Digital technologies, equitable gender norms, and sexual health practices across sexting patterns among forcibly displaced adolescents in the slums of Kampala, Uganda

Okumu, Moses; Logie, Carmen H.; Ansong, David; Mwima, Simon; Hakiza, Robert; Newman, Peter A.

doi:10.1016/j.chb.2022.107453

Cited by 3 publications

(6 citation statements)

References 41 publications

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“…The items were summed to create a cumulative condom self-efficacy score, with a lower score indicating lower levels of condom self-efficacy and higher scores indicating higher levels of condom self-efficacy. The 7-item scale has been used in studies among refugee youth [ 28 , 47 , 66 ], and among other vulnerable populations. [ 40 , 52 , 67 ]…”

Section: Methodsmentioning

confidence: 99%

“…However, previous studies have estimated that only 53–66% [ 21 , 24 , 25 ] of sexually active youth living in Uganda’s slums consistently use external condoms, signalling significant gaps between reported knowledge of and actual use of condoms, far below the global target of 90% by 2025 [ 26 ]. Among sexually active youth living in Kampala slums specifically, a cross-sectional survey found that only half reported using condoms [ 25 , 27 , 28 ]. This figure is likely not only attributable to a lack of access to condoms, but also other barriers to condom use such as cost, negative attitudes, reduced sexual pleasure, fit-and-feel problems and erection difficulties.…”

Section: Introductionmentioning

confidence: 99%

“…The same study found that adolescent girls who supported equitable gender norms reported significantly higher rates of condom use during their last sexual encounter. Yet despite the fact that inequitable gender norms, attitudes, and practices remain entrenched in many societies [ 53 – 56 ], including Uganda [ 28 ], to date, only a limited number of studies have investigated the association between gender norms and condom self-efficacy and use.…”

Section: Introductionmentioning

confidence: 99%

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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

Okumu,

Logie,

Chitwanga

et al. 2023

Confl Health

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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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Okumu,

Logie,

Chitwanga

et al. 2023

Confl Health

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“… 25 However, a study conducted in Uganda by Nabunya et al 29 demonstrated that adherence to traditional gender norms regarding sexuality was associated with a lower propensity to adopt risky sexual behaviours among pupils aged 14–17 years. Previous studies 12 , 24 , 28 , 30 , 31 have shown the mediating role of various factors on the effects of gender norms. Peers, the media, disability, and parental communication on sexuality can either amplify or mitigate the impact of internalising gender stereotypes on risky behaviours.…”

Section: Introductionmentioning

confidence: 95%

“… 29 a montré que l’adhésion aux normes de genre traditionnelles sur la sexualité était liée à une moindre propension à adopter des comportements sexuels à risque chez les élèves âgés de 14 à 17 ans. D’autres études antérieures 12 , 24 , 28 , 30 , 31 ont révélé le rôle médiateur de divers facteurs sur les effets des normes de genre. Les pairs, les médias, le handicap et la communication parentale sur la sexualité peuvent amplifier ou atténuer l’impact de l’intériorisation des stéréotypes de genre sur les comportements à risque.…”

Section: Introductionunclassified

Effets identitaires de la socialisation différentielle de genre sur les aspirations au premier enfant et au mariage des jeunes adolescent(e)s à Ouagadougou: une étude mixte

Bambara,

Wayack-Pambè,

Ouili

et al. 2023

Sexual and Reproductive Health Matters

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Résumé Des études montrent que la socialisation de genre développe différemment chez les filles et les garçons leur identité sexuée, leur estime de soi et leurs comportements sexuels. Alors que la préadolescence est considérée comme une période charnière de la socialisation genrée, peu d’études en Afrique francophone questionnent le rôle des effets identitaires de genre sur les aspirations et les comportements sexuels et reproductifs à cette étape de vie. Cet article examine la manière dont l’intériorisation des stéréotypes de genre au cours de la socialisation est associée aux aspirations qu’ont les filles et les garçons pour certains événements de leurs vies comme avoir un premier enfant ou se marier. Une enquête a été réalisée dans 10 écoles primaires de Ouagadougou, auprès d’élèves âgé(e)s entre 9 et 16 ans, ainsi que sept discussions de groupes avec leurs parents. Les résultats montrent une variation selon le sexe des effets de l’adhésion aux normes de genre inégalitaires chez les jeunes adolescent(e)s. Cela a pour conséquence de développer des aspirations, chez les filles plus précoces au mariage et plus tardives à l’enfantement, et chez les garçons, plus précoces à l’enfantement et plus tardives au mariage. Ces effets peuvent exposer les filles et les garçons à des risques de mauvaise santé sexuelle et reproductive. Des interventions promouvant des normes égalitaires de genre pourraient renforcer l’estime de soi des filles ainsi que le respect mutuel entre les jeunes adolescent(e)s des deux sexes afin d’améliorer leur santé sexuelle et reproductive à l’adolescence et à l’âge adulte.

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Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings

Logie,

MacKenzie,

Malama

et al. 2024

Reprod Health

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Background Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. Methods Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. Findings The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. Conclusions This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Plain English summary Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.

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Digital technologies, equitable gender norms, and sexual health practices across sexting patterns among forcibly displaced adolescents in the slums of Kampala, Uganda

Cited by 3 publications

References 41 publications

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

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

Effets identitaires de la socialisation différentielle de genre sur les aspirations au premier enfant et au mariage des jeunes adolescent(e)s à Ouagadougou: une étude mixte

Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings

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