Examining the substance use, violence, and HIV and AIDS (SAVA) syndemic among urban refugee youth in Kampala, Uganda: cross-sectional survey findings

Abstract

BackgroundInteractions between substance use, violence, HIV and AIDS, known as the ‘SAVA’ syndemic, are understudied among refugee youth. We assessed the synergistic effects of frequent alcohol use, depression and violence on HIV vulnerability among urban refugee youth aged 16–24 years in Kampala, Uganda.MethodsWe conducted a cross-sectional survey between January and April 2018 with a convenience sample of refugee youth aged 16–24 years living in informal settlements in Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya). We assessed non-communicable health conditions (frequent [≥3 times per week] alcohol use [FAU]; depression); violence (young adulthood violence [YAV] at age ≥16 years, intimate partner violence [IPV]), and HIV vulnerability (past 12-month transactional sex; recent [past 3-month] multiple [≥2] sex partners). We calculated the prevalence and co-occurrence of non-communicable health conditions, violence and HIV vulnerability variables. We then conducted multivariable logistic regression analyses to first create unique profiles of FAU, depression, YAV and IPV exposures, and second to assess for interactions between exposures on HIV vulnerability outcomes.ResultsMost participants (n=445; mean age: 19.59, SD: 2.6; women: n=333, 74.8%, men: n=112, 25.2%) reported at least one non-communicable health condition or violence exposure (n=364, 81.8%), and over half (n=278, 62.4%) reported co-occurring exposures. One-fifth reported FAU (n=90; 20.2%) and one-tenth (n=49; 11%) major depression. In logistic regression models including all two-way product terms, adjusted for sociodemographics, we found (a) multiplicative interaction for joint effects of FAU and IPV (adjusted OR (aOR)=4.81, 95% CI: 1.32 to 17.52) on multiple sex partners, and (b) multiplicative interaction for joint effects of FAU and IPV (aOR=3.72, 95% CI: 1.42 to 9.74), and YAV and depression (aOR=7.13, 95% CI: 1.34 to 37.50), on transactional sex.ConclusionFindings signal the importance of addressing the SAVA syndemic among urban refugee youth in Uganda. Synergistic interactions indicate that addressing FAU, depression or violence may concomitantly reduce HIV vulnerability with urban refugee youth.

Prevalence of physical violence against people in insecure migration status: A systematic review and meta-analysis

“…Generally, there was a lot of diversity in the way violence was conceptualised and measured. Hadush et al [ 86 ], Logie et al [ 88 ], Ogbonnaya et al [ 72 ], Okenwa-Emegwa et al [ 73 ], Segneri [ 90 ], Stewart et al [ 78 ] and Zadnik et al [ 82 ] all adopted a validated tool to measure violence (see Table 1 ).…”

“…We collected data on violence occurring in 44 different countries, grouped by region: Europe [ 22 , 62 , 65 , 68 , 81 , 91 ]; North America [ 64 , 67 , 69 , 72 , 74 , 75 , 78 , 80 , 82 , 85 ]; Asia [ 31 , 76 , 87 ]; and Africa [ 70 , 71 , 77 , 84 , 86 , 88 ]. Twenty-five of the included reports measured violence in a single country [ 64 , 65 , 67 , 69 , 70 – 72 , 74 , 75 , 77 , 78 , 81 , 82 , 84 – 89 , 91 , 93 , 94 ].…”

“…Studies measured insecure immigration status in a number of different ways. These included ‘undocumented’ [ 22 , 64 – 67 , 69 , 72 , 74 , 75 , 77 , 80 – 82 , 85 , 89 ], ‘refugee /asylum seeker’ [ 62 , 63 , 68 , 70 , 71 , 73 , 83 , 84 , 86 – 88 , 90 , 91 ], ‘spousal /family visa’, ‘employment related’ [ 31 , 76 , 79 ]. Two studies measured more than one status but sufficiently disaggregated the data to allow for insecure status to be verified [ 78 ].…”

“…Similarly, the amount of time a person spends in state custody might vary, but as a period is defined by the characteristic of being incarcerated. This grouping also included ‘past 12 months’ to capture studies that shared this measurement characteristic but did not fall into one of the other categories; for example, Dias et al [ 65 ] measured community violence, while Hadush et al, Islam et al, Logie et al, Ogbonnaya et al and Vives-Cases et al [ 72 , 81 , 86 – 88 ] all measured domestic violence. The ‘not specified’ category grouped all remaining studies where violence happened after arrival in the receiving country but did not include the time period or one of the aforementioned characteristics.…”

War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda

“…These findings are consistent with the existing literature (36,37) that has found that continuous exposure to traumatic events is associated with alcohol use. Additionally, researchers (35,(43)(44)(45) have illuminated that refugees who experience war or conflict-related trauma are at greater risk for poor mental health and alcohol abuse. This study has revealed that some youth consume alcohol to cope with and forget war-related atrocities.…”