A syndemic of inequitable gender norms and intersecting stigmas on condom self-efficacy and practices among displaced youth living in urban slums in Uganda: a community-based cross-sectional study
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways The study highlights how harmful norms and stigma form a “syndemic” that compromises youth sexual health. Norms around gender roles and sexuality foster shame and silence, particularly for girls, and limit their ability to communicate about or use condoms. Effective HIV prevention must include gender-transformative and stigma-reduction approaches that empower youth with both knowledge and communication skills.
Objectives This study explored how adverse socio-cultural conditions—such as inequitable gender norms, adolescent sexual and reproductive health (ASRH) stigma, and HIV-related stigma—impact condom self-efficacy and consistent condom use among displaced youth in Kampala, Uganda. The aim was to understand how these factors interact to shape HIV risk and inform better-targeted interventions.
Methods A community-based cross-sectional survey was conducted with 445 displaced youth aged 16–24 across five informal urban settlements. Peer research assistants who were also displaced youth administered structured tablet-based surveys. Analyses included multivariable logistic and linear regressions to assess both individual and combined effects of socio-cultural stigmas on condom-related outcomes.
Results Over 80% of participants reported high A-SRH stigma, and nearly half reported perceiving high levels of HIV-related stigma (41.6%) and
personal beliefs in harmful inequitable gender norms (46.3%). These factors often co-occurred, especially among girls. Joint effects of gender norms and ASRH stigma, and of ASRH and HIV stigma, were significantly associated with reduced condom self-efficacy and lower recent consistent condom use. However, protective factors like condom self-efficacy and safer sex communication mitigated these negative effects.
Conclusions Intersecting stigmas and gender norms reduce displaced youths’ ability to consistently use condoms, increasing their vulnerability to HIV. Addressing these combined socio-cultural barriers through multilevel interventions is critical to improving sexual health outcomes, particularly for girls in urban slums.
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