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Examining the substance use, violence, and HIV and AIDS (SAVA) syndemic among urban refugee youth in Kampala, Uganda: cross-sectional survey findings
  1. Carmen H. Logie1,2,3,4,
  2. Moses Okumu5,6,
  3. Kalonde Malama1,
  4. Simon Mwima5,7,
  5. Robert Hakiza8,
  6. Uwase Mimy Kiera8,
  7. Peter Kyambadde7,9
  1. 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
  2. 2Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
  3. 3Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
  4. 4United Nations University Institute for Water, Environment & Health, Hamilton, Ontario, Canada
  5. 5School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
  6. 6School of Social Science, Uganda Christian University, Mukono, Uganda
  7. 7National AIDS Coordinating Program, Uganda Ministry of Health, Kampala, Uganda
  8. 8Young African Refugees for Integral Development, Kampala, Uganda
  9. 9Most At Risk Population Initiative (MARPI), Mulago National Referral Hospital, Kampala, Uganda
  1. Correspondence to Dr Carmen H. Logie; carmen.logie{at}


Background 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.

Methods 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.

Results 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.

Conclusion 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.

  • Child health
  • Mental Health & Psychiatry
  • HIV
  • Community-based survey

Data availability statement

Data are available upon reasonable request. Data available upon request and upon receiving research ethics approval via amendment.

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Data availability statement

Data are available upon reasonable request. Data available upon request and upon receiving research ethics approval via amendment.

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  • Handling editor Seye Abimbola

  • Twitter @carmenlogie

  • Contributors CHL conceptualised the paper, acquired funding to support data collection, and led the writing and revision and is the guarantor of this study and its overall content. MO supported data collection, led the data analysis and contributed to writing. KM contributed to writing and editing the manuscript. SM, RH, UMK and PK contributed to funding acquisition, supported data collection, and provided edits and input to the data interpretation and manuscript.

  • Funding The study was supported by funding from the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health and the Canada Foundation for Innovation. CHL was also supported by funding from the Ontario Ministry of Research & Innovation Early Researcher Award and the Canada Research Chairs Programme.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.