While the rate of HIV in Kampala, Uganda, is more than double the national average, a recent survey of displaced youths in the city found that only about 20% consistently used condoms and just half of the study participants had been tested for HIV in the past year.
Moses Okumu, a professor of social work at the University of Illinois Urbana-Champaign, led the study, which included more than 330 young people ages 16-24 who were living in one of five informal settlements.
"Our findings show that both past-year access to HIV self-test kits, HIV testing and consistent condom use remain markedly below national and international targets, despite respondents reporting moderate condom-use self-efficacy," Okumu said.
Numerous factors at the societal, community and interpersonal levels affect use of HIV-prevention services in this population, highlighting the urgent need for multilevel, contextually tailored interventions that address intersecting vulnerabilities, Okumu said.
The participants - who had an average age of 21 and more than half of whom were women - were surveyed on how frequently they and their partners used condoms, their confidence in their ability to effectively use them, whether they had been tested for HIV in the past year and their access to self-tests.
Those in committed relationships and those with children were more likely to report that they consistently used condoms and were tested for HIV, the researchers found.
Although more than 62% had postsecondary education, an even greater proportion - more than 69% - were unemployed, the data indicated. About 19% had part-time employment and 11% worked full-time jobs. More than 91% of those in the sample reported they were food insecure, and more than half of the participants indicated they lacked adequate access to water, according to the study.
All of these factors - lower levels of education, financial precarity and inadequate access to food and water - are barriers to condom use self-efficacy, the team found.
"These findings show the critical need for interventions at the societal, community and interpersonal levels that concurrently address economic insecurity and promote education and employment as well as access to food, water and health care," Okumu said. "For youths living in informal settlements, these could address widespread challenges that may prevent them from affording access to transportation to clinics to obtain HIV testing, self-testing kits or condoms. Education and literacy also play crucial roles in HIV prevention, as studies have found that individuals with greater education tended to engage more with HIV services."
The Canadian Institutes of Health Research funded the work.
The study participants were part of a larger controlled trial that examined the effectiveness of HIV self-testing methods alone and in combination with mental health and livelihood programs. That project was led by University of Toronto researcher Carmen H. Logie, the Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations, who was a co-author of the current study, along with Paul Bukuluki, a social work professor at Makerere University.
Additional co-authors were Catherine N. Nafula of the Association of Volunteers for International Service Foundation; co-founder and the executive director Robert Hakiza and research manager Brenda Katisi, both of the Young African Refugees for Integral Development; and Peter Kyambadde, the managing director of the AIDS Control Program in the Uganda Ministry of Health.
Other co-authors were research coordinator Frannie Mackenzie, then-postdoctoral research associate Zerihun Admassu and doctoral candidate Lauren S. Tailor, all of the University of Toronto; and consulting director Daniel Kibuuka Musoke and research coordinator Aidah Nakitende, both of the International Research Consortium Limited.
Morris D.C. Komakech, a professor at the Nipissing University School of Nursing; David Okimait, a sociologist and lecturer at Kyambogo University; professor of health research methods, evidence and impact Lawrence Mbuagbaw of McMaster University; and Liliane C. Windsor, the Lillian F. Harris Professor of Social Work at Case Western Reserve University, also co-wrote the paper.
