Submission ID 130402
| Issue/Objective | HIV-related stigma, restrictive legal environments, and structural inequities limit access to HIV prevention, testing, and treatment services among adolescents and young people living with HIV (YPLHIV) in Uganda, particularly among key populations such as men who have sex with men and sex workers. These challenges are shaped by broader social and policy contexts characterized by criminalization, discrimination, and limited youth-responsive services, which hinder sustained engagement in care. This study aimed to examine how social and structural factors influence HIV service engagement among adolescents and young people in Uganda, contributing to efforts to advance global health equity in high-stigma settings. |
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| Methodology/Approach | This qualitative grounded theory study was conducted in Kampala, Uganda, within urban HIV clinics and community-based counseling centers. We carried out semi-structured interviews and focus group discussions with adolescents and young people aged 18-25 years. Participants were purposively recruited to capture diverse experiences of HIV service engagement. Data were collected between December 2023 and May 2024, audio-recorded, transcribed verbatim, and analyzed thematically using Andersen's model of health service utilization. |
| Results | Five key themes influencing HIV service engagement were identified. Structural barriers included restrictive legal and policy environments and limited provider capacity to deliver adolescent-responsive services. Social influences were shaped by multi-level stigma (internalized, perceived, and enacted), affecting willingness to seek and remain in care. Informal support systems, including peers, partners, and family members, played a critical role in facilitating or hindering engagement. Health system factors, particularly service delivery models and provider-client interactions, further shaped care experiences. Despite these challenges, participants demonstrated resilience by leveraging peer networks and social support to navigate stigma and maintain engagement. |
| Discussion/Conclusion | Multi-level, equity-driven interventions are needed to address structural and social barriers to HIV service engagement. Strengthening youth-friendly, stigma-responsive services and provider capacity, alongside reforms to restrictive legal environments, can improve access to care. Scaling peer-led and community-based support models offers a sustainable pathway to enhance service utilization. By addressing upstream determinants such as stigma and criminalization, these findings support actionable, rights-based strategies to advance global health equity among marginalized youth. |
| Presenters and Affiliations | Annet Nambeela Mulago National Referal Hospital/Most At Risk Population Clinic Uganda Leah Namono Uganda Red Cross Society Winnie Namukambi Uganda Christian University Gorretti Katushabe Mulago National Referal Hospital/Most At Risk Population Clinic Uganda |
