Factors and Barriers Associated with the Knowledge, Perceptions, and Utilization of Contraceptive, STI & HIV Services Among Adolescents in Mugombwa Refugee Camp, Gisagara District Rwanda

Introduction
Adolescents experience exacerbated vulnerability in refugee settings, where there is often an
increase in sexual violence and a deficient emphasis on their right to access SRH services.
Mugombwa refugee camp in Rwanda is home to 11,304 refugees from the DRC, of which
18.4% are between the ages of 12-17. In 2021, there were 47 adolescent childbirths, and in
2022, five positive cases of HIV between the ages of 12-17. This study aimed to understand
the knowledge, perceptions, and utilization of SRH services among female and male
adolescents following the health belief model via a feminist intersectional approach. This study
also centers on the voices of adolescents to explore their barriers and recommendations.
Methods
This study employed a convergent parallel mixed-methods study design. Simple random and
purposive sampling methods were used to select 422 quantitative and 32 FGD participants,
respectively. A semi-structured questionnaire was used to collect quantitative data on
knowledge, perceptions, and utilization of SRH services, while FGD guide collected
information on barriers and recommendations. Descriptive statistical analysis, bivariate
analysis, and multinomial logistic regression were performed on quantitative data. Qualitative
data were transcribed, translated, and analyzed using deductive thematic content analysis.
Results
Under half of all adolescents had low SRH knowledge, and males had higher SRH knowledge
than females. Predictive factors of high SRH knowledge among males were being 15-19 years
old, ever having sex, and not being disabled, and among females, being 15-19 and having a
child. The vast majority of adolescents had high knowledge of SRH services in Mugombwa
camp. Predictive factor of high service knowledge among females was a high level of SRH
knowledge. Most adolescents had positive perceptions toward contraceptive services; however,
some felt service providers were judgmental. Of the participants who had ever had sex, 38.3%
had never utilized contraceptives, mainly due to fear of side effects. Predictive factors of
contraceptive utilization among males were high SRH knowledge and being out of school.
More males had ever been tested for STIs than females, and while 91.0% of adolescents
reported the desire to know their HIV status, only 48.1% had ever tested. Common predictive
factors of testing for HIV and STIs were being out of school, being 15-19 years old, and having
high SRH knowledge.
The five major themes surrounding barriers and recommendations were: 1) socio-cultural
factors; 2) the need for improved SRH service delivery; 3) parents as SRH stakeholders; 4)
lack of knowledge preventing contraceptive utilization; and 5) negative perceptions preventing
STI and HIV utilization.
Conclusion
Many adolescents have low SRH knowledge, positive perceptions of SRH services, and yet
sub-optimal utilization of contraceptive, STI, and HIV services. The intersectional identities
and socio-cultural factors associated with being an adolescent refugee impact the knowledge,
perceptions, and utilization of contraceptive, STI, and HIV services and must be further
prioritized to curb teenage pregnancy, STIs, and HIV among adolescent refugees. Increasing
the regularity of SRH training and human resource capacity and training youth and parents as
champions of SRH in Mugombwa Refugee camp are recommended.