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Primary Submission Category: Reproductive health
The Association between Adolescent Sexual and Reproductive Health Stigma and Psychological Distress among Adolescents and Young Adults in Western Kenya
Authors: Abigail Lee, Nema Aluku, Carolyne Mabeya, William Story,
Presenting Author: Abigail Lee*
Background: Kenyan youth are sexually active and experience challenging outcomes like young pregnancy and HIV. They also experience high rates of psychological distress (distress), which is influenced by stigma related to adolescent sexual and reproductive health (ASRH). This study describes the association between ASRH stigma and distress among youth in western Kenya.
Methods: In 2022, 1,598 unmarried youth ages 15-24 completed a survey in Kakamega and Uasin Gishu counties. Factor analyses of stigma items identified lay stigmatizing attitudes (girls and boys) and enacted stigma (girls and boys) as four stigma factors. Multivariable logistic regression analyses were conducted, regressing all stigma factors on distress. The moderating effects of gender and previous sexual behavior were additionally assessed using stratification and interaction.
Results: Among all youth, after controlling for covariates, an increase of lay stigmatizing attitudes towards girls was associated with reduced odds of distress (AOR=0.62, p<0.001), while increased lay stigmatizing attitudes towards boys was associated with increased odds of distress (AOR=1.26, p<0.05). Gender stratified analyses demonstrated that increased lay stigmatizing attitudes towards girls was associated with reduced odds of distress for girls (AOR=0.70, p<0.05). Interactions between girls’ stigma factors and previous sexual behavior demonstrated that for girls who have not had sex, holding more stigmatizing attitudes was associated with a lower probability of distress, while the probability of distress increased (or did not change) with more stigmatizing attitudes for girls who had previously had sex.
Conclusions: Our data show associations between ASRH stigma and distress, with differences by gender and previous sexual behavior. These findings suggest the importance of deconstructing stigma to improve health, while recognizing that holding stigmatizing attitudes is a powerful position that may benefit some people.