Inequalities in non-HIV sexually transmitted infections in Uganda: a 22-year sex disaggregated trend analysis using...

Non-HIV sexually transmitted infections (STIs) remain a significant but under-prioritized component of sexual and reproductive health in Uganda. While national trends have been documented, less is known about whether reductions in STI burden have translated into equitable health gains across sexes. This study assessed 22-year trends and sex-based inequalities in non-HIV STI prevalence in Uganda.

We conducted a secondary analysis of age-standardized prevalence estimates from the World Health Organization Health Equity Assessment Toolkit (HEAT) from 2000-2021. The STI category included chlamydia, gonorrhea, syphilis, trichomoniasis, genital herpes, and "other STIs". Sex was used as the primary equity stratifier. Inequality was quantified using four summary measures: Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF).

Between 2000 and 2021, non-HIV STI prevalence declined in both sexes. The absolute difference between women and men was 24,171.5 per 100,000 in 2000 and 13,507.9 per 100,000 in 2021. During this period, R was 1.78 in 2000,1.81 in 2005,1.76 in 2010, 1.89 in 2015, and 1.46 in 2021. These ratios indicate that across the five time points non-HIV STIs prevalence among women was over 50% higher than that of men. The PAR for Uganda was - 12,703.3 in 2000, -12,669 in 2005, -11492.1 in 2010, -10625.8 in 2015 and - 7,146.1 in 2021 with a corresponding PAF of -29.1% in 2000, -30.0 in 2005, -28.7 in 2010, -32.2% in 2015, and - 19.7% in 2021. Comparative analysis showed that Uganda's level of inequality falls within the mid-to-upper range among low-income African countries.

Approximately 20% of the estimated prevalence of non-HIV STIs in Uganda could be reduced if women experienced the same infection rate as men. Addressing this inequity requires strengthening integrated STI services, improving detection of asymptomatic infections in women beyond syndromic management, and implementing gender-responsive policies to reduce structural vulnerabilities.

Not applicable.