(Withdrawn) Exploring Factors Associated with Sexually Transmitted Infection Testing Practices Among Adolescents and Young People in Uganda

Background: Adolescents and young people (AYP) are disproportionately impacted by sexually transmitted infections (STIs), including HIV. In Uganda, there are profound sexual and mental health disparities among adolescents and young people, with the recent increase in HIV rates 4-fold higher and sexual violence rates double the country’s average. Yet, factors spanning interpersonal, community, and structural levels converge to reduce their access to HIV and STI testing and elevate exposure to HIV and other STIs. There is limited evidence on risk and promotive factors across the social ecology needed to increase STI/HIV testing among AYP in Uganda.

Methods: Data were drawn from the 2015 Ugandan Violence Against Children and Youth Survey (N=5804) that includes women and men aged 13 to 24 years. We conducted descriptive and bivariate analyses to understand the sample. Then, we conducted a stepwise multivariate logistic regression analysis to explore the association between risk factors risk (sexual violence experience) and protective factors (attending school, their level of school completion, religion, and marital status) on STI/HIV testing.

Results: Out of the 5804 respondents, more respondents were women (54.4%; n= 3,159), did not test for HIV (56.7%; n=3,290) nor STI (79.3%; n= 4,585). About 45% were currently attending school, and 34.4% experienced sexual abuse. Multivariate logistic regression analysis showed that sexual violence experiences (adjusted odds [aOR] = 0.22, 95% CI = 0.16, 0.31) was associated with reduced odds for HIV testing. While age (aOR = 4.14, CI = 95% 3.40, 5.05), education (aOR = 3.37, 95% CI = 2.76, 4.12), catholic religion (aOR = 4.14, 95% CI = 0.64, 0.91), woman gender (aOR = 1.29, 95% CI = 1.09, 1.54), were associated with greater odds for HIV testing. For STI testing, findings showed that experiencing sexual violence (aOR = 1.45, 95% CI = 1.19, 1.79) was associated with reduced odds of testing for STIs. While ever being married (aOR = 0.61, 95% CI = 0.49, 0.73), age (aOR = 0.54, 95% CI = 0.44, 0.65), woman gender (aOR = 0.55, 95% CI = 0.47,0.64), and education (aOR = 0.76, 95% CI = 0.61, 0.92) were associated with reduced odds of testing for STIs.

Conclusion and Implications: Findings reveal that STIs, including HIV testing, remain below the UNAIDS target of 95% of the young people knowing their HIV status by 2025. HIV and STI testing disparities can be reduced by strengthening promotive factors identified (including; age, education, and religion, i.e., catholic). There is an urgent need for a policymakers to adopt HIV/STI dual testing models and scale-up Pre Exposure Prophylaxis access among adolescents and young people in Uganda. These interventions should also target adolescents experiencing sexual violence.