Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada.
BMJ Glob Health. 2022 Jul;7(Suppl 5). doi: 10.1136/bmjgh-2021-006583.
Interactions between substance use, violence, HIV and AIDS, known as the 'SAVA' syndemic, are understudied among refugee youth. We assessed the synergistic effects of frequent alcohol use, depression and violence on HIV vulnerability among urban refugee youth aged 16-24 years in Kampala, Uganda.
We conducted a cross-sectional survey between January and April 2018 with a convenience sample of refugee youth aged 16-24 years living in informal settlements in Kampala (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya). We assessed non-communicable health conditions (frequent [≥3 times per week] alcohol use [FAU]; depression); violence (young adulthood violence [YAV] at age ≥16 years, intimate partner violence [IPV]), and HIV vulnerability (past 12-month transactional sex; recent [past 3-month] multiple [≥2] sex partners). We calculated the prevalence and co-occurrence of non-communicable health conditions, violence and HIV vulnerability variables. We then conducted multivariable logistic regression analyses to first create unique profiles of FAU, depression, YAV and IPV exposures, and second to assess for interactions between exposures on HIV vulnerability outcomes.
Most participants (n=445; mean age: 19.59, SD: 2.6; women: n=333, 74.8%, men: n=112, 25.2%) reported at least one non-communicable health condition or violence exposure (n=364, 81.8%), and over half (n=278, 62.4%) reported co-occurring exposures. One-fifth reported FAU (n=90; 20.2%) and one-tenth (n=49; 11%) major depression. In logistic regression models including all two-way product terms, adjusted for sociodemographics, we found (a) multiplicative interaction for joint effects of FAU and IPV (adjusted OR (aOR)=4.81, 95% CI: 1.32 to 17.52) on multiple sex partners, and (b) multiplicative interaction for joint effects of FAU and IPV (aOR=3.72, 95% CI: 1.42 to 9.74), and YAV and depression (aOR=7.13, 95% CI: 1.34 to 37.50), on transactional sex.
Findings signal the importance of addressing the SAVA syndemic among urban refugee youth in Uganda. Synergistic interactions indicate that addressing FAU, depression or violence may concomitantly reduce HIV vulnerability with urban refugee youth.
物质使用、暴力、艾滋病毒和艾滋病之间的相互作用，被称为“萨瓦”综合征，在难民青年中研究不足。我们评估了频繁饮酒、抑郁和暴力对乌干达坎帕拉市 16-24 岁城市难民青年艾滋病毒易感性的协同作用。
我们于 2018 年 1 月至 4 月期间，对居住在坎帕拉非正规住区（卡巴拉拉、鲁巴加、坎桑加、卡特韦、恩萨姆比亚）的 16-24 岁难民青年进行了一项横断面调查。我们评估了非传染性健康状况（频繁[每周≥3 次]饮酒[FAU]；抑郁）；暴力（成年暴力[YAV]≥16 岁、亲密伴侣暴力[IPV]）和艾滋病毒易感性（过去 12 个月的交易性性行为；最近[过去 3 个月]有≥2 个性伴侣）。我们计算了非传染性健康状况、暴力和艾滋病毒易感性变量的患病率和共现率。然后，我们进行了多变量逻辑回归分析，首先创建 FAU、抑郁、YAV 和 IPV 暴露的独特特征，其次评估暴露在艾滋病毒脆弱性结果上的相互作用。
大多数参与者（n=445；平均年龄：19.59，标准差：2.6；女性：n=333，74.8%，男性：n=112，25.2%）报告至少有一种非传染性健康状况或暴力暴露（n=364，81.8%），超过一半（n=278，62.4%）报告同时存在暴露。五分之一的人报告有 FAU（n=90；20.2%）和十分之一的人（n=49；11%）有重度抑郁。在包括所有双向乘积项的逻辑回归模型中，我们发现（a）FAU 和 IPV 联合作用的乘法交互作用（调整后的比值比（aOR）=4.81，95%CI：1.32 至 17.52）与多个性伴侣有关，（b）FAU 和 IPV（aOR=3.72，95%CI：1.42 至 9.74）和 YAV 和抑郁（aOR=7.13，95%CI：1.34 至 37.50）联合作用的乘法交互作用，与交易性性行为有关。
研究结果表明，在乌干达的城市难民青年中，解决萨瓦综合征的重要性。协同作用表明，解决 FAU、抑郁或暴力问题可能会同时降低城市难民青年的艾滋病毒易感性。
