Date of Award
Doctor of Philosophy (PhD)
Monica Swahn, PhD
Background. The HIV epidemic continues to be a major global health challenge. The interconnected relationship between HIV, alcohol use and violence contributes to an increased burden among vulnerable populations. Youth in sub-Saharan Africa are disproportionately impacted by the synergistic effects of these co-occurring conditions. However, there is limited empirical knowledge regarding the nature of these bi-directional interactions in this population. These studies aim to fill a gap in the literature by describing the mechanisms through which HIV, alcohol and violence intersect among Ugandan youth living in slums by: (1) identifying socio-cognitive correlates of sexual activity among older adolescents; (2) examining the impact of community cohesion on HIV status and related-risk behaviors and; (3) assessing alcohol consumption patterns and sexual risk behaviors among youth involved in intimate partner violence.
Methods. Secondary analyses were based on data from the 2014 Kampala Youth Survey, in which 1,137 youth aged 12- 18, living in 6 slum communities throughout Kampala, Uganda were surveyed about sociodemographic factors and various health outcomes including drinking patterns, sexual behavior, HIV status, and violence exposure. Participants were recruited, consented and interviewed by trained UYDEL staff. All respondents received a small soda and snack for their participation in the study.
Results. In study 1, after controlling for significant sociodemographic factors, older adolescent (aged 15-18 years old, n=757, males= 44%, female 56%) sexual abstainers (never had sexual intercourse) were more likely than sexually active youth to: (1) perceive HIV as a serious health issue; (2) have positive perceptions of condom use; (3) believe that their friends planned to delay sex and; (4) be confident in their ability to avoid or refuse sex. Sexual abstinence was also associated with lower odds of reporting drunkenness. In study 2, the results (N=1,134, male=44%, female=56%) revealed that perceptions of community cohesion were significantly correlated with drinking behaviors and sexual practices. High levels of cohesion were associated with fewer sexual partners, decreased odds of engaging in transactional sex and increased odds of being a consistent condom user. High cohesion was also associated with a decreased engagement in high-risk alcohol consumption patterns, including drinking before sex and drunkenness. Finally, in study 3, youth involved in violent relationships were significantly more likely to have HIV, multiple sexual partners, engagement in transactional sex and have a partner that drinks alcohol before sex.
Conclusions and Recommendations. Results across all three studies support findings in the existing literature and also provides further evidence about the inextricable link between HIV- risk related behaviors, alcohol use and violence exposure. Future intersectional research is needed to further explicate additional factors that contribute to SAVA among adolescent populations in sub-Saharan Africa and to guide prevention and intervention efforts.
Waajid, Malikah; Swahn, Monica H.; Ramsey-White, Kim; and Salazar, Laura F., "Beyond an Epidemic: Examining the Syndemic Relationship between Alcohol, Violence and HIV among Youth Living in the Slums of Kampala." Dissertation, Georgia State University, 2018.