Publication Cover
AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 36, 2024 - Issue 1
155
Views
0
CrossRef citations to date
0
Altmetric
Research Article

Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda

ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, , ORCID Icon & ORCID Icon show all
Pages 36-43 | Received 18 Dec 2022, Accepted 23 Oct 2023, Published online: 03 Nov 2023
 

ABSTRACT

Synergistic associations between social inequities and HIV vulnerabilities – known as a syndemic – are understudied with youth in humanitarian settings. We explored refugee youths’ HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16–24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16–24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.

Acknowledgements

The authors acknowledge all of the peer navigators and participants, as well as collaborating agencies: Uganda Refugee Disaster and Management Council (URDMC), Ugandan Ministry of Health, Office of the Prime Minister, Most At Risk Populations Initiative (MARPI), and International Research Consortium.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was funded by Grand Challenges Canada (grant number R-ST-POC-1908-26653) with additional support from the Canadian Institutes of Health Research (CIHR) and Social Sciences and Humanities Research Council of Canada (SSHRC). Logie was also supported by Canada Research Chairs (CRC), Canada Foundation for Innovation (CFA), and the Ontario Ministry for Research and Innovation. Funders played no role in the study design.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.