Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, Canada.
J Int AIDS Soc. 2021 Mar;24(3):e25674. doi: 10.1002/jia2.25674.
INTRODUCTION: HIV-related risks may be exacerbated in humanitarian contexts. Uganda hosts 1.3 million refugees, of which 60% are aged under 18. There are knowledge gaps regarding HIV testing facilitators and barriers, including HIV and intersecting stigmas, among urban refugee youth. In response, we explored experiences and perspectives towards HIV testing strategies, including HIV self-testing, with urban refugee youth in Kampala, Uganda. METHODS: We implemented a qualitative study with refugee cisgender youth aged 16 to 24 living in Kampala's informal settlements from February-April 2019. We conducted five focus groups with refugee youth, including two with adolescent boys and young men, two with adolescent girls and young women and one with female sex workers. We also conducted five key informant (KI) interviews with government, non-government and community refugee agencies and HIV service providers. We conducted thematic analyses to understand HIV testing experiences, perspectives and recommendations. RESULTS: Participants (n = 49) included young men (n = 17) and young women (n = 27) originally from the Democratic Republic of Congo [DRC] (n = 29), Rwanda (n = 11), Burundi (n = 3) and Sudan (n = 1), in addition to five KI (gender: n = 3 women, n = 2 men; country of origin: n = 2 Rwanda, n = 2 Uganda, n = 1 DRC). Participant narratives revealed stigma drivers included fear of HIV infection; misinformation that HIV is a "Ugandan disease"; and blame and shame for sexual activity. Stigma facilitators included legal precarity regarding sex work, same-sex practices and immigration status, alongside healthcare mistreatment and confidentiality concerns. Stigma experiences were attributed to the social devaluation of intersecting identities (sex work, youth, refugees, sexual minorities, people living with HIV, women). Participants expressed high interest in HIV self-testing. They recommended HIV self-testing implementation strategies to be peer supported and expressed concerns regarding sexual- and gender-based violence with partner testing. CONCLUSIONS: Intersecting stigma rooted in fear, misinformation, blame and shame, legal precarity and healthcare mistreatment constrain current HIV testing strategies with urban refugee youth. Findings align with the Health Stigma and Discrimination Framework that conceptualizes stigma drivers and facilitators that devalue intersecting health conditions and social identities. Findings can inform multi-level strategies to foster enabling HIV testing environments with urban refugee youth, including tackling intersecting stigma and leveraging refugee youth peer support.
简介:在人道主义环境中,与艾滋病毒相关的风险可能会加剧。乌干达收容了 130 万难民,其中 60%的年龄在 18 岁以下。关于艾滋病毒检测的促进因素和障碍,包括艾滋病毒和交叉污名,在城市难民青年中存在知识差距。有鉴于此,我们探讨了城市难民青年对艾滋病毒检测策略(包括艾滋病毒自我检测)的经验和看法。
方法:我们于 2019 年 2 月至 4 月在乌干达坎帕拉的非正规住区对 16 至 24 岁的跨性别难民青年进行了一项定性研究。我们对难民青年进行了五次焦点小组讨论,包括两次针对青少年男孩和年轻男性,两次针对青少年女孩和年轻女性,以及一次针对女性性工作者。我们还对政府、非政府和社区难民机构以及艾滋病毒服务提供者进行了五次关键意见(KI)访谈。我们进行了主题分析,以了解艾滋病毒检测的经验、观点和建议。
结果:参与者(n=49)包括原籍刚果民主共和国(DRC)(n=29)、卢旺达(n=11)、布隆迪(n=3)和苏丹(n=1)的年轻男性(n=17)和年轻女性(n=27),以及 5 名 KI(性别:n=3 名女性,n=2 名男性;原籍国:n=2 名卢旺达,n=2 名乌干达,n=1 名 DRC)。参与者的叙述揭示了以下导致污名的因素:对艾滋病毒感染的恐惧;艾滋病毒是“乌干达病”的错误信息;以及对性活动的指责和羞耻。污名的促进因素包括性工作、同性行为和移民身份的法律不稳定,以及医疗保健方面的虐待和保密性问题。污名的经历归因于相互交织的身份(性工作者、青年、难民、性少数群体、艾滋病毒感染者、妇女)的社会贬值。参与者对艾滋病毒自我检测表现出浓厚的兴趣。他们建议实施以同伴支持为基础的艾滋病毒自我检测实施策略,并对伴侣检测中存在的性暴力和性别暴力表示担忧。
结论:以恐惧、错误信息、指责和羞耻、法律不稳定和医疗保健虐待为根源的交叉污名限制了城市难民青年目前的艾滋病毒检测策略。研究结果与健康污名和歧视框架一致,该框架将污名的驱动因素和促进因素概念化为相互交织的健康状况和社会身份的贬值。研究结果可以为培养有利于城市难民青年的艾滋病毒检测环境的多层次战略提供信息,包括解决交叉污名问题和利用难民青年的同伴支持。
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