A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda:

Okumu, Moses, Logie, Carmen H., Chitwanga, Anissa S., Hakiza, Robert and Kyambadde, Peter, (2023). A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda:. Conflict and Health, 17 1379-n/a

Document type:
Article
Collection:
UNU-INWEH Journal Articles

Metadata
Links
Versions
Statistics
  • Sub-type Journal article
    Author Okumu, Moses
    Logie, Carmen H.
    Chitwanga, Anissa S.
    Hakiza, Robert
    Kyambadde, Peter
    Title A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda:
    Appearing in Conflict and Health
    Volume 17
    Publication Date 2023-12-01
    Place of Publication Amesterdam
    Publisher Elsevier
    Start page 1379
    End page n/a
    Language eng
    Abstract Background: Adverse socio-cultural factors compromise the implementation of HIV prevention strategies among displaced youth. While condoms are an affordable and effective HIV prevention strategy for youth, stigma and inequitable gender norms may constrain condom self-efficacy (i.e., knowledge, intentions, and relationship dynamics that facilitate condom negotiation) and use. Further, knowledge of contextually appropriate HIV prevention approaches are constrained by limited understanding of the socio-cultural conditions that affect condom self-efficacy and use among displaced youth. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among displaced youth living in urban slums in Kampala, Uganda. Methods: We conducted a community-based cross-sectional survey of displaced youth aged 16–24 years living in five slums in Kampala. We used multivariable logistic regression and multivariate linear regression to assess independent and two-way interactions among adverse socio-cultural factors (adolescent sexual and reproductive health-related stigma [A-SRH stigma], perceived HIV-related stigma, and beliefs in harmful inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural factors; conducted regression analyses to create unique profiles of adverse socio-cultural factors; and then assessed joint effects of adverse socio-cultural factors on condom self-efficacy and practices. Results: Among participants (mean age: 19.59 years; SD: 2.59; women: n = 333, men: n = 112), 62.5% were sexually active. Of these, only 53.3% reported recent consistent condom use. Overall, 42.73% of participants reported two co-occurring adverse socio-cultural factors, and 16.63% reported three co-occurring exposures. We found a joint effect of beliefs in harmful inequitable gender norms with high A-SRH stigma (β = − 0.20; p < 0.05) and high A-SRH stigma with high perceived HIV stigma (β = − 0.31; p < 0.001) on reduced condom self-efficacy. We found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR = 0.52; 95% CI 0.28, 0.96) on recent consistent condom use. Additionally, we found that condom self-efficacy (aOR = 1.01; 95% CI 1.05, 1.16) and safer sexual communication (aOR = 2.12; 95% CI 1.54, 2.91) acted as protective factors on inconsistent condom use. Conclusions: Displaced youth living in urban slums exhibited low consistent condom use. Intersecting stigmas were associated with lower condom self-efficacy—a protective factor linked with increased consistent condom use. Findings highlight the importance of gender transformative and intersectional stigma reduction approaches to increase sexual agency and safer sex practices among Kampala’s slum-dwelling displaced youth.
    Keyword Condom use efficacy and use
    Displaced urban refugees
    Inequitable gender norms
    Intersectional stigma
    Syndemics
    Uganda
    Copyright Holder Elsevier B. V.
    Copyright Year 2024
    Copyright type All rights reserved
    DOI https://doi.org/10.1186/s13031-023-00531-y
  • Versions
    Version Filter Type
  • Citation counts
    Google Scholar Search Google Scholar
    Access Statistics: 33 Abstract Views  -  Detailed Statistics
    Created: Wed, 25 Sep 2024, 01:02:20 JST by Haideh Beigi on behalf of UNU INWEH