Prevalence and correlates of prevalent sexually transmitted infections among young women employed as domestic workers in Central Uganda: a community-based cross-sectional study
Annet Onzia, Andrew Mujugira, Vivian Nakate, Joseph Musaazi, Eric Ssegujja, Justine Bukenya, Rosalind Parkes Ratanshi, Patricia A Ajeru, Johan H Melendez, Matthew M Hamill, Yukari Carol Manabe, Barbara CastelnuovoIntroduction
Little is known about the burden of sexually transmitted infections (STIs) among adolescent girls and young women (AGYW) employed as domestic workers in Ugandan households.
Methods
We conducted a community-based cross-sectional study from November 2023 to March 2024 to determine the prevalence and correlates of STIs among Ugandan AGYW aged 14–24 in the Kampala Metropolitan Area. Self-collected vaginal swabs were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using GeneXpert. HIV and syphilis testing were performed using the Bioline HIV/syphilis Duo test. Correlates of STI prevalence were determined using modified Poisson regression.
Results
Among 262 AGYW, median age was 20 years (IQR 18–23) and 87 (33%) had an STI: CT (27.5%), syphilis (5.7%), HIV (4.6%) and NG (1.5%). Overall, 14.9% had >1 STI. Of 12 AGYW with HIV, 3 (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 and 54% believed it was protective against STIs, including HIV. Factors associated with STI prevalence included non-cash compensation for domestic work (adjusted prevalence ratio (aPR) 2.26; 95% CI 1.04 to 4.92; p=0.040), lower educational attainment (aPR 1.73; 95% CI 1.16 to 2.57; p=0.007), alcohol consumption in the past 6 months (aPR 1.72; 95% CI 1.12 to 2.64; p=0.013) and transactional sex during the past 6 months (aPR 1.43; 95% CI 1.01 to 2.04; p=0.045). Conversely, self-reported sexual abuse was negatively associated with STIs (aPR 0.48; 95% CI 0.28 to 0.83; p=0.008).
Conclusion
The high prevalence of undiagnosed STIs and unsuppressed HIV among AGYW domestic workers in Central Uganda highlights the urgent need to increase STI/HIV prevention, testing and treatment coverage for these underserved and vulnerable young women. Targeted interventions are needed to mitigate STI/HIV acquisition in this population.