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Sexual and gender-based violence (SGBV) is a persistent concern in humanitarian contexts, yet there is a dearth of SGBV prevention and post-rape clinical care interventions tailored for refugee youth. Graphic medicine, the use of images and text such as in comic books, has been employed to depict lived experiences to promote health, wellbeing, and education. Comic books provide a low-cost, youth-friendly approach to health promotion that is accessible to varying literacy levels. Limited research, however, has described the process of developing graphic medicine approaches for SGBV prevention and sexual violence stigma reduction with and for refugee youth in humanitarian settings. To address this knowledge gap, this paper shares a Qualitative Comic Book Mapping approach, whereby qualitative data alongside theoretical and empirical SGBV literature informed the development of comic book scenarios with refugee youth aged 16-24 in Bidi Bidi refugee settlement, Uganda. Steps included conducting focus groups and in-depth individual interviews with 78 community members (youth, elders, service providers) in Bidi Bidi to explore SGBV lived experiences among refugee youth in Bidi Bidi and ideas for solutions to reduce SGBV and related stigma, in addition to improving post-rape care experiences and engagement. The Qualitative Comic Book Mapping approach involved: a) thematic analysis of qualitative data and identification of overarching themes; b) aligning qualitative themes with theories of change for SGBV prevention and stigma reduction; and c) co-developing comic book scenarios with refugee youth peer navigators and community experts to integrate SGBV prevention and stigma reduction theory with refugee youth lived experiences. The final comic book involved five youth-focused scenarios and was integrated in an intervention with refugee youth, including providing youth with a blank version of the comic book to complete themselves. We share how theoretically-informed comic books can be developed from qualitative data with refugee youth in a humanitarian setting. [ABSTRACT FROM AUTHOR]

There is a dearth of evidence-based post-rape clinical care interventions tailored for refugee adolescents and youth in low-income humanitarian settings. Comics, a low-cost, low-literacy and youth-friendly method, integrate visual images with text to spark emotion and share health-promoting information. We evaluated a participatory comic intervention to increase post-exposure prophylaxis (PEP) knowledge and acceptance, and prevent sexual and gender-based violence, in Bidi Bidi refugee settlement, Uganda. Following a formative qualitative phase, we conducted a pre-test post-test pilot study with refugee youth (aged 16–24 years) (n = 120). Surveys were conducted before (t0), after (t1), and two-months following (t2) workshops. Among participants (mean age: 19.7 years, standard deviation: 2.4; n = 60 men, n = 60 women), we found significant increases from t0 to t1, and from t0 to t2 in: (a) PEP knowledge and acceptance, (b) bystander efficacy, and (c) resilient coping. We also found significant decreases from t0 to t1, and from t0 to t2 in sexual violence stigma and depression. Qualitative feedback revealed knowledge and skills acquisition to engage with post-rape care and violence prevention, and increased empathy to support survivors. Survivor-informed participatory comic books are a promising approach to advance HIV prevention through increased PEP acceptance and reduced sexual violence stigma with refugee youth. Trial registration: ClinicalTrials.gov identifier: NCT04656522. [ABSTRACT FROM AUTHOR]

With over 1.4 million refugees, Uganda is Sub-Saharan Africa's largest refugee-hosting nation. Bidi Bidi, Uganda's largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16–24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention's efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts. [ABSTRACT FROM AUTHOR]