Uganda Martyrs University, PO Box 5498, Kampala, Uganda.
Baylor College of Medicine Children's Foundation Uganda, PO Box 72052, Kampala, Uganda.
BMC Public Health. 2023 Aug 7;23(1):1497. doi: 10.1186/s12889-023-16399-9.
Adequate sexual and reproductive health literacy (SRHL) among young people has been linked to informed sexual behaviours. Studies on SRHL have largely been conducted among the general adolescent population. Little is known about youth aged 15-24 years living with human immunodeficiency virus (YLHIV). There is a possible lack of SRHL in this population, considering the high rate of teenage pregnancies and unprotected sex reported by YLHIV. This study aimed to assess the prevalence and associated personal and environmental factors for SRHL among YLHIV at a high-volume urban HIV Clinic in Uganda.
Through a cross-sectional survey, YLHIV receiving routine HIV care services at Baylor-Uganda HIV Clinic were interviewed using an adapted European Health Literacy Survey (HLS-EU). Using simple random sampling, eligible youth who received HIV care services between August and November 2019 were enrolled in the study. SRHL scores were computed using the HLS-EU index method; and individuals whose scores ranged from 34 to 50 were considered health literate. We used descriptive statistics to determine the prevalence. Potential associated personal and environmental factors (p<0.05) were identified by performing two-step inferential statistics, bivariate analysis and binary logistic regression. Odds ratios were calculated to estimate the likelihood of youth being health literate on sexual and reproductive health (SRH) issues in comparison with the reference categories, and 95% confidence intervals were determined to establish whether the relationships were statistically significant.
Of the 267 YLHIV interviewed at Baylor-Uganda HIV Clinic, 167 (62.5%) were female with a mean age of 18.9 years (SD± 2.8), and the majority (242; 90.6%) were vertically infected with HIV. Only 52 (19.5%) were health literate on SRH issues. At the multivariate level, YLHIV who never had difficulty accessing SRH information were 0.391 times less likely to be health literate on SRH issues than their counterparts with challenges in accessing SRH information (Adjusted Odds Ratio [AOR] = 0.391, 95% CI =0.178 to 0.860; p= 0.019). YLHIV who did not find it easy to access SRH care service points were 2.929 times more likely to be literate in SRH than those who found it easy to access such services (Adjusted Odds Ratio [AOR] = 2.929, 95% CI =1.241 to 6.917; p=0.014). Additionally, YLHIV who did not listen to radio health talks were 2.406 times more likely to be health literate on SRH issues than those who did (AOR = 2.406, 95% CI =1.133 to 5.112; p=0.022).
SRHL is an unmet need among YLHIV; only 19.5% were health literate on SRH issues. This could complicate the achievement of the UNAIDS sustainable development goal (SDG) of an HIV/AIDS-free generation by 2030 because low health literacy (HL) skills can affect the efficacy of almost all HIV disease prevention and health promotion efforts. Inaccessible SRH care service points and not listening to radio health talks were positively associated with SRHL, while having access to SRH information was negatively associated with SRHL.
年轻人具备足够的性与生殖健康素养（SRHL）与知情的性行为有关。大多数关于 SRHL 的研究都是在一般青少年群体中进行的。对于 15-24 岁的青少年 HIV 感染者（YLHIV），人们对他们的 SRHL 知之甚少。考虑到 YLHIV 中报告的青少年怀孕和无保护性行为的高发生率，他们可能存在 SRHL 不足的问题。本研究旨在评估乌干达一家大容量城市 HIV 诊所中 YLHIV 的 SRHL 流行情况及其相关的个人和环境因素。
通过横断面调查，使用改编的欧洲健康素养调查（HLS-EU）对在 Baylor-Uganda HIV 诊所接受常规 HIV 护理服务的 YLHIV 进行访谈。采用简单随机抽样，招募 2019 年 8 月至 11 月期间接受 HIV 护理服务的合格青年入组。使用 HLS-EU 指数法计算 SRHL 评分；得分在 34 到 50 分之间的个体被认为具有健康素养。我们使用描述性统计来确定流行率。通过进行两步推断统计、单变量分析和二元逻辑回归，确定潜在的相关个人和环境因素（p<0.05）。使用优势比（OR）来估计青年在性与生殖健康（SRH）问题上具有健康素养的可能性与参考类别相比，置信区间为 95%，以确定这些关系是否具有统计学意义。
在 Baylor-Uganda HIV 诊所接受采访的 267 名 YLHIV 中，167 名（62.5%）为女性，平均年龄为 18.9 岁（标准差±2.8），大多数（242 名；90.6%）为垂直感染 HIV。仅有 52 名（19.5%）在 SRH 问题上具有健康素养。在多变量水平上，从未有过获取 SRH 信息困难的 YLHIV 在 SRH 问题上具有健康素养的可能性比有获取 SRH 信息困难的 YLHIV 低 0.391 倍（调整后的优势比 [AOR] = 0.391，95%CI = 0.178 至 0.860；p=0.019）。不容易获得 SRH 护理服务点的 YLHIV 在 SRH 方面具有健康素养的可能性比容易获得此类服务的 YLHIV 高 2.929 倍（调整后的优势比 [AOR] = 2.929，95%CI = 1.241 至 6.917；p=0.014）。此外，不收听广播健康讲座的 YLHIV 在 SRH 问题上具有健康素养的可能性比收听广播健康讲座的 YLHIV 高 2.406 倍（AOR = 2.406，95%CI = 1.133 至 5.112；p=0.022）。
YLHIV 的 SRHL 是一个未满足的需求；仅有 19.5%的人在 SRH 问题上具有健康素养。这可能会使实现联合国艾滋病规划署（UNAIDS）关于到 2030 年实现艾滋病零感染的可持续发展目标（SDG）变得复杂，因为低健康素养（HL）技能会影响几乎所有艾滋病预防和健康促进工作的效果。难以获得 SRH 护理服务点和不收听广播健康讲座与 SRHL 呈正相关，而能够获取 SRH 信息与 SRHL 呈负相关。
