Browsing by Author "Okumu, Moses"
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Item Applying the Index of Vulnerability approach to understand water insecurity and other social-ecological factors associated with depression among urban refugee youth in Kampala, Uganda(Elsevier Ltd, 2024-06) Logie, Carmen H; Okumu, Moses; Admassu, Zerihun; MacKenzie, Frannie; Kortenaar, Jean-Luc; Perez-Brumer, Amaya; Gittings, Lesley; Khan, Naimul; Hakiza, Robert; Kibuuka Musoke, Daniel; Nakitende, Aidah; Katisi, Brenda; Kyambadde, Peter; Taing, Lina; Mbuagbaw, LawrenceAbstract Water insecurity and other social-ecological factors may be associated with depression in low and middle-income contexts (LMICs). This is understudied among urban refugee youth in LMICs, who experience multiple forms of marginalization. We conducted a cross-sectional survey with a peer-driven sample of urban refugee youth aged 16–24 in Kampala, Uganda. We explored: the prevalence of depression (moderate, moderately severe); associations between social-ecological (structural, community, interpersonal, intrapersonal) factors and depression; and associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors and depression. Among n = 335 participants (mean age: 20.8 years, standard deviation: 3.1), in multivariable analyses, longer time in Uganda, water insecurity, lower social support, parenthood, and recent intimate partner violence were associated with moderate depression; and longer time in Uganda, water insecurity, and lower social support were associated with moderately severe depression. IoV scores were associated with moderate depression among men and women, and moderately severe depression among women. The IoV scores accounted for more variance in moderate/moderately severe depression among women than any single indicator; among men, water insecurity was most strongly associated with moderate depression. Future research can explore strategies to address water insecurity and other social-ecological stressors to promote health and wellbeing with urban refugee youth.Item Contextual factors associated with depression among urban refugee and displaced youth in Kampala, Uganda: findings from a cross-sectional study(Conflict and Health, 2020) Logie, Carmen H.; Okumu, Moses; Mwima, Simon; Hakiza, Robert; Chemutai, Doreen; Kyambadde, PeterAdvancing mental health among refugee and displaced adolescents and youth is critically important, as chronic psychological stress can have lifelong harmful impacts. These groups experience socio-environmental stressors that can harm mental health. Informed by a social contextual framework, this study explored the prevalence of depression among urban refugee and displaced youth in Kampala, Uganda and associations with symbolic (violence), relational (social support), and material (food and community insecurity) contexts. We implemented a cross-sectional survey with refugee and displaced adolescent girls and young women and adolescent boys and young men aged 16–24 living in Kampala’s informal settlements. We conducted peer-driven recruitment, whereby peer navigators shared study information with their networks and in turn participants were invited to recruit their peers. We conducted gender disaggregated analyses, including stepwise multiple regression to examine factors associated with depression. We then conducted structural equation modeling (SEM) using weighted least squares estimation to examine direct paths from violence, food insecurity, and community insecurity to depression, and indirect effects through social support. Among participants (n = 445), young women (n = 333) reported significantly higher depression symptoms than young men (n = 112), including any symptoms (73.9% vs. 49.1%, p < 0.0001), mild to moderate symptoms (60.4% vs. 45.5%, p = 0.008), and severe symptoms (13.5% vs 3.6%, p = 0.002). SEM results among young women indicate that the latent violence factor (lifetime sexual and physical violence) had direct effects on depression and social support, but social support did not mediate the path from violence to depression. The model fit the data well: χ2(3) = 9.82, p = 0.020; RMSEA = 0.08, 90% CI [0.03, 0.14], CFI = 0.96). Among young men, SEM findings indicate that food insecurity had direct effects on social support, and an indirect effect on depression through the mediating role of social support. Fit indices suggest good model fit: χ2(3) = 2.09, p = 0.352; RMSEA = 0.02, 90% CI [0.000, 0.19], CFI = 0.99. Findings reveal widespread depression among urban refugee and displaced youth in Kampala, disproportionately impacting young women. Contextual factors, including food insecurity and violence, increase depression risks. Strategies that reduce gender-based violence and food insecurity, and increase social support networks, have the potential to promote mental health among urban refugee and displaced youth.Item Examining the substance use, violence, and HIV and AIDS (SAVA) syndemic among urban refugee youth in Kampala, Uganda: cross-sectional survey findings(BMJ global health, 2022) Logie, Carmen H.; Okumu, Moses; Malama, Kalonde; Mwima, Simon; Hakiza, Robert; Kiera, Uwase Mimy; Kyambadde, PeterInteractions between substance use, violence, HIV and AIDS, known as the ‘SAVA’ syndemic, are understudied among refugee youth. We assessed the synergistic effects of frequent alcohol use, depression and violence on HIV vulnerability among urban refugee youth aged 16–24 years in Kampala, Uganda. We conducted a cross-sectional survey between January and April 2018 with a convenience sample of refugee youth aged 16–24 years living in informal settlements in Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya). We assessed non-communicable health conditions (frequent [≥3 times per week] alcohol use [FAU]; depression); violence (young adulthood violence [YAV] at age ≥16 years, intimate partner violence [IPV]), and HIV vulnerability (past 12-month transactional sex; recent [past 3-month] multiple [≥2] sex partners). We calculated the prevalence and co-occurrence of non-communicable health conditions, violence and HIV vulnerability variables. We then conducted multivariable logistic regression analyses to first create unique profiles of FAU, depression, YAV and IPV exposures, and second to assess for interactions between exposures on HIV vulnerability outcomes. Most participants (n=445; mean age: 19.59, SD: 2.6; women: n=333, 74.8%, men: n=112, 25.2%) reported at least one non-communicable health condition or violence exposure (n=364, 81.8%), and over half (n=278, 62.4%) reported co-occurring exposures. One-fifth reported FAU (n=90; 20.2%) and one-tenth (n=49; 11%) major depression. In logistic regression models including all two-way product terms, adjusted for sociodemographics, we found (a) multiplicative interaction for joint effects of FAU and IPV (adjusted OR (aOR)=4.81, 95% CI: 1.32 to 17.52) on multiple sex partners, and (b) multiplicative interaction for joint effects of FAU and IPV (aOR=3.72, 95% CI: 1.42 to 9.74), and YAV and depression (aOR=7.13, 95% CI: 1.34 to 37.50), on transactional sex. Findings signal the importance of addressing the SAVA syndemic among urban refugee youth in Uganda. Synergistic interactions indicate that addressing FAU, depression or violence may concomitantly reduce HIV vulnerability with urban refugee youth.Item Exploring associations between adolescent sexual and reproductive health stigma and HIV testing awareness and uptake among urban refugee and displaced youth in Kampala, Uganda(Sexual and Reproductive Health Matters, 2019) Logie, Carmen H.; Okumu, Moses; Mwima, Simon P.; Kyambadde, Peter; Kibathi, Irungu Peter; Kironde, Emmanuel; Musinguzi, Joshua; Kipenda, Claire Uwase; Hakiza, RobertUganda, 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.Item Gender, transactional sex, and HIV prevention cascade engagement among urban refugee and displaced adolescents and youth in Kampala, Uganda(AIDS care, 2021) Logie, Carmen Helen; Okumu, Moses; Mwima, Simon; Hakiza, Robert; Abela, Heather; Kyambadde, PeterHIV prevention needs among urban refugee and displaced youth engaged in transactional sex are understudied. We examined associations between transactional sex and the HIV prevention cascade among urban refugee/displaced youth in Kampala, Uganda. We conducted a cross-sectional survey with a peer-driven sample of refugee/displaced adolescent girls and young women (n = 324) and adolescent boys and young men (n = 88) aged 16–24 living in Kampala’s informal settlements. We conducted gender-disaggregated multivariable linear and logistic regressions to examine associations between past 12-month transactional sex and: lifetime HIV testing, condom self-efficacy, and recent [past 3-month] consistent condom use. Among the 27% of young women reporting transactional sex, 63% reported HIV testing. In multivariable analyses with young women, transactional sex was associated with higher condom self-efficacy, increased consistent condom use, but not HIV testing. Among the 48% of young men reporting transactional sex, 50% reported HIV testing. In multivariable analyses with young men, transactional sex was associated with lower HIV testing but not with condom self-efficacy or consistent condom use. Young men were 68% less likely to report HIV testing if transactional sex engaged. Findings point to urgent HIV testing gaps among transactional sex engaged urban refugee/displaced youth and a need for gender-tailored HIV prevention strategies.Item Intersecting stigma and HIV testing practices among urban refugee adolescents and youth in Kampala, Uganda: qualitative findings(Journal of the International AIDS Society, 2021) Logie, Carmen H; Okumu, Moses; Musoke, Daniel Kibuuka; Hakiza, Robert; Mwima, Simon; Kyambadde, Peter; Abela, Heather; Gittings, Lesley; Musinguzi, Joshua; Mbuagbaw, Lawrence; Bara, StefanHIV-related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self-testing, with urban refugee youth in Kampala, Uganda. We implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February-April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non-government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations. Participants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a “Ugandan disease”; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same-sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self-testing. They recommended HIV self-testing implementation strategies to be peer supported and expressed concerns regarding sexual- and gender-based violence with partner testing. Intersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi-level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.Item Kukaa Salama (Staying Safe): study protocol for a pre/post-trial of an interactive mHealth intervention for increasing COVID-19 prevention practices with urban refugee youth in Kampala, Uganda(BMJ open, 2021) Logie, Carmen H.; Okumu, Moses; Hakiza, Robert; Musoke, Daniel Kibuuka; Kyambadde, Peter; Mwima, Simon; Baral, StefanWith over 82.4 million forcibly displaced persons worldwide, there remains an urgent need to better describe culturally, contextually and age-tailored strategies for preventing COVID-19 in humanitarian contexts. Knowledge gaps are particularly pronounced for urban refugees who experience poverty, overcrowded living conditions and poor sanitation access that constrain the ability to practise COVID-19 mitigation strategies such as physical distancing and frequent hand washing. With over 1.4 million refugees, Uganda is sub-Saharan Africa’s largest refugee hosting nation. More than 90 000 of Uganda’s refugees live in Kampala, most in informal settlements, and 27% are aged 15–24 years old. There is an urgent need for tailored COVID-19 responses with urban refugee adolescents and youth. This study aims to evaluate the effectiveness of an 8-week interactive informational mobile health intervention on COVID-19 prevention practices among refugee and displaced youth aged 16–24 years in Kampala, Uganda. We will conduct a pre-test/post-test study nested within a larger cluster randomised trial. Approximately 385 youth participants will be enrolled and followed for 6 months. Data will be collected at three time points: before the intervention (time 1); immediately after the intervention (time 2) and at 16-week follow-up (time 3). The primary outcome (self-efficacy to practise COVID-19 prevention measures) and secondary outcomes (COVID-19 risk awareness, attitudes, norms and self-regulation practices; depression; sexual and reproductive health practices; food and water security; COVID-19 vaccine acceptability) will be evaluated using descriptive statistics and regression analyses.Item Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other(JMIR research protocols, 2021) Logie, Carmen; Okumu, Moses; Hakiza, Robert; Kibuuka Musoke, Daniel; Berry, Isha; Mwima, Simon; Kyambadde, Peter; Mimy Kiera, Uwase; Loutet, Miranda; Neema, Stella; Newby, Katie; McNamee, Clara; Baral, Stefan D.; Lester, Richard; Musinguzi, Joshua; Mbuagbaw, LawrenceHIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations.Item Multi-method findings on COVID-19 vaccine acceptability among urban refugee adolescents and youth in Kampala, Uganda(Global public health, 2023) Logie, Carmen H.; Okumu, Moses; Musoke, Daniel Kibuuka; Kyambadde, PeterScant studies have explored COVID-19 vaccine acceptability among refugees. However, contexts of forced migration may elevate COVID-19 vulnerabilities, and suboptimal refugee immunisation rates are reported for other vaccine-preventable diseases. We conducted a multi-methods study to describe COVID-19 vaccine acceptability among urban refugee youth in Kampala, Uganda. This study uses cross-sectional survey data from a cohort study with refugees aged 16–24 in Kampala to examine socio-demographic factors associated with vaccine acceptability. A purposively sampled cohort subset (n = 24) participated in semi-structured in-depth individual interviews, as did key informants (n = 6), to explore COVID-19 vaccine acceptance. Among 326 survey participants (mean age: 19.9; standard deviation 2.4; 50.0% cisgender women), vaccine acceptance was low (18.1% reported they were very likely to accept an effective COVID-19 vaccine). In multivariable models, vaccine acceptance likelihood was significantly associated with age and country of origin. Qualitative findings highlighted COVID-19 vaccine acceptability barriers and facilitators spanning social-ecological levels, including fear of side effects and mistrust (individual level), misinformed healthcare, community and family attitudes (community level), tailored COVID-19 services for refugees (organisational and practice setting), and political support for vaccines (policy environment). These data signal the urgent need to address social-ecological factors shaping COVID-19 vaccine acceptability among Kampala’s young urban refugees.Item 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(Annals of epidemiology, 2022) Logie, Carmen H.; Berry, Isha; Okumu, Moses; Miranda, Loutet; McNamee, Clara; Hakiza, Robert; Musoke, Daniel Kibuuka; Mwima, Simon; Kyambadde, Peter; Mbuagbaw, LawrenceThere is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. Data from a cohort of refugee youth (n = 367) aged 16–24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. The prevalence of depression was high, but there was no significant difference before (27.5%), and after (28.9%) the pandemic declaration (P = .583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21–5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07–5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81–0.89). These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.Item Relational Factors and HIV Testing Practices: Qualitative Insights from Urban Refugee Youth in Kampala, Uganda(AIDS and Behavior, 2022) Logie, Carmen H.; Okumu, Moses; Latif, Maya; Hakiza, Robert; Musoke, Daniel Kibuuka; Mwima, Simon; Batte, Shamilah; Kyambadde, PeterDespite the global phenomenon of refugee urbanization, little is known of relational contexts that shape HIV testing among urban refugee youth. We explored perspectives, experiences, and preferences for social support in HIV testing among refugee youth aged 16–24 in Kampala, Uganda. We conducted five focus groups with refugee youth (n = 44) and five in-depth key informant interviews. Participant narratives signaled relational contexts shaping HIV testing included informal sources (intimate partners and family members) and formal sources (peer educators and professionals). There was heterogeneity in perspectives based on relationship dynamics. While some felt empowered to test with partners, others feared negative relationship consequences. Participant narratives reflected kinship ties that could facilitate testing with family, while others feared coercion and judgment. Peer support was widely accepted. Professional support was key for HIV testing as well as conflict-related trauma. Findings emphasize bonding and bridging social capital as salient components of enabling HIV testing environments.Item Sexual violence stigma experiences among refugee adolescents and youth in Bidi Bidi refugee settlement, Uganda: Qualitative insights informed by the stigma power process framework(Elsevier Ltd, 2023-12) Logie, Carmen H; Okumu, Moses; Coelho, Madelaine; Loutet, Miranda G; Berry, Isha; Lukone, Simon Odong; Kisubi, Nelson; Musoke, Daniel Kibuuka; Kyambadde, PeterAbstract There are over 100 million forcibly displaced persons who experience elevated risks for sexual violence. Sexual violence stigma can have immediate and long-lasting effects on social and health outcomes among survivors. There is a dearth of information on the experiences of sexual violence stigma among refugee adolescents and youth, particularly in low and middle-income contexts where most forcibly displaced persons are hosted. Our study focuses on understanding the lived experiences of sexual violence stigma among refugee adolescents and youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved twelve individual in-depth interviews and six focus groups in Bidi Bidi with refugee youth aged 16–24, refugee elder interviews (n = 8), and service provider interviews (n = 10). We explored experiences and impacts of sexual violence stigma, including accessing supportive resources. We conducted thematic analysis informed by the Stigma Power Process framework. This framework examines how social processes of stigma serve to keep people ‘in’, ‘down’, and ‘away’. Participant narratives highlighted negative cultural conceptions of sexual violence survivors and of women and girls, as well as daily indignities targeting survivors that reinforced their lower status. Shaming sexual violence survivors as ‘immoral’ operated to keep people ‘in’ the social order where it was expected that ‘moral’ persons would not experience sexual violence. Fear of such judgment, and wanting to stay ‘in’, produced barriers for survivors to access healthcare and legal support. Participants reported community-level blame and punishment kept them ‘down’, and community isolation and rejection kept them ‘away’. At the individual level, survivors were kept ‘down’ through internalizing shame, low self-esteem, self-isolation, and hiding. Findings signal the need to address the far-ranging impacts of sexual violence stigma on refugee youth health, wellbeing, and rights. Meaningfully engaging refugee youth and communities in reducing sexual violence stigma must concomitantly transform inequitable gender norms and power relations.Item 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(BMJ Sexual & Reproductive Health, 2020) Logie, Carmen Helen; Okumu, Moses; Mwima, Simon; Kyambadde, Peter; Hakiza, Robert; Kibathi, Irungu Peter; Kironde, EmmanuelSexually 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. We 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. Participants (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. Social 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.Item Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings(International journal of STD & AIDS, 2022) Logie, Carmen H.; Okumu, Moses; Berry, Isha; Hakiza, Robert; Musoke, Daniel Kibuuka; Mwima, Simon; Kyambadde, PeterUrban 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. 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. 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). 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.Item Social ecological factors associated with experiencing violence among urban refugee and displaced adolescent girls and young women in informal settlements in Kampala, Uganda: a cross-sectional study(Conflict and health, 2019) Logie, Carmen H.; Okumu, Moses; Mwima, Simon; Hakiza, Robert; Irungi, Kibathi Peter; Kyambadde, Peter; Kironde, Emmanuel; Narasimhan, ManjulaaResearch on violence targeting urban forcibly displaced adolescent girls and young women (AGYW) is limited, particularly regarding polyvictimization (exposure to multiple forms of violence). Yet there is a global trend of refugee urbanization, and urban AGYW are at the nexus of violence disparities among adolescents, forcibly displaced persons, and slum dwellers. This study explored factors associated with young adulthood violence (> 16 years) (YAV) and intimate partner violence (IPV) among forcibly displaced AGYW in Kampala, Uganda. We conducted a cross-sectional survey with forcibly displaced AGYW aged 16–24 from five informal settlement (slum) communities across Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) using peer network sampling. We assessed YAV (experienced at age 16 or above) (sexual, physical, emotional violence) and recent (past 12-month) IPV (physical, sexual, control violence). We conducted descriptive statistics, followed by multinomial logistic regression analyses to explore social ecological factors (e.g., intrapersonal: depression; interpersonal: sexual relationship power, community: food insecurity) associated with experiencing YAV and YAV polyvictimization, and IPV and IPV polyvictimization. Over half of participants (n = 333; mean age = 19.31; SD = 2.56, range = 16–24) reported YAV (n = 179; 53.7%) and 9.3% (n = 41) reported YAV polyvictimization. Most participants that were in an intimate relationship in the last 12 months (n = 200; 85.8%) reported IPV, among these, 45.5% reported one form of IPV and 54.5% reported IPV polyvictimization. In adjusted analyses, experiencing any YAV was significantly associated with: adolescent sexual and reproductive health (SRH) stigma; sexual relationship power; mobile app usage; depressive symptoms; childhood abuse; and childhood polyvictimization. In adjusted analyses YAV polyvictimization was associated with: depressive symptoms; childhood polyvictimization; sexual relationship power; and food insecurity. Recent IPV polyvictimization in adjusted analyses was associated with owning/using a mobile phone and depressive symptoms. Participants with higher sexual relationship power had lower odds of recent IPV polyvictimization. Findings suggest that YAV and IPV polyvictimization require urgent attention among forcibly displaced AGYW in Kampala. Multi-level strategies are required to address intrapersonal e.g. (depression), interpersonal (e.g. childhood abuse, sexual relationship power) and community (e.g. adolescent SRH stigma, food insecurity) factors associated with experiencing violence. Future research can tailor approaches to advance health, agency and human rights among urban forcibly displaced AGYW.