Massy Mutumba

Our study examined how multiple dimensions of HIV-related stigma affect mental health and antiretroviral therapy (ART) adherence among school-engaged adolescents living with HIV in Uganda. Using structural equation modeling with 833 participants recruited from 42 HIV clinics, we examined multiple dimensions of internalized and externalized HIV stigma, and their associations with adherence outcomes. We found that internalized shame and family-based stigma were significantly associated with poor mental health which, in turn, strongly predicted nonadherence to ART. Mediation analyses confirmed indirect pathways from family-based stigma and internalized shame to ART nonadherence via poor mental health. Disclosure stigma was unexpectedly associated with better ART adherence, suggesting possible benefits of selective self-disclosure. However, school-based stigma was not associated with mental health or ART adherence, possibly because of nondisclosure within school settings. Findings underscore the need for multilevel stigma reduction interventions that address internalized and family-level stigma to support ART adherence among school-engaged adolescents living with HIV.

Sexual violence (SV) is a critical public health and societal issue, affecting individuals across gender, age, and socioeconomic backgrounds. Studies reveal that a substantial proportion of women g...

Among Adolescents living with HIV (ALHIV) in Uganda, pathways linking HIV-related stigma to mental health (depression, hopelessness and self-esteem) and academic engagement (school satisfaction and self-concept) are under-examined. Using cross-sectional data from 833 ALHIV (ages 10-17), we first estimated a fully latent structural equation model to assess these pathways. Model fit was excellent (χ²[21] = 45.16, p = .002; CFI = .987; RMSEA = .037; SRMR = .028). Stigma was associated with poorer mental health (β = -.214, SE = .058, p < .001); positive mental health predicted academic engagement (β = .956, SE = .262, p < .001), while the direct stigma to academic path was small and marginally non-significant (β = -.089, SE = .046, p = .052). Next, we examined the roles of social support and family cohesion, using an observed-variable path model with composite scores. Higher stigma predicted lower perceived social support (β = -.445, SE = .041, p < .001) and family cohesion (β = -.311, SE = .048, p < .001). Perceived social support significantly buffered mental health (β = -.184, SE = .025, p < .001), and poorer mental health strongly predicted lower academic engagement (β = -.491, SE = .037, p < .001). The findings indicate that HIV stigma undermines academic engagement primarily by eroding mental well-being, while social support is a key upstream protective factor. Interventions for ALHIV should, therefore, prioritise stigma reduction alongside integrated mental health services and programmes to strengthen social support in educational settings.Trial Registration: ClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250.

Gendered parenting practices influence children’s cognitive and developmental competencies such as emotional regulation and social wellbeing, and may contribute to or exacerbate disruptive behavioral disorders among children. This paper assesses whether there are any gender differences in parenting practices among caregivers of children with disruptive behavioral disorders in Uganda, and identifies any other psychosocial factors that may contribute to these variations. We utilize data from data from the SMART Africa – Uganda study, a longitudinal experimental study that examined the effectiveness of Amaka Amasanyufu, an evidence-based Multiple Family Group (MFG) intervention aimed at improving child behavioral challenges among children aged 8 – 13 years. The primary outcome was parenting practices, measured using the 9-item Alabama Parenting Questionnaire (APQ-9). Key independent predictors included gender conceptualized as threefold taxonomy of distinctive intra-familial relationships corresponding to father-son, mother-daughter, and mixed gender; family cohesion and caregiver mental health. Using bivariate and multivariate analyses, we found that compared to mixed caregiver-child dyads, caregivers in the female caregiver – female child dyads (both females) were significantly less likely to report poor parenting practices, overall (β = −0.99; 95% CI: −1.62 - −0.35) and on the poor supervision sub-scale (β = −0.56; 95% CI: −1.04 - −0.08). Higher family cohesion, lower caregiver mental distress, higher education attainment and asset ownership were associated with positive parenting practices. Our findings suggest that family-based interventions should take into account how gender dynamics and caregiver characteristics may shape intervention outcomes through their impact on family processes such as parenting practices.

Reliable and valid assessment tools are crucial for measuring alcohol use expectancies (AUE) among youth living with HIV (YLHIV). In this paper, we assess the psychometric properties of the original 17-item East Africa Alcohol Expectancy Scale (AFEXS) among Ugandan YLHIV—a scale developed and validated by Woolf-King et al. for use among Uganda adults living with HIV. Specifically, we applied the measure to a sample of 100 Ugandan YLHIV enrolled in a substance use intervention. To analyze the psychometric properties, we conducted exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent validity analyses. The resulting 15-item youth AFEXS scale differed from the 11-item adult version. The 15-item Youth AFEXS demonstrated high internal consistency (α = 0.85), aligning with theoretical expectations of a three-factor structure related to sexual expectancies (7 items; α = 0.89), negative expectancies (4 items; α = 0.72), and release of inhibition expectancies (4 items; α = 0.77). The global scale and sub-scales demonstrated satisfactory convergent validity through positive correlations measures of frequency of alcohol consumption in the past 12 months: global AFEXS (r = 0.617; p = 0.000), sexual expectancies (r = 0.583; p = 0.000), negative expectancies (r = 0.618; p = 0.000), and release expectancies (r = 0.596; p = 0.000). The study confirms the youth AFEXS as a reliable and valid tool for assessing AUE among Ugandan YLHIV.

Introduction Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence. Methods and analysis The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models. Ethics and dissemination The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.

Caregiver-adolescent sexual health communication can reduce sexual risk attitudes and behaviors, but less is known about caregiver-adolescent sexual health communication in Uganda. Using a risk-focused approach, this paper seeks to characterize caregiver-adolescent sexual health communication and associated individual and family-based attributes, and associations with adolescents’ sexual risk attitudes. We used latent class analyses to derive typologies (classes) of sexual health communication and assess their relationships with respondents’ socio-demographic characteristics and sexual risk-taking attitudes. We derived three latent classes of sexual risk communication characterized as avoidant (class 1; 48%), functional (class 2; 22.2%) and comprehensive (class 3; 29.8%), each representing varying levels of frequency and type of content covered in the caregiver-adolescent sexual health communication. Primary caregiver’s sex and respondents’ comfort talking to their caregiver were significantly associated with membership in the functional class (RRR = 1.52; 95% CI: 1.05–2.19; p < 0.05) and comprehensive class (RRR = 1.68; 95% CI: 1.13–2.49; p < 0.05). Caregivers and their adolescents are attempting to engage in conversations related to sexual health, but many caregivers tend to shy away from potentially embarrassing topics such as sex. The wide variations in type and content of covered in caregiver-adolescent sexual health communications may compromise adolescents’ sexual health knowledge, putting them at risk for poor sexual health outcomes. Given the cultural taboos around caregiver-adolescent communications on sex related topics, family interventions to address to strengthen caregiver-adolescent communication on sexual health are required.