Scoping study in preparation for the design of an intervention with mobile young people in Kampala

This scoping work explored access to health care services, including HIV care and pre-exposure prophylactics (PrEP) among, young migrant populations particularly those who had stayed in the informal settlements in Kampala for up to one year. In order to do this, it was important to understand the social structure of where they live, what influences decisions to seek care, including where the health facilities are situated as well as the challenges that impede access. While we did not find many differences in the barriers and perceptions about health access among the non-migrants, migrants and refugees, those from the Democratic Republic of Congo and migrants from the Karamoja region in Uganda reported receiving a harsh reception and treatment from the health facilities. We found that general access to care by the migrant population is a challenge due to several factors such as payments asked for at the health facilities, shortage of drugs, unfavourable working hours, language barriers, stigma and marginalization and unfriendly health workers. As a result, some young people decided not to seek treatment at all, others used remedies such as herbs and substances like khat for illnesses like malaria fever while many sought care after suffering for some time, when the illness did not go away, sometimes after serious damage had been caused. While health care services are largely provided by government facilities the young people preferred to seek care from small private clinics because the government ones were not stocked with enough medicines, and charged much money more than the private health facilities. There was mention of some institutions that tried to offer young people friendly services and hope. These services provided sexual and reproductive health services and other services such as counselling and translation services. However, some of these institutions decried the fact that they were unable to serve all the young people because of underfunding. The most common health problems mentioned in the communities were related to the specific environments we found the young people and these included fevers (including malaria), tuberculosis, HIV, skin diseases and poor sanitation. In terms of specific services, the young people who engaged in sex work were able to access sexual and reproductive health services, although young men pointed out their lack of access to these services. Long-term family planning methods were generally scarce. While COVID-19 was perceived to be real and a threat, observation of the prevention measures was very low at the time of this study (October 2021) in all the communities, and in some communities COVID 19 was not considered a serious condition. Young people rarely wore masks. Some people explained that they drank and smeared themselves with alcohol, which they referred to as sanitiser. With regards to knowledge about PrEP, it was limited, mostly known by those involved in sex work and some young people had difficulty differentiating post exposure prophylactics PEP from PrEP. Nonetheless, a good number of young people said they were willing to use PrEP if it was made available and easily accessible at no charge. These findings provide some valuable information for in-depth research on barriers to accessing health care in Kampala by mobile populations most especially the migrants and refugees to inform policymakers, planners, and intervention partners who include the leaders of ‘organized groups’ of young people in some communities