Nearly 36% of forcibly displaced adolescent girls and young women living in urban informal settlements in Kampala, Uganda, reported that their first sexual experience was nonconsensual - which, for many, marked the beginning of a cycle of sexual and physical violence perpetrated by their intimate partners or other people, a recent study found.
Of those who reported being forced or coerced into their first sexual experience, about 82% were survivors of physical violence and 67% were survivors of sexual abuse by nonpartners, University of Illinois Urbana-Champaign social work professor Moses Okumu and his colleagues found. The research involved scholars at universities and nongovernmental agencies in Uganda and Canada as well as the U.S.
More than 200 sexually active girls and young women 16-24 years old were surveyed in the project. Participants, whose average age was about 20, were asked if a person they were dating had intentionally physically hurt them or forced them into sexual activities against their will within the past 12 months. Participants also were asked if they had ever experienced sexual or physical violence from people other than intimate partners and whether they had used postexposure prophylaxis - a regimen of antiretroviral medication taken to prevent infection after possible exposure to HIV.
"We found that more than a third of the displaced girls and young women in our sample experienced forced sexual initiation - more than double Uganda's national rate of 15% and greater than the rates of 14-18% that were observed in other studies of displaced youths," Okumu said. "However, only 5.6% of the survivors in our study were aware of postexposure prophylaxis or where to access it in their community. And only 1% of them reported they had accessed these resources in the past three months."
According to the study, more than 80% of the world's 120 million forcibly displaced people are in Africa, the majority of them girls and women. More than 116,000 refugees - 27% of them girls and women - are living in informal urban settlements in Kampala. The authors said the paper, published in the journal AIDS and Behavior, is believed to be the first to assess forced sexual initiation - defined as nonconsensual sex - occurring before age 16 among this population and links to potential reproductive health outcomes in Africa.
Among the study sample, more than 72% of those who reported experiencing forcible sex said they became sexually active before age 15. More than 71% of these survivors also reported recent sexual violence by an intimate partner, the researchers found.
Of those who experienced forced sexual initiation, more than 59% did not have a high school education, and about half of them were unemployed and not attending school, the data indicated.
Okumu said that multiple factors including poverty, overcrowding, depression and the breakdown of social support systems heighten female refugees' vulnerability to rape and other forms of violence. These risk factors include having to navigate unfamiliar environments that may have less community oversight, increasing young people's potential or being abused or exploited.
Moreover, Okumu said harmful gender norms about females, sexual abuse and other types of violence at the individual, community and societal levels shape girls' attitudes and behaviors, causing them to normalize these crimes. Survivors of violence are also exposed to shaming by those around them, discouraging them from reporting the incidents and perpetuating the cycles of violence.
"Our study reveals a concerning landscape of sexual violence and inadequate knowledge of the availability and use of prophylactic emergency protections among displaced girls and young women," Okumu said. "These point to critical gaps in comprehensive sexuality education and youth-responsive sexual health service provision, potentially increasing the risk of HIV acquisition and transmission in an already vulnerable population."
The researchers recommended several potential interventions, including peer education programs and bystander intervention training using participatory comic books that increase awareness of these crimes and empower young people to recognize and respond to potentially violent situations. Accordingly, they wrote that the disproportionately high rates of forced sexual initiation among displaced girls and young women in the study highlight the need for sexual violence prevention programs in humanitarian settings that include girls under the age of 15.
At the community level, the researchers suggested engaging local leaders in awareness campaigns that help reduce stigma and encourage supportive attitudes toward those who are victimized. For health care providers, they recommended that the training promote youth-friendly, trauma-informed care to better support survivors who reach out for help.
The paper was co-written by Carmen H. Logie, the Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations at the University of Toronto; and social work professors Thabani Nyoni at Dalhousie University, Flora Cohen at Illinois and Bernadette K. Ombayo at the University of Memphis. Joseph C. Wabwire, a doctoral student at Illinois, also was a co-author.
Additional co-authors were Catherine N. Nafula of the Association of Volunteers for International Service Foundation, Robert Hakiza of the Young African Refugees for Integral Development, and Peter Kyambadde of the AIDS Control Program in the Uganda Ministry of Health.
The Canadian Institutes of Health Research funded the work. In addition, Logie's work was supported by the Canada Foundation for Innovation, the Canada Research Chairs and the Ontario Ministry of Research and Innovation.
