Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings

Abstract

Background Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. Methods We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Results Participants ( n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Conclusions Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.

Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda

“…Adolescent sexual and reproductive health (SRH) stigma was assessed using the Ugandan version [ 9 ] of the Adolescent SRH Stigma scale [ 54 ]. The study's scale reliability scores are reported elsewhere [ 55 ]. Due to data collection issues leading to differential item non‐response by study arms, scales, including the CUSES (modified scale, six of eight original items): α = 0.90; Adolescent SRH Stigma (modified scale, 12 of 14 original items): α = 0.86 and SRP Scale (modified scale, 14 of 15 original items): α = 0.89, were modified to use only questions asked to all participants.…”

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

“…Higher scores indicated the presence of higher perceived HIV-related stigma. Following the distribution, sums of scores were dichotomized using a median cut-off of > 32, indicating high perceived HIV-related stigma, which was coded as “1.” This scale has previously been used with displaced youth living in urban slums in Uganda [ 69 ].…”

“…Belief in harmful inequitable gender norms were assessed using the gender belief scale (Cronbach α = 0.76). Responses include “strongly agree,” “agree,” “disagree,” and “strongly disagree” [ 69 ]. We reverse coded the items, and summed them up so that high scores represented more traditional beliefs about gender roles and low scores indicated low progressive beliefs.…”

Todurujo na Kadurok (empowering youth): study protocol of an HIV self-testing and edutainment comic cluster randomised trial among refugee youth in a humanitarian setting in Uganda

“…11 Studies conducted among urban refugee youth in Kampala, Uganda have found that inequitable gender norms and intersecting forms of stigma, including HIV-related stigma and refugee stigma, may also limit HIV testing and prevention engagement among refugee youth. [12][13][14][15] Social network breakdown, poverty and travel distance to clinics, confidentiality concerns, language barriers and other logistic hurdles may also present obstacles to HIV testing. 16 17 HIV self-testing (HIVST) is a promising approach documented across systematic reviews to increase HIV testing access and uptake.…”

“…There is limited inclusion of refugee adolescents and youth in sexual and reproductive health (SRH) research and programming8–10 that may result in a lack of age, gender, and culturally tailored programmes, which in turn may contribute to low engagement with HIV testing and prevention services in humanitarian contexts 11. Studies conducted among urban refugee youth in Kampala, Uganda have found that inequitable gender norms and intersecting forms of stigma, including HIV-related stigma and refugee stigma, may also limit HIV testing and prevention engagement among refugee youth 12–15. Social network breakdown, poverty and travel distance to clinics, confidentiality concerns, language barriers and other logistic hurdles may also present obstacles to HIV testing 16 17…”