O19.6 Pathways between intersectional stigma, gender equitable norms, and condom outcomes among urban refugee and displaced youth in Kampala, Uganda

• Published in: Sexually transmitted infections Vol. 97; no. Suppl 1; p. A62
• Main Authors: Logie, C, Okumu, M, Mwima, S, Kyambadde, P, Hakiza, R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2021
• Subjects: Condoms; Gender; Stigma; Uganda; Kampala Uganda
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sextrans-2021-sti.163

BackgroundSocial inequities elevate HIV vulnerabilities among youth in humanitarian contexts. Condom efficacy—knowledge, intention, and relationship dynamics that facilitate condom negotiation—is understudied among refugee youth. We examined social-ecological factors (stigma, gender equitable norms [GEN], depression) associated with condom efficacy and use among urban refugee youth in Kampala, Uganda.MethodsWe conducted a cross-sectional survey with refugee youth aged 16–24 in Kampala’s informal settlements. In multivariable regression analyses we examined associations between adolescent sexual and reproductive health (SRH)-related stigma, HIV-related stigma, and GEN with condom efficacy and recent (past 3-month) consistent condom use among sexually active participants. In path analyses we tested: direct effects of stigma (adolescent SRH-related, HIV-related) and GEN on condom efficacy, and indirect effects via depression; and direct effects of stigma (adolescent SRH-related, HIV-related) and GEN on recent consistent condom use, and indirect effects via condom efficacy.ResultsAmong participants (mean age: 19.59, SD: 2.59; women: n=333, men: n=112), 62.5% were sexually active. Of these, only 53.3% reported consistent condom use. In multivariable analyses, lower adolescent SRH-related (β= -0.18, p<0.001) and HIV-related (β= -0.18, p<0.001) stigma and higher GEN (β=0.15, p<0.001) were associated with condom efficacy. Among sexually active participants, GEN was associated with increased (AOR: 1.07, 95%CI: 1.01–1.13), and adolescent SRH-related stigma with reduced (AOR: 0.92, 95%CI: 0.84–0.99), odds of recent consistent condom use. There were direct pathways from lower stigma (adolescent SRH-related, HIV-related) and higher GEN to condom efficacy. Depression partially mediated the pathway from HIV-related stigma to condom efficacy. Condom efficacy mediated pathways from stigma (HIV-related, adolescent SRH-related) and GEN to consistent condom use.ConclusionConsistent condom use was low and associated with community (lower stigma, gender equity), interpersonal (condom efficacy), and intrapersonal (reduced depression) factors. Gender transformative and intersectional stigma reduction interventions are needed to advance HIV/STI prevention among urban refugee youth in Kampala.