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RESEARCH ARTICLE
Contents Vol 21(5)

Social-ecological factors associated with trajectories of adolescent sexual and reproductive health stigma: longitudinal cohort findings with urban refugee youth in Kampala

Carmen H. Logie https://orcid.org/0000-0002-8035-433X A B C D * , Moses Okumu https://orcid.org/0000-0003-2555-3077 E F , Frannie MacKenzie https://orcid.org/0000-0002-3517-8330 A , Daniel Kibuuka-Musoke https://orcid.org/0000-0002-2793-1580 G , Robert Hakiza https://orcid.org/0000-0001-7857-9436 H , Brenda Katisi https://orcid.org/0000-0002-2775-9565 H , Aidah Nakitende https://orcid.org/0000-0002-2587-8528 G , Lawrence Mbuagbaw https://orcid.org/0000-0001-5855-5461 I J K L M N , Peter Kyambadde https://orcid.org/0000-0002-9606-218X O P and Zerihun Admassu https://orcid.org/0000-0002-1670-8949 A
+ Author Affiliations
- Author Affiliations

A Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada.

B United Nations University Institute for Water, Environment, and Health (UNU-INWEH), Hamilton, ON L8P 0A1, Canada.

C Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 2K5, Canada.

D Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5G 1N8, Canada.

E School of Social Work, University of Illinois at Urbana Champaign, Urbana, IL 61801, USA.

F School of Social Sciences, Uganda Christian University, Mukono, Uganda.

G International Research Consortium, Kampala, Uganda.

H Young African Refugees for Integral Development, Kampala, Uganda.

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

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

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

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

M Department of Anesthesia, McMaster University, Hamilton, ON, Canada.

N Department of Pediatrics, Department of Pediatrics, Hamilton, ON, Canada.

O National STD/HIV/AIDS Control Program, Ugandan Ministry of Health, Kampala, Uganda.

P Most at Risk Population Initiative (MARPI), Kampala, Uganda.

* Correspondence to: carmen.logie@utoronto.ca

Handling Editor: Megan Lim

Sexual Health 21, SH24098 https://doi.org/10.1071/SH24098
Submitted: 4 May 2024  Accepted: 14 August 2024  Published: 29 August 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Stigma towards sexually active young people presents profound barriers to uptake of sexual and reproductive health (SRH) services, including HIV testing and contraception. Yet, few studies have examined adolescent SRH stigma trajectories over time. To address this knowledge gap, we examined associations between social-ecological factors and trajectories of adolescent SRH stigma among urban refugee youth in Kampala, Uganda.

Methods

This longitudinal cohort study with refugee youth in Kampala collected data on adolescent SRH stigma at four time-points between 2022 and 2024. We used latent class growth analyses to examine distinct trajectories of adolescent SRH stigma, and examined baseline social-ecological and socio-demographic factors associated with class membership using multivariable logistic regression.

Results

Among the participants (n = 164 with n = 668 observations; mean age 19.9 years, standard deviation 2.5 years; 52.8% cisgender women), we categorised two distinct adolescent SRH stigma trajectories: consistently high (n = 496; 74.2%) and sustained low (n = 172; 25.8%). In multivariable analyses, living in Uganda ≥1 year at baseline assessment (1–5 years: adjusted odds ratio [aOR] 5.28, confidence interval [CI] 2.29–12.19, P < 0.001; 6–10 years: aOR 6.20, CI 2.61–14.69, P < 0.001; or >10 years: aOR 3.89, CI 1.56–9.68, P < 0.01) compared with <1 year, unemployment (aOR 1.62, CI 1.02–2.56, P < 0.05), having children (aOR 2.84, CI 1.30–6.21, P < 0.05), past 3-month multiple sexual partners (aOR 6.14, CI 1.73–21.75, P < 0.01) and higher depression symptoms (aOR 1.04, CI 1.01–1.08, P < 0.01) were associated with the consistently high (vs sustained low) adolescent SRH stigma trajectory.

Conclusions

Social-ecological and socio-demographic factors were associated with consistently high levels of adolescent SRH stigma over 2 years. Multi-level strategies can meaningfully engage youth in developing stigma reduction strategies for SRH service delivery.

Keywords: adolescents, adolescent parents, depression, longitudinal, multiple sex partners, refugee, sexual and reproductive health, social-ecological theory, stigma, stigma drivers, Uganda.

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