Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

Abstract

BackgroundSexually transmitted infection (STI) prevention needs among urban refugee and displaced youth are understudied. The study objective was to explore factors associated with the STI prevention cascade (STI services awareness, testing, diagnosis) among urban refugee and displaced youth in Kampala, Uganda.MethodsWe implemented a cross-sectional survey with youth aged 16–24 years in informal settlements in Kampala. We conducted bivariate and multivariable logistic regression analyses to identify social ecological (intrapersonal, interpersonal, community) level factors associated with STI testing services awareness, lifetime STI testing, and lifetime STI diagnosis.ResultsParticipants (n=445; mean age 19.3, SD 2.6, years) included young women (n=333, 74.8%) and young men (n=112, 25.2%). Less than half (43.8%) were aware of community STI services. One-quarter (26.1%) reported lifetime STI testing. Of these, 39.5% reported a lifetime STI diagnosis. In multivariable analyses among young women, age, lifetime sex partners, and lower adolescent sexual and reproductive health (SRH)-related stigma were associated with STI services awareness; and age, lower adolescent SRH-related stigma, and food security were associated with STI testing. Among young men, time in Uganda and lower HIV-related stigma were associated with STI services awareness; and age, condom self-efficacy, and increased adolescent SRH-related stigma were associated with testing. Lifetime sex partners, lower condom self-efficacy, and lower adolescent SRH-related stigma were associated with lifetime STI diagnosis.ConclusionsSocial ecological factors including stigma (adolescent SRH-related, HIV-related) were associated with STI testing and diagnosis among young urban refugees. Gender, age and stigma-tailored strategies can advance the STI prevention cascade among urban young refugees.

Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study

“…In addition to a lack of availability or knowledge of services, costs and long waiting times as a barrier to access, perceived judgmental attitudes of health-care providers, and concerns surrounding confidentiality result in low uptake of services. 6 , 7 Therefore, STI testing strategies will need to account for and address these factors to facilitate optimum uptake and acceptability.…”

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

“…Police violence and criminalisation targeting sex workers in other contexts was associated with constrained access to condom use and increased HIV vulnerabilities [37,38]. A large body of research describes gender-based stigma and discrimination, and its intersection with other stigmatised health concerns such as HIV, and social identities such as sex work, as profound barriers to HIV testing and prevention [27], including with young refugees in Kampala [3].…”

“…People in humanitarian contexts experience elevated exposure to sexual and gender-based violence (SGBV), poverty, and unmet sexual and reproductive health (SRH) needs [2]. Barriers to accessing SRH services such as HIV prevention and testing in humanitarian contexts include a lack of information, insufficient healthcare services and language barriers [3,4]. These SRH barriers may be exacerbated for young refugee/displaced persons [5] who often experience stigma, poverty, and are at a developmental phase where they value privacy [3][4][5].…”

“…Barriers to accessing SRH services such as HIV prevention and testing in humanitarian contexts include a lack of information, insufficient healthcare services and language barriers [3,4]. These SRH barriers may be exacerbated for young refugee/displaced persons [5] who often experience stigma, poverty, and are at a developmental phase where they value privacy [3][4][5]. Non-judgmental and empowering enabling environments are key to facilitating access to, and uptake of, HIV preventive resources [6,7].…”

“…Among young women, adolescent SRH stigma was associated with poorer HIV testing outcomes [4]. STI testing was also suboptimal among this population, with 26% of urban refugee/displaced youth in Kampala ever testing for STI, and among those ever tested, nearly 40% reported a lifetime STI diagnosis [3]. Socio‐environmental factors such as stigma and food insecurity were associated with STI testing practices, underscoring the need to better understand the role of social environments in influencing engagement with HIV/STI services.…”