Problem drinking linked to HIV, other sexually transmitted infections in Ugandan youth, study finds
Youth living in the slums of Uganda who are infected with both HIV and sexually transmitted infections are more likely to engage in problem drinking, according to a study led by Georgia State University.
HIV prevalence among individuals living in Uganda is high (6.5 percent), and Uganda is one of the few countries where HIV rates are increasing rather than decreasing. However, HIV prevalence is even higher among youth living in the slums of Kampala. They are vulnerable because of food scarcity, lack of parental oversight and limited infrastructure.
Having both HIV and a sexually transmitted infection, known as co-infection, may result in severe complications, including increased mortality, challenges with treating HIV and increased transmission of HIV. This public health matter warrants urgent attention, and it's important to identify risk factors associated with co-infection of HIV and sexually transmitted infections in Ugandan youth to reverse this trend.
Overall, 13.8 percent of youth (ages 12 to 18) living in the slums of Kampala, Uganda reported having HIV and 42.8 percent reported having a sexually transmitted infection. Among those living with HIV, 72 percent reported having another sexually transmitted infection, such as herpes or syphilis. This is nearly seven times higher than co-infection percentages among people living with HIV in other areas of sub-Saharan Africa.
When identifying risk factors for reporting both HIV and sexually transmitted infections, the researchers found that 32.8 percent of co-infected youth reported problem drinking and 29 percent reported participating in commercial sex work. The findings are reported in the journal AIDS and Behavior.
"Our results demonstrate there is a high prevalence of co-infection with HIV and sexually transmitted infections among young, sexually active youth living in the slums of Kampala, Uganda," said Rachel Culbreth, lead author of the study and a Ph.D. candidate in the School of Public Health at Georgia State. "The findings reinforce the need for comprehensive alcohol reduction and prevention strategies. The legal drinking age in Uganda is 18, and stronger alcohol policies may prevent youth from getting HIV and sexually transmitted infections and other negative alcohol-related outcomes. Ugandan policies also don't address particularly vulnerable groups, such as youth engaging in sex work.
"The results also emphasize the need for preventive strategies targeted at increasing the number of testing centers, teaching youth about how HIV is transmitted and informing youth of the health complications that result from being infected with another sexually transmitted infection."
The researchers surveyed 1,134 youth (ages 12 to 18) who live on the streets or in the slums of Kampala, Uganda. The youth were asked to self-report if they've ever had sexual intercourse and if they've ever been told by a doctor, nurse or HIV counselor they have HIV or a sexually transmitted infection such as syphilis, herpes, bola bola or gonorrhea.
The study was conducted in partnership with the Uganda Youth Development Link, which offers services and vocational training for vulnerable youth in the slums.
"We are very grateful for our long-standing collaboration with the Uganda Youth Development Link and their executive director, Mr. Rogers Kasirye, and his great staff," said Dr. Monica Swahn, Distinguished Professor in the School of Public Health at Georgia State and principal investigator for this National Institutes of Health-funded study.
"Because these results were self-reported, the youth potentially underreported HIV and sexually transmitted infection due to social desirability," Culbreth said. "So it's possible the prevalence of these infections is much higher. Despite the study's limitations, we believe the results are significant because the study is among the first to report the prevalence of co-infection with HIV and sexually transmitted infections and associated risk factors among these youth."
The results also point to modifiable risk factors and possible prevention interventions that could help avoid acquisition of HIV among youth living with a sexually transmitted infection. For instance, youth who reported sexually transmitted infections were more likely to be female, reported multiple sexual partners and reported problem drinking and drinking alcohol in general.
In the future, the researchers would like to use laboratory testing to confirm infection with HIV and sexually transmitted infections.
More information: Rachel Culbreth et al. Risk Factors Associated with HIV, Sexually Transmitted Infections (STI), and HIV/STI Co-infection Among Youth Living in the Slums of Kampala, Uganda, AIDS and Behavior (2019). DOI: 10.1007/s10461-019-02444-5