Beyond an Epidemic: Examining the Syndemic Relationship between Alcohol, Violence and HIV among Youth Living in the Slums of Kampala

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

Comparing the Characteristics of Adolescent Smoking in Politically Stable and Unstable Countries

Background: As the number of smokers in industrialized nations declines the number of smokers in developing countries increases. Many of the nations that are experiencing an increase in smoking prevalence are poor, politically unstable countries. The smoking rates among adolescents are increasing at an especially alarming rate. The tumultuous sociopolitical conditions such as civil unrest, the overthrowing of government regimes and the presence of political violence makes adolescents in these environments susceptible to engagement in high risk behavior such as smoking as a means of self- medicating the symptoms of mental disorder or unhealthy coping mechanisms. The purpose of this study was to analyze the difference in smoking behaviors and beliefs among adolescents in politically unstable countries compared to those in more stable areas. Methods: The West Bank, Gaza Strip, Yemen, Iraq, United Arab Emirates, Oman, Qatar and Kuwait were selected for inclusion in the study based on their World Bank Indicators. Stable countries were defined by their ranking in the 50th percentile or higher on the Political Stability and Absence of Violence Index, whereas unstable countries were defined as being in the 10th percentile or lower. Using secondary data from the 2001, 2002, 2003, 2004, 2005 and 2006 Global Youth Tobacco Survey (GYTS) for eight countries, univariate and multivariate analyses were conducted to assess the factors associated with smoking behaviors. Cases were truncated for 13- 15 year old respondents. A p- value of \u3c .05 and 95% confidence intervals was used to determine statistical significance through the various analyses performed. Results: The univariate and multivariate analysis found that living in an unstable country and being male was associated with increased odds of smoking and experimentation among 13- 15 year old adolescents. Conclusion: The study results suggest that political stability may be associated with smoking behaviors and beliefs among adolescents. Since the factors that create political instability are multi-factorial and beyond the scope of this study, interventions should be designed to address smoking and other risk behaviors within this unique sociopolitical context. Previous interventions in similar settings have found programs integrating mental health dimension and religious leaders have been successful in staving off the onset of smoking among study populations. INDEX WORDS: teens, adolescents, trauma, political instability, risk behavior, tobacco, smoking, interventions