Background Sexually 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.
Methods 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.
Results 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.
Conclusions 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.
- sexually transmitted infections
- education and training
- ethnic minority and cultural issues
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Contributors CHL conceptualised study and design, contributed to data analysis and interpretation, and led manuscript writing. MO contributed to study conceptualisation and manuscript writing, led data analysis, and contributed to data acquisition. SM, PK, RH, IPK, EK contributed to study conceptualisation, planning, reporting, data acquisition and data interpretation.
Funding The study was supported by funding from the Canadian Institutes of Health Research (CIHR) and the Canada Foundation for Innovation. Funders played no role in study design or interpretation of findings. C. Logie was also supported by funding from the Ontario Ministry of Research & Innovation Early Researcher Award and the Canada Research Chairs Program.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study protocol was approved by the University of Toronto, Canada Research Ethics Board (#35405) and the Uganda Ministry of Health (ADM: 105/261/01).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The data that support the findings of this study are available on reasonable request from the corresponding author, CL. The data are not publicly available due to research ethics board restrictions.
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