Associations between extreme weather, resource insecurities and mobility with HIV risks among Ugandan refugee youth

Abstract

BACKGROUND: Humanitarian settings face elevated extreme weather events (EWEs), yet few studies with refugees have examined EWE-related risks and associations with human immunodeficiency virus (HIV) vulnerabilities. METHODS: Among refugee youth ages 16-24 y in a Ugandan refugee settlement, we conducted latent class analysis to examine EWE-related risk classes (resource insecurities [water, food, sanitation], EWE exposure, mobility) and multivariable regression to assess associations between class membership and HIV vulnerabilities (sexual relationship power [SRP], intimate partner violence [IPV], condom use self-efficacy [CUSE], reproductive autonomy). RESULTS: Participants' (n=400, 50% women; mean age 19.49 y [standard deviation 2.3]) class profiles included Class-1 (moderate resource insecurity, high mobility, high EWE), Class-2 (water insecurity, low mobility, low EWE) and Class-3 (severe resource insecurity, moderate mobility, high EWE). Compared with Class-2, Class-1 and Class-3 reported lower SRP (Class-1: adjusted beta coefficient (aβ)=-3.63 [95% confidence interval {CI} -6.27 to -0.98]; Class-3: aβ=-4.24 [95% CI -6.80 to -1.68]) and CUSE (Class-1: aβ=-2.55 [95% CI -4.21 to -0.90]; Class-3: aβ=-3.09 [95% CI -4.69 to -1.48]) and higher IPV (Class-1: odds ratio [OR] 4.81 [95% CI 1.00 to 23.03]; Class-3: OR 5.59 [95% CI 1.19 to 26.36]), and Class-1 reported lower reproductive autonomy (aβ=-0.27 [95% CI -0.54 to -0.01]). CONCLUSION: Converging EWE, mobility and resource insecurities increase refugee youths' HIV vulnerabilities, requiring urgent attention.