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While much focus has been put on rural household food insecurity, with increasing urbanisation leading to urban slum formation, food insecurity is potentially on the rise particularly among women of reproductive age (WRA). We determined the prevalence and factors associated with food insecurity among women aged 18-49 years in Makindye slums of Kampala capital city, Uganda. In a community based cross-sectional study, we recruited a random sample of 573 women aged 18-49 years, resident in the slums for at least one year prior to the study. Quantitative data were collected using interviewer administered questionnaires while qualitative information was obtained through key informant interviews and focus group discussions. Multivariable logistic regression (using STATA® 13) and manifest content analysis methods were used to analyse quantitative and qualitative data respectively. Of the 573 participants, 60.7% were aged 20-34 years, 53.7% were married/cohabiting, 12.2% had no formal education and 82.5% lived in rented homes. Overall 88.5% of the women were food insecure of which 68.4% were severely food insecure. Factors that increased likeli hood of food insecurity were; socioeconomic factors such as absence of electricity in the household (AOR; 2.2, 95%CI: 1.05-4.86, p = 0.036) and having more than one school going child (AOR; 2.6, 95%CI: 1.42-4.89, p = 0.002). Qualitative findings indicate that food insecurity is indeed a problem among women in the slums with unemployment, high food prices, poverty and increasing number of household members reported as the major causes of food insecurity. The prevalence of food insecurity among women in Kampala slums is high. These findings suggest the need to invest in economic empowerment of women with emphasis on those living in deprived communities.

Aims: To establish the prevalence of intoxication before sex and its association with risky sexual behavior. Design:The data were from the 2006 Uganda Demographic and Health Survey which had been designed for a cross-sectional descriptive study. Setting:The study covered the whole of Uganda. Participants:The respondents were 6,253 women and 1,804 men who had ever had sex. Measurements:The key independent variable was intoxication before last sexual intercourse, while the major outcome variables were condom use and sex with non-regular partners. Weighted prevalence of intoxication was computed and multivariate logistic regression was applied to assess the independent association of intoxication with risky sexual behavior.Findings: Twelve percent of men and 16% of women reported having been intoxicated before last sexual intercourse. Of the women who reported that one of the partners was intoxicated before last sexual intercourse, 78% said it was their partner who was intoxicated. Of the men who reported intoxication, 83% said it was they themselves who were intoxicated. Intoxication of men was associated with having sex with non-regular partners (OR = 1.78, 95% CI: 1.04-3.03) and having unprotected sex (OR = 1.71, 95% CI: 1.07-2.73). Women who were intoxicated were less likely to have been with non-regular partners (OR = 0.55, 95% CI: 0.32-0.95). The women whose partners were intoxicated were more likely to report having had unprotected sex (OR = 1.55, 95% CI: 1.12-2.15).Conclusions: HIV prevention mechanisms should address intoxication before sex. More effort is needed to find ways of helping women avoid unprotected sex with intoxicated partners.

BackgroundAlthough WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/[µ]L, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 < 50 cells/[µ]L. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda.MethodsAll adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of < 50 cells/[µ]L (very late initiators) were classified as cases and 50-200 cells/[µ]L (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals.ResultsReported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6).ConclusionPolicy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and user-friendly to make them more attractive than traditional healers

BackgroundYoung people in Uganda have a large unmet need for modern contraception, and the reasons are unclear. This study describes young peoples’ experiences of contraceptive care, client-provider interactions and its aftermath on choice, access and satisfaction.MethodsSimulated client method, with 128 encounters with providers in public and private health care facilities was used. Semi-structured narrative debriefing and a structured questionnaire were used to collect data. Content analysis, descriptive and inferential statistics were applied.ResultsBoth qualitative and quantitative results highlight favorable reception, provider bias, low client satisfaction and reservations about contraceptive methods. Two thirds of the providers choose a contraceptive method for the client. The clients reported satisfaction with contraceptive services in 29 % of the consultations. Privacy was reported to be observed in 42 % and clients felt respectfully treated in 50 % of the consultations. However, most clients would not recommend the visited facility to others. Client-provider interactions revealed contradictory views on methods to use, whether to first have children, and whether to use contraceptives at all. Younger clients seemed to be treated differently than older clients; contraceptives were provided after a prolonged debate. Inaccurate information about contraceptives was provided and costs were high. Providers conveyed potential adverse effects of contraceptives to young people in a way that indicated providers own fears and doubts.ConclusionYoung people are not able to exercise their rights to choose, obtain and use contraceptives when needed. Overall satisfaction with the services was rated low and client- provider interactions were often unfavorable.