The Population Council, Inc.

Experiences of childhood violence and violence perpetration and the association with inequitable gender norms and violence justification have been extensively studied in non-humanitarian settings, and among older populations. However, there is a gap in understanding these associations within humanitarian contexts, particularly from the perspective of children and youth. We used data from the Uganda Humanitarian Violence Against Children and Youth Survey, a representative, cross-sectional household survey of 2,265 children and youth aged 13-24 years living in refugee settlements in Uganda. We explored associations between endorsement of inequitable gender norms, intimate partner violence (IPV) justification, and experiences of violence and/or perpetration of violence in childhood. Experience of any childhood violence was significantly associated with an increase in endorsement of inequitable gender norms among females and IPV justification among males. This pattern was similar for 18-24-year-olds. Among 13-17-year-olds, IPV justification was significantly associated with experience of any childhood violence among females and perpetration of violence among males. Our findings suggest the need for gender-transformative violence prevention interventions that start early in the life course, and that address inequitable gender socialisation and power relations. School-based violence prevention interventions, community-based approaches to form gender equitable attitudes among adolescents, parenting interventions, and interventions with children and adolescents that had experienced childhood violence have shown considerable success in other settings, and could be adapted to humanitarian settlements.

A dual prevention pill (DPP) for co-delivery of pregnancy and HIV prevention is currently in development and will offer an alternative to taking two separate products. We examined behavioral, partnership/interpersonal, social, and structural correlates of preferences for an over-encapsulated DPP (as a proxy for the product in development, consisting of oral contraceptive pill and oral PrEP pill) among women and adolescent girls in South Africa and Zimbabwe to inform DPP introduction and counseling strategies.

This secondary analysis used data from two clinical crossover studies that compared the acceptability, adherence, and preference for the over-encapsulated DPP versus separate PrEP and oral contraceptives. HIV-uninfected, non-pregnant cisgender women were enrolled in Johannesburg, South Africa (n = 96, ages 18-40) and Harare, Zimbabwe (n = 30, ages 16-24). Participants were randomized 1:1 to use either DPP or two separate pills for three 28-day cycles, then switched. Preferences were measured at the end of crossover and via exit in-depth interviews.

The mean age was 27 years in South Africa and 19 years for Zimbabwe. Most participants had completed secondary school. Childbearing was more common in Zimbabwe (97%) than South Africa (74%). Pregnancy prevention was highly valued in both sites (~ 90%), but Zimbabwean participants voiced greater concern about HIV. DPP preference was higher in Zimbabwe (62%) than South African (39%). In South Africa, DPP preference was associated with behavioral factors (anal sex, experience of sexual violence, relationship conflict, and transactional relationships/sex) and product characteristics (ease of use, side effects). In Zimbabwe, concern about HIV acquisition, interpersonal power, and structural factors (i.e., food insecurity and housing security) were associated with DPP preference. Qualitative interviews highlighted the DPP's simplicity as key advantage over two separate pills, though participants desired a smaller DPP and more discreet packaging to reduced stigma and ease use.

While women in both countries value integrated HIV and pregnancy prevention, distinct demographic, behavioral, and social factors influence DPP preference. Tailoring DPP introduction and support strategies to address specific challenges-such as relationship dynamics and product usability-may optimize the acceptance and effectiveness of dual prevention strategies.

Violence against children (VAC) has garnered attention as a priority issue, in part, due to the Violence Against Children and Youth Surveys (VACS). Although children are disproportionately represented among forcibly displaced people, VACS are a novelty in humanitarian settings.

This paper presents the approach to the first-ever VACS conducted exclusively in a humanitarian setting (HVACS) in Uganda, in addition to providing an overview of the results of this novel survey, along with their implications.

Participants included 1338 females and 927 males aged 13-24 years living in refugee settlements in Uganda.

This was a cross-sectional representative household survey conducted in all 13 refugee settlements in Uganda between March and April 2022. A three-stage sampling process was used to identify participants. Descriptive analysis was conducted, involving the application of sample weights to obtain estimates that are representative of the study population.

VAC in refugee settings is pervasive, with females being more likely than males to experience sexual violence and males being more likely than females to experience physical violence. VAC perpetrators were mostly people who were known to child survivors. Whereas knowledge of where to seek help for violence was relatively high (more so for males compared to females), the levels of disclosure and help-seeking were very low for both groups.

Robust surveys that have traditionally excluded humanitarian settings can be conducted in these contexts. Data emanating from such surveys are critical for developing relevant guidance on interventions to appropriately address major public health issues, such as VAC.