The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda: findings from a qualitative study

Abstract

objective To explore experiences, preferences and engagement with HIV testing and prevention among urban refugee and displaced adolescents and youth in Kampala, Uganda, with a focus on the role of contextual factors in shaping access and uptake.methods This qualitative community-based study with urban refugee and displaced youth aged 16-24 living in Kampala's informal settlements involved five focus groups (FG), including two with young women, two with young men, and one with sex workers from March to May 2019. We also conducted five in-depth key informant interviews. We conducted thematic analysis informed by Campbell and Cornish's conceptualisation of material and symbolic contexts.results Refugee/displaced youth participants (n = 44; mean age: 20.25, SD: 2.19; men: n = 17; women: n = 27) were from the Democratic Republic of Congo (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1). Participant narratives reflected material and symbolic contexts that shaped HIV testing awareness, preferences and uptake. Material contextual factors that presented barriers to HIV testing and prevention engagement included transportation costs to clinics, overcrowded living conditions that limited access to private spaces, low literacy and language barriers. Symbolic contexts that constrained HIV testing engagement included medical mistrust of HIV testing and inequitable gender norms. Religion emerged as an opportunity to connect with refugee communities and to address conservative religious positions on HIV and sexual health.conclusion Efforts to increase access and uptake along the HIV testing and prevention cascade can meaningfully engage urban refugee and displaced youth to develop culturally and contextually relevant services to optimise HIV and sexual health outcomes. keywords refugee and internally displaced, HIV testing, HIV self-testing, stigma, Uganda, adolescent and youth Sustainable Development Goals (SDGs): Good health and well-being, gender equality; universal health coverage Migrant Health Dermatology Working Group (alphabetical order

The prevalence and correlates of depression before and after the COVID-19 pandemic declaration among urban refugee adolescents and youth in informal settlements in Kampala, Uganda: A longitudinal cohort study

“…This may be particularly important for youth in informal settlements at large, as these environments can include social disorganization, weaker social ties, high mobility, and smaller social networks [52] —these may be exacerbated for urban refugees. Qualitative research noted the ways in which urban refugee youth in Kampala access support from peer educators [53] and religious communities [54] . Tsai et al identified instrumental social support was a stronger buffer than emotional support in the relationship between food insecurity and depression among people living with HIV in Uganda [46] , signalling the need to further disentangle the mechanisms through which social support dimensions can buffer the effect of stressors on depression with urban refugee youth.…”

Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda

“…In this study, the stigma youth experienced for being sexually active and engaging in SRH care was associated with reduced odds of ever having tested for HIV [20]. Qualitative findings have also pointed to the important role of intersecting forms of stigma, including HIV, adolescent SRH, refugee, and sex work stigma, as well as cost and transportation challenges, in producing HIV testing barriers for urban refugee youth in Kampala [22,23]. Less is known about relational contexts of HIV testing decision-making among urban refugee youth.…”

“…This communitybased study was a collaboration with refugee youth serving agencies, Ugandan researchers, the Ugandan Ministry of Health, and academics. Five focus groups, approximately 45-min in duration, were conducted with refugee youth: two with young men (one aged 16-19, one aged 20-24), two with young women (one aged 16-19, one aged 20-24), and one with young women sex workers (aged [16][17][18][19][20][21][22][23][24]. Additionally, we conducted five key informant (KI) interviews, approximately 30 min in duration.…”

“…"Since you share with your partner everything, deep things," one young man put forth, "there's no secrets, and we know that we are safe." (focus group [FG], young men, aged [20][21][22][23][24].…”

“…(FG, young men, aged 20-24) This sentiment was corroborated by another participant, framing support from families as long-term: "A family member, because, if you get any problem, they won't give up on you so quickly." (FG, young men, aged [20][21][22][23][24].…”