Independent and Joint Effects of Inequitable Gender Norms, and Intersecting Stigmas on Condom Practices Among Forcibly Displaced Youth in the Slums of Kampala, Uganda

Background: Adverse socio-cultural exposures compromise uptake of HIV prevention among forcibly displaced youth. While condoms are a cost-effective 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), which remains understudied among forcibly displaced youth. Further, knowledge of condom self-efficacy remain impeded by a lack of synergistic understandings of the socio-cultural conditions that affect condom self-efficacy and use. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among urban forcibly displaced youth in Kampala, Uganda.

Methods: We conducted a community-based cross-sectional survey of urban forcibly displaced youth aged 16-24 years 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 exposures (adolescent sexual and reproductive health-related stigma [A-SRH stigma], HIV-related stigma, and inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural exposure; conducted regression analyses to create unique profiles of adverse socio-cultural exposures; and then assessed joint effects of adverse socio-cultural exposures on condom 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 exposures, and 16.63% reported three co-occurring exposures. We found a joint effect of inequitable gender norms with high A-SRH stigma (β = -.20; p < .05) and high A-SRH stigma with high perceived HIV stigma (β = -.31; p < .001) on reduced condom self-efficacy. We also found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR =.52; 95% CI: [.28, .96]) on recent consistent condom use.

Conclusions: Urban forcibly displaced youth 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 among Kampala’s urban forcibly displaced youth.