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Disasters and gender-based violence (GBV) are interconnected factors that increase the risk of exploitation and hinder recovery for trafficking survivors. In Uganda, frequent climate-related disasters coexist with widespread GBV, undermining livelihoods, eroding social protective measures, and creating cumulative stressors that may increase vulnerability to human trafficking and mental health problems. While literature is increasingly recognizing these relationships, there are still paucity of empirical studies on the interactions between disaster exposure, GBV, trafficking vulnerability, and mental health outcomes among survivors of human trafficking in low-resource settings. This study examines the independent, interactive, and mediated pathways linking disaster exposure and GBV to human trafficking vulnerability and mental health.
Methods
We analyzed cross-sectional data (16th –30th January 2025) from 350 female survivors of human trafficking aged 18–35 years receiving services at seven sites in Kampala. Trained female interviewers administered face-to-face interviews, using a five-item lifetime disaster checklist, a WHO/DHS-adapted seven-item GBV module (in the past 12 months), a modified Adult Human Trafficking Screening Tool capturing current HTV, and mental health (MH) assessed via a z-scored composite of GAD-7, PHQ-9, and PCL-5 (Cronbach’s α=0.89). Adjusted prevalence ratios (aPRs) were estimated using a modified Poisson regression model with robust variance. GBV×disaster interaction was tested, and nonparametric bootstrap causal mediation decomposed total, direct, and indirect effects via HTV, adjusting for socio-demographic were generated using Stata software version 18.0.
Results
Mental Health (MH) symptoms were prevalent (48.9%). Exposure to natural disasters 53.4% of the study sample; GBV prevalence was 90.3%. Exposure to natural disasters was associated with higher HTV (aPR=1.26, 95% CI 1.03–1.54). GBV was strongly associated with poorer MH (aPR=2.48, 95% CI 1.19–5.19). After adjustment, ED was inversely associated with MH (aPR=0.68, 95% CI 0.49–0.93). The GBV×disaster interaction predicted worse MH outcomes (aPR=1.10, p<0.001). Mediation indicated a GBV total effect on MH of 0.39 (95% CI 0.28–0.51), comprising a direct effect of 0.25 (0.13–0.37) and an indirect effect via HTV of 0.14 (0.08–0.20).
Conclusion
Among Ugandan women survivors of human trafficking, GBV imposes a substantial, partly HTV-mediated burden on MH, whereas disasters appear to exacerbate mental health (MH) distress primarily through interaction with GBV. Embedding trauma-informed MH care within GBV services and integrating anti-trafficking safeguards into disaster preparedness are urgent priorities for prevention and survivor reintegration.