Social-ecological factors associated with trajectories of adolescent sexual and reproductive health stigma: longitudinal cohort findings with urban refugee youth in Kampala
Why this work is in the frame
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Bibliographic record
Abstract
Background Stigma towards sexually active young people presents profound barriers to uptake of sexual and reproductive health (SRH) services, including HIV testing and contraception. Yet, few studies have examined adolescent SRH stigma trajectories over time. To address this knowledge gap, we examined associations between social-ecological factors and trajectories of adolescent SRH stigma among urban refugee youth in Kampala, Uganda. Methods This longitudinal cohort study with refugee youth in Kampala collected data on adolescent SRH stigma at four time-points between 2022 and 2024. We used latent class growth analyses to examine distinct trajectories of adolescent SRH stigma, and examined baseline social-ecological and socio-demographic factors associated with class membership using multivariable logistic regression. Results Among the participants (n = 164 with n = 668 observations; mean age 19.9 years, standard deviation 2.5 years; 52.8% cisgender women), we categorised two distinct adolescent SRH stigma trajectories: consistently high (n = 496; 74.2%) and sustained low (n = 172; 25.8%). In multivariable analyses, living in Uganda ≥1 year at baseline assessment (1–5 years: adjusted odds ratio [aOR] 5.28, confidence interval [CI] 2.29–12.19, P < 0.001; 6–10 years: aOR 6.20, CI 2.61–14.69, P < 0.001; or >10 years: aOR 3.89, CI 1.56–9.68, P < 0.01) compared with <1 year, unemployment (aOR 1.62, CI 1.02–2.56, P < 0.05), having children (aOR 2.84, CI 1.30–6.21, P < 0.05), past 3-month multiple sexual partners (aOR 6.14, CI 1.73–21.75, P < 0.01) and higher depression symptoms (aOR 1.04, CI 1.01–1.08, P < 0.01) were associated with the consistently high (vs sustained low) adolescent SRH stigma trajectory. Conclusions Social-ecological and socio-demographic factors were associated with consistently high levels of adolescent SRH stigma over 2 years. Multi-level strategies can meaningfully engage youth in developing stigma reduction strategies for SRH service delivery.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it