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Abu-Ba'are GR, Torpey K, Guure C, Nelson LE, Jeon S, McMahon J, Leblanc NM, Shamrock OW, Zigah EY, Apreku A, Dakpui HD, Agbemedu GRK, Boakye F, Adu P, Attisoe A, Adjaka G. Status-neutral community-based multilevel intervention to address intersectional stigma and discrimination, and increase HIV testing, PrEP, and ART uptake among YGBMSM in Ghanaian Slums: A clustered randomized control trial protocol. RESEARCH SQUARE 2024:rs.3.rs-4486078. [PMID: 38854081 PMCID: PMC11160908 DOI: 10.21203/rs.3.rs-4486078/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background While GBMSM constitute less than 2% of Ghana's population, their HIV prevalence surpasses the national average by more than eightfold, emphasizing the critical need for targeted interventions to improve detection, care linkage, and reduce community transmission. This study seeks to increase HIV testing, Pre-Exposure Prophylaxis (PrEP), and Antiretroviral Therapy (ART) uptake (HPART) among YGBMSM through the adaptation of an evidence-based intervention (LAFIYA). Methodology We will employ the ADAPTT-IT framework to adapt LAFIYA and evaluate its feasibility and effectiveness in addressing intersectional stigma and increasing HPART uptake among YGBMSM residing in Ghanaian slums. In aim 1, we will hold focus groups (n=5) and interviews (n=20) among YGBMSM and two FGDs among GBMSM-led organizations. At the HCF level, we will hold 6 FGDs and interviews (n=20) among nurses. In AIM 2, we will randomly assign 6 healthcare facilities (HCFs) to receive the LAFIYA (n=3) or wait-list control (n=3). Friend groups (cluster) of YGBMSM (N=240) will be assigned to receive LAFIYA (n=120) or a wait-list control (n=120). We will collect 3-, 6-, and 9-months post-intervention data among YGBMSM(n=240) and HCWs(n=300) to measure HPART adherence (primary outcomes), ISD reduction, HIV and status-neutral knowledge (secondary outcomes), and intervention acceptability, appropriateness, and feasibility (implementation outcomes). Conclusion The intervention group will observe increased HPART adherence, reduced ISD, and enhanced HPART knowledge and efficacy relative to the wait-list control group. The findings will inform ISD reduction and HIV status-neutral implementation strategies - and place-based interventions that address access to HIV prevention and care among YGBMSM, slum and in different settings. Trail Registration This study was registered on clinicalTrail.gov, with identifier number NCT06312514 on 03/14/2023. https://classic.clinicaltrials.gov/ct2/show/NCT06312514.
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Affiliation(s)
- Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Sangchoon Jeon
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Osman Wumpini Shamrock
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Amos Apreku
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Henry Delali Dakpui
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | | | - Prince Adu
- Priorities on Rights and Sexual Health, Accra, Ghana
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Lee N, Self-Brown SR, Bachman G, Howard AL, Gilbert LK, Hegle J, Perry EW, Saul J, Behl I, Massetti GM. Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey. PSYCHOL HEALTH MED 2024; 29:655-669. [PMID: 37434351 PMCID: PMC10782587 DOI: 10.1080/13548506.2023.2235280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18-24 years old) from Lesotho's 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01-1.46) and HIV (aOR, 1.69; 95% CI, 1.24-2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02-2.02), male sex (aOR, 1.74; 95% CI, 1.27-2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14-1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09-2.39), female (aOR, 3.08; 95% CI, 2.14-4.42) and double orphans (aOR, 2.54; 95% CI, 1.56-4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.
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Affiliation(s)
- NaeHyung Lee
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
- Copial Business Strategists LLC, Atlanta, GA, USA
- Office of Strategy and Innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon R. Self-Brown
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | - Ashleigh L. Howard
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah K. Gilbert
- Office of Safety, Security, and Asset Management, Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Hegle
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth W. Perry
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Janet Saul
- Office of the Global AIDS Coordinator and Health Diplomacy, US Department of State, Washington, DC, USA
| | - India Behl
- School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Behzadifar M, Ehsanzadeh SJ, Darvishi Teli B, Azari S, Bakhtiari A, Behzadifar M. Prevalence of HIV in slums area: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:52. [PMID: 38183027 PMCID: PMC10770918 DOI: 10.1186/s12879-023-08877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations. METHODS A rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle-Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I2 test. Publication bias was also assessed using Egger's test. Additionally, subgroup analysis was performed to explore potential factors contributing to the observed heterogeneity. RESULTS A systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI: 7-13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI: 8-19%, 18 studies: I2 = 98%), as opposed to men, where the prevalence was found to be 8% (95% CI: 6-12%, 16 studies: I2 = 95%). A geographical breakdown of the included studies revealed that Africa exhibited the highest prevalence, with a figure of 11% (95% CI: 9-13%, 18 studies: I2 = 98%). Subsequently, studies conducted in the American continent reported a prevalence of 9% (95% CI: 7-11%, 2 studies: I2 = 57%). The Asian continent, on the other hand, displayed the lowest prevalence of 1% (95% CI: 0-3%, 2 studies: I2 = 94%). Notably, studies employing rapid tests indicated a prevalence of 13% (95% CI: 9-17%, 6 studies: I2 = 94%), while those relying on self-reported data reported a lower prevalence of 8% (95% CI: 5-11%, 6 studies: I2 = 99%). Moreover, studies utilizing ELISA reported a prevalence of 9% (95% CI: 6-12%, 10 studies: I2 = 96%). Finally, it was determined that studies conducted in upper-middle-income countries reported a higher prevalence of 20% (95% CI: 16-24%, 5 studies: I2 = 45%), whereas studies conducted in lower- and middle-income countries reported a prevalence of 8% (95% CI: 6-10%, 12 studies: I2 = 98%). CONCLUSION The current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.
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Affiliation(s)
- Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Seyed Jafar Ehsanzadeh
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Banafshe Darvishi Teli
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Samad Azari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Bakhtiari
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Okumu M, Logie CH, Chitwanga AS, Hakiza R, Kyambadde P. A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda: a community-based cross-sectional study. Confl Health 2023; 17:38. [PMID: 37599369 PMCID: PMC10440931 DOI: 10.1186/s13031-023-00531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Adverse socio-cultural factors compromise the implementation of HIV prevention strategies among displaced youth. While condoms are an affordable and effective HIV prevention strategy for youth, stigma and inequitable gender norms may constrain condom self-efficacy (i.e., knowledge, intentions, and relationship dynamics that facilitate condom negotiation) and use. Further, knowledge of contextually appropriate HIV prevention approaches are constrained by limited understanding of the socio-cultural conditions that affect condom self-efficacy and use among displaced youth. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among displaced youth living in urban slums in Kampala, Uganda. METHODS We conducted a community-based cross-sectional survey of displaced youth aged 16-24 years living in five slums in Kampala. We used multivariable logistic regression and multivariate linear regression to assess independent and two-way interactions among adverse socio-cultural factors (adolescent sexual and reproductive health-related stigma [A-SRH stigma], perceived HIV-related stigma, and beliefs in harmful inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural factors; conducted regression analyses to create unique profiles of adverse socio-cultural factors; and then assessed joint effects of adverse socio-cultural factors on condom self-efficacy and practices. RESULTS Among participants (mean age: 19.59 years; SD: 2.59; women: n = 333, men: n = 112), 62.5% were sexually active. Of these, only 53.3% reported recent consistent condom use. Overall, 42.73% of participants reported two co-occurring adverse socio-cultural factors, and 16.63% reported three co-occurring exposures. We found a joint effect of beliefs in harmful inequitable gender norms with high A-SRH stigma (β = - 0.20; p < 0.05) and high A-SRH stigma with high perceived HIV stigma (β = - 0.31; p < 0.001) on reduced condom self-efficacy. We found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR = 0.52; 95% CI 0.28, 0.96) on recent consistent condom use. Additionally, we found that condom self-efficacy (aOR = 1.01; 95% CI 1.05, 1.16) and safer sexual communication (aOR = 2.12; 95% CI 1.54, 2.91) acted as protective factors on inconsistent condom use. CONCLUSIONS Displaced youth living in urban slums exhibited low consistent condom use. Intersecting stigmas were associated with lower condom self-efficacy-a protective factor linked with increased consistent condom use. Findings highlight the importance of gender transformative and intersectional stigma reduction approaches to increase sexual agency and safer sex practices among Kampala's slum-dwelling displaced youth.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA.
- School of Social Sciences, Uganda Christian University, Mukono, Uganda.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
- United Nations University Institute for Water, Environment, and Health (UNU-INWEH), 204-175 Longwood Rd S, Hamilton, ON, L8P 0A1, Canada
| | - Anissa S Chitwanga
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W. Nevada St., Urbana, IL, 61801, USA
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | - Peter Kyambadde
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- Most at Risk Population Initiative, Mulago Hospital, Kampala, Uganda
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Ssekamatte T, Nalugya A, Mugambe RK, Wagaba B, Nakalembe D, Mutebi A, Bagonza RA, Tigaiza A, Kansiime WK, Ssempala R, Wafula ST, Isunju JB, Buregyeya E. Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. BMC Public Health 2023; 23:801. [PMID: 37131127 PMCID: PMC10152422 DOI: 10.1186/s12889-023-15679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. METHODS A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered. RESULTS About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04-1.34), being 20-24 years of age (PR: 1.22, 95% CI: 1.04-1.44), being married (PR 1.15, 95% CI: 1.01-1.31) or divorced/separated (PR 1.43, 95% CI: 1.26-1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99-1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79-1.03) and using alcohol (PR 1.43, 95% CI: 1.25-1.69), marijuana (PR 1.16, 95% CI: 1.02-1.31) and khat (PR 1.25, 95% CI: 1.10-1.42) in the last 30 days. CONCLUSION The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20-24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.
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Affiliation(s)
- Tonny Ssekamatte
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Richard K. Mugambe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Brenda Wagaba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Doreen Nakalembe
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, P.o Box 7072, Kampala, Uganda
| | - Richard Asaba Bagonza
- School of Women & Gender Studies, College of Humanities and Social Sciences, Makerere University, P.o Box 7062, Kampala, Uganda
| | - Arnold Tigaiza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Winnifred K. Kansiime
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Richard Ssempala
- Department of Economic Theory and Analysis, School of Economics, College of Business and Management Sciences, Makerere University, P.o Box 7062, Kampala, Uganda
| | - Solomon T. Wafula
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University , P.o Box 7072, Kampala, Uganda
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Ssekamatte T, Mugambe RK, Nalugya A, Isunju JB, Matovu JK, Kansiime WK, Balugaba BE, Oputan P, Tigaiza A, Wafula ST, Kibira SP, Wanyenze RK. Predictors of consistent condom use among young psychoactive substance users in Kampala's informal settlements, Uganda. DIALOGUES IN HEALTH 2022; 1:100080. [PMID: 38515898 PMCID: PMC10953897 DOI: 10.1016/j.dialog.2022.100080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 03/23/2024]
Abstract
Introduction The use of psychoactive substances increases the likelihood of unprotected sexual intercourse with individuals whose health status is not known, and consequently sexually transmitted infections, especially among young people. Despite this risk, there is limited evidence of the predictors of consistent condom use among young psychoactive substance users (YPSUs) in informal settings. This study examined the predictors of condom use among YPSUs in Kampala's informal settlements, Uganda. Methods A cross-sectional study was conducted among 768 YPSUs. Respondent-driven sampling was used to recruit respondents. A structured questionnaire was used to collect respondent data on condom use. Data were analysed using Stata version 15.0. Prevalence ratios (PR) were used to determine the predictors of consistent condom use. Results Out of the 744 YPSUs, only 37.4% of the respondents reported consistent condom use in the last 30 days. The prevalence of condom use was statistically lower among young people aged 20-24 years (35.4%) compared to those aged 18-19 years (43.7%), and among the married (17.3%) compared to respondents with a "single" marital status (43.0%). Being married (PR 0.42, 95% CI: 0.30-0.59), longer duration between meeting the most recent partner and having initial sexual contact with them (7 months to 1 year: PR 0.56, 95% CI: 0.36-0.88; more than a year: PR 0.36, 95% CI: 0.17-0.75) was negatively associated with consistent condom use. Spending less than 24 h between meeting the most recent partner and having initial sexual contact was positively associated with consistent condom use (PR 1.60, 95% CI: 1.24-2.08). Conclusion The prevalence of consistent condom use in the last 30 days among YPSUs was low. Marital status and the duration between meeting the most recent partner and initial sexual contact predicted consistent condom use. There is a need to intensify awareness on the importance of consistent condom use among young people.
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Affiliation(s)
- Tonny Ssekamatte
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Richard K. Mugambe
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Aisha Nalugya
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - John Bosco Isunju
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Joseph K.B. Matovu
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Winnie K. Kansiime
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Bonny E. Balugaba
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Patience Oputan
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Arnold Tigaiza
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Solomon Tsebeni Wafula
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Simon P.S. Kibira
- Makerere University College of Health Sciences, School of Public Health, Department of Community Health and Behavioural Sciences, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
| | - Rhodah K. Wanyenze
- Makerere University College of Health Sciences, School of Public Health, Department of Disease Control and Environmental Health, New Mulago Gate Rd, P.o Box 7072, Kampala, Uganda
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Whitton A, Swahn MH, Culbreth R, Kasirye R. Attitudes and risky sexual behavior among youth in Kampala, Uganda: Empirical analyses of risk factors by gender. PEC INNOVATION 2022; 1:100090. [PMID: 36532298 PMCID: PMC9757820 DOI: 10.1016/j.pecinn.2022.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study sought to examine gender differences and the influence of peer and parental perceptions on sexual risk behaviors among an at-risk sample of youth living in Kampala, Uganda. METHODS Using the cross-sectional Kampala Youth Survey (2014) based in Kampala, Uganda (n = 1134), bivariate and multivariable logistic regressions were conducted to determine the odds of sexual risk behaviors based on peer and parental influence variables and gender. RESULTS The perceptions of peer, adult, and parental opinions on sexual activity were significantly associated with varying levels across all risky sexual behaviors explored. When indexed and adjusted for other variables, females compared to males were at increased odds of participating in 3-4 risky sexual behaviors (OR: 0.63, 95% CI: 0.44, 0.90) and 5-6 risky sexual behaviors (OR: 0.38, 95% CI: 0.21, 0.68) compared to zero risky sexual behaviors. CONCLUSIONS Adolescent sexual risk behaviors are subject to peer and parental influence and vary between genders. INNOVATION This study emphasizes the importance of peer influences in adolescent sexual risk behaviors. Many of these youth are orphans, which may explain the lack of association between parental influences and sexual risk behavior. School-based and community-based interventions may be effective at preventing risky sexual behaviors for this vulnerable population.
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Affiliation(s)
- Alaina Whitton
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Rachel Culbreth
- Toxicology Investigators Consortium, American College of Medical Toxicology, Phoenix, AZ, USA
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Swahn MH, Robow Z, Balenger A, Staton CA, Kasirye R, Francis JM, Komba S, Siema P. Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14979. [PMID: 36429695 PMCID: PMC9690202 DOI: 10.3390/ijerph192214979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work. METHODS We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey. RESULTS In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score. CONCLUSIONS Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.
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Affiliation(s)
- Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Zakaria Robow
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Adelaide Balenger
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Rogers Kasirye
- Uganda Youth Development Link, Kampala P.O. Box 12659, Uganda
| | - Joel M. Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sophia Komba
- East Africa Alcohol Policy Alliance, Dar es Salam, Tanzania
| | - Patterson Siema
- African Population and Health Research Center, Nairobi 00100, Kenya
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Patterson AQ, Culbreth R, Kasirye R, Kebede S, Bitarabeho J, Swahn MH. Self-rated physical health, health-risk behaviors, and disparities: A cross-sectional study of youth in the slums of Kampala, Uganda. Glob Public Health 2022; 17:2962-2976. [PMID: 34882514 PMCID: PMC9177902 DOI: 10.1080/17441692.2021.2007974] [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] [Received: 11/25/2020] [Accepted: 10/30/2021] [Indexed: 12/15/2022]
Abstract
Self-rated physical health (SRPH) has been extensively used to assess health status. In this study, we examine how youth living in the slums of Kampala perceive their physical health and the psychosocial correlates of poor health. Cross-sectional data from the 2014 Kampala Youth Survey (N = 1,134) of youth ages 12-18 years was used to conduct the analyses. Chi-square tests and logistic regression analyses were conducted to determine associations between SRPH, demographic and psychosocial characteristics. Overall, 72% of youth rated their health as 'excellent' or 'good.' Poor SRPH was associated with older age and lower education, but not with sex. Also, orphans (OR = 2.03; 95%CI:1.51-2.72), those who lived on the streets (OR=3.09; 95%CI:2.30-4.15), who did not have electricity (OR = 2.83;95%CI:2.12-3.78), who initiated alcohol use early (OR = 2.08; 95%CI:1.47-2.94), who frequently get drunk (OR = 5.67; 95%CI:2.69-11.96), who were HIV positive (OR = 2.18; 95%CI:1.47-3.23), who had been injured due to their drinking (OR = 2.09; 95%CI:1.44-3.03), who thought about hurting themselves (OR = 2.09; 95%CI:1.60-2.73), and those who often felt lonely (OR = 2.54; 95%CI:1.61-4.02) had higher odds of poor SRPH compared to their peers without these characteristics. Poor SRPH may serve as a marker for multiple health-risk behaviors and severe health disparities among youth in vulnerable and resource-limited settings.
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Affiliation(s)
- Annabel Q. Patterson
- Department of Population Health Sciences, School of Public Health, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Apollo Kaggwa Rd, PO Box 12659, Kampala, Uganda
| | | | - Jackson Bitarabeho
- Childen’s AIDS Fund Uganda, Plot 36, Ntinda II Road, P.O. Box 7633, Kampala, Uganda
| | - Monica H. Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, PO Box 3984, Atlanta, Georgia 30302, USA
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University. 520 Parliament Garden Way, Kennesaw, GA 30144, USA
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Swahn MH, Nassaka J, Nabulya A, Palmier J, Vaught S. A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18-24 Living in the Urban Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12935. [PMID: 36232235 PMCID: PMC9566181 DOI: 10.3390/ijerph191912935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
This paper examines the link between place and mental health using a qualitative assessment and focus group discussion with young women, ages 18 to 24 years of age, residing in three slums in Kampala, Uganda. The assessment, conducted in August of 2022, engaged 15 women who participated in Uganda Youth Development Drop-in center activities. The objective was to assess mental health and the link between place and mental health. Facilitated group discussions and photograph review yielded the following results. In terms of understanding their views of mental health and wellbeing, participants clearly focused on feelings. However, they also assessed resilience, the environment and a person's choice as relating to their mental health. Participants also found the physical spaces related to sports, education, worship, workplaces and green space to be linked to happiness. In terms of the attributes that were linked to sadness, participants listed the physical locations where drugs are sold, clubs for dancing and partying and also sanitation issues in the community. Participants frequently reported on the social environment and reflected on harassment, discrimination, alcohol use and criminal behavior that did not reflect a specific physical space, but rather the embedded social interactions they may face or observe by living in close proximity to hotspots for criminal activity. Given the dire shortages of mental health services and care that are available in this setting, a better understanding of young women's perceptions of place and mental health will be key for low-cost interventions and strategies to mitigate the contextual factors that may exacerbate mental illness.
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Affiliation(s)
- Monica H. Swahn
- Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | | | - Anna Nabulya
- Uganda Youth Development Link, Kampala P.O. Box 12659, Uganda
| | - Jane Palmier
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Seneca Vaught
- Interdisciplinary Studies, Radow College of Humanities and Social Sciences, Kennesaw State University, Kennesaw, GA 30144, USA
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11
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Logie CH, Okumu M, Latif M, Parker S, Hakiza R, Kibuuka Musoke D, Mwima S, Batte S, Kyambadde P. Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda. AIDS Behav 2022; 26:2191-2202. [PMID: 35098391 PMCID: PMC9162965 DOI: 10.1007/s10461-021-03567-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/01/2022]
Abstract
Despite the global phenomenon of refugee urbanization, little is known of relational contexts that shape HIV testing among urban refugee youth. We explored perspectives, experiences, and preferences for social support in HIV testing among refugee youth aged 16-24 in Kampala, Uganda. We conducted five focus groups with refugee youth (n = 44) and five in-depth key informant interviews. Participant narratives signaled relational contexts shaping HIV testing included informal sources (intimate partners and family members) and formal sources (peer educators and professionals). There was heterogeneity in perspectives based on relationship dynamics. While some felt empowered to test with partners, others feared negative relationship consequences. Participant narratives reflected kinship ties that could facilitate testing with family, while others feared coercion and judgment. Peer support was widely accepted. Professional support was key for HIV testing as well as conflict-related trauma. Findings emphasize bonding and bridging social capital as salient components of enabling HIV testing environments.
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Perry EW, Culbreth R, Self-Brown S, Gilmore AK, Kasirye R, Musuya T, Ndetei D, Swahn MH. Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022; 53:83-110. [PMID: 38577222 PMCID: PMC10989775 DOI: 10.1080/00207411.2022.2073755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12 to 18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12 to 18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience.
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Affiliation(s)
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | | | - Amanda K Gilmore
- School of Public Health, National Center for Sexual Violence Prevention, Georgia State University, Atlanta, GA USA
| | | | - Tina Musuya
- Center for Domestic Violence Prevention, Kampala, Uganda
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Africa Mental Health Foundation, Nairobi, Kenya
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA USA, School of Public Health, Georgia State University, Atlanta, GA USA
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Abstract
The current study examines the prevalence of depression, anxiety, suicide risk, and PTSD in Ugandan youth (13-25 years) attending vocational training programs. Youth from five urban (n=224 females, 81 males) and four rural (n=153 females only) vocational training centers operated by a non-governmental organization completed demographic and mental health questionnaires. Nearly half of the youth reported moderate or severe depression and/or anxiety. More than half reported anxiety and depression-related impairment. Nearly a quarter of youth had considered or attempted suicide. More than half screened positive on the PC-PTSD screen. Rural female youth reported the most food insecurity (56.9%), trafficking (37.9%), severe depression (35.9%), depression-related impairment (56.9%), severe anxiety (26.1%), and anxiety-related impairment (55.6%). Results from this study suggest that Ugandan youth have exceedingly high rates of depression, anxiety, suicide risk, and probable PTSD. Rural female youth may be especially at risk. Relevant treatment interventions are needed that can be adapted to youth in vocational training centers.
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Lunkuse JF, Kamacooko O, Muturi-Kioi V, Chinyenze K, Kuteesa MO, Price MA, Mayanja Y. Low awareness of oral and injectable PrEP among high-risk adolescent girls and young women in Kampala, Uganda. BMC Infect Dis 2022; 22:467. [PMID: 35578163 PMCID: PMC9109298 DOI: 10.1186/s12879-022-07398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) account for a disproportionate number of new HIV infections worldwide. HIV prevalence among young sex workers in Uganda is 22.5%. Although pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, awareness of PrEP among AGYW in Uganda has not been studied systematically. We aimed to assess awareness of PrEP and factors associated with awareness of PrEP among AGYW who frequently reported paid sex. METHODS We conducted a cross-sectional study among 14-24-year old AGYW at high risk of HIV infection in Kampala, Uganda from January to October 2019. Participants were screened for PrEP eligibility using a national screening tool of whom 82.3% were eligible. Data on socio-demographics, behavioral and sexual risks were collected by interview. Awareness of oral or injectable PrEP, the latter of which is currently in late-stage trials, was defined as whether an individual had heard about PrEP as an HIV prevention method. Multivariable robust poisson regression model was used to assess factors associated with oral PrEP awareness. RESULTS We enrolled 285 participants of whom 39.3% were under 20 years old, 54.7% had completed secondary education, 68.8% had multiple sex partners in the past 3 months, 8.8% were screened as high risk drinkers'/ alcohol dependent (AUDIT tool) and 21.0% reported sex work as main occupation. Only 23.2% were aware of oral PrEP and 3.9% had heard about injectable PrEP. The prevalence of oral PrEP awareness was significantly higher among volunteers screened as alcohol dependents (aPR 1.89, 95% CI 1.08-3.29) and those with multiple sexual partners (aPR 1.84, 95% CI 1.01-3.35), but was lower among those who reported consistent condom use with recent sexual partners (aPR 0.58, 95% CI 0.37-0.91). CONCLUSIONS Majority of AGYW were not aware of any kind of PrEP. Those with higher risk behavior, i.e. alcohol dependents or multiple sexual partners, were more aware of oral PrEP. Interventions to increase awareness among female youth are needed. Improving PrEP awareness is critical to increasing PrEP uptake among high-risk AGYW in Uganda.
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Affiliation(s)
- Jane Frances Lunkuse
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, 256 Uganda
| | - Onesmus Kamacooko
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, 256 Uganda
| | | | | | | | - Matt A. Price
- grid.420368.b0000 0000 9939 9066IAVI, 125 Broad St, New York, NY 10004 USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA 94143 USA
| | - Yunia Mayanja
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, 256 Uganda
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15
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Swahn MH, Palmier JB, May A, Dai D, Braunstein S, Kasirye R. Features of alcohol advertisements across five urban slums in Kampala, Uganda: pilot testing a container-based approach. BMC Public Health 2022; 22:915. [PMID: 35534847 PMCID: PMC9082884 DOI: 10.1186/s12889-022-13350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high prevalence of alcohol use and marketing in many settings across sub-Saharan Africa, few studies have systematically sought to assess alcohol marketing exposure, particularly in vulnerable areas such as urban slums where alcohol is often highly prevalent but where educational programs and alcohol prevention messages are scarce. OBJECTIVE To pilot test the development and implementation of environmental scans of alcohol advertisements in five urban slums across different areas of Kampala, Uganda: Bwaise, Kamwokya, Makindye, Nakulabye, and Nateete. METHODS Each of the five scans was conducted in geographical circles, within a 500-m radius of a Uganda Youth Development Link (UYDEL) drop-in Center using a container-based approach. Using a Garmin GPS with photo capabilities and a tablet for data entry, teams of at least two trained researchers walked the main roads within the target area and gathered information about each alcohol advertisement including its location, type, size, and placement and other characteristics. Data with the GPS coordinates, photos and descriptive details of the adverts were merged for analyses. RESULTS A total of 235 alcohol adverts were found across all five data collection sites reflecting 32 different brands. The majority of the adverts (85.8%) were smaller and medium sizes placed by restaurants and bars, stores and kiosks, and liquor stores. The most frequently noted types of alcohol in the adverts were spirits (50.6%) and beer (30.6%). RECOMMENDATIONS The pilot test of the methodology we developed indicated that implementation was feasible, although challenges were noted. Since monitoring alcohol marketing is key for addressing underage alcohol use and harm, the advantages and disadvantages of the approach we developed are discussed. Future research needs to strengthen and simplify strategies for monitoring alcohol marketing in low-resource settings such as urban slums which have unique features that need to be considered. Meanwhile, the findings may yield valuable information for stakeholders and to guide intervention developments and alcohol marketing policy to protect youth.
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Affiliation(s)
- Monica H Swahn
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA. .,Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, 30144, USA.
| | - Jane B Palmier
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, 30144, USA
| | - Alicia May
- School of Public Health, University of Georgia, Athens, GA, USA
| | - Dajun Dai
- Department of Geosciences, Georgia State University, P.O. Box 4105, Atlanta, GA, 30302, USA
| | - Sarah Braunstein
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda
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Jennings Mayo-Wilson L, Kang BA, Mathai M, Mak'anyengo MO, Ssewamala FM. Mobile phone access, willingness, and usage for HIV-related services among young adults living in informal urban settlements in Kenya: A cross-sectional analysis. Int J Med Inform 2022; 161:104728. [PMID: 35228007 PMCID: PMC8940651 DOI: 10.1016/j.ijmedinf.2022.104728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile phone-based health (mHealth) interventions have the potential to improve HIV outcomes for high-risk young adults living in informal urban settlements in Kenya. However, less is known regarding young adults' differential access to mobile phones and their willingness and use of mobile phone technologies to access HIV prevention, care, and treatment services. This is important as young adults make up the largest demographic segment of impoverished, informal urban settlements and are disproportionately impacted by HIV. METHODS This study used observational survey data from 350 young adults, aged 18-22, who were living informal urban settlements in Nairobi, Kenya. Respondent driven sampling methods were used to recruit and enroll eligible youth. Using descriptive statistics and logistical regressions, we examined the prevalence of mobile phone access, willingness, and use for HIV services. We also assessed associated demographic characteristics in the odds of access, willingness, and use. RESULTS The mean age of participants was 19 years (±1.3). 56% were male. Mobile phone coverage, including text messaging and mobile internet, was high (>80%), but only 15% of young adults had ever used mobile phones to access HIV services. Willingness was high (65%), especially among those who had individual phone access (77%) compared to lower willingness (18%) among those who shared a phone. More educated (OR = 1.84, 95 %CI:1.14-2.97) and employed (OR = 1.70, 95 %CI:1.02 = 2.83) young adults were also more willing to use phones for HIV services. In contrast, participants living in large households (OR = 0.47, 95 %CI:0.24-0.921), were religious minorities (OR = 0.56, 95 %CI:0.32-0.99), partnered/married (OR = 0.30, 95 %CI:0.10-0.91), or female (OR = 0.29, 95 %CI:0.16-0.55) were significantly less likely to have mobile phone access or usage, limiting their potential participation in HIV-related mHealth interventions. Given the low usage of mobile phones currently for HIV services, no differences in demographic characteristics were observed. CONCLUSION Mobile health technologies may be under-utilized in HIV services for at-risk youth. Our findings highlight the importance of preliminary, formative research regarding population differences in access, willingness, and use of mobile phones for HIV services. More efforts are needed to ensure that mHealth interventions account for potential differences in preferences for mobile phone-based HIV interventions by gender, age, religion, education, and/or employment status.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Sciences, 1025 E. 7th Street, Bloomington, IN 47405, USA; Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Bee-Ah Kang
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Muthoni Mathai
- University of Nairobi, College of Health Sciences, Department of Psychiatry. Kenyatta National Hospital, Off-Ngong Road, Nairobi, Kenya; National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453 Nairobi, Kenya
| | - Margaret O Mak'anyengo
- National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Department of Mental Health, Ralph Bunche Road, P.O. Box 20453 Nairobi, Kenya
| | - Fred M Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, Room 235, Campus Box 1196, One Brookings, Drive, St. Louis, MO 63130, USA.
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Okumu M, Logie CH, Ansong D, Mwima S, Hakiza R, Newman PA. Exploring the Protective Value of Using Sexting for Condom Negotiation on Condom use Determinants and Practices Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda. AIDS Behav 2022; 26:3538-3550. [PMID: 35476165 DOI: 10.1007/s10461-022-03677-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
Given the global growth of adolescent texting, we evaluate texting-based sexual communication as a potential site for interventions encouraging condom use cascades, particularly among displaced adolescents-a population with disproportionate levels of sexually transmitted infections, including HIV. With data from 242 forcibly displaced adolescents in the slums of Kampala, Uganda, we used path analysis to examine pathways from gender/dating relationship to condom determinant (knowledge of where to access condoms) and practices (access/use of condoms), through sexting-based condom negotiation, controlling for sexting practices. We found direct pathways from gender (boys vs. girls) and from dating relationship (dating vs. not) to condom determinant. Sexting-based condom negotiation partially mediated the pathway from gender/dating relationship to condom determinant, and fully mediated the pathways from gender/dating relationship to condom practices. Future digital sexual health interventions should consider the utility of texting-based applications in promoting knowledge and use of condoms among adolescents.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, USA.
- School of Social Sciences, Uganda Christian University, Mukono, Uganda.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, ON, M5S 1V4, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health (UNU- INWEH), 204-175 Longwood Rd S, L8P 0A1, Hamilton, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
- Canada Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - David Ansong
- School of Social Work, University of North Carolina- Chapel Hill, 325 Pittsboro St CB#3550, Chapel Hill, NC, 27599, USA
| | - Simon Mwima
- School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, USA
- AIDS Control Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Nsambya Gogonya, Kampala, Uganda
| | - Peter A Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, ON, M5S 1V4, Toronto, Canada
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Okumu M, Logie CH, Ansong D, Mwima S, Hakiza R, Newman PA. Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale. JMIR Public Health Surveill 2022; 8:e27792. [PMID: 35384852 PMCID: PMC9021939 DOI: 10.2196/27792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/16/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results The one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). Conclusions The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States.,School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - 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
| | - David Ansong
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Simon Mwima
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States.,AIDS Control Program, Ministry of Health, Kampala, Uganda.,Bukedi Prevention Institute, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Peter A Newman
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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19
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Mootz JJ, Odejimi OA, Bhattacharya A, Kann B, Ettelbrick J, Mello M, Wainberg ML, Khoshnood K. Transactional sex work and HIV among women in conflict-affected Northeastern Uganda: a population-based study. Confl Health 2022; 16:8. [PMID: 35216637 PMCID: PMC8876753 DOI: 10.1186/s13031-022-00441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Armed conflict and the HIV pandemic are significant global health issues. Evidence of the association between armed conflict and HIV infection has been conflicting. Our objective was to examine the role of mediating risk factors, such as engagement in transactional sex work, to elucidate the relation between armed conflict and HIV infection. METHODS We used multistage sampling across three Northeastern Ugandan districts to randomly select 605 women aged 13 to 49 to answer cross-sectional surveys from January to May of 2016. We used multivariate logistic regression model with R 4.0.3 to examine if exposure to armed conflict has an indirect effect on reporting having an HIV-positive serostatus through engagement in transactional sex work. Age and district residence were included as covariates. RESULTS Exposure to armed conflict β = .16, SE = .04, p < .05, OR = 1.17, 95% [CI .08, .23] was significantly associated with reporting a HIV-positive serostatus. For each 1-unit increase in exposure to armed conflict (i.e., additional type of armed conflict exposure), there was a 17% increase in the odds of reporting a HIV-positive serostatus. Engagement in transactional sex work was not associated with reporting a HIV-positive serostatus β = .04, SE = .05, p = .37, 95% [CI - .051, .138]. We found district of residence, age, and interaction effects. CONCLUSIONS Although exposure to armed was associated with reporting an HIV-positive serostatus, this relationship was not mediated by engagement in transactional sex. Further research is needed on risk factors that mediate this relationship. The likelihood of reporting a HIV-positive serostatus increased with each additional type of exposure to armed conflict. Thus, screening for exposure to multiple traumatic stressors should occur in HIV prevention settings. Healthcare services that are trauma-informed and consider mental distress would likely improve HIV outcomes.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA.
| | - Omolola A Odejimi
- Educational Psychology, Texas Tech University, 2500 Broadway, Lubbock, TX, 79409, USA
| | | | - Bianca Kann
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Julia Ettelbrick
- The New School, Eugene Lang College, 72 5th Avenue, New York, NY, 10011, USA
| | - Milena Mello
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 171, New York, NY, 10032, USA
| | - Kaveh Khoshnood
- School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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20
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Sexual Victimization, Self-Efficacy to Refuse Sex While Drinking, and Regretting Alcohol-Involved Sex among Underserved Youth in Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041915. [PMID: 35206104 PMCID: PMC8871664 DOI: 10.3390/ijerph19041915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruited from Uganda Youth Development Link drop-in centers were used to conduct the analyses. Multivariable statistics were computed to determine the correlates (i.e., sex, education, homelessness, problem drinking, and SV) for (1) self-efficacy to refuse sex, (2) self-efficacy to refuse sex while drinking, and (3) regretting sex due to alcohol use. Among participants, 16.9% reported SV (79% were female and 21% were male). In the final adjusted model, self-efficacy to refuse sex while drinking was only associated with homelessness (OR: 0.52; 95% CI: 0.36, 0.74). Previous SV was not associated with lower self-reports of self-efficacy to refuse sex compared to those who had not experienced SV. Additionally, SV was not associated with increased reports of regrets for sex attributed to alcohol use. Alcohol prevention strategies for the most at-risk youth, including homeless youth, are warranted to improve self-efficacy to refuse sex among youth living in the slums of Kampala.
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21
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Culbreth R, Swahn MH, Salazar LF, Kasirye R, Musuya T. Intimate Partner Violence and Associated Risk Factors Among Youth in the Slums of Kampala. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP11736-NP11755. [PMID: 31782337 DOI: 10.1177/0886260519889927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The purpose of this study is to examine the factors associated with intimate partner violence (IPV) among youth living in the slums of Kampala. This analysis is based on a cross-sectional study of youth living in the slums of Kampala conducted in spring 2014 (N = 1,134). The participants (12-18 years of age) were attending Uganda Youth Development Link centers, which serve youth living on the streets and slums of Kampala. Bivariate and multivariable multinomial analyses were conducted to examine risk factors associated with IPV victimization only, IPV perpetration only, and both IPV victimization and perpetration compared with no IPV victimization or perpetration. Among youth who reported having a boyfriend or girlfriend (n = 600), 18.3% (n = 110) reported experiencing both IPV victimization and perpetration, 11.0% (n = 66) reported IPV perpetration only, 7.7% (n = 46) reported experiencing IPV victimization only, and 63.0% (n = 378) reported no IPV experiences. In the multivariable analysis, IPV victimization only was associated with witnessing parental IPV (odds ratio [OR] = 2.78; 95% confidence interval [CI] = [1.42, 5.48]), experiencing parental physical abuse (OR = 2.27; 95% CI = [1.16, 4.46]), and neighborhood cohesiveness (OR = 0.73; 95% CI = [0.31, 1.69]). IPV perpetration was only associated with experiencing parental physical abuse (OR = 2.86; 95% CI = [1.62, 5.07]). Reporting both IPV victimization and perpetration was associated with non-problem drinking (OR = 2.03; 95% CI = [1.15, 3.57]), problem drinking (OR = 2.65; 95% CI = [1.48, 4.74]), witnessing parental IPV (OR = 2.94; 95% CI = [1.80, 4.80]), experiencing parental physical abuse (OR = 2.23; 95% CI = [1.38, 3.60]), and homelessness (OR = 1.90; 95% CI = [1.14, 3.16]). Levels of IPV victimization and perpetration are very high in this population and warrant urgent attention.
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Affiliation(s)
| | | | | | | | - Tina Musuya
- Center for Domestic Violence Prevention, Kampala, Uganda
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22
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Swahn MH, Culbreth R, Masyn KE, Salazar LF, Wagman J, Kasirye R. The Intersection of Alcohol Use, Gender Based Violence and HIV: Empirical Findings among Disadvantaged Service-Seeking Youth in Kampala, Uganda. AIDS Behav 2021; 25:3106-3114. [PMID: 33988783 PMCID: PMC8120497 DOI: 10.1007/s10461-021-03301-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the “Kampala Youth Survey 2014,” a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV.
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Affiliation(s)
- Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, 520 Parliament Garden Way, Kennesaw, GA 30144 USA
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA 30302-4019 USA
| | - Katherine E. Masyn
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Laura F. Salazar
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Jennifer Wagman
- Fielding School of Public Health, University of California, P.O. Box 951772, Los Angeles, CA 90095-1772 USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda, USA
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23
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Ssekamatte T, Kibira SPS, Tetui M, Isunju JB, Mugambe RK, Wafula ST, Buregyeya E, Nalwadda CK, Bukenya JN, Wanyenze RK. Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in informal settlements in Kampala, Uganda. BMC Public Health 2021; 21:1506. [PMID: 34348701 PMCID: PMC8336356 DOI: 10.1186/s12889-021-11536-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychoactive substance use is a public health challenge among young people in informal settlements. Though rarely examined, psychoactive substance use is linked to sexual expectancies and inhibitions, and consequently high-risk sexual behaviours. This study examined the association between sexual expectancies and inhibitions, and high-risk sexual behaviours among young psychoactive substance users (PSUs) in informal settlements in Kampala, Uganda. METHODS This cross-sectional study recruited 744 young PSUs from informal settlements in Kampala. Respondent driven sampling was used to recruit respondents. A 'modified' Poisson regression model was used for inferential statistics. Data were analysed using the Stata 14 software. RESULTS Of the 744 study participants, 45.6% believed that psychoactive substance use improves sexual performance; 43.3% believed that psychoactive substances make sex more pleasurable, and 53.3% believed that psychoactive substances give courage or confidence to approach a partner for sex. The belief that psychoactive substance use improves sexual performance (PR 1.14, 95% CI: 1.01-1.30), increases the likelihood of engaging in sex (PR 1.20, 95% CI: 1.04-1.40) or gives courage or confidence to approach a sexual partner (PR 1.21, 95% CI: 1.05-1.39) were associated with having sex while under the influence of psychoactive substances. The belief that a psychoactive substance user under the influence of psychoactive substances is more likely to engage in sex (PR 1.48, 95% CI: 1.15-1.90), and likely to find it difficult to refuse sex (PR 1.28, 95% CI: 1.06-1.55) were positively associated with engaging in multiple sexual partnerships. The belief that one easily forgets to use a condom when under the influence of psychoactive substances was positively associated with inconsistent condom use (PR 1.26, 95% CI: 1.09-1.45). CONCLUSION Psychoactive substance use expectancies associated with high-risk sexual behaviours included the belief that psychoactive substances improve sexual performance and improve confidence in approaching a sexual partner. Psychoactive substance use inhibitions associated with high-risk sexual behaviours included an increased likelihood of engaging in sexual intercourse, difficulties in refusing to engage in sexual intercourse, and forgetting to use condoms while intoxicated. Interventions targeting a reduction in high-risk sexual behaviour should integrate the impact of psychoactive substance use on sexual behaviour.
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Affiliation(s)
- Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Moses Tetui
- School of Pharmacy, University of Waterloo, Waterloo, Canada
- Departement of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Richard K. Mugambe
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Christine Kayemba Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Justine Nnakate Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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24
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Tuhebwe D, Babirye S, Ssendagire S, Ssengooba F. The extent to which the design of available reproductive health interventions fit the reproductive health needs of adolescents living in urban poor settings of Kisenyi, Kampala, Uganda. BMC Public Health 2021; 21:933. [PMID: 34001043 PMCID: PMC8130317 DOI: 10.1186/s12889-021-10933-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The rate at which informal urban settlements (slums) are developing in Low and Middle Income. Countries (LMICs) like Uganda is high. With this, comes the growing intersection between urbanization and the reproductive health of key populations. Currently, a number of interventions are being implemented to improve the Reproductive Health (RH) of adolescents in Kisenyi, the largest informal urban settlement in Kampala, the capital of Uganda. Despite these efforts, adolescent RH indicators have persistently remained poor in Kisenyi. This could be indicative of a gap between the provided and needed adolescent RH interventions. We assessed the fit between the available interventions and the RH needs of adolescents living in Kisenyi. METHODS We conducted a qualitative study in July 2019-February 2020 in Kisenyi. The methodology was guided by the Word Health Organization global standards for quality-health care services for adolescents, the "For whom? Where? By whom? and What?" Framework of sexual RH service delivery and the realist evaluation approach. Eight focus group discussions were conducted with adolescents 15-19 years to explore their RH needs. The design and implementation of the available adolescent RH interventions were assessed by conducting Key Informant interviews with 10 RH service providers in Kisenyi. Validation meetings were held with adolescents and they scored the extent to which the various design features of the existing interventions fit the adolescents' RH needs. RESULTS The available RH interventions focused on meeting the sexual RH needs like providing family planning services but less on social needs like livelihood and sanitation which the adolescents identified as equally important. While the providers designed intervention to target 10-24 year olds, the adolescents preferred to have interventions that specifically targeted the study population 15-19 years. Most interventions were facility-based while, the adolescents desired community based outreaches. CONCLUSION The packaging and mode of delivery of interventions were perceived less holistic to meet the adolescents' needs. Most interventions were designed to address the sexual and family planning needs while ignoring the wider social and livelihood needs. More holistic and outreach-based programming that addresses RH within the broader context of livelihood and sanitation requirements are more likely to be effective.
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Affiliation(s)
- Doreen Tuhebwe
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - Susan Babirye
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Steven Ssendagire
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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25
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Nabifo SC, Tsai AC, Bajunirwe F. HIV-related stigma and its association with HIV transmission risk behaviors among boda boda motorcyclists in Mbarara Municipality, southwestern Uganda. Int J STD AIDS 2021; 32:791-798. [PMID: 33769905 DOI: 10.1177/0956462420987760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among boda boda (motorcycle taxi) riders, a key population in Uganda. Methods: We conducted a cross-sectional study among boda boda motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. Results: We enrolled 401 boda boda motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. Conclusions: HIV transmission risk behavior is common among boda boda motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.
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Affiliation(s)
- Stella C Nabifo
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Francis Bajunirwe
- Department of Community Health, 108123Mbarara University of Science and Technology, Mbarara, Uganda
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Self-Brown S, Culbreth R, Wilson R, Armistead L, Kasirye R, Swahn MH. Individual and Parental Risk Factors for Sexual Exploitation Among High-Risk Youth in Uganda. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP3263-NP3284. [PMID: 29685056 DOI: 10.1177/0886260518771685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study examined risk factors to determine associations with commercial sexual exploitation of children and youth (CSEC) in a convenience sample of adolescents living in the slums in Kampala, Uganda. Individual-level factors included demographic, adverse experiences (ever living on the streets; victim of dating violence, parental abuse, or rape), and behavioral risk (social media, alcohol use, age at first intercourse). Parental-risk factors included parent alcohol use and approval attitudes toward youth sex. Analyses included those who self-reported sexually active adolescents (n = 593) of whom 39% reported CSEC history. CSEC was significantly associated with being female (odds ratio [OR] = 6.85, 95% confidence interval (CI) = [4.22, 11.12]), living on the streets (OR = 2.68; 95% CI = [1.65, 4.36]), using social media (OR = 1.48; 95% CI = [0.94, 2.35]), being a victim of physical dating violence (OR = 1.74; 95% CI = [1.08, 2.80]), and ever being raped (OR = 4.03; 95% CI = [2.51, 6.47]). Further analyses suggested differential risk associates among females and males. This study contributes to our knowledge of risk factors for CSEC among adolescents living in high-risk circumstances in low-resource countries and suggests that preventive efforts should prioritize adolescents with a history of living on the streets who engage in social media, use alcohol, and have a history of trauma.
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27
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Culbreth R, Masyn KE, Swahn MH, Self-Brown S, Kasirye R. The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda. CHILD ABUSE & NEGLECT 2021; 112:104904. [PMID: 33385928 PMCID: PMC7855690 DOI: 10.1016/j.chiabu.2020.104904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Youth living in the slums of Kampala face many adversities, such as dire environmental conditions, poverty, and lack of government infrastructure. OBJECTIVE The purpose of this study is to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda. PARTICIPANTS AND SETTING The study sample includes service-seeking youth who were attending Uganda Youth Development Link (UYDEL) drop-in centers in spring 2014 (n = 1134). METHODS Indicators of child maltreatment included parental physical abuse, parental neglect, and sexual abuse. Problematic alcohol use was specified using a hybrid structural equation mixture model that distinguished current drinking status with the frequency and intensity of use among current drinkers. This novel approach is more flexible than restricting our analysis to only drinkers or analyzing only current drinking status. The primary outcome of interest was suicidal ideation. All associations controlled for gender and age, and all associations were estimated simultaneously. All analyses were conducted in SAS 9.4 and Mplus 7.4. RESULTS The overall prevalence of suicidal ideation was 23.5 % (n = 266). Overall, current drinking status (OR: 1.80; 95 % CI: 1.31, 2.46), the child maltreatment sum score (OR: 1.88; 95 % CI: 1.48, 2.39), and sexual abuse (OR: 2.88; 95 % CI: 1.52, 5.47) were statistically significantly associated with reporting suicidal ideation. CONCLUSIONS This study highlights a population that would potentially benefit from prevention efforts not only aimed at suicide prevention but also harm reduction in terms of alcohol use and experiences of child maltreatment.
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Affiliation(s)
- Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302-4019, United States.
| | - Katherine E Masyn
- Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Monica H Swahn
- Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Shannon Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Rogers Kasirye
- Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda
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Darteh EKM, Dickson KS, Amu H. Understanding the Socio-demographic Factors Surrounding Young Peoples' Risky Sexual Behaviour in Ghana and Kenya. J Community Health 2020; 45:141-147. [PMID: 31444777 DOI: 10.1007/s10900-019-00726-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Globally, young people in sub-Saharan Africa continue to be the population at the greatest risk for sexually transmitted infections (STIs) such as HIV and AIDS, Syphilis, and Gonorrhoea. Research has shown significant relationship between young peoples risky sexual behaviours and their vulnerability to these STIs. The study examined risky sexual behaviours among the youth in Ghana and Kenya in relation to socio-demographic characteristics. The paper uses data from the 2014 Demographic and Health Surveys of Ghana and Kenya. Young people between the ages of 15 to 24 years who were not married or living with a man/woman were included in the study. They comprised 2545 females and 1437 males from Ghana and 3546 females and 4317 males from Kenya. Descriptive analyses and binary logistic regression estimation technique were used to analyse the data. While awareness of AIDS was universal among the youth of both countries, utilisation of condoms on last penetrative sex was low. Risky sexual behaviour among young people was significantly associated with age, level of education, wealth status and religion. Among males and females in Ghana, the odds of sexual risk taking behaviour were higher among those who were employed than those who were unemployed. The reverse of this, however, occurred in Kenya, where males and females who were employed were less likely to engage in risky sexual behaviours than their counterparts who were unemployed. Our findings underscore the need for the relevant stakeholders in the two countries; Ministries of Health, Ghana/KenyaHealth Service, and NGOs concerned with sexual and reproductive health of young people, to intensify education on consistent and proper use of condoms and, position condom use as an acceptable behaviour especially among young people who are sexually active; with multiple partners and who may have STIs. Health literacy, which is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions, should be given priority. The governments of the two countries, especially Kenya, should promote youth entrepreneurship to reduce unemployment and strengthen job creation as a way of ensuring that young people engage on productive economic activities. With productive economic activities, females for instance may not have to engage in transactional multiple sexual relationships which is risky and, therefore, predisposes them to STIs such as gonorrhoea and HIV.
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Affiliation(s)
| | | | - Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
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Perry EW, Culbreth R, Swahn M, Kasirye R, Self-Brown S. Psychological Distress Among Orphaned Youth and Youth Reporting Sexual Exploitation in Kampala, Uganda. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105587. [PMID: 33363296 PMCID: PMC7755130 DOI: 10.1016/j.childyouth.2020.105587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Psychological distress is a priority health issue in low- and middle-income countries; however, it is inadequately addressed among vulnerable youth living in extremely underserved communities (i.e., on the streets and in the slums) who are at a high risk of experiencing adversity. The purpose of this study was to compute the prevalence of self-reported psychological distress among youth living in the slums of Kampala, Uganda, and examine how orphan status and commercial sexual exploitation (CSE) are related to youth psychological distress. Analyses are based on a 2014 cross-sectional survey of service-seeking youth (N = 1134) in Kampala, Uganda. Bivariate and multivariable multinomial regression analyses were used to determine associations between orphan status, sexual exploitation, and psychological distress (defined as experiencing the following proxy variables for more complex psychopathology: hopelessness and/or worry). Among all youth participants, 83.2% (n = 937) reported at least one type of psychological distress; 51.3% (n = 578) reported experiencing both types. The reported prevalence of any type of psychological distress was highest among youth who reported experiencing sexual exploitation (91.2%), double orphans (90.0%), and single orphans (83.8%); however, a high prevalence (76.7%) of any type of distress was also found among youth who reported both parents alive. Experiencing both types of distress was associated with being a double orphan (adjusted odds ratio [AOR] = 2.92, 95% confidence interval [CI] = [1.77, 4.81]), reporting CSE (AOR = 2.71, 95% CI = [1.67, 4.41]), and increased age (AOR = 1.31, 95% CI = [1.20, 1.44]). Psychological distress is prevalent among all youth living in the slums of Kampala and is independently associated with being a double orphan and experiencing CSE. These findings underscore the urgent need to intervene with all youth who reside in this particular underserved community, especially those who have lost both parents, and to prevent CSE among this vulnerable, underserved population.
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Affiliation(s)
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Monica Swahn
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Multiple sexual partnerships and associated factors among young psychoactive-substance-users in informal settlements in Kampala, Uganda. PLoS One 2020; 15:e0239323. [PMID: 33021998 PMCID: PMC7537871 DOI: 10.1371/journal.pone.0239323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Multiple sexual partnerships increase the risk of transmission of HIV and can be exacerbated by substance abuse. However, the association between psychoactive substance use and multiple sexual partnerships among young people in informal settlements of low-income countries is not well known. This study established the prevalence of multiple sexual partnerships and associated factors among young psychoactive-substance-users in informal settlements in Kampala, Uganda. METHODS This was a cross-sectional study involving 744 young (aged 18-24 years), sexually active, psychoactive substance-users selected from 12 of the 57 informal settlements of Kampala City. The prevalence of multiple sexual partnerships and their differential distribution by socio-demographic strata was established. Modified Poisson regression models were run in Stata 14 software to generate prevalence rate ratios for the factors associated with multiple sexual partnerships. RESULTS About 40.6% (37.9% of males and 50.0% of females) had engaged in multiple sexual partnerships in the last 30 days. Engaging in multiple sexual partnerships in the last 30 days was positively associated with being female (PR 1.29, 95% CI: 1.03-1.63); staying in the informal settlement for 6-10 years (PR 1.34, 95% CI: 1.02-1.75) and chewing khat in the last 30 days (PR 1.93, 95% CI: 1.10-3.40). CONCLUSION Multiple sexual partnerships are highly prevalent among young psychoactive-substance-users, irrespective of the socio-demographic strata. Being female, having lived in the informal settlement for 6-10 years, and chewing khat were significantly associated with having multiple sexual partners in the last 30 days. In tackling this high-risk sexual behaviour, it is recommended that risk-reduction interventions are considered for the different socio-demographic strata identified in this study, i.e. females, those who have lived in the informal settlement for about 6-10 years, and those who chew khat.
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Laird JJ, Klettke B, Hall K, Clancy E, Hallford D. Demographic and Psychosocial Factors Associated With Child Sexual Exploitation: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2017682. [PMID: 32960280 PMCID: PMC7509625 DOI: 10.1001/jamanetworkopen.2020.17682] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Although research has examined factors associated with child sexual exploitation (CSE), consensus is lacking in regard to which factors should be prioritized, thereby hindering policy reform, prevention efforts, and development of early detection and intervention. OBJECTIVE To provide a meta-analytic synthesis of studies examining factors associated with CSE and to quantify their relative importance. DATA SOURCES Electronic databases searched to June 2019 included Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Informit, yielding 396 nonduplicative records. Literature search was performed in July 2019. STUDY SELECTION Inclusion criteria were quantitative investigations of sexual exploitation and mean sample age of 18 years or younger. DATA EXTRACTION AND SYNTHESIS Literature review and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Thirty-seven studies met final inclusion criteria. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive odds ratios (ORs) for each factor. Data were analyzed from September 1 to October 28, 2019, and prediction intervals calculated in June 2020. MAIN OUTCOMES AND MEASURES Child sexual exploitation, defined as coerced sexual acts between a child or a young person (aged ≤18 years) and an individual or a group in exchange for money, gifts, substances, or other commodities and associated factors. RESULTS Thirty-seven unique studies were included with a total of 67 453 unique participants (mean [SD] age of 16.2 [2.5] years; 49.9% female). Fifty-two factors associated with CSE were included in the meta-analysis. The strongest factors significantly associated with exposure to sexual exploitation were engagement in sexual risk behaviors (OR, 6.31 [95% CI, 3.12-12.76]; P < .001), having more than 5 sexual partners (OR, 5.96 [95% CI, 1.63-21.87]; P = .007), a diagnosis of posttraumatic stress disorder (OR, 5.29 [95% CI, 3.40-8.22]; P < .001), historical exposure to child pornography (OR, 5.50 [95% CI, 0.99-30.53]; P = .049), and a history of childhood sexual abuse (OR, 3.80 [95% CI, 3.19-4.52]; P < .001). A number of other potentially modifiable factors had moderate to strong associations. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, children and adolescents affected by sexual exploitation showed high levels of sexual risk taking, multiple sexual partners, posttraumatic stress disorder, exposure to child pornography, and childhood trauma. Accurate detection of CSE may prevent this type of sexual violence occurring to adolescents and/or provide opportunities for intervention and recovery. Therefore, prevention and intervention efforts will likely benefit from integrating these factors into screening, assessment, and treatment.
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Affiliation(s)
- Jessica J. Laird
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Bianca Klettke
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
| | - Kate Hall
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Addictive and Anti-Social Behaviour Research, Deakin University Centre for Drug Use, Geelong, Australia
| | - Elizabeth Clancy
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Australia
| | - David Hallford
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
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Kumar S, Culbreth RE, Swahn MH, Kasirye R. Examining correlates of alcohol related condom-less sex among youth living in the slums of Kampala, Uganda. AIDS Care 2020; 32:1246-1250. [PMID: 32397865 DOI: 10.1080/09540121.2020.1762066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined factors associated with alcohol related condom-less sex (ARCS) among youth living in Kampala, Uganda. Analyses are based on 2014 cross-sectional survey data of urban service-seeking youth participating in a Uganda Youth Development Link (UYDEL) drop-in center. The analytic sample consisted of only youth reporting alcohol use (n = 347). Logistic regression analyses were computed to determine the factors associated with ARCS. In the bivariable analysis, ARCS was associated with being female (OR: 1.86; 95% CI: 1.21, 2.85), age of first drinking being between ages 13-16 (OR: 2.63; 95% CI: 1.42,4.86), age of first time drunk being between ages 13-16 (OR: 2.88; 95% CI: 1.47, 5.67), binge drinking (OR: 3.64; 95% CI: 2.21, 5.98), rape (OR: 2.69; 95% CI: 1.64, 4.41), sex work (OR: 5.91; 95% CI: 3.09, 11.29), and being able to refuse sex when intoxicated (OR: 1.69; 95% CI: 1.10, 2.61). In the multivariable analysis, ARCS was associated with binge drinking (AOR: 2.97; 95% CI: 1.71, 5.17) and sex work (AOR: 3.48; 95% CI: 1.62, 7.49). These findings emphasize unmet needs of this population. Strategies seeking to prevent teenage alcohol use, particularly delaying initial alcohol use, may be beneficial for reducing ARCS in this population.
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Affiliation(s)
- Sagar Kumar
- School of Public Health, Georgia State University, Atlanta, USA
| | | | - Monica H Swahn
- School of Public Health, Georgia State University, Atlanta, USA
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The Prevalence and Context of Alcohol Use, Problem Drinking and Alcohol-Related Harm among Youth Living in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072451. [PMID: 32260246 PMCID: PMC7178083 DOI: 10.3390/ijerph17072451] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The purpose of this paper is to investigate the prevalence and context of alcohol use, problem drinking and alcohol-related harm among boys and girls in the slums of Kampala, Uganda. METHODS The Kampala Youth Survey is a cross-sectional study conducted in 2014 among youth (ages 12-18 years) living in the slums of Kampala (n = 1133) who were participating in Uganda Youth Development Link (UYDEL) centers. Chi-square tests were used to determine differences in alcohol use behaviors between 1) gender (boys vs. girls), and 2) alcohol use behaviors between problem drinkers and non-problem drinkers, stratified by gender. RESULTS Among all participants (n = 1133), the prevalence of any alcohol use in the past 12 months was 31% (n = 346). A higher percentage of girl drinkers reported having sex in the past month, without a condom (57.9%) due to alcohol consumption, compared to boy drinkers (41.9%) ( χ 2 = 8.09, df = 1, p = 0.005). For girl and boy drinkers, nearly half (49.5% and 44.1%, respectively) met the criteria for problem drinkers, measured using the Cut-Annoyed-Guilty-Eye-Opener (CAGE) questionnaire. CONCLUSIONS The high prevalence of alcohol use and problem drinking among youth, as well as alcohol-related harm, warrant urgent alcohol prevention and intervention strategies, particularly among these underserved girls.
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Culbreth R, Swahn MH, Salazar LF, Ametewee LA, Kasirye R. Risk Factors Associated with HIV, Sexually Transmitted Infections (STI), and HIV/STI Co-infection Among Youth Living in the Slums of Kampala, Uganda. AIDS Behav 2020; 24:1023-1031. [PMID: 30825036 DOI: 10.1007/s10461-019-02444-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this analysis was to examine the associated factors of self-reported HIV/STI co-infection among youth living in the slums of Kampala. The study sample consists of a cross-sectional survey. Participants comprised a convenience sample (N = 1134) of youth living on the streets or in the slums (age 12-18). Multinomial logistic regression analyses were used to determine the association between hypothesized risk factors and levels of HIV/STI co-infection, adjusting for sociodemographic variables. Among the sample of youth who were sexually active (n = 586), 9.9% (n = 58) of youth reported HIV/STI co-infection. Among youth with HIV (13.8%), 71.6% reported a co-infection with another STI. In the multivariable analysis, youth with HIV/STI co-infection were more likely to engage in problem drinking (OR 2.55; 95% CI 1.08, 6.02) and drinking alcohol without problematic alcohol behavior (OR 3.43; 95% CI 1.60, 7.36). HIV/STI co-infection rates are high among youth living in the slums of Kampala and warrant urgent attention.
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Affiliation(s)
- Rachel Culbreth
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA
| | - Monica H Swahn
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA.
| | - Laura F Salazar
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA
| | - Lynnette A Ametewee
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda
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Grosso A, Busch S, Mothopeng T, Sweitzer S, Nkonyana J, Mpooa N, Taruberekera N, Baral S. HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho. J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485709 PMCID: PMC5978702 DOI: 10.1002/jia2.25042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Sustainable Development Goals (SDGs) about gender equality; decent work; and peace, justice, and strong institutions include a focus on eradicating trafficking and sexual exploitation of and violence against women and children. In Lesotho, 86% of women have experienced gender‐based violence. In addition, overall HIV prevalence is among the highest globally, and higher among adolescent girls than boys. Moreover, nearly three quarters of female sex workers (FSW) are estimated to be living with HIV in Lesotho. In this context, sexually exploited children may be particularly vulnerable to violence and HIV acquisition risks. This study's objective is to examine the prevalence and correlates of experiencing sexual exploitation as a child among FSW in Lesotho. Methods FSW (≥18 years) recruited through respondent‐driven sampling in Maseru and Maputsoe from February to September 2014 completed HIV and syphilis testing and an interviewer‐administered survey, including a question about the age at which they started providing sex for money. This study examined correlates of experiencing sexual exploitation as a child (<18 years) through multivariable logistic regression analyses for each city, controlling for current age. Results Across both cities, 20.0% (142/710) of participants were sexually exploited as children. Among them, 65.5% (93/142) tested positive for HIV and 31.0% (44/142) for syphilis, which was similar to those who started selling sex as adults, after adjusting for current age. Participants who experienced child sexual exploitation were more likely to have been forced to have sex before age 18 than those who started selling sex as adults (Maseru‐adjusted odds ratio (aOR): 3.52, 95% Confidence Interval (CI): 1.61 to 7.66, p = 0.002; Maputsoe‐aOR: 4.39, 95% CI: 1.22 to 15.75, p = 0.023). In Maseru, participants who were sexually exploited as children were more likely to avoid carrying condoms to prevent trouble with police (aOR: 3.18, 95% CI: 1.50 to 6.75, p = 0.003). Conclusions Risk determinants for HIV and violence among sexually exploited children can be studied retrospectively through research with adult FSW. Further research working directly with sexually exploited children will improve understanding of their needs. Preventing commercial sexual exploitation of children and addressing the social and healthcare needs of those who are exploited are necessary to fully achieve SDGs 5, 8 and 16 and an AIDS‐Free Generation.
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Affiliation(s)
- Ashley Grosso
- Public Health Solutions, Research and Evaluation Unit, New York, NY, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | - Shianne Busch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | | | - Stephanie Sweitzer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
| | | | - Nkomile Mpooa
- Care for Basotho, Maseru, Lesotho.,Care-Lesotho, Maseru, Lesotho
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, MD, USA
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Francis JM, Cook S, Morojele NK, Swahn MH. Rarity and limited geographical coverage of individual level alcohol interventions in sub Saharan Africa: findings from a scoping review. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Joel M. Francis
- Department of Family Medicine & Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Cook
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Neo K. Morojele
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Monica H. Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GE, USA
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Swahn MH, Culbreth R, Salazar LF, Tumwesigye NM, Kasirye R. Psychosocial correlates of self-reported HIV among youth in the slums of Kampala. BMC Public Health 2019; 19:1176. [PMID: 31455348 PMCID: PMC6712737 DOI: 10.1186/s12889-019-7480-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) rates are high in Uganda (6.7%), and rates are especially high among at-risk groups such as youth living in the slums of Kampala, Uganda. The objective of this study was to assess the psychosocial correlates, particularly alcohol use, associated with HIV among youth living in the slums of Kampala, Uganda. Methods Analyses are based on cross-sectional survey data collected in Spring of 2014. Participants comprised a convenience sample (N = 1134) of urban service-seeking youth living on the streets or in the slums, 12–18 years of age who were participating in a Uganda Youth Development Link drop-in center (56.1% female and 43.9% male). Chi-Square Tests were used to determine differences in the proportions of alcohol use patterns between self-reported HIV-positive and HIV-negative youth. Bivariate and multivariable logistic regression were conducted to determine the associated risk factors with self-reported HIV. Institutional Review Board approvals were obtained from the Georgia State University and the Uganda National Council for Science and Technology. Results Among the total sample of youth (N = 1103), 10.5% (n = 116) reported being HIV-positive. There were statistically significant differences between HIV-positive and HIV-negative youth on ever living on the streets (χ2 =10.14, df = 1, p = 0.002), past 12-month alcohol use (χ2 =16.38, df = 1, p < .0001), ever having sexual intercourse (χ2 =14.52, df = 1, p = 0.0001), ever engaging in sex work (χ2 =13.19, df = 1, p = 0.0003), inconsistent condom use in the past 3 months (χ2 =5.03, df = 1, p = 0.03), and ever being raped (χ2 =15.29, df = 1, p < 0.0001). A higher percentage of HIV-positive youth were classified as problem drinkers, defined by the CAGE scores (21.6% vs. 13.9%, respectively). In the multivariable analysis, previously being raped (OR: 1.70; 95% CI: 1.02, 2.83) and alcohol use without problem drinking (OR: 2.14; 95% CI: 1.24, 3.69) was associated with HIV. Conclusion Youth living in the slums of Kampala, Uganda have a high prevalence of HIV. These youth are in dire need of interventions which address both alcohol use behaviors and sexual risk behaviors to reduce further complications of their existing health conditions, including HIV.
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Affiliation(s)
- Monica H Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA.
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Laura F Salazar
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA
| | - Nazarius M Tumwesigye
- Department of Epidemology and Biostatistics, School of Public Health, Makerere University, PO Box 7062, Kampala, Uganda
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda
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Shah P, Kibel M, Ayuku D, Lobun R, Ayieko J, Keter A, Kamanda A, Makori D, Khaemba C, Ngeresa A, Embleton L, MacDonald K, Apondi E, Braitstein P. A Pilot Study of "Peer Navigators" to Promote Uptake of HIV Testing, Care and Treatment Among Street-Connected Children and Youth in Eldoret, Kenya. AIDS Behav 2019; 23:908-919. [PMID: 30269232 PMCID: PMC6458975 DOI: 10.1007/s10461-018-2276-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research suggests a burden of HIV among street-connected youth (SCY) in Kenya. We piloted the use of peer navigators (PNs), individuals of mixed HIV serostatus and with direct experience of being street-connected, to link SCY to HIV testing and care. From January 2015 to October 2017, PNs engaged 781 SCY (585 male, 196 female), median age 16 (IQR 13-20). At initial encounter, 52 (6.6%) were known HIV-positive and 647 (88.8%) agreed to HIV testing. Overall, 63/781 (8.1%) SCY engaged in this program were HIV-positive; 4.6% males and 18.4% females (p < 0.001). Of those HIV-positive, 48 (82.8%) initiated ART. As of October 2017, 35 (60.3%) of the HIV-positive SCY were alive and in care. The pilot suggests that PNs were successful in promoting HIV testing, linkage to care and ART initiation. More research is needed to evaluate how to improve ART adherence, viral suppression and retention in care in this population.
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Affiliation(s)
- Pooja Shah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mia Kibel
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Regina Lobun
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - John Ayieko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Collins Khaemba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Lonnie Embleton
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Katherine MacDonald
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, USA
| | - Edith Apondi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
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Greenbaum VJ, Livings MS, Lai BS, Edinburgh L, Baikie P, Grant SR, Kondis J, Petska HW, Bowman MJ, Legano L, Kas-Osoka O, Self-Brown S. Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings. J Adolesc Health 2018; 63:745-752. [PMID: 30293860 DOI: 10.1016/j.jadohealth.2018.06.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/13/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Estimate the prevalence of child sex trafficking (CST) among patients seeking care in multiple healthcare settings; evaluate a short screening tool to identify victims in a healthcare setting. METHODS This cross-sectional observational study involved patients from 16 sites throughout the U.S.: five pediatric emergency departments, six child advocacy centers, and five teen clinics. Participants included English-speaking youth ages 11-17 years. For emergency department sites, inclusion criteria included a chief complaint of sexual violence. Data on several domains were gathered through self-report questionnaires and examiner interview. Main outcomes included prevalence of CST among eligible youth; sensitivity, specificity, positive/negative predictive values, and positive/negative likelihood ratios for a CST screening tool. RESULTS Eight hundred and ten participants included 91 (11.52%) youth from emergency departments, 395 (48.8%) from child advocacy centers, and 324 (40.0%) from teen clinics. Overall prevalence of CST was 11.1%: 13.2% among emergency department patients, 6.3% among child advocacy center patients, and 16.4% among teen clinic patients, respectively. The screen had a sensitivity, specificity, and positive likelihood ratio of 84.44% (75.28, 91.23), 57.50% (53.80, 61.11), and 1.99% (1.76, 2.25), respectively. CONCLUSIONS This study demonstrates a significant rate of CST among patients presenting to emergency departments (for sexual violence complaints), child advocacy centers, and teen clinics. A six-item screen showed relatively good sensitivity and moderate specificity. Negative predictive value was high. Intervention for a "positive" screen may identify victims and help prevent high-risk youth from becoming victimized. This is one of the first CST screening tools specifically developed and evaluated in the healthcare setting.
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Affiliation(s)
- V Jordan Greenbaum
- Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | | | - Betty S Lai
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Laurel Edinburgh
- Midwest Children's Resource Center, Children's Hospital and Clinics of Minnesota, St. Paul, Minnesota
| | - Peggy Baikie
- Denver Health, Now at Colorado Department of Human Services, Denver, Colorado
| | | | - Jamie Kondis
- Washington University School of Medicine, St. Louis, Mississippi
| | - Hillary W Petska
- Medical College of Wisconsin, Milwaukee, Wisconsin; Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Oriaku Kas-Osoka
- Las Vegas School of Medicine, University of Nevada, Las Vegas, Nevada
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Swahn MH, Culbreth R, Tumwesigye NM, Topalli V, Wright E, Kasirye R. Problem Drinking, Alcohol-Related Violence, and Homelessness among Youth Living in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1061. [PMID: 29882915 PMCID: PMC6025561 DOI: 10.3390/ijerph15061061] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/25/2022]
Abstract
This paper examines problem drinking, alcohol-related violence, and homelessness among youth living in the slums of Kampala—an understudied population at high-risk for both alcohol use and violence. This study is based on a cross-sectional survey conducted in 2014 with youth living in the slums and streets of Kampala, Uganda (n = 1134), who were attending Uganda Youth Development Link drop-in centers. The analyses for this paper were restricted to youth who reported current alcohol consumption (n = 346). Problem drinking patterns were assessed among youth involved in alcohol-related violence. Mediation analyses were conducted to examine the impact of homelessness on alcohol-related violence through different measures of problem drinking. Nearly 46% of youth who consumed alcohol were involved in alcohol-related violence. Problem drinkers were more likely to report getting in an accident (χ² = 6.8, df = 1, p = 0.009), having serious problems with parents (χ² = 21.1, df = 1, p < 0.0001) and friends (χ² = 18.2, df = 1, p < 0.0001), being a victim of robbery (χ² = 8.8, df = 1, p = 0.003), and going to a hospital (χ² = 15.6, df = 1, p < 0.0001). For the mediation analyses, statistically significant models were observed for frequent drinking, heavy drinking, and drunkenness. Interventions should focus on delaying and reducing alcohol use in this high-risk population.
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Affiliation(s)
- Monica H Swahn
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3984 Atlanta, GA 30302-3984, USA.
| | - Rachel Culbreth
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3984 Atlanta, GA 30302-3984, USA.
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala 00256, Uganda.
| | - Volkan Topalli
- Department of Criminal Justice and Criminology, Andrew Young School of Policy Studies, Georgia State University, P.O. Box 3992, Atlanta, GA 30302-3992, USA.
| | - Eric Wright
- Department of Sociology, College of Arts and Science, Georgia State University, P.O. Box 5020, Atlanta, GA 30302-5020, USA.
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala 00256, Uganda.
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Culbreth R, Swahn MH, Ndetei D, Ametewee L, Kasirye R. Suicidal Ideation among Youth Living in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020298. [PMID: 29425129 PMCID: PMC5858367 DOI: 10.3390/ijerph15020298] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban service-seeking youth participating in a Uganda Youth Development Link drop-in center. Logistic regression analyses were computed to determine the psychosocial factors associated with suicidal ideation. Among youth participants, 23.54% (n = 266) reported suicidal ideation in the past year. In the multivariable analysis, suicidal ideation was associated with being female (OR: 1.61; 95% CI: 1.15, 2.25), reporting one (OR: 1.51; 95% CI: 1.05, 2.18) or two deceased parents (OR: 1.55; 95% CI: 1.03, 2.35), ever living on the streets (OR: 2.65; 95% CI: 1.86, 3.79), problem drinking (OR: 1.83; 95% CI: 1.19, 2.80), sexually transmitted infection (OR: 1.59; 95% CI: 1.14, 2.21), ever being raped (OR: 1.49; 95% CI: 1.01, 2.20), and experiencing physical child abuse (OR: 2.40; 95% CI: 1.75, 3.27). Our findings underscore many unmet needs in this vulnerable population. However, strategies that specifically seek to address problem drinking—a modifiable risk factor for suicidal ideation—may be particularly warranted in this low-resource setting.
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Affiliation(s)
- Rachel Culbreth
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Monica H Swahn
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, University Way, Nairobi 00100, Kenya.
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi 00100, Kenya.
| | - Lynnette Ametewee
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Apollo Kaggwa Rd, P.O. Box 12659, Kampala 00256, Uganda.
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Swahn MH, Buchongo P, Kasirye R. Risky Behaviors of Youth Living in the Slums of Kampala: A Closer Examination of Youth Participating in Vocational Training Programs. VULNERABLE CHILDREN AND YOUTH STUDIES 2018; 13:276-290. [PMID: 31452668 PMCID: PMC6709978 DOI: 10.1080/17450128.2018.1489168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Obtaining formal education is associated with a decreased risk of HIV transmission among youth in sub-Saharan Africa. However, little is known about the role vocational skills training programs may have on risk behaviors linked to HIV transmission among vulnerable youth in sub-Saharan Africa. This study examined the characteristics and risk behaviors among vulnerable youth who receive vocational skills training by a community-based organization. Empirical analyses were conducted using a cross-sectional survey administered in 2014 to youth (ages 12 to 18 years) in the slums of Kampala (N=1134). Five multivariable logistic regression models were computed to determine the association between participating in a vocational training program and self-reported risk behaviors pertaining to alcohol use, lack of condom use, sex with multiple partners, and transactional sex. In our study, 29.6% of youth attended a vocational training program. Our findings show that youth who participated in vocational training were more likely to report often feeling hopeful (AOR: 1.7; 95% CI: 1.1, 3.0) and less likely to report alcohol use (AOR: 0.4; 95% CI: 0.2, 0.7) than those not attending vocational training programs, in multivariable analyses. Overall, findings varied for males and females. These findings, while preliminary, indicate that self-reported behaviors associated with risk for HIV transmission vary in some respects for youth participating in vocational training versus those who do not. However, additional research is needed, as are evaluations of the benefits and potential impact of vocational training in both the short and long-term for vulnerable youth in resource-poor settings and with limited access to formal education.
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Affiliation(s)
- Monica H. Swahn
- Distinguished Professor, Division of Epidemiology and Biostatistics Partnership for Urban Health Research School of Public Health, Georgia State University 140 Decatur St. SE Atlanta, GA 30303,
| | - Portia Buchongo
- Georgia State University School of Public Health, 140 Decatur St. SE Atlanta, GA 30303
- Corresponding:
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Swahn MH, Culbreth RE, Staton CA, Self-Brown SR, Kasirye R. Alcohol-Related Physical Abuse of Children in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1124. [PMID: 28954410 PMCID: PMC5664625 DOI: 10.3390/ijerph14101124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022]
Abstract
This study examines the patterns of alcohol-related physical abuse and alcohol use and related behaviors among children living in the slums of Kampala, Uganda. The study is based on a cross-sectional survey, conducted in spring 2014, of service-seeking children ages 12 to 18 years (n = 1134) attending Uganda Youth Development Link drop-in centers for vulnerable children in the slums. Descriptive statistics, chi-squares, and bivariate and multivariable logistic regression analyses were conducted to determine patterns of children's alcohol-related behaviors, based on alcohol-related physical abuse and neglect. Nearly 34% of children (n = 380) reported experiencing physical abuse, and 12.4% (n = 140) reported experiencing alcohol-related physical abuse. Alcohol-related neglect was reported among 19.6% (n = 212) of the children. Past year alcohol use was significantly more prevalent among children who reported experiencing alcohol-related neglect ( χ 2 = 79.18, df = 1, p < 0.0001) and alcohol-related physical abuse ( χ 2 = 62.02, df = 1, p < 0.0001). Reporting physical abuse was also associated with parental alcohol use (OR: 1.85; 95% CI: 1.38, 2.48) and parental partner violence (OR: 5.51; 95% CI: 4.09, 7.43), after adjusting for other variables in the model. Given the high levels of alcohol-related abuse and neglect reported in this population, both primary and secondary prevention initiatives are needed to improve parenting strategies and to reduce alcohol-related harm. Similarly, strategies to reduce and delay alcohol use among these vulnerable children are also needed.
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Affiliation(s)
- Monica H Swahn
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Rachel E Culbreth
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Catherine A Staton
- Duke University Medical Center, Duke Global Health Institute and Department of Emergency Medicine, Duke University, Durham, NC 27703, USA.
| | - Shannon R Self-Brown
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Appollo Kaggwa Rd, Box 12659, Kampala, Uganda.
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