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HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings

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Abstract

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16–24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19–3.08; FI: aOR: 2.31. 95%CI: 1.36–3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24–6.17; FI: aOR: 2.62, 95%CI: 1.03–6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22–7.89; FI: aOR: 3.51, 95%CI: 1.15–10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.

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Funding

This study is funded by the Canadian Institutes of Health Research (Project Grant 389142), International Development Research Centre (IDRC) Operating Grant (109549-001), and Grand Challenges Canada Global Mental Health Grant (R-GMH-POC-2107-43740). Logie’s efforts were in part supported by the Canada Research Chairs Program (CRC 2 in Global Health Equity and Social Justice with Marginalized Populations) and the Canada Foundation for Innovation.

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Authors and Affiliations

  1. Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, ON, M5S 1V4, Canada

    Carmen H. Logie, Zerihun Admassu, Rushdia Ahmed & Frannie MacKenzie

  2. United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada

    Carmen H. Logie & Lina Taing

  3. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Carmen H. Logie

  4. Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada

    Carmen H. Logie

  5. School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA

    Moses Okumu

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Amaya Perez-Brumer, Jean-Luc Kortenaar & Isha Berry

  7. Department of Geography and Planning, University of Toronto, Toronto, ON, Canada

    Marianne Lahai Luna

  8. Young African Refugees for Integral Development (YARID), Kampala, Uganda

    Robert Hakiza & Brenda Katisi

  9. International Research Consortium, Kampala, Uganda

    Daniel Kibuuka Musoke & Aidah Nakitende

  10. Organization for Gender Empowerment and Rights Advocacy (OGERA) Uganda, Kampala, Uganda

    Shamilah Batte

  11. National AIDS Control Program, Ministry of Health, Kampala, Uganda

    Peter Kyambadde

  12. Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda

    Peter Kyambadde

  13. World Food Programme East Africa, Nairobi, Kenya

    Gio Giordana

  14. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

    Lawrence Mbuagbaw

  15. Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, ON, Canada

    Lawrence Mbuagbaw

  16. Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon

    Lawrence Mbuagbaw

  17. Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa

    Lawrence Mbuagbaw

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  1. Carmen H. Logie
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Correspondence to Carmen H. Logie.

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Ethics Approval and Consent to Participate

We received Research Ethics Board approval from the University of Toronto (Protocol Number: 37496), Mildmay Uganda Research Ethics Committee (Ref: 0806–2019), and Uganda National Council for Science & Technology (Ref: HS2716). We obtained written informed consent from all participants where data collection was in-person, and verbal informed consent in cases of phone-based data collection. The Tushirikiane trial is registered at ClinicalTrials.gov (NCT04504097).

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Logie, C.H., Okumu, M., Admassu, Z. et al. HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings. AIDS Behav 28, 507–523 (2024). https://doi.org/10.1007/s10461-023-04240-8

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