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Hladik W, Nasirumbi Muniina P, Familiar I, Kaiser P, Ogwal M, Serwadda D, Sande E, Kiyingi H, Siya Bahinduka C, Dolan C. Sexual and nonsexual violence and mental health among male refugees from the Democratic Republic of Congo residing in Kampala, Uganda: a population-based survey. Med Confl Surviv 2023; 39:389-411. [PMID: 37849278 DOI: 10.1080/13623699.2023.2263730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly (p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.
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Affiliation(s)
- Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan
| | - Peter Kaiser
- Center for Victims of Torture and War, Swiss Red Cross, Bern, Switzerland
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Chris Dolan
- Global Sustainable Development Department, Warwick University, Coventry, UK
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, Hladik W. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda. BMC Pregnancy Childbirth 2022; 22:646. [PMID: 35978285 PMCID: PMC9382809 DOI: 10.1186/s12884-022-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - Reena H Doshi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
| | - Herbert Kiyingi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Jonathan Standish
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, USA
| | - Wolfgang Hladik
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
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Kim B, Ogwal M, Sande E, Kiyingi H, Serwadda D, Hladik W. Using geographical data and rolling statistics for diagnostics of respondent-driven sampling. Soc Networks 2022; 69:74-83. [PMID: 38616951 PMCID: PMC11009932 DOI: 10.1016/j.socnet.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Respondent-driven sampling (RDS) is commonly used to sample from key populations without a sampling frame since traditional methods are unable to efficiently survey them. Surveying these populations is often desirable to inform service delivery, assess effectiveness of programs, and determine prevalence of diseases. However, there are concerns about how RDS works in practice due to its many assumptions. To assess some of these assumptions, we develop diagnostics using geographical data and demonstrate their utility by identifying lack of convergence and characterizing RDS reach in surveys conducted among female sex workers and men who have sex with men in Kampala, Uganda.
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Affiliation(s)
- Brian Kim
- Joint Program in Survey Methodology, University of Maryland, 1218 LeFrak Hall, 7251 Preinkert Dr., College Park, MD 20742, USA
| | - Moses Ogwal
- Makerere University School of Public Health, Old Mulago Hill Road, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Enos Sande
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - David Serwadda
- Makerere University School of Public Health, Old Mulago Hill Road, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
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Laws RL, Biraro S, Kirungi W, Gianetti B, Aibo D, Awor AC, West C, Sachathep KK, Kiyingi H, Ward J, Mwangi C, Nkurunziza P, Okimait D, Currie D, Ajiboye A, Moore CS, Patel H, Sendagala S, Naluguza M, Mugisha V, Low A, Delgado S, Hoos D, Brown K, Galbraith JS, Hladik W, Nelson L, El-Sadr W, Musinguzi J, Voetsch AC. Coronavirus Disease 2019 (COVID-19) Mitigation Efforts and Testing During an In-Person Training Event-Uganda, 12-29 October 2020. Clin Infect Dis 2021; 73:S42-S44. [PMID: 33912911 PMCID: PMC8135603 DOI: 10.1093/cid/ciab331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Large public-health training events may result in SARS-CoV-2 transmission. Universal SARS-CoV-2 testing during trainings for the Uganda Population-based HIV Impact Assessment identified 28/475 (5.9%) individuals with COVID-19 among attendees; most (89.3%) were asymptomatic. Effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are recommended for in-person trainings, particularly when trainees will have subsequent contact with survey participants.
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Affiliation(s)
- Rebecca L Laws
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sam Biraro
- ICAP at Columbia University, Kampala, Uganda
| | | | - Brittany Gianetti
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Anna C Awor
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Christine West
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jennifer Ward
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Christina Mwangi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | - Dustin Currie
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aderonke Ajiboye
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carole S Moore
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hetal Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sam Sendagala
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Mary Naluguza
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Andrea Low
- ICAP at Columbia University, New York, New York, USA
| | | | - David Hoos
- ICAP at Columbia University, New York, New York, USA
| | - Kristin Brown
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer S Galbraith
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Nelson
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wafaa El-Sadr
- ICAP at Columbia University, New York, New York, USA
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, Hladik W. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey. Confl Health 2021; 15:42. [PMID: 34039400 PMCID: PMC8157662 DOI: 10.1186/s13031-021-00377-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. METHODS Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. RESULTS Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). CONCLUSIONS Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI USA
| | | | - Chris Dolan
- Refugee Law Project, School of Law, Makerere University, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, MS E-30, 1600 Clifton Rd, Atlanta, GA-30333 USA
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2020; 6:e19893. [PMID: 32396517 PMCID: PMC7351262 DOI: 10.2196/19893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/12118.].
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2019; 5:e12118. [PMID: 31407673 PMCID: PMC6771531 DOI: 10.2196/12118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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King R, Nanteza J, Sebyala Z, Bbaale J, Sande E, Poteat T, Kiyingi H, Hladik W. HIV and transgender women in Kampala, Uganda - Double Jeopardy. Cult Health Sex 2019; 21:727-740. [PMID: 30328785 DOI: 10.1080/13691058.2018.1506155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.
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Affiliation(s)
- Rachel King
- a Global Health Sciences , University of California San Francisco , San Francisco , CA , USA
| | - Justine Nanteza
- b School of Public Health , Makerere University , Kampala , Uganda
| | - Zubayiri Sebyala
- b School of Public Health , Makerere University , Kampala , Uganda
| | - Joy Bbaale
- b School of Public Health , Makerere University , Kampala , Uganda
| | - Enos Sande
- b School of Public Health , Makerere University , Kampala , Uganda
| | - Tonia Poteat
- c Department of Epidemiology, International Health, Health Behavior and Society, Johns Hopkins University , Baltimore , MD , USA
| | - Herbert Kiyingi
- d Strategic Information, Centers for Disease Control and Prevention , Kampala, Uganda
| | - Wolfgang Hladik
- e Division of Global HIV/AIDS, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Apodaca K, Doshi RH, Ogwal M, Kiyingi H, Aluzimbi G, Musinguzi G, Lutalo I, Akello E, Hladik W. Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda. JMIR Public Health Surveill 2019; 5:e12316. [PMID: 30942697 PMCID: PMC6468338 DOI: 10.2196/12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/18/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers. Objective The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda. Methods We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis. Results We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono. Conclusions The CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.
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Affiliation(s)
- Kevin Apodaca
- Public Health Institute, Oakland, CA, United States.,Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Reena Hemendra Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | | | - Ibrahim Lutalo
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Evelyn Akello
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Doshi RH, Sande E, Ogwal M, Kiyingi H, McIntyre A, Kusiima J, Musinguzi G, Serwadda D, Hladik W. Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda. PLoS One 2018; 13:e0201352. [PMID: 30231030 PMCID: PMC6145590 DOI: 10.1371/journal.pone.0201352] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.
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Affiliation(s)
- Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Moses Ogwal
- Makerere University School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Anne McIntyre
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joy Kusiima
- Makerere University School of Public Health, Kampala, Uganda
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Brown K, Williams DB, Kinchen S, Saito S, Radin E, Patel H, Low A, Delgado S, Mugurungi O, Musuka G, Tippett Barr BA, Nwankwo-Igomu EA, Ruangtragool L, Hakim AJ, Kalua T, Nyirenda R, Chipungu G, Auld A, Kim E, Payne D, Wadonda-Kabondo N, West C, Brennan E, Deutsch B, Worku A, Jonnalagadda S, Mulenga LB, Dzekedzeke K, Barradas DT, Cai H, Gupta S, Kamocha S, Riggs MA, Sachathep K, Kirungi W, Musinguzi J, Opio A, Biraro S, Bancroft E, Galbraith J, Kiyingi H, Farahani M, Hladik W, Nyangoma E, Ginindza C, Masangane Z, Mhlanga F, Mnisi Z, Munyaradzi P, Zwane A, Burke S, Kayigamba FB, Nuwagaba-Biribonwoha H, Sahabo R, Ao TT, Draghi C, Ryan C, Philip NM, Mosha F, Mulokozi A, Ntigiti P, Ramadhani AA, Somi GR, Makafu C, Mugisha V, Zelothe J, Lavilla K, Lowrance DW, Mdodo R, Gummerson E, Stupp P, Thin K, Frederix K, Davia S, Schwitters AM, McCracken SD, Duong YT, Hoos D, Parekh B, Justman JE, Voetsch AC. Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15-24 Years - Seven African Countries, 2015-2017. MMWR Morb Mortal Wkly Rep 2018; 67:29-32. [PMID: 29329280 PMCID: PMC5769792 DOI: 10.15585/mmwr.mm6701a6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Kiyingi H, Egwang T, Nannyonga M. Prolonged elevation of viral loads in HIV-1-infected children in a region of intense malaria transmission in Northern Uganda. Retrovirology 2010. [PMCID: PMC3316000 DOI: 10.1186/1742-4690-7-s1-p72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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