Epidemiological Findings of Alcohol Misuse and Dependence Symptoms among Adolescent Girls and Young Women Involved in High-Risk Sexual Behavior in Kampala, Uganda

Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda

BACKGROUND

Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with illicit drug and high-risk alcohol consumption.

METHODS

We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25 March 2019 to 30 March 2020. Data was collected on social demographics, sexual behavior, and reproductive health using interviewer-administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression.

RESULTS

We enrolled 490 participants (60.6% female) with a median age of 18 (IQR 17-18) years, 84.9% had less than secondary education, 48.4% had their sexual debut before 15 years, 47.1% reported paid sex in the past 3 months and 22.8% had a sexually transmitted infection (chlamydia, gonorrhea, and active syphilis) baseline characteristics associated with illicit drug use in the past 3 months were male gender (aOR 12.45; 95% CI 7.21-21.50) being married (aOR 2.26; 95%CI 1.03-4.94) 10 or more paying sexual partners (aOR 2.45; 95%CI 1.05-5.69) and high-risk alcohol use (aOR 3.94; 95%CI 2.10-7.40), baseline characteristics associated with high-risk alcohol use were male gender (aOR 0.29; 95% CI 0.13-0.63) emotional violence from sexual partners (aOR 2.35; 95%CI 1.32-418) illicit drug users com (aOR 3.94; 95% CI 2.10-7.40).

CONCLUSION

Illicit drug and high-risk alcohol use are prevalent among male adolescents and adolescents involved in high-risk sexual behavior living in the urban slums of Kampala.

Centring the health of women across the HIV research continuum

Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.

Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda

Background; Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption. Methods; We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression. Results; We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners. Conclusion: Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.

Prevalence and Factors Associated with Illicit Drug and High-Risk Alcohol Use among Adolescents Living in Urban Slums of Kampala, Uganda

Background

Illicit drug and high risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence, and factors associated with illicit drug and high-risk alcohol consumption.

Methods

We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25-March-2019 to 30-March 2020. Data was collected on social-demographics, sexual behavior and reproductive health using interviewer administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression.

Results

We enrolled 490 participants (60.6% female) with median age 18 (IQR 17-18) years, 91.0% had less than secondary education, 48.4% had their sexual debut before 15years, 47.1% reported paid sex in the past 3 months and 24.7% had a sexually transmitted infection (chlamydia, gonorrhea and/ or active syphilis) at enrolment. The prevalence of illicit drug use was 34.9% while 16.1% were screened as high-risk alcohol users. Illicit drug use was associated with being male (aOR 9.62; 95% CI 5.74-16.11), being married (aOR 2.24; 95%CI 1.07-4.68) and having ≥10 paying sexual partners in the past 3 months (aOR 3.13; 95%CI 1.40-6.98). High risk alcohol use was associated with reporting sex work as the main job (aOR 3.19; 95%CI 1.02-9.94) and having experienced physical (aOR 1.96 95%CI 1.01-3.81) or emotional violence (aOR 2.08; 95%CI 1.14-3.82) from sexual partners.

Conclusion

Illicit drug and high-risk alcohol use are prevalent among adolescents involved in high risk sexual behavior and living in urban slums of Kampala. Comprehensive interventions that target substance use among this group of young people are needed and should include measures against intimate partner violence.

Prevalence, Perpetrators, and Factors Associated With Intimate Partner Violence Among Adolescents Living in Urban Slums of Kampala, Uganda

Intimate partner violence (IPV) poses a public health burden, yet few studies have assessed co-existence of physical, emotional, and sexual IPV among adolescents. We assessed recent IPV victimization and associated factors and described IPV patterns and perpetrators among young people from urban slums in Kampala, Uganda. We conducted a prospective cohort study among 14 to 19-year-old individuals enrolled from March 2019 to March 2020 and followed quarterly for 12 months. We collected data on socio-demographics, sexual behavior, and substance use through interviews. Recent IPV victimization was documented at all visits if a participant reported experiencing physical, emotional, and/or sexual IPV in the past 3 months. Baseline factors associated with recent IPV victimization were determined using multivariable logistic regression. We enrolled 490 adolescents (60.6% female) with median age 18 years (Interquartile range (IQR) 17-18 years), 91.0% had less than secondary level education. Females mainly engaged in sex work (17.5%) and selling fruits/snacks (9.1%) while males commonly earned from sale of metal scrap or plastic waste (28.5%), 41% reported ≥10 life-time sexual partners, 16.1% were high-risk alcohol drinkers and 34.9% used illicit drugs in the past 3 months. Overall, 27.8% reported recent IPV victimization (20.0% females) with emotional IPV being common (17.8%). At baseline, recent IPV victimization was associated with high-risk alcohol consumption (adjusted odds ratio [aOR] 2.57; 95% confidence interval [CI] [1.44, 4.58]), reported paid sex in the past 3 months (aOR 1.82; [1.02, 3.22]) and being separated (aOR 2.47; [1.29, 4.73]). Recent IPV victimization declined from baseline to month 9 and increased at month 12 visits which coincided with the COVID-19 pandemic. IPV victimization is high among young people living in urban slums with emotional IPV being prevalent. IPV interventions are needed and should also address excessive alcohol consumption.

Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda

Background

In sub-Saharan Africa, one in every five young women becomes pregnant, and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes and a high abortion rate, yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who were frequently engaged in transactional sex in Kampala, Uganda.

Methods

We analyzed data from a study that investigated the uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on sociodemographics, sexual behavior, reproductive health outcomes, and substance use. Pregnancy was determined by testing for beta-human chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan-Meier technique, and logistic regression was used to determine the correlates of pregnancy.

Results

We included 285 volunteers with a mean age of 19.9 [standard deviation (SD), ± 2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to the interview, of whom 12.8% consumed alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhoeae. The mean age at first sexual intercourse was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow-up, an incidence of 23.5 per 100 person-years [95% confidence interval (CI), 17.5-31.6]. Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months [adjusted risk ratio (aRR) 1.97; 95% CI, 1.05-3.70] and those who reported not using contraception (aRR 5.89; 95% CI, 2.74-12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI, 0.30-0.90).

Conclusion

The incidence of unintended pregnancy was high despite the availability of free contraceptive services. We recommend sociobehavioral studies to explore this further. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.

Low awareness of oral and injectable PrEP among high-risk adolescent girls and young women in Kampala, Uganda

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.