Exploring Associations Between Adolescent Sexual and Reproductive Health Stigma and HIV Testing Awareness and Uptake Among Urban Refugee and Displaced Youth in Kampala, Uganda

Overview

Journal Sex Reprod Health Matters

Specialties Public Health
Reproductive Medicine

Date 2019 Dec 28

PMID 31880507

Citations 29

Authors

Carmen H Logie

Moses Okumu

Simon P Mwima

Peter Kyambadde

Robert Hakiza

Irungu Peter Kibathi

Emmanuel Kironde

Joshua Musinguzi

Claire Uwase Kipenda

Affiliations

Soon will be listed here.

Abstract

Uganda, hosting over 1.3 million refugees, is a salient context for exploring HIV testing with urban refugee and displaced youth. We examined associations between stigma (HIV-related and adolescent sexual and reproductive health [SRH]-related) and HIV testing services awareness and HIV testing uptake among urban refugee and displaced youth in Kampala, Uganda. We implemented a cross-sectional survey with refugee and displaced adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) aged 16-24. We conducted exploratory and confirmatory factor analysis of an adolescent SRH stigma scale and identified a two-factor structure ("Sexual activity & pregnancy stigma","Modern family planning & abortion stigma"). We conducted multivariable logistic regression analysis to determine the adjusted risk ratio for HIV testing services awareness and testing uptake. Among participants (n=445; mean age=19.59, SD=2.60; AGYW: n=333; 74.7%), two-thirds were aware of HIV testing services in their community and over half (56.0%) had received a lifetime HIV test. In adjusted multivariable regression analysis findings with AGYW: (a) higher sexual activity & pregnancy stigma and modern family planning & abortion stigma were associated with reduced odds of HIV testing services awareness, and (b) modern family planning & abortion stigma was associated with reduced lifetime HIV testing odds. Stigma was not associated with HIV testing awareness/uptake among ABYM. HIV testing services awareness among AGYW was lower than among ABYM, yet AGYW were more likely to have been tested and to experience adolescent SRH stigma as a testing barrier. Addressing adolescent SRH stigma may optimise AGYW's HIV testing.

Citing Articles

Community and familial dynamics influencing risk behavior for HIV acquisition among adolescent girls and young women in Uganda: Qualitative analysis using Protective Motivation Theory.

Apondi R, Bastiaens H, Nostlinger C, Galbraith J, Aholou T, Medley A PLoS One. 2025; 20(1):e0301311.

PMID: 39854504 PMC: 11759986. DOI: 10.1371/journal.pone.0301311.

Findings From the Todurujo na Kadurok (Empowering Youth) HIV Self-Testing and Edutainment Comic Randomized Controlled Trial With Refugee Youth in a Humanitarian Setting in Uganda.

Logie C, Loutet M, Okumu M, MacKenzie F, Coelho M, Lukone S J Int Assoc Provid AIDS Care. 2024; 23:23259582241307057.

PMID: 39692067 PMC: 11653462. DOI: 10.1177/23259582241307057.

Contextualizing HIV testing experiences within the HIV prevention cascade: qualitative insights from refugee youth in Bidi Bidi refugee settlement, Uganda.

Logie C, Okumu M, Loutet M, Coelho M, McAlpine A, MacKenzie F BMC Public Health. 2024; 24(1):2599.

PMID: 39334074 PMC: 11429596. DOI: 10.1186/s12889-024-20135-2.

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

Logie C, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M Reprod Health. 2024; 21(1):51.

PMID: 38609975 PMC: 11010352. DOI: 10.1186/s12978-024-01780-7.

Barriers and facilitators to utilizing HIV prevention and treatment services among migrant youth globally: A scoping review.

Li K, Thaweesee N, Kimmel A, Dorward E, Dam A PLOS Glob Public Health. 2024; 4(2):e0002851.

PMID: 38354206 PMC: 10866458. DOI: 10.1371/journal.pgph.0002851.

References

Malamba S, Muyinda H, Spittal P, Ekwaru J, Kiwanuka N, Ogwang M . "The Cango Lyec Project - Healing the Elephant": HIV related vulnerabilities of post-conflict affected populations aged 13-49 years living in three Mid-Northern Uganda districts. BMC Infect Dis. 2016; 16(1):690. PMC: 5117608. DOI: 10.1186/s12879-016-2030-0. View

Dahab M, Spiegel P, Njogu P, Schilperoord M . Changes in HIV-related behaviours, knowledge and testing among refugees and surrounding national populations: a multicountry study. AIDS Care. 2013; 25(8):998-1009. DOI: 10.1080/09540121.2012.748165. View

Nostlinger C, Loos J . Migration patterns and HIV prevention in Uganda. Lancet HIV. 2018; 5(4):e158-e160. DOI: 10.1016/S2352-3018(18)30023-7. View

Spiegel P . The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet. 2017; . DOI: 10.1016/S0140-6736(17)31278-3. View

Quinn D, Chaudoir S . Living with a concealable stigmatized identity: the impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. J Pers Soc Psychol. 2009; 97(4):634-51. PMC: 4511710. DOI: 10.1037/a0015815. View

Spiegel P, Bennedsen A, Claass J, Bruns L, Patterson N, Yiweza D . Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review. Lancet. 2007; 369(9580):2187-2195. DOI: 10.1016/S0140-6736(07)61015-0. View

Warren E, Post N, Hossain M, Blanchet K, Roberts B . Systematic review of the evidence on the effectiveness of sexual and reproductive health interventions in humanitarian crises. BMJ Open. 2015; 5(12):e008226. PMC: 4691726. DOI: 10.1136/bmjopen-2015-008226. View

Choko A, Kumwenda M, Johnson C, Sakala D, Chikalipo M, Fielding K . Acceptability of woman-delivered HIV self-testing to the male partner, and additional interventions: a qualitative study of antenatal care participants in Malawi. J Int AIDS Soc. 2017; 20(1):21610. PMC: 5515040. DOI: 10.7448/IAS.20.1.21610. View

Logie C, Khoshnood K, Okumu M, Rashid S, Senova F, Meghari H . Self care interventions could advance sexual and reproductive health in humanitarian settings. BMJ. 2019; 365:l1083. PMC: 6441869. DOI: 10.1136/bmj.l1083. View

10.

Steward W, Herek G, Ramakrishna J, Bharat S, Chandy S, Wrubel J . HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008; 67(8):1225-35. PMC: 2603621. DOI: 10.1016/j.socscimed.2008.05.032. View

11.

Gesesew H, Gebremedhin A, Demissie T, Kerie M, Sudhakar M, Mwanri L . Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis. PLoS One. 2017; 12(3):e0173928. PMC: 5373570. DOI: 10.1371/journal.pone.0173928. View

12.

OLaughlin K, Kasozi J, Walensky R, Parker R, Faustin Z, Doraiswamy S . Clinic-based routine voluntary HIV testing in a refugee settlement in Uganda. J Acquir Immune Defic Syndr. 2014; 67(4):409-13. PMC: 4213244. DOI: 10.1097/QAI.0000000000000317. View

13.

Stark L, DeCormier Plosky W, Horn R, Canavera M . 'He always thinks he is nothing': The psychosocial impact of discrimination on adolescent refugees in urban Uganda. Soc Sci Med. 2015; 146:173-81. DOI: 10.1016/j.socscimed.2015.10.045. View

14.

Nyblade L, Stockton M, Nyato D, Wamoyi J . Perceived, anticipated and experienced stigma: exploring manifestations and implications for young people's sexual and reproductive health and access to care in North-Western Tanzania. Cult Health Sex. 2017; 19(10):1092-1107. DOI: 10.1080/13691058.2017.1293844. View

15.

Khatoon S, Budhathoki S, Bam K, Thapa R, Bhatt L, Basnet B . Socio-demographic characteristics and the utilization of HIV testing and counselling services among the key populations at the Bhutanese Refugees Camps in Eastern Nepal. BMC Res Notes. 2018; 11(1):535. PMC: 6069810. DOI: 10.1186/s13104-018-3657-2. View

16.

Shedlin M, Decena C, Noboa H, Betancourt O . Sending-country violence and receiving-country discrimination: effects on the health of Colombian refugees in Ecuador. J Immigr Minor Health. 2013; 16(1):119-24. PMC: 4226797. DOI: 10.1007/s10903-013-9777-9. View

17.

Magnani R, Sabin K, Saidel T, Heckathorn D . Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005; 19 Suppl 2:S67-72. DOI: 10.1097/01.aids.0000172879.20628.e1. View

18.

Pantelic M, Shenderovich Y, Cluver L, Boyes M . Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa. Health Psychol Rev. 2015; 9(4):469-90. DOI: 10.1080/17437199.2014.996243. View

19.

Madise N, Ziraba A, Inungu J, Khamadi S, Ezeh A, Zulu E . Are slum dwellers at heightened risk of HIV infection than other urban residents? Evidence from population-based HIV prevalence surveys in Kenya. Health Place. 2012; 18(5):1144-52. PMC: 3427858. DOI: 10.1016/j.healthplace.2012.04.003. View

20.

Hall K, Manu A, Morhe E, Harris L, Loll D, Ela E . Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana. J Sex Res. 2017; 55(1):60-72. PMC: 5901672. DOI: 10.1080/00224499.2017.1292493. View