Peer-reviewed article
Prevalence and correlates of prevalent sexually transmitted infections among young women employed as domestic workers in Central Uganda: a community-based cross-sectional study.
Onzia A, Mujugira A, Nakate V, Musaazi J, Ssegujja E et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined sexually transmitted infections (STIs) and HIV among young women aged 14-24 working as domestic workers in Kampala, Uganda. Among 262 young women, 33% had at least one STI, including Chlamydia (27.5%), syphilis (5.7%), and HIV (4.6%). Risk factors included receiving non-cash payment for work, lower education, alcohol use, and transactional sex. The findings show that young domestic workers face high rates of undiagnosed and untreated infections, highlighting their vulnerability and need for targeted health services.
Key points
- 33% of young women domestic workers had at least one STI, with Chlamydia trachomatis being most common at 27.5%
- 25% of the 12 HIV-positive women were newly diagnosed, and 67% of those tested had detectable viral loads
- Only 28% of women who received STI treatment in the past year notified their sexual partners
- Non-cash compensation for domestic work, lower education, alcohol consumption, and transactional sex were significantly associated with STI prevalence
- 54% of women believed emergency contraception protected against STIs including HIV, indicating a knowledge gap
Limitations
This cross-sectional study cannot determine causality, only associations. The study is limited to the Kampala Metropolitan Area, so findings may not generalize to rural Uganda or other regions.
Abstract
Introduction 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.