Longitudinal associations between condom use self-efficacy trajectories, HIV-related stigma, and HIV prevention engagement among refugee youth in Kampala, Uganda

Vollständiger Abstract

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Background: Little is known of condom use self-efficacy (CUSE) trajectories over time and associations with HIV prevention engagement. We examined longitudinal associations between CUSE trajectories and HIV prevention engagement, and the mediating role of HIV-related stigma, among urban refugee youth in Kampala, Uganda. Methods: This cohort study with refugee youth in Kampala collected data at three timepoints from 2022 to 2024. We conducted latent class growth analysis (LCGA) to identify distinct CUSE trajectories over time. We then conducted path analysis to explore associations between CUSE trajectory classes and HIV prevention engagement (lifetime HIV/ STI testing, HIV self-testing [HIV-ST] uptake and awareness, recent condom use), examining the mediating role of HIV-related stigma. Results: We included 176 participants (mean age: 21.0, standard deviation: 2.5; 51.7% women, 48.3% men) with 520 observations. Two latent CUSE trajectories were identified: persistently high (n=451; 86.7%) and sustained low (n=69; 13.3%). In the direct effect model, higher CUSE trajectory scores were associated with increased lifetime STI testing, HIV-ST uptake and awareness, and recent condom use. In the indirect effect model including HIV-related stigma: a) HIV-related stigma partially mediated the associations between the high CUSE trajectory and lifetime STI testing, and b) HIV-related stigma was associated with reduced HIV-ST uptake and awareness and reduced recent condom use, even in the high CUSE trajectory class. Conclusions: Higher CUSE trajectories were associated with improved HIV prevention engagement, yet HIV-related stigma attenuated these associations. While CUSE is important for HIV prevention agency, sustained attention to HIV-related stigma reduction is necessary.