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

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.

KEYWORDS:

• Refugee
• youth
• Uganda
• poverty
• syndemics
• violence
• HIV risks

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.