Social Drivers of Infectious Disease Transmission and Treatment Among Young Women in Kampala, Uganda's Informal Settlements: A Qualitative Analysis of Focus Group Data From a Community-Based Cohort Study.

Abstract

Young women in informal settlements in sub-Saharan Africa (SSA) experience significant health disparities. Despite growing understanding that population health outcomes are socially determined, the social determinants of health among young women in the informal settlements of SSA are not well understood. Furthermore, young women's emic perspectives on the pathways that contribute to health risk are rarely reported in scientific research. This research brief describes findings from a qualitative study and specifically addresses young women's insights into the social drivers of infectious disease transmission and treatment. We conducted focus groups including 60 young women participants aged 18 to 24 at three sites across Kampala, Uganda. Using thematic analysis, we identified four thematic clusters: (1) intersectional social injustices drive sexual exploitation and HIV transmission; (2) inadequate housing and sanitation contribute to the spread of infectious disease; (3) existing health care resources have limited capacity to address high infectious disease incidence; and (4) participants recommended building health promotion efforts on existing resources and developing community infrastructure to improve outcomes. This study highlights the social influences that contribute to the burden of infectious disease among young women living in Kampala's informal settlements. Young women named several ecological factors and resources which, if engaged, could promote health and well-being in their communities. Future research should engage young women in SSA's informal settlements as partners and peers in the development of community-owned research and intervention efforts to better understand community perspectives, address areas of most urgent need, and investigate barriers and facilitators to successful program implementation.