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Poverty and economic insecurity are driving forces in entering sex work among women in low resource areas. This increases their risk for HIV by influencing the decision-making process for high-risk behaviors. Few studies have examined the financial behaviors and capacities of women engaged in sex work (WESW). This paper describes the methodology used in a financial diary study aimed at characterizing women's spending patterns within a larger prevention intervention trial among WESW in Uganda. From June 2019 to March 2020, a subsample of 150 women randomized to the combination HIV prevention and economic empowerment treatment was asked to complete financial diaries to monitor daily expenditures in real time. Two hundred and forty financial diaries were distributed to study participants during the financial literacy sessions at eight sites. A total of 26,919 expense entries were recorded over 6 months. Sex-work-related expenses comprised approximately 20.01% of the total. The process of obtaining quality and consistent data was challenging due to the transient and stigmatized nature of sex work coupled with women's varying levels of education. Frequent check-ins, using peer support, code word or visuals, and a shorter time frame would allow for a more accurate collection of high-frequency data. Moreover, the ability of women to complete the financial diaries despite numerous challenges speaks to their potential value as a data collection tool, and also as an organizing tool for finances. [ABSTRACT FROM AUTHOR]

This study assesses the impact of a voucher project that targeted vulnerable and poor pregnant women in Uganda. Highly subsidised vouchers gave access to a package of safe delivery services consisting of four antenatal visits, safe delivery, one postnatal visit, the treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. Vouchers were sold during the project's operational period from 2016 to 2019. This study covers 8 out of 25 project-benefiting districts in Uganda and a total of 1,881 pregnancies, including both beneficiary and non-beneficiary mothers. Using a matching design, the results show a positive effect on the survival of new-born babies. The difference in the survival rate between the control group and the treatment group is 5.4% points, indicating that the voucher project reduced infant mortality by more than 65 per cent. [ABSTRACT FROM AUTHOR]

Uganda is home to 1.5 million refugees from DRC, Burundi, South Sudan and other countries. The Uganda political framework is one of the most progressive and inclusive toward refugees. Only a fraction of the refugees is likely to revert to their home countries. The papers collected in this special issue assess Uganda's progressive refugee policy with reference to how it functioned in the era of COVID-19 using a unique panel data collected between 2017 and 2021. The findings of the special issue stress that the support to refugees and hosts is helping to manage daily challenges but not to ultimately get them out of poverty. Further, this support was insufficient to provide a comprehensive response to COVID-19. For the long-term sustainable integration and development, new policy approaches are needed. [ABSTRACT FROM AUTHOR]

This paper analyses poverty dynamics and checks for the existence of poverty traps among refugee and host communities living close to each other in Uganda. Although some non-linearities emerge in asset dynamics, there is convergence towards one stable equilibrium for the whole sample that suggests the existence of a structural poverty trap. However, households are quite heterogeneous: when analysing refugees and hosts separately, refugees converge to a lower own-group equilibrium than hosts. The household size and education are asset growth enablers for both communities. Noticeably, access to land, past history and social cohesion are also significant correlates of refugees' asset dynamics. From a policy perspective, structural poverty traps are bad news, because standard anti-poverty interventions would not unlock the trap. Our results stress the need of more structural approaches aimed at promoting economic growth in the whole area where refugee and host communities live, targeting both communities. [ABSTRACT FROM AUTHOR]

Synergistic associations between social inequities and HIV vulnerabilities – known as a syndemic – are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16–24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16–24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities. [ABSTRACT FROM AUTHOR]

Women engaged in sex work (WESW) are at heightened risk of experiencing intimate partner violence (IPV) compared to women in the general population. This study examines the impact of an economic empowerment intervention on IPV among WESW in Southern Uganda. We used data from 542 WESW in Southern Uganda recruited from 19 HIV hotspots between June 2019 and March 2020. Eligible participants were 18+ years old, engaged in sex work—defined as vaginal or anal sexual intercourse in exchange for money, alcohol, or other goods, reported at least one episode of unprotected sexual intercourse in the past 30 days with a paying, casual, or regular sexual partner (spouse, main partner). We analyzed data collected at baseline, 6, and 12months of follow up. To examine the impact of the intervention on IPV, separate mixed-effects logistic regression models were run for each type of IPV (physical, emotional, and sexual) as experienced by participants in the last 90 days. Results show that the intervention was efficacious in reducing emotional and physical IPV as evidenced by a statistically significant intervention main effect for emotional IPV, χ2(1) = 5.96, p = 0.015, and a significant intervention-by-time interaction effect for physical IPV, χ2(2) = 13.19, p < 0.001. To qualify the intervention impact on physical IPV, pairwise comparisons showed that participants who received the intervention had significantly lower levels of physical IPV compared to those in the control group at six months (contrasts = −0.12 (95% CI: −0.22, −0.02), p = 0.011). The intervention, time, and intervention-by-time main effects for sexual IPV were not statistically significant. Our findings suggest economic empowerment interventions as viable strategies for reducing emotional IPV among WESW. However, it is also essential to understand the role of interventions in addressing other forms of IPV especially for key populations at high risk of violence, HIV, and STI. The study was registered at ClinicalTrials.gov , ID: NCT03583541. • Women engaged in sex work (WESW) in Southern Uganda face heightened risks of Intimate Partner Violence (IPV). • Among WESW, physical and emotional IPV are predominant forms of experienced violence. • Economic empowerment interventions significantly reduce both emotional and physical IPV among WESW. [ABSTRACT FROM AUTHOR]

• Informal kinship care is a vital cultural asset and important alternative to forms of residential or institutional care. • Informal kinship care occurs within the legacies of colonialism, strained by specific social, political and economic contexts. • Informal kinship care networks are essential for children from low socio-economic backgrounds. • Informal kinship care challenges western notions of family units and caregiving which prevail in global health programmes. • Context-specific and meaningful understanding of children's care and living arrangements is needed in programming and policy. There is strong evidence that outside parental care, informal kinship care is the most practiced, sustainable and affordable form of childcare in SSA (sub-Saharan Africa). As a longstanding cultural tradition, informal kinship care embraces childcare as the responsibility of all extended family members, and often the wider community. However, over the past decades, informal kinship care has become gradually strained by political, economic and social conditions, such as: legacies of colonialism, increasing levels of poverty and inequality, instability, or infectious diseases. Drawing on qualitative biographical data from the Contexts of Violence in Adolescence Cohort Study (CoVAC) (2018–2022), we examine and showcase how practices of informal kinship care are perceived and experienced by young people. Doing so, we pay attention to the political, economic and social environment affecting informal kinship care in Uganda. Young people's accounts point to four main features of their experiences of informal kinship care, that relate to: 1) mitigating poverty; 2) ensuring continuation of schooling and/or income generation; 3) generating and navigating family disputes and ruptures; 4) posing and moderating threats to safety and security of children. In analysing young people's narratives, we critically reflect on implications for research and practice to support informal childcare. We argue that informal kinship care remains a vital cultural asset and an important alternative to forms of residential or institutional care in Uganda. This has implications for health, social protection, education programming and policy for children. Culturally sensitive and context-specific approaches, informed by the perspectives and lived experiences of young people, are needed to properly support children and young people in informal kinship care. [ABSTRACT FROM AUTHOR]

We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs. • Intensive adherence counseling addresses barriers to detectable viral load in PLHIV. • Detectable viral load is common even after intensive adherence counseling in PLHIV. • PLHIV face personal, interpersonal, health systems, community, and policy barriers. • Tackling these helps in reaching at ≥95% viral load suppression rate in PLHIV. [ABSTRACT FROM AUTHOR]