Associations with Prevalent Sexually Transmitted Infection Prevalence among Young Women Domestic Workers in Central Uganda.

OBJECTIVE

Our study aimed to determine the prevalence and correlates of sexually transmitted infections (STIs) among adolescent girls and young women (AGYW) employed as household domestic workers in Kampala, Uganda.

METHODS

Ugandan AGYW aged 14-24 participated in a community-based cross-sectional study in the Kampala Metropolitan Area from November 2023 to March 2024. Self-collected vaginal swabs were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using GeneXpert™. Testing for HIV and syphilis was performed using the Bioline™ HIV/syphilis Duo test. Correlates of STI prevalence were determined using modified Poisson regression.

RESULTS

Of 262 AGYW enrolled, the median age was 20 years (IQR 18-23), and 87 (33%) had an STI: Chlamydia trachomatis (27.5%), syphilis (5.7%), HIV (4.6%), and Neisseria gonorrhoea (1.5%). Overall, 14.9% had >1 STI. Of 12 AGYW with HIV, three (25%) were newly diagnosed, and 6/9 had detectable viral loads (≥1000 copies/ml). In the prior 12 months, 126 (48%) had received syndromic STI treatment, but only 35 (28%) notified their partners. Additionally, 102 (39%) had used emergency contraception, with 54% believing it was protective against STIs, including HIV. Factors associated with STI prevalence included receipt of non-cash (instead of salary) remuneration for domestic work (adjusted prevalence ratio [aPR] 2.26; 95% CI:1.04-4.92; P=0.040), lower education attainment (aPR 1.73; 95% CI: 1.16-2.57; P=0.007), alcohol consumption in past six months (aPR 1.72; 95% CI: 1.12-2.64; P=0.013) and transactional sex during the past six months (aPR 1.43; 95% CI: 1.01-2.04; P=0.045). Conversely, self-reported sexual abuse was negatively associated with STIs (aPR 0.48; 95% CI: 0.28-0.83; P=0.008).

CONCLUSION

The high prevalence of undiagnosed STIs and unsuppressed HIV among AGYW domestic workers in Kampala highlights the urgent need to increase HIV/STI prevention, testing and treatment coverage for these underserved and vulnerable young women. Targeted interventions are needed to mitigate STI/HIV acquisition in this population.