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Logie CH, Newman PA, Admassu Z, MacKenzie F, Chakrapani V, Tepjan S, Shunmugam M, Akkakanjanasupar P. Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings. Glob Ment Health (Camb) 2024; 11:e31. [PMID: 38572259 PMCID: PMC10988155 DOI: 10.1017/gmh.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand. Methods This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes. Results Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience. Conclusion Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Peter A. Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Pakorn Akkakanjanasupar
- Department of Educational Policy, Management, and Leadership, Faculty of Education, Chulalongkorn University, Bangkok, Thailand
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Logie CH, Okumu M, Admassu Z, Perez-Brumer A, Ahmed R, Luna ML, MacKenzie F, Kortenaar JL, Berry I, Hakiza R, Katisi B, Musoke DK, Nakitende A, Batte S, Kyambadde P, Taing L, Giordana G, Mbuagbaw L. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 2024; 28:507-523. [PMID: 38048017 DOI: 10.1007/s10461-023-04240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.
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Affiliation(s)
- Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada.
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Marianne Lahai Luna
- Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | | | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda
| | - Peter Kyambadde
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
| | - Lina Taing
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
| | - Gio Giordana
- World Food Programme East Africa, Nairobi, Kenya
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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