Browsing by Author "Bukenya, Justine N."

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    Barriers to access and utilisation of HIV/STIs prevention and care services among transwomen sex workers in the greater Kampala metropolitan area, Uganda
    (BMC infectious diseases, 2020) Ssekamatte, Tonny; Isunju, John B.; Muyanga, Naume; Buregyeya, Esther; Mugambe, Richard K.; Wanyenze, Rhoda K.; Bukenya, Justine N.
    Trans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilization of HIV/STI prevention services. This study explored barriers to access and utilization of HIV/STI prevention services and associated coping mechanisms. This exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilization of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analyzed through thematic analysis using a hybrid of inductive and deductive approaches. Individual level barriers to access and utilization of HIV/STI prevention and care services included internalized stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity
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    High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study
    (International journal of environmental research and public health, 2016) Weiss, Helen A.; Vandepitte, Judith; Bukenya, Justine N.; Mayanja, Yunia; Nakubulwa, Susan; Kamali, Anatoli; Seeley, Janet; Grosskurth, Heiner
    The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.
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    Menstrual health challenges in the workplace and consequences for women’s work and wellbeing: A cross-sectional survey in Mukono, Uganda
    (PLOS Global Public Health, 2022-07-21) Hennegan, Julie; Bukenya, Justine N.; Nakamya, Petranilla; Makumbi, Fredrick E.; Kibira, Simon P. S.
    This study describes women’s menstrual health needs at work in Uganda and explores the associations between unmet needs and women’s work and wellbeing. We undertook a cross-sectional survey of women working in marketplaces, public primary schools, and health care facilities in Mukono district, central Uganda. Survey questions were designed to capture women’s experiences of managing menstrual bleeding, pain, social support, and the social environment. A total 435 women working in markets, 45 teachers and 45 health care facility workers participated. Of these, 15% missed work due to their last period, and 41% would prefer not to work during menstruation. Unmet menstrual health needs were associated with consequences for women’s work and psychological wellbeing. Experiencing menstrual pain (aPR 3.65 95%CI 1.48–9.00), along with the use of improvised menstrual materials (aPR 1.41 95%CI 1.08–1.83), not feeling comfortable to discuss menstruation at work (aPR 1.54 95%CI 1.01–2.34) and the expectation that women should stay home when menstruating (aPR 2.44 95%CI 1.30–4.60) were associated with absenteeism due to menstruation. In contrast, not having menstrual management needs met (aPR 1.45 95%CI 1.17–1.79) and the attitude that menstruating women are dirty (aPR 1.94 95%CI 1.50–2.51), along with pain (aPR 1.59 95%CI 1.12–2.24) and norms around absenteeism were associated with wanting to miss work. After adjustment for age and poverty, unmet menstrual management needs (b = -5.97, 95%CI -8.89, -2.97), pain (b = -3.89, 95%CI -7.71, -0.08) and poor social support (b = -5.40, 95%CI -9.22, -1.57) were associated with lower wellbeing measured using the WHO-5. Attitudes that menstruation should be kept secret (b = 4.48, 95%CI 0.79, 8.17) and is dirty (b = 4.59, 95%CI 0.79, 8.40) were associated with higher wellbeing. Findings suggest that supporting care for menstrual pain, addressing secrecy surrounding menstruation and the perception of menstruation as dirty, and improving access to materials and facilities for managing menstrual bleeding are avenues for programs and policies to support working women.
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    Pregnancy Planning among Female Sex Workers in Uganda: Evaluation of the Psychometric Properties of the London Measure of Unplanned Pregnancy
    (African Journal of Reproductive Health, 2019) Bukenya, Justine N.; Nalwadda, Christine K.; Neema, Stella; Kyambadde, Peter; Wanyenze, David K.; Barrett, Geraldine
    The aim of the study was to evaluate the psychometric properties of the London Measure of Unplanned Pregnancy (LMUP) among female sex workers (FSWs) in Uganda. The LMUP was translated into Luganda and adapted for use with FSWs and underwent cognitive testing and two field tests. From the final Luganda LMUP, three other language versions were created (Acholi, Lugisu and Runyakole), and preliminary field test data were collected. Final data were collected from 819 FSWs attending the ‗Most at Risk Population Initiative‘ clinics. The Luganda field testing showed that there were no missing data, the scale was well targeted, Cronbach‘s alpha was 0.82, weighted Kappa was 0.78, measurement was unidimensional, and all construct validity hypotheses were met. Likewise, with the Acholi, Lugisu, and Runyankole translations, field testing showed that there were no missing data, the scales were well targeted, Cronbach‘s alpha were>0.70, and measurement was unidimensional. We concluded that the Luganda LMUP is a valid and reliable tool for assessing pregnancy planning among FSWs in Uganda and that the Acholi, Lugisu, and Runyankole versions of the LMUP also had good initial psychometric properties. (Afr J Reprod Health 2019; 23[3]: 79-95).
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    Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: A cross-sectional study
    (PLoS ONE, 2021) Matovu, Joseph K. B.; Bukenya, Justine N.; Kasozi, Dickson; Kisaka, Stephens; Kisa, Rose; Nyabigambo, Agnes; Tugume, Abdulaziz; Bwanika, John B.; Mugenyi, Levicatus; Murungi, Irene; Serwadda, David; Wanyenze, Rhoda K.
    Adolescent girls and young women (AGYW) are at increased risk of sexually transmitted infections (STIs). We assessed sexual-risk behaviours and HIV and syphilis prevalence among AGYW in Uganda to inform the design of target-specific risk-reduction interventions. Methods This analysis utilizes data from 8,236 AGYW aged 10–24 years, collected in 20 districts, between July and August 2018. AGYW engaged in sexual-risk behaviour if they: a) reported a history of STIs; or b) had their sexual debut before age 15; or c) engaged in sex with 2+ partners in the past 12 months; or c) did not use or used condoms inconsistently with their most recent partners. We diagnosed HIV using DetermineTM HIV-1/2, Stat-PakTM HIV-1/2 and SD Bioline. We used SD Bioline Syphilis test kits to diagnose syphilis and Treponema Pallidum Hemagglutination Assay for confirmatory syphilis testing. Comparison of proportions was done using Chi-square (χ2) tests. Data were analysed using STATA (version 14.1). Results Of 4,488 AGYW (54.5%) that had ever had sex, 12.9% (n = 581) had their sexual debut before age 15; 19.1% (n = 858) reported a history of STIs. Of those that had ever had sex, 79.6% (n = 3,573) had sex in the 12 months preceding the survey; 75.6% (n = 2,707) with one (1) and 24.2% (n = 866) with 2+ partners. Condom use with the most recent sexual partner was low, with only 20.4% (n = 728) reporting consistent condom use while 79.6% (n = 2,842) reported inconsistent or no condom use. In-school AGYW were significantly less likely to have ever had sex (35.6% vs. 73.6%, P<0.001), to have had sexual debut before age 15 (7.7% vs. 15.5%, P<0.001) or to engage in sex with 2+ partners (5.3% vs. 15.8%,