Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies

Agardh, Anette; Ross, Michael W.; Östergren, Per-Olof; Larsson, Markus; Tumwine, Gilbert; Månsson, Sven-Axel; Simpson, Julie A.; Patton, George C.

doi:10.1371/journal.pone.0150627

Cited by 5 publications

(12 citation statements)

References 22 publications

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“…Demographic and behavior data were collected using the combined WHO-Ministry of Health Uganda data collection form, albeit the same-sex sexual activity question was removed to reduce the risk of harm to respondents [24]. Data were manually entered into Access database software (Microsoft Inc) prior to data analysis.…”

Section: Data Management and Analysismentioning

confidence: 99%

“…Cefixime's continued potency may be the result of its own scarcity. Data on same-sex sexual activity were not collected, since disclosure could be potentially dangerous [24]. The Joint United Nations Program on HIV/AIDS reported a much higher rate of HIV in Ugandan men who have sex with men (13.2%) than that in men who have sex with women (5.3%) [25], so it is likely that N gonorrhoeae prevalence is also higher, particularly at extragenital sites.…”

Section: Principal Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Workneh¹,

Hamill²,

Kakooza³

et al. 2020

JMIR Public Health Surveill

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Background Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends. Objective This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda. Methods Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing. Results Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity. Conclusions This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.

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Section: Data Management and Analysismentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Workneh¹,

Hamill²,

Kakooza³

et al. 2020

JMIR Public Health Surveill

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“…Only six papers explored the differential health risks that SGM young people are subjected to compared to their cisgender and/or heterosexual peers. The limited number of studies identi ed and their differing ndings suggest that more research is needed in order to better understand which adverse health outcomes SGM young people may experience at a higher risk and in which settings [21,24,[28][29][30]34].…”

Section: Discussionmentioning

confidence: 99%

“…These papers relied on datasets that provided disaggregated data on SGM young people. In particular, Agardh et al and Larsson et al reported greater mental health risks and unmet sexual health counselling needs among college students who identi ed as SGM in Uganda [21,28]. Manalastas also found more signi cant mental health risks, including suicide ideation and attempts, among young sexual minority women in the Philippines [30].…”

Section: Risks To the Health Of Sgm Populationsmentioning

confidence: 99%

Neglected gaps in improving the health, wellbeing, and care for sexual and gender minority young people living in low- and lower-middle- income countries: a scoping review

Kraus-Perrotta¹,

Garnsey²,

DeMulder³

2022

Preprint

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Background There is a lack of reliable data on the size, characteristics, and experiences of sexual and gender minority (SGM) young people (ages 10–24) in low- and lower-middle- income countries (LMICs). This review examines the scant research conducted in the last decade with and about SGM young people living in low-income settings and seeks to answer the question: What is known about the mental and physical health needs, safety, and wellbeing of SGM young people living in LMICs? Methods We conducted a scoping review informed by the methodological frameworks put forth by Arksey and O’Malley and the Joanna Briggs Institute. We systematically searched two general social science databases and one topic-specific database for peer-reviewed papers, of any research design, that included SGM young people or explored attitudes toward SGM young people in LMICs. We included papers that reported on factors influencing the health and wellbeing of SGM populations, including physical and mental health, healthcare-seeking behaviors, substance use, experiences of discrimination and/or stigma, experiences of violence and abuse (emotional, physical, and/or sexual), economically motivated paid sex practices, housing or economic security, and attitudes of others toward SGM populations. Results Of the 3,729 unique records identified, 47 papers drawing from data collected from 44 unique studies met the inclusion criteria. Only 26 of the 47 papers included SGM young people as participants, with just 10 exclusively focusing on young people ages 10–24. The included papers were classified into three thematic groupings: attitudes toward SGM populations (n = 20), risks to the health of SGM populations (n = 19), and experiences of stigma and discrimination among SGM populations (n = 8). Conclusion The findings indicate that the research that does exist for SGM young people in LMICs is disjointed and sparse, and often studies are about SGM young people, rather than with and for them. Our review highlights the need for more and better research, more accurate and disaggregated demographic data, and leadership and participation of SGM-led community-based organizations in the co-design of studies that are about them.

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“…Youth is a period of sexual exploration, and same-sex attraction may be common in young adults and in student populations ( 14 – 16 ). Although previous reports suggest that students at the Mbarara University of Science and Technology (MUST) generally have high rates of unmet healthcare needs and unmet sexual health counselling needs ( 17 , 18 ), those with experience of same-sex sexuality had elevated risk for poor health outcomes and unmet healthcare needs compared to the general student population ( 19 ). The findings showed by Agardh et al indicating increased risk for poor mental health, substance abuse, risky sexual behaviour, exposure to sexual coercion, and unmet sexual health counselling needs among students with same-sex sexuality are thus particularly alarming ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience

Larsson

Ross

Tumwine

et al. 2016

Global Health Action

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BackgroundResearch from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited.ObjectiveTo identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality.DesignIn 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex.ResultsFindings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7–5.7; OR 2.0, 95% CI: 1.3–3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1–4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7–3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9–5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04–3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1–8.5; AOR 2.8, 95% CI: 1.3–5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6–7.1; AOR 2.7, 95% CI: 1.4–5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking.ConclusionsThese findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental health and trauma response are critical to meet the health needs of this population.

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Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies

Cited by 5 publications

References 22 publications

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report

Neglected gaps in improving the health, wellbeing, and care for sexual and gender minority young people living in low- and lower-middle- income countries: a scoping review

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience

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