Voluntary HIV Counseling and Testing (VCT): Knowledge, attitudes, hinderances, and practices of adults seeking treatment at Gulu Regional Referral Hospital on the spread of HIV in Northern Uganda. A cross-sectional study

Background: In 2011, Uganda had a national HIV prevalence of 6.7%. Between 2008 and 2009, there was an upsurge in HIV in Gulu District from 9.4% to 16.0% with Gulu Municipality at 22.1%. Similarly, in 2020, the prevalence of HIV in Gulu District persistently remained high at 14.0%, much higher than the national average at 6.0%.The objective of this study was to assess knowledge, attitudes, hindrances, and practices on voluntary HIV counseling and testing (VCT) and determine factors associated with VCT practices among adults seeking treatment at the outpatient department of Gulu Regional Referral Hospital.Methods: A cross-sectional study was conducted with 384 participants. Simple random sampling was used to recruit participants. Knowledge and practices on VCT were determined using knowledge ratings and attitudes using a modified Likert scale. A questionnaire with an internal validity of Cronbach’s α=0.71 was used. Ethical approval was obtained, and SPSS was used for data analysis at univariate, bivariate and multivariable logistic regression. A p-value less than 0.05 was considered significant.Results: The most significant findings were that knowledge and attitude significantly affect VCT practices among adults in Gulu Hospital. Most participants had adequate knowledge (297/379, 78.4%), the most common source of VCT information was radio (236/372, 63.4%) and few from parents (30/372, 8.1%). 158/380(41.6%) had strongly positive attitudes however, 4/10(40.0%) believed knowing HIV status was not beneficial because of fear of stigma, 299/380(78.7%) had good practices,13/45(28.9%) did not undertake VCT due to ignorant on the importance, 9/45(20.0%) feared positive results, and 5/45(11.0%) for far-off service centers. Among those who discouraged others, 15/45 (83.0%) did it for no reason, while 2/45 (11.0%) believed it was a risky and painful process.Knowledge and attitude on VCT practices had an adjusted R square of 0.421, p<0.001. The independent predictors of VCT practices in a multivariable regression analysis was knowledge (β=0.478, t=10.374, p<0.001) and attitudes (β=0.257, t=5.570, p<0.001).Conclusion: Knowledge and attitudes significantly influenced VCT practices among adults attending outpatient services at Gulu Hospital. The independent determinants of VCT practices were knowledge and attitudes. However, HIV stigma, fear of positive results and divorce/separation were the most deterring factors on VCT practices among participants.

Non-attitudinal and non-knowledge based factors constrain households from translating good nutritional knowledge and attitude to achieve the WHO recommended minimum intake level for fruits and vegetables in a developing country setting: evidence from Gulu district, Uganda

Background The high level of incidence of mortality attributed to non-communicable diseases such as cancer, diabetes and hypertension being experienced in developing countries requires concerted effort on investment in strategies that can reduce the risks of development of such diseases. Fruits and vegetables (FV) contain natural bioactive compounds, and if consumed at or above 400 g per day (RDMIL) as recommended by World Health Organization (WHO) is believed to contribute to reduced risk of development of such diseases. The objective of this study was to determine in a developing country set-up, the extent to which rural and urban households conform to RDMIL, the status of nutritional attitude (NA) and knowledge (NK) associated with consumption of FV, and to delineate non-attitudinal and non-knowledge-based factors (NANK) that hinder achievement of RDMIL. Method A cross-sectional survey of 400 randomly selected households and 16 focus group discussions (FGD) were conducted using Gulu district of Uganda as a microcosm for a developing country setting. Level of consumption of FV was assessed using 24-h dietary recall and compared to RDMIL as a fraction (%). The status of NK and NA were determined using sets of closed-ended questions anchored on a three-point Likert scale. Further quantitative statistical analyses were conducted using t-test, chi-square, Pearson’s correlation and multiple linear regression. FGD provided data on NANK factors and were analysed using qualitative content analysis procedure. Results Urban and rural inhabitants met up to 72.0 and 62.4% of the RMDIL, respectively, with absolute intake being higher among urban than rural households by 37.54 g. NK and NA were good but the intensity of NK was higher among urban respondents by 11%. RDMIL was positively correlated with NA while socio-demographic predictors of RDMIL varied with household location. FGD revealed that primary agricultural production constraints, market limitations, postharvest management limitations, health concerns, social discomfort and environmental policy restrictions were the major NANK factors that hindered achievement of the RDMIL. Conclusions These results indicate that NANK factors constrain households from translating good NA and NK to achieve the RMDIL.

Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study

Background Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda. Methods We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression. Conclusions There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers.

Factors associated with use of long-acting reversible contraception among female sex workers operating in Gulu district, Northern Uganda – a cross-sectional study

Background: Long-acting reversible contraception (LARC) are the most effective and reliable contraceptives for female sex workers (FSWs) and require periodic users’ involvement only at the time of application or re-application. However, information on LARC use among FSWs in Uganda is scarce. To fill this gap, we determined the prevalence of LARC use among FSWs and examined factors associated with LARC use among FSWs operating in Gulu district, Northern Uganda.Methods: Across-sectional study was conducted among 300 FSWs aged 18 years and above and operating in Gulu district. Semi-structured questionnaires were used to measure factors associated with the use of LARC: intrauterine device (IUD), Implants, and injectables. Data analyses were conducted using STATA 14.0 and restricted to 280 non-gravid adult FSWs aged 18-49 years who were not on permanent contraception method. To examine factors associated with LARC use, prevalence ratios (PR) with robust standard errors were computed using Poisson regression.Results: Among the participants, the mean age (SD, range) was 26.5 (5.9, 18 - 45) years, 53.2% never married, 66.1% reported consistent condom use independent of LARC, 58.9% had unintended pregnancy during a lifetime, 48.6% had at least one unintended pregnancy during sex work, and 37.4% had at least one induced abortion. The prevalence of LARC use was 58.6%; the majority were using Implants (48.2%), followed by injectables (42.7%), and IUDs (9.1%). Independent factors associated with LARC use included: longer duration of sex work [≥ two years] (adjusted PR=1.44, 95% CI: 1.03-2.02), higher parity [≥ two] (adjusted PR=1.13, 95% CI: 1.02-1.26), history of unintended pregnancy during sex work (adjusted PR=1.24 CI: 1.01-1.51), and being a brothel/lodge-based FSWs (adjusted PR=1.28, 95% CI: 1.01-1.63).Conclusions: There is a big gap in LARC use with only 58.6% of FSWs using LARC. LARC use was associated with longer duration of sex work, higher parity, history of sex work-related unintended pregnancy, and being a brothel/lodge-based FSW. Therefore, interventions to improve LARC use should intensively target the newly recruited FSWs, FSWs with low parity, and FSWs not based in brothels or lodges.

Client-perpetrated gender-based violence among female sex workers in post-conflict Gulu district, Northern Uganda: a cross-sectional study

Background: Gender-based violence (GBV) among female sex workers (FSWs) negatively affects their mental wellbeing and sexual and reproductive health and rights. This study aimed to determine the prevalence and associated factors of client-perpetrated GBV among FSWs in post-conflict Gulu district, Northern Uganda. Methods: A cross-sectional study was conducted among 300 FSWs aged 18+ years who were operating in Gulu district. Participants were selected using simple random sampling and interviewed between March and June 2020. Pre-tested semi-structured questionnaires were utilized to collect information on socio-demographic and sex-work-related characteristics, alcohol and illicit drug use, HIV status, and exposure to client-perpetrated GBV. Data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results: Sixty one percent (61.0%) of the participants reported client-perpetrated GBV. The most common forms of GBV in this population were economic (58.7%) and emotional (52.0%) violence. Meanwhile, sexual violence (21.0%) was the least common form of GBV among the study participants. At multivariate level; street-based sex work (aOR=9.66, 95%CI: 2.78-33.5), mobile sex work (aOR=3.21, 95%CI: 1.83-5.64), HIV-positive status (aOR=1.90, 95%CI: 1.09-3.31), and low monthly income below 50th percentile {<200,000 UGX}(aOR= 2.26, 95% CI: 1.18-4.30) remained independently associated with client-perpetrated GBV. Conclusion: Our findings revealed a high prevalence of client-perpetrated GBV driven by street-based sex work, sex work-related mobility, HIV-positive status, and low income. Therefore, interventions to address client-perpetrated GBV should target FSWs who are street-based, HIV-positive, mobile, and with low income.

Prevalence and Factors Associated with Major Depression Among Female Sex Workers in Post-Conflict Gulu District: A Cross-Sectional Study

Background: Depression is the world’s leading cause of disability and a major contributor to the overall global burden of disease. Female sex workers operating in conflict-affected settings could be more prone to depression, yet the prevalence and factors associated with depression among this special population remain inadequately addressed. This study thus aimed to determine the prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district. Methods: This cross-sectional study was conducted among 300 randomly selected female sex workers in Gulu district between March and June 2020. Possible factors associated with depression were assessed using pre-tested semi-structured questionnaire and participants assessed for major depression using Mini-International Neuropsychiatric Interview (MINI) version 7.0.0. We utilized STATA 14.0 for univariate, bivariate and multivariate data analyses.Results: The mean age of study participants was 26.4 years (SD = 6), 57.7% attained primary education, 51.7% never married and 42.1% were living with HIV. Almost half (47.7%) of the participants had major depression, of whom half (50.4%) had severe depression and one-thirds (34.3%) had suicidal ideation. At multivariate level, factors that showed positive association with major depression were: psychological stressor (aOR = 11.0, 95%CI: 5.77-20.86), living with HIV (aOR= 2.32, 95%CI: 1.29-4.15), being verbally abused (aOR = 2.27, 95%CI: 1.26-4.07), and being 30+ years of age (aOR = 1.95, 95%CI: 1.05-3.61). Meanwhile, factors that showed negative association with major depression were: providing sexual services at client’s place (aOR=0.46, 95%CI: 0.24-0.91), using modern family planning method (aOR=0.47, 95%CI: 0.25-0.87), and daily intake of alcohol (aOR=0.50, 95%CI: 0.28-0.88).Conclusion: The findings underscore the high prevalence of major depression among female sex workers driven by psychological stress, living with HIV/AIDs, being verbally abused by clients and being 30+years of age. The high prevalence of major depression has important public health ramifications at individual and societal levels and requires urgent attention of all stakeholders.