services using a combination of oral contraceptive pills. "No health unit surveyed [used] the dedicated product of emergency contraception" (31). It was also found that no health unit offered elective abortion services for unintended pregnancies resulting from rape and defilement, nor did any health unit provide follow-up care after a sexual assault. Women are left to deal with the physical pain of the assault but also the symbolic meaning of their rape in their practical lives, which may translate into material consequences and injustices (Kelly, 2000). Quite simply, women, who come forward and announce their rape can often face 85 retaliation, stigma, disbelief and are attributed blame. Not surprising then, women who are raped choose to remain silent about the abuses they experienced. In the precarious socioeconomic and political environment of a post-conflict nation women are left to negotiate for their survival, part of this survival will depend on their integration into the society and their social capital.

Intentional HIV Infection

Intentional HIV infection is a contentious topic that has received little investigation. The only literature on documented cases has referred to the events in the 1994 genocide in Rwanda, where, the Interhamwe leaders ordered the Hutu militia members who were infected with HIV to rape Tutsi women in the hopes of transmitting HIV, to ensure the murder of Tutsi women was 'slow and agonizing' (Christian Science Monitor, 2002).

Similar reports of intentional HIV infection have emerged from other countries in the region. In 1999 the government of the DRC made claims to the African High Commission on Human and People's Rights that military soldiers from Uganda, Rwanda and Burundi known to be HIV positive were involved in the intentional infection of rape victims. "Failing to respond to the allegations, the Commission found the countries liable for the allegations made against them" (Mills and Nachega, 2006, p. 714).

In a 2004 report, the International Crisis Group, cited narratives from northern Uganda in which women alleged they were intentionally infected through rape by UDPF soldiers. Similarly, a report by the UN-OCHA/IRIN (2007) documented claims made by women that the Ugandan army was deliberately bringing HIV-positive soldiers to rape and abuse the Acholi people. The authors of the report suggest that these allegations may be largely supported by anecdotal inferences rather than hard evidence (UN- OCHA/IRIN, 2007).

A controversial subject matter in Uganda is that there have been no independent confirmations that the military or the LRA have knowingly sent out HIV infected combatants with the expressed purpose of infecting the community. There have been, 86 however, accusations made by community members that warrant further investigation. In my research, I found that all the respondents perceived a positive association between sexual violence and the spread of HIV; however, they had conflicting opinions when the issue of intentional HIV infection was raised. An association was noted on how a respondent responded to this issue and their professional affiliation. All the government and UN officials, for example, immediately dismissed the question; whereas, NGO workers and women's activists who work with women in IDP camps revealed that they have heard these accusations before, and believed them to be true.

Three of the people I interviewed confirmed hearing reports of intentional HIV infection. All of them were women's rights activists who worked closely with women who had experienced sexual violence.

Some girls that have come out of the bush are HIV positive. Most of Museveni soldiers who came out of the bush were HIV positive. Many of them are now dead. This is why many think it was their intent. (P-l)

Another NGO worker confirmed hearing these claims made in her work in the field. She stated:

Yes, most definitely, one woman said a government soldier said ' I paid for my HIV, but I am giving it to you for free just before he raped her. That is something we heard primarily in Lira in the late 90s early 2000. Women were saying they know for a fact, and I don't know how they know, that the government intentionally tried to kill off the people in the community through HIV transmission and they also alluded to the Rwanda situation. And the reason that they know, and this is the same community that told us that soldiers would disguise themselves as LRA rebels is because of the comments made during rape and the prevalence of HIV/AIDS skyrocketed during this one period. So, they see that and they are not dumb people and they know it is intentional. (P-2)

Another women's rights activist had this to say, Actually that has been in circulation because when the NRM leaders came into power, the top leaders, the commanders that were sent to the North, it has been circulating that these people were infected with HIV/AIDS and when they came in the Northern district and were raping women and young girls and what have you and giving money 87

dishing money to the young girls and what have you and after a year they died and that is what people said that these people had come to spread diseases. (P-13)

When asked if there is any documentation supporting this claim she stated

That is what people say. Documentation, maybe by other NGOs. This information came from where the main soldier/colonel office are from. We could get additional information in Lira. Ms. X could give you the stories and the details. This is what makes people say why they were intentional infected. There are too many things and no one talks about it. It is not just the LRA, there were atrocities committed by the solider. (P-4)

The vast majority, however, were unable to confirm or deny these claims. The government and UN officials interviewed, categorically denounced such a possibility. Their response to my questions concerning this issue generally went something like this,

This, no. (P-3)

Things are said but are they true? This I do not know. (P-5)

No. / cannot see this was happening. (P-6)

A researcher is very cautious when he responds and suggests the importance of evaluating where and who are making these claims as well as who is denouncing them

The question is from who are you hearing this. There have always been accusations. So, the question is who are you listening to and who is informing, that is the other aspect. Once you answer that you can get a clearer picture. (P-11)

These findings highlight two important issues: one, sexual violence poses a significant risk in the transmission of HIV in war zones. Two, if HIV is being used in this way, this practice demonstrates a new form of warfare that directly targets non- combatants on the basis of their gender. It is clear that furmer research is required on this issue. A suggestion to any researcher interested in further examining this possible practice is to undertake the study in a site specific manner for a lengthier period of time 88 than allotted in this study. This issue is of extreme sensitivity and poses a number of security threats for interviewees who engage in a discussion of this nature. It would be essential for a researcher to develop trusting relationships within the community to really get a sense of what the community perceives, knows, and has witnessed.

Summary

This chapter has outlined the research findings and analysis concentrating on the causes and motivations of SGBV, the gaps in the judicial and health-care system, the community's response to SGBV, and intentional HIV transmission. The research uncovered the high prevalence rates of SGBV in the war affected communities of Kitgum and Pader with the majority of the cases of violence taking place within the family and community structures with perpetrators known to the survivor. Moreover, cases are generally reported to the family first and are resolved at the community level, which in most cases means the survivor has not received medical attention. Along with this, the research revealed that intentional HIV infection is a practice that some of the actors involved in protection and service delivery in the conflict-affected communities believe occurred during the conflict. 89

CHAPTER SEVEN: CONCLUSION

Introduction

The primary objective of this research was to gain an understanding of the experiences of SGBV among women living through and beyond the conflict-affected areas of northern Uganda. A second objective of this research was to examine the reports of armed combatants raping women with the intent to spread HIV (African High Commission on Human and People's Rights, 1999; Christian Science Monitor, 2002; International Crisis Group, 2004; Mills et al., 2006; UN-OCHA/IRIN, 2007). In keeping with the two main objectives in this study, this chapter presents a summary of the findings. I conclude this chapter with some recommendations on how issues of SGBV can be addressed in the communities of Pader and Kitgum.

Reflections on the Findings

This study highlights that SGBV remains to be a pervasive feature in conflict- affected communities well after the conflict itself has ended. The vast majority of the literature on SGBV in settings of conflict has focused on violence perpetrated in the community by rebels, government forces, and those in authority. As northern Uganda transitions into peace, the findings revealed a lower prevalence of violence from societal conflict, and a higher prevalence of violence occurring in the household setting by intimate partners and relatives.

The primary cause attributed to the increase of VAW is the change in the social dynamics and gender relationships between men and women. The conflict, subsequent displacement and dependency on humanitarian aid, coupled with the overall conditions in the IDP camp have challenged the traditional authoritarian notions of masculinity, leaving many men to feel disenfranchised and irrelevant in the domestic sphere. In some cases this has resulted in men attempting to reassert their authority in the household through violence. Other factors identified include systematic discrimination and 90 subordination of women at all levels of society, demoralisation of Acholi culture; and, a failing criminal justice system.

The shift from a very public form of SGBV to a private form is of great concern, as private forms of violence by intimate partners or acquaintances may be even more difficult for women to talk about and report because exposing violence within a relationship or home may threaten a women's security; as well as, jeopardize important familial and material supports.

In addition, the study revealed that perceptions on the 'alleged' practice of raping women with the intent to transmit HIV are mixed; however, the supporting accounts are persistent enough to warrant additional research into this issue. By gaining a greater understanding of the relationship between sexual violence and the transmission of HIV in conflict-affected communities in northern Uganda, local and international efforts will be able to more effectively address the vulnerabilities of women affected by conflict.

Recommendations

The findings of this research provide important insights on the lived experiences of SGBV for women in the IDP camps within Kitgum and Pader district, and offer some indications for future inquiry. In the following section are a set of recommendations proposed in consultation with the staff of KIWEPI.

Inclusion of SGBV Prevention in HIV/AIDS Prevention Programmes

The vast majority of HIV/AIDS prevention programmes in SSA enforce the 'ABC strategy-Abstinence, Be Faithful, and Condoms. A strategy that has demonstrated some success for some groups, one of the key weaknesses of this programme is it assumes that all women will have the ability to negotiate safer sex. The reality is when we are talking about sexual violence and exploitation, issues that mar the conflict zone, women simply do not. SGBV prevention needs to be included in HIV programmes 91

Community sensitization of the causes and consequences of SGBV should be extensively carried out. HIV/AIDS prevention programming should include strategies that educate communities on SGBV and related issues. Specific programmes need to be implemented in school-based prevention education (for boys and girls). In addition, sexual violence prevention training should be mandatory for all health-care providers, police officers and teachers to identify, counsel, and refer survivors of violence to health services.

Improved Criminal Justice System

Access to protection and support for survivors is glaringly inadequate within the IDP camp setting. Structural and administrative changes need to take place within the reporting process; as issues of access, finance, and concerns of confidentiality contribute to women not seeking judicial justice. In addition, cases of sexual violence languish and the prosecution of perpetrators are too few to act as a deterrent or engender a sense of confidence in the judicial system. The successful prosecution of perpetrators will demonstrate to community members that justice can be achieved through judicial means. In turn, a stronger effective criminal justice system may reduce the current pattern of survivors and their families resolving incidences of SGBV through local leaders.

Improvement in the Measurement of SGBV

There is a need for improvement in the documentation and measurement of SGBV during and after the conflict. It is clear that the legal systems within the camps are under- resourced and unable to effectively handle this important issue. One way to remedy this deficiency is to train women in the community to systematically document the violations other women experience. One of the added benefits to this approach is women are more inclined to talk to other women from their communities about taboo topics like SGBV. 92 This form of documentation is currently being implemented by Isis-WICCE5 and appears to be an effective means of addressing this gap.

Improved Healthcare System

The findings found that the medical units are grossly inadequate, some facilities are difficult to access; few can supply survivors with emergency contraception or post­ exposure prophylaxis for HIV (PEP-HIV). It is essential that ALL health facilities are equipped with supplies and services to manage cases of SGBV such as PEP-HIV, emergency contraception and forensic evidence.

Additionally, the violence women have experienced can have serious long-term psychological consequences, including insomnia, depression, post-traumatic stress disorder, and suicidal ideation. These symptoms can have debilitating effects on one's day- to-day living. It is essential that psychosocial counselling services are made available to survivors of SGBV.

Enforcement of Resolutions and Legislation on SGBV

In recent years, Uganda has adopted a number of resolutions that criminalizes sexual and gender-based crimes, and encourages the support of victims. Uganda has adopted the following protocols: the UN Resolution 1325 in 2000, the African Union Protocol on women's rights in 2003; and, in 2006 the Protocol on the Prevention and Suppression of Sexual Violence against Women and Children (New Vision, 2007). The issue, then, is not whether the legal rights of women have been acknowledged at the legislative level, but rather whether the mechanisms to ensure the safeguarding of

Isis-Women's International Cross Cultural Exchange (Isis-WICCE) is a global action oriented women's organisation that promotes justice and empowerment of women globally through documenting violations of women's rights and facilitating the exchange of information and skills, to strengthen women's capacities, potential, and visibility. More on the organization can be found at www.isis.or.ug 93 women's rights are embraced at the prescriptive level. In order to address this gap, there needs to be a joint effort among all stakeholders to work together to advocate and realize the implementation of SGBV prevention strategies.

Reintegration

Reintegration in a post-conflict society normally refers to demobilised combatants returning to their home communities, but reintegration is also a process that survivors of sexual violence, who are often alienated and stigmatized after an assault, need assistance in achieving. The reintegration for survivors should include two key aspects: one, helping women achieve acceptance in their community. A challenging task, this can be assisted through community education initiatives that focus on the effects of SGBV on the survivor and their family members, as well as emphasizes that the onus of the assault does not rest on the survivor or her male kin. Two, assisting women in developing sustainable livelihood activities, education and vocational training programmes are important in achieving this end.

One of the inherent challenges in the implementation and operation of development programmes is the matter of finances. This issue is particularly salient in post-conflict settings where government resources were primarily directed to the conflict efforts. Bearing this constraint in mind the recommendations proposed are financially conservative strategies that reduce costs by calling for the expansion of existing programmes and community involvement. Of course this does not completely resolve financial barriers.

In terms of the availability of finances, at the moment there is a significant amount of funds entering the country to assist in the peace-building and reconstruction efforts in the form of international humanitarian aid, loans and charitable donations. For example, the conflict-affected district of Gulu in northern Uganda, best known in Canada for the fund-raising initiative called the Gulu Walk, has the highest concentration of international NGOs in the region. The saturation of NGOs, poor communication and coordination among them and the lack of consultation with community members as to 94 their needs and best practices has resulted in the duplication of services in this district to the neglect of neighbouring communities. Therefore, my recommendations also call for the improved operations and accountability measures of existing NGOs. The reality is that aid and humanitarian services do work if directed to sound institutions

Final Remarks

The findings of this study demonstrate the magnitude of these problems and the urgency in which they must be addressed. As long as laws, socio-cultural norms and practices continue to discriminate against women, their participation in the fragile transition from conflict to peace in this region will not be realized.

Quite often literature that examines the impact of conflict on the lives of women is limited to the 'victim' narrative. During my process of writing this thesis I struggled with this issue. The challenge for me has been making sure that I adequately portray the egregious violations women experience in conflict-affected communities in a manner that conveys women's resilience, despite the accounts of suffering. I would like to end this thesis highlighting to the reader that the experiences of SGBV does not define the survivor. In addition, I ask that it is not a woman's victimization that is remembered but her spirit of survival. 95

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