Associations Between Forced Sexual Initiation, Post-exposure Prophylaxis Cascades and Subsequent Violence Experiences...

Along their displacement trajectory, displaced adolescent girls and young women (AGYW) face elevated HIV risk early in their sexual life course, often due to forced sexual initiation (FSI), marking the beginning of cycles of violence. However, knowledge gaps exist regarding FSI prevalence rates and the association between FSI, violence experiences, and post-exposure prophylaxis (PEP) cascades (awareness, access and uptake) among displaced AGYW in Uganda. Using peer-driven sampling, we conducted a community-based cross-sectional survey of 201 sexually active displaced AGYW living in informal settlements in Kampala. We conducted bivariate analyses to examine associations between FSI and PEP cascades and multivariable logistic regressions to examine associations between FSI and (a) non-partner physical/sexual violence and (b) recent sexual/physical intimate partner violence (IPV). Among participants (n = 72), 35.8% reported forced sexual initiation (FSI); of these, 66.7% experienced lifetime non-partner sexual violence, 81.9% non-partner physical violence, 35.2% recent intimate partner physical violence, and 70.4% recent intimate partner sexual violence. Very few participants who experienced FSI reported awareness of and knowledge of access to PEP in their community, and none had accessed PEP in the past 3 months. Multivariable logistic regression findings showed that compared to AGYW who did not experience FSI, those who experienced FSI had increased odds of reporting non-partner lifetime physical violence, non-partner lifetime sexual violence, intimate partner physical violence, and intimate partner sexual violence. FSI appears to be prevalent among displaced AGYW and is linked to multiple forms of violence, and limited PEP awareness, access and use. Tailored, trauma-informed, multisectoral interventions are needed to address FSI and violence and improve PEP access.