Associations between extreme weather events and HIV vulnerabilities among refugee youth in a Ugandan refugee settlement: cross-sectional survey findings
Carmen H. Logie
A
B
C
D
E
F
G
H
I
J
K
L
Abstract
There is growing evidence of associations between extreme weather events (EWE) and HIV vulnerabilities, yet this is understudied in humanitarian settings. We examined associations between EWE and HIV vulnerabilities among refugee youth in Bidi Bidi Refugee Settlement, Uganda.
We collected baseline (February to March 2024) cohort data with refugee youth aged 16–24 years in Bidi Bidi. We conducted linear and logistic regression to assess associations between (a) number of past-year EWE types (e.g. extreme rain/flooding, changes in expected rain patterns, drought, extreme heat, fire, changes in expected temperature), and (b) frequency of past-year EWE, with HIV vulnerabilities (sexual relationship power, reproductive autonomy, condom use self-efficacy, transactional sex, intimate partner violence, multiple sex partners), adjusted for age, gender, education and employment.
Among 400 participants (50% women; mean age: 19 years, standard deviation: 2.3), a higher number of past-year EWE types (vs 1) was significantly associated with reduced sexual relationship power (2–4 EWE: adjusted beta [aβ] = −2.96, P = 0.009; ≥5 EWE: aβ = −4.92, P < 0.001), reproductive autonomy (2–4 EWE: aβ = −0.32, P = 0.006; ≥5 EWE: aβ = −0.42, P = 0.001) and condom use self-efficacy (2–4 EWE: aβ = −3.02, P < 0.001; ≥5 EWE aβ = −3.04, P < 0.001), and increased transactional sex (≥5 EWE: adjusted odds ratio [aOR] 8.70, P = 0.040), intimate partner violence (≥5 EWE: aOR 3.13, P = 0.007) and multiple sex partners (≥5 EWE: aOR 4.70, P = 0.002). Increased EWE frequency was significantly associated with lower sexual relationship power, reproductive autonomy and condom use self-efficacy.
EWE experiences were associated with multiple HIV vulnerabilities among refugee youth. Climate-informed, youth-tailored HIV prevention strategies are urgently needed.
Keywords: condom efficacy, extreme weather, refugee, reproductive autonomy, sexual relationship power, transactional sex, Uganda, youth.
References
1 Logie CH, Toccalino D, MacKenzie F, et al. Associations between climate change-related factors and sexual health: a scoping review. Glob Public Health 2024; 19: 2299718.
| Crossref | Google Scholar |
2 Burns PA, Mutunga C. Addressing the impact of climate change on sexual and reproductive health among adolescent girls and young women in low- and middle-income countries. Glob Health Sci Pract 2024; 12: e2300374.
| Crossref | Google Scholar |
3 Arunda MO, Sorcher R, Canabarro APF, et al. Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review. BMJ Public Health 2024; 2: e001090.
| Crossref | Google Scholar |
4 Treibich C, Bell E, Blanc E, et al. From a drought to HIV: an analysis of the effect of droughts on transactional sex and sexually transmitted infections in Malawi. SSM - Popul Health 2022; 19: 101221.
| Crossref | Google Scholar |
5 Trickey A, Johnson LF, Bonifacio R, et al. Investigating the associations between drought, poverty, high-risk sexual behaviours, and HIV incidence in sub-saharan Africa: a cross-sectional study. AIDS Behav 2024; 28: 1752-1765.
| Crossref | Google Scholar | PubMed |
6 Nagata JM, Hampshire K, Epstein A, et al. Analysis of heavy rainfall in Sub-Saharan Africa and HIV transmission risk, HIV prevalence, and sexually transmitted infections, 2005-2017. JAMA Netw Open 2022; 5: e2230282.
| Crossref | Google Scholar |
7 Fransen S, Werntges A, Hunns A, et al. Refugee settlements are highly exposed to extreme weather conditions. Proc Natl Acad Sci USA 2023; e2206189120.
| Crossref | Google Scholar |
8 Baral S, Logie CH, Grosso A, et al. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health 2013; 13: 482.
| Crossref | Google Scholar |
9 Lieber M, Chin-Hong P, Whittle HJ, et al. The synergistic relationship between climate change and the HIV/AIDS epidemic: a conceptual framework. AIDS Behav 2021; 25: 2266-2277.
| Crossref | Google Scholar | PubMed |
10 Epstein A, Nagata JM, Ganson KT, et al. Drought, HIV testing, and HIV transmission risk behaviors: a population-based study in 10 high HIV prevalence countries in Sub-Saharan Africa. AIDS Behav 2023; 27: 855-863.
| Crossref | Google Scholar | PubMed |
11 Becker ML, Bhattacharjee P, Blanchard JF, et al. Vulnerabilities at first sex and their association with lifetime gender-based violence and HIV prevalence among adolescent girls and young women engaged in sex work, transactional sex, and casual sex in Kenya. JAIDS J Acquir Immune Defic Syndr 2018; 79: 296-304.
| Crossref | Google Scholar | PubMed |
12 Hatcher AM, Gibbs A, McBride R-S, et al. Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa. Soc Sci Med 2022; 295: 112637.
| Crossref | Google Scholar |
13 Sullivan TP. The intersection of intimate partner violence and HIV: detection, disclosure, discussion, and implications for treatment adherence. Top Antivir Med 27: 84-87.
| Google Scholar |
14 Epstein A, Bendavid E, Nash D, et al. Drought and intimate partner violence towards women in 19 countries in Sub-Saharan Africa during 2011-2018: a population-based study. PLoS Med 2020; 17: e1003064.
| Crossref | Google Scholar |
15 Mannell J, Brown LJ, Jordaan E, et al. The impact of environmental shocks due to climate change on intimate partner violence: a structural equation model of data from 156 countries. PLOS Clim 2024; 3: e0000478.
| Crossref | Google Scholar |
16 Logie CH, Okumu M, Latif M, et al. Relational factors and HIV testing practices: qualitative insights from urban refugee youth in Kampala, Uganda. AIDS Behav 2022; 26: 2191-2202.
| Crossref | Google Scholar | PubMed |
17 Campbell C, Cornish F. How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa. AIDS Behav 2012; 16: 847-857.
| Crossref | Google Scholar | PubMed |
18 Darling J. Thinking beyond place: the responsibilities of a relational spatial politics. Geogr Compass 2009; 3: 1938-1954.
| Crossref | Google Scholar |
19 Romanello M, Napoli Cd, Green C, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet 2023; 402: 2346-2394.
| Crossref | Google Scholar | PubMed |
20 Tallman PS, Collins S, Salmon-Mulanovich G, et al. Water insecurity and gender-based violence: a global review of the evidence. WIREs Water 2023; 10: e1619.
| Crossref | Google Scholar |
21 Hatcher AM, Page S, Aletta van Eck L, et al. Systematic review of food insecurity and violence against women and girls: mixed methods findings from low- and middle-income settings. PLOS Glob Public Health 2022; 2: e0000479.
| Crossref | Google Scholar |
22 Logie CH, Earnshaw V, Ahmed R, et al. Experiences of gender-based stigma and health care-related outcomes in the African region: a scoping review. Stigma Health 2024;
| Crossref | Google Scholar |
23 Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles 2000; 42: 637-660.
| Crossref | Google Scholar |
24 Closson K, Ndungu J, Beksinska M, et al. Gender, power, and health: measuring and assessing sexual relationship power equity among young sub-saharan African women and men, a systematic review. Trauma Violence Abuse 2022; 23: 920-937.
| Crossref | Google Scholar | PubMed |
25 Klein H. Condom use self-efficacy and HIV risk practices among men who use the internet to find male partners for unprotected sex. Am J Mens Health 2014; 8: 190-204.
| Crossref | Google Scholar | PubMed |
26 Baele J, Dusseldorp E, Maes S. Condom use self-efficacy: effect on intended and actual condom use in adolescents. J Adolesc Health 2001; 28: 421-431.
| Crossref | Google Scholar | PubMed |
27 Closson K, Dietrich JJ, Lachowsky NJ, et al. Gender, sexual self-efficacy and consistent condom use among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. AIDS Behav 2018; 22: 671-680.
| Crossref | Google Scholar | PubMed |
28 Logie CH, Lys CL, Okumu M, et al. Exploring factors associated with condom use self-efficacy and condom use among Northern and Indigenous adolescent peer leaders in Northern Canada. Vulnerable Child Youth Stud 2018; 14: 50-62.
| Crossref | Google Scholar |
29 Closson K, Dietrich JJ, Lachowsky NJ, et al. Sexual self-efficacy and gender: a review of condom use and sexual negotiation among young men and women in Sub-Saharan Africa. J Sex Res 2018; 55: 522-539.
| Crossref | Google Scholar | PubMed |
30 Upadhyay UD, Dworkin SL, Weitz TA, et al. Development and validation of a reproductive autonomy scale. Stud Fam Plann 2014; 45: 19-41.
| Crossref | Google Scholar | PubMed |
31 Capasso A, DiClemente RJ, Wingood GM. Pregnancy coercion as a risk factor for HIV and other sexually transmitted infections among young African American Women. JAIDS J Acquir Immune Defic Syndr 2019; 82: S155-S161.
| Crossref | Google Scholar | PubMed |
32 Rwafa T, Shamu S, Christofides N. Relationship power and HIV sero-status: an analysis of their relationship among low-income urban Zimbabwean postpartum women. BMC Public Health 2019; 19: 792.
| Crossref | Google Scholar |
33 McCloskey LA, Hitchcock S, Eloff I, et al. The role of reproductive coercion in women’s risk for HIV: a case-control study of outpatients in Gauteng, South Africa. Int J Gynecol Obstet 2020; 151: 377-382.
| Crossref | Google Scholar |
34 PettyJohn ME, Reid TA, Miller E, et al. Reproductive coercion, intimate partner violence, and pregnancy risk among adolescent women with a history of foster care involvement. Child Youth Serv Rev 2021; 120: 105731.
| Crossref | Google Scholar |
35 UNHCR. Uganda - refugee statistics August 2024 - active population by settlement; 2024. Available at https://data.unhcr.org/en/documents/details/111041
36 Ott MA, Campbell J, Imburgia TM, et al. Community engagement and venue-based sampling in adolescent male sexually transmitted infection prevention research. J Adolesc Health 2018; 62: S58-S64.
| Crossref | Google Scholar | PubMed |
37 Wolf EJ, Harrington KM, Clark SL, et al. Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety. Educ Psychol Meas 2013; 73: 913-934.
| Crossref | Google Scholar |
38 Heptulla R, Hashim R, Johnson DN, et al. Evaluating emergency preparedness and impact of a hurricane sandy in pediatric patients with diabetes. Disaster Mil Med 2016; 2: 2.
| Crossref | Google Scholar |
39 Felton JW, Cole DA, Martin NC. Effects of rumination on child and adolescent depressive reactions to a natural disaster: the 2010 Nashville flood. J Abnorm Psychol 2013; 122: 64-73.
| Crossref | Google Scholar | PubMed |
40 Shah HJ, Lai BS, Leroux AJ, et al. Understanding open access data using visuals: integrating prospective studies of children’s responses to natural disasters. Child Youth Care Forum 2019; 48: 563-583.
| Crossref | Google Scholar | PubMed |
41 Horiguchi H, Nakazawa M. Long-lasting effects of the 2013 Yolanda Typhoon on overall health of mothers and children. Disaster Med Public Health Prep 2021; 15: 344-351.
| Crossref | Google Scholar | PubMed |
42 Lee I, Ha YS, Kim YA, et al. PTSD symptoms in elementary school children after Typhoon Rusa. Taehan Kanho Hakhoe Chi 2004; 34: 636-645.
| Crossref | Google Scholar | PubMed |
43 Brafford LJ, Beck KH. Development and validation of a condom self-efficacy scale for college students. J Am Coll Health 1991; 39: 219-225.
| Crossref | Google Scholar |
44 WHO. WHO multi-country study on women’s health and domestic violence against women: summary report; 2005. Available at https://www.who.int/publications/i/item/9241593512 [accessed 19 August 2024]
45 Kim JC, Watts CH, Hargreaves JR, et al. Understanding the impact of a microfinance-based intervention on women’s empowerment and the reduction of intimate partner violence in South Africa. Am J Public Health 2007; 97: 1794-1802.
| Crossref | Google Scholar | PubMed |
46 Wamoyi J, Ranganathan M, Kyegombe N, et al. Improving the measurement of transactional sex in Sub-Saharan Africa: a critical review. J Acquir Immune Defic Syndr 2019; 80: 367-374.
| Crossref | Google Scholar | PubMed |
47 Moorhouse L, Schaefer R, Thomas R, et al. Application of the HIV prevention cascade to identify, develop and evaluate interventions to improve use of prevention methods: examples from a study in east Zimbabwe. J Int AIDS Soc 2019; 22: e25309.
| Crossref | Google Scholar |
48 Hargreaves JR, Delany-Moretlwe S, Hallett TB, et al. The HIV prevention cascade: integrating theories of epidemiological, behavioural, and social science into programme design and monitoring. Lancet HIV 2016; 3: e318-e322.
| Crossref | Google Scholar | PubMed |
49 Chop E, Duggaraju A, Malley A, et al. Food insecurity, sexual risk behavior, and adherence to antiretroviral therapy among women living with HIV: a systematic review. Health Care Women Int 2017; 38: 927-944.
| Crossref | Google Scholar | PubMed |
50 Logie CH, Okumu M, Coelho M, et al. Sexual violence stigma experiences among refugee adolescents and youth in Bidi Bidi refugee settlement, Uganda: qualitative insights informed by the stigma power process framework. SSM - Ment Health 2023; 4: 100242.
| Crossref | Google Scholar |
51 Feseha G, G/mariam A, Gerbaba M. Intimate partner physical violence among women in Shimelba refugee camp, northern Ethiopia. BMC Public Health 2012; 12: 125.
| Crossref | Google Scholar |
52 Chynoweth SK, Buscher D, Martin S, et al. A social ecological approach to understanding service utilization barriers among male survivors of sexual violence in three refugee settings: a qualitative exploratory study. Confl Health 2020; 14: 43.
| Crossref | Google Scholar |
53 Wirtz AL, Glass N, Pham K, et al. Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia. Confl Health 2013; 7: 13.
| Crossref | Google Scholar |
54 Vu A, Adam A, Wirtz A, et al. The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLOS Curr Disasters 2014; 6: ecurrents.dis.835f10778fd80ae031aac12d3b533ca7.
| Crossref | Google Scholar |
55 Familiar I, Muniina PN, Dolan C, et al. 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.
| Crossref | Google Scholar |
56 Gittings L, Grimwood A. ‘We need other men to stand up and start the journey’ engaging men as HIV community health workers - a gender transformative approach? Cult Health Sex 2020; 23: 192-206.
| Crossref | Google Scholar | PubMed |
57 Kågesten A, Chandra-Mouli V. Gender-transformative programmes: implications for research and action. Lancet Glob Health 2020; 8: e159-e160.
| Crossref | Google Scholar | PubMed |
58 Gibbs A, Jewkes R, Sikweyiya Y. “I Tried to Resist and Avoid Bad Friends”: the role of social contexts in shaping the transformation of masculinities in a gender transformative and livelihood strengthening intervention in South Africa. Men Masculinities 2018; 21: 501-520.
| Crossref | Google Scholar |
59 James S, Pisa PT, Imrie J, et al. Assessment of adolescent and youth friendly services in primary healthcare facilities in two provinces in South Africa. BMC Health Serv Res 2018; 18: 809.
| Crossref | Google Scholar |
60 Mannell J, Willan S, Shahmanesh M, et al. Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa. J Int AIDS Soc 2019; 22: e25380.
| Crossref | Google Scholar |
61 Marchezini V, Trajber R, Olivato D, et al. Participatory early warning systems: youth, citizen science, and intergenerational dialogues on disaster risk reduction in Brazil. Int J Disaster Risk Sci 2017; 8: 390-401.
| Crossref | Google Scholar |
62 Athirah NA, Radzi NH, Abdullah MN, et al. Solar-powered flood early warning system with short message service (SMS) notifications. Indones J Electr Eng Comput Sci 2020; 18: 1156-1162.
| Crossref | Google Scholar |
63 Lowe D, Ebi KL, Forsberg B. Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves. Int J Environ Res Public Health 2011; 8: 4623-4648.
| Crossref | Google Scholar | PubMed |
64 Tran DN, Ching J, Kafu C, et al. Interruptions to HIV care delivery during pandemics and natural disasters: a qualitative study of challenges and opportunities from frontline healthcare providers in Western Kenya. J Int Assoc Provid AIDS Care JIAPAC 2023; 22: 23259582231152041.
| Crossref | Google Scholar |
65 Brown W, III, Lopez Rios J, Sheinfil A, et al. Text messaging and disaster preparedness aids engagement, re-engagement, retention, and communication among Puerto Rican participants in a human immunodeficiency virus (HIV) self-testing study after Hurricanes Irma and Maria. Disaster Med Public Health Prep 2023; 17: e2.
| Crossref | Google Scholar |