HIV among refugee youth in Uganda: unmasking the crisis
Authors: Nhial T Tutlam, Samuel Kizito, Tewodros W Liyew, Fred M Ssewamala
Journal: The Lancet (2024)

Uganda is one of the countries severely affected by the HIV/AIDS pandemic and currently hosts the largest number of refugees in sub-Saharan Africa, estimated at 1·5 million, of whom 24% are youth aged 15–24 years.1UNHCROverview of Refugees and Asylum-seekers in Uganda.https://reporting.unhcr.org/uganda-population-statistics-dashboard-5602Date: 2023Date accessed: November 25, 2023Google Scholar Many refugees are settled in regions with some of the highest HIV prevalence and new infection rates. Refugee youth—due to numerous intersecting factors, including a high prevalence of trauma-associated mental health conditions, sexual violence, engagement in risky behaviours, such as substance use, poor knowledge about HIV, and low testing rates at 56%—are at an elevated risk of contracting and spreading HIV.2Logie CH Okumu M Latif M et al.Relational factors and HIV testing practices: qualitative insights from urban refugee youth in Kampala, Uganda.AIDS Behav. 2022; 26: 2191-2202Crossref Scopus (2) Google Scholar Additionally, insufficient food due to substantial cuts in food rations, which have been reduced by up to 70% in the last 2 years,3UNHCRImpact of underfunding in 2023 (September—December).https://data.unhcr.org/en/documents/details/104363Date: 2023Date accessed: November 26, 2023Google Scholar means adherence to powerful HIV medications that require adequate food intake is challenging. Over the last year and a half, our team, funded by the US National Institutes of Health, has been conducting research in refugee settlements in Uganda, and we are concerned about the possibly very low level of viral load suppression (VLS) among refugee youth. Although our results have not yet been published, correspondingly low viral suppression was reported in a recent study by the Uganda Ministry of Health.4Ministry of Health UgandaUganda Refugee Population-Based HIV Impact Assessment (RUPHIA 2021). Final Report.https://phia.icap.columbia.edu/wp-content/uploads/2023/04/230323_RR1_SS_RUPHIA-2021.pdfDate: March, 2023Date accessed: December 1, 2023Google Scholar Using a VLS threshold of less than 1000 copies per mL, the study found a dismal 72% VLS among refugees.4Ministry of Health UgandaUganda Refugee Population-Based HIV Impact Assessment (RUPHIA 2021). Final Report.https://phia.icap.columbia.edu/wp-content/uploads/2023/04/230323_RR1_SS_RUPHIA-2021.pdfDate: March, 2023Date accessed: December 1, 2023Google Scholar Applying the revised VLS guidelines from the Uganda Ministry of Health,5Ministry of Health UgandaConsolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda.https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/UGA-RH-43-01-GUIDELINE-2018-eng-Final-Uganda-HIV-Guidelines.pdfDate: 2022Date accessed: November 28, 2023Google Scholar which defines VLS at less than 200 copies per mL for plasma, the level of VLS among refugee youth is lower than 72%. These VLS levels are substantially lower than the national prevalence of 92%5Ministry of Health UgandaConsolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda.https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/UGA-RH-43-01-GUIDELINE-2018-eng-Final-Uganda-HIV-Guidelines.pdfDate: 2022Date accessed: November 28, 2023Google Scholar and a far cry from the 95–95–95 targets set by UNAIDS. The low VLS among refugee youths suggests underlying concerns in the HIV care continuum, such as poor adherence to HIV medication, even though these are freely available to the patients. Additionally, of great concern, some participants who are unaware of how they acquired the disease are recent arrivals from remote villages in South Sudan (which has no data on the current HIV situation), raising alarm about the prevailing conditions upstream of the refugee displacement continuum. This confluence of factors that converge to exacerbate an already major public health crisis in a humanitarian setting requires urgent remediation. If this situation is not addressed swiftly and decisively, it will impede progress towards elimination of AIDS as a public health threat by 2030. The consequences could be devastating, not only for refugee youth at an increased risk of contracting HIV, but for the host communities as well. We declare no competing interests.