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Stamatakis CE, Sumner SA, Massetti G, Kress H, Basile KC, Marcelin LH, Cela T, Wadonda-Kabondo N, Onotu D, Ogbanufe O, Chipimo PJ, Conkling M, Apondi R, Aluzimbi G. Sexual Violence Prevalence and Related Pregnancy Among Girls and Young Women: A Multicountry Analysis. J Interpers Violence 2022; 37:NP2428-NP2441. [PMID: 32618217 DOI: 10.1177/0886260520936366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed.
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Affiliation(s)
| | - Steven A Sumner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Greta Massetti
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Howard Kress
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Louis Herns Marcelin
- Interuniversity Institute for Research and Development, Port-au-Prince, Haiti
- University of Miami, Coral Gables, FL, USA
| | - Toni Cela
- Interuniversity Institute for Research and Development, Port-au-Prince, Haiti
- University of Miami, Coral Gables, FL, USA
| | | | - Dennis Onotu
- Centers for Disease Control and Prevention, Abuja, Nigeria
| | | | | | | | - Rose Apondi
- Centers for Disease Control and Prevention, Kampala, Uganda
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2020; 6:e19893. [PMID: 32396517 PMCID: PMC7351262 DOI: 10.2196/19893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/12118.].
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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King R, Sebyala Z, Ogwal M, Aluzimbi G, Apondi R, Reynolds S, Sullivan P, Hladik W. How men who have sex with men experience HIV health services in Kampala, Uganda. BMJ Glob Health 2020. [PMCID: PMC7245422 DOI: 10.1136/bmjgh-2019-001901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In sub-Saharan Africa, men who have sex with men (MSM) are socially, largely hidden and face disproportionate risk for HIV infection. Attention to HIV epidemics among MSM in Uganda and elsewhere in sub-Saharan Africa has been obscured by repressive governmental policies, criminalisation, stigma and the lack of basic epidemiological data describing these epidemics. In this paper, we aim to explore healthcare access, experiences with HIV prevention services and structural barriers to using healthcare services in order to inform the acceptability of a combination HIV prevention package of services for men who have sex with men in Uganda. We held focus group discussions (FGDs) with both MSM and healthcare providers in Kampala, Uganda, to explore access to services and to inform prevention and care. Participants were recruited through theoretical sampling with criteria based on ability to answer the research questions. Descriptive thematic coding was used to analyse the FGD data. We described MSM experiences, both negative and positive, as they engaged with health services. Our findings showed that socio-structural factors, mediated by psychological and relational factors impacted MSM engagement in care. The socio-structural factors such as stigma, homophobia and policy issues emerged strongly as did the mediating factors such as relations with specific health staff and a social support structure. A combination intervention addressing structural, social and psychological barriers could have an impact even in the precarious policy environment where this study was conducted.
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Affiliation(s)
- Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Zubayiri Sebyala
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Uganda, Kampala, Uganda
| | - Rose Apondi
- Centers for Disease Control and Prevention, Uganda, Kampala, Uganda
| | - Steven Reynolds
- Department of Medicare, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- National Institute of Allergy and Infectious Diseases Division of Intramural Research, Bethesda, Maryland, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nguyen KH, Padilla M, Villaveces A, Patel P, Atuchukwu V, Onotu D, Apondi R, Aluzimbi G, Chipimo P, Kancheya N, Kress H. Coerced and forced sexual initiation and its association with negative health outcomes among youth: Results from the Nigeria, Uganda, and Zambia Violence Against Children Surveys. Child Abuse Negl 2019; 96:104074. [PMID: 31445403 PMCID: PMC6760991 DOI: 10.1016/j.chiabu.2019.104074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Coerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences. METHODS The Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13-24 years in three countries in sub-Saharan Africa. RESULTS Over one in ten youth aged 13-24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1-2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1-2.3), physical violence (OR = 2.2, 95%CI: 1.6-3.0), and emotional violence (OR = 2.0, 95%CI: 1.3-2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1-2.0), hurting oneself (OR = 2.0, 95%CI: 1.3-3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1-2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI. CONCLUSION FSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.
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Affiliation(s)
- Kimberly H Nguyen
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mabel Padilla
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victor Atuchukwu
- Nigeria Country Office, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Nigeria Country Office, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Rose Apondi
- Uganda Country Office, Center for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | - George Aluzimbi
- Uganda Country Office, Center for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Peter Chipimo
- Zambia Country Office, Center for Global Health, Centers for Disease Control and Prevention, Lukasa, Zambia
| | - Nzali Kancheya
- Zambia Country Office, Center for Global Health, Centers for Disease Control and Prevention, Lukasa, Zambia
| | - Howard Kress
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2019; 5:e12118. [PMID: 31407673 PMCID: PMC6771531 DOI: 10.2196/12118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Swedo EA, Sumner SA, Hillis SD, Aluzimbi G, Apondi R, Atuchukwu VO, Auld AF, Chipimo PJ, Conkling M, Egbe OE, Kalanda MS, Mapoma CC, Phiri E, Wasula LN, Massetti GM. Prevalence of Violence Victimization and Perpetration Among Persons Aged 13-24 Years - Four Sub-Saharan African Countries, 2013-2015. MMWR Morb Mortal Wkly Rep 2019; 68:350-355. [PMID: 30998666 PMCID: PMC6476058 DOI: 10.15585/mmwr.mm6815a3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Apodaca K, Doshi RH, Ogwal M, Kiyingi H, Aluzimbi G, Musinguzi G, Lutalo I, Akello E, Hladik W. Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda. JMIR Public Health Surveill 2019; 5:e12316. [PMID: 30942697 PMCID: PMC6468338 DOI: 10.2196/12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/18/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers. Objective The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda. Methods We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis. Results We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono. Conclusions The CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.
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Affiliation(s)
- Kevin Apodaca
- Public Health Institute, Oakland, CA, United States.,Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Reena Hemendra Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | | | - Ibrahim Lutalo
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Evelyn Akello
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Aluzimbi G, Lubwama G, Muyonga M, Hladik W. HIV Testing and Risk Perceptions: A Qualitative Analysis of Secondary School Students in Kampala, Uganda. J Public Health Afr 2017; 8:577. [PMID: 28878868 PMCID: PMC5575453 DOI: 10.4081/jphia.2017.577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 02/07/2017] [Accepted: 05/31/2017] [Indexed: 11/23/2022] Open
Abstract
The purpose of this paper is to explore the perceptions of self-reported HIV testing and risk behavior among sexually active adolescents and youth in secondary schools in Kampala Uganda. This was a cross-sectional survey conducted between June and October 2010 among secondary school students in Kampala, Uganda. Forty eight (48) students across the 54 schools were purposively selected for the qualitative sub-study based on their responses to particular questions. We thematically analyzed 28 interviews for our qualitative study using Nvivo software. Drug and alcohol use coupled with peers pressure impaired students’ perceptions towards HIV risk and therefore increased their susceptibility to HIV risk behaviors. Of the 28 scripts analyzed, 82% (23/28) had ever had sexual partners, 79% (22/28) were currently sexually active, and 57% (16/28) had ever been tested for HIV. In conclusion, most adolescents interviewed did not perceive HIV testing to be important to HIV prevention and reported low perception of susceptibility to HIV infection. Development of an adolescent HIV prevention model is important in improving uptake of HIV services.
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Affiliation(s)
- George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS and Tuberculosis, Kampala, Uganda
| | - George Lubwama
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | | | - Wolfgang Hladik
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.,Centers for Disease Control and Prevention, Division of Global HIV/AIDS and Tuberculosis, Atlanta, GA, USA
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Aluzimbi G, Barker J, King R, Rutherford G, Ssenkusu JM, Lubwama GW, Muyonga M, Hladik W. Risk factors for unplanned sex among university students in Kampala, Uganda: a qualitative study. International Journal of Adolescence and Youth 2013. [DOI: 10.1080/02673843.2012.685947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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