Background The HIV epidemic in Uganda appears to be exacerbated by co-occuring substance use and gender-based violence (GBV), a syndemic commonly referred to as the SAVA syndemic. The high prevalence of the three complex epidemics warrant investigation of the extent to which they co-occur at the individual level and the psychosocial correlates that increase risk.

Methods Analyses are based on cross-sectional data collected in 2014. Participants comprised a convenience sample (N = 1,134) of urban service-seeking youth living on the streets or in the slums, 12–18 years of age who were participating in a Uganda Youth Development Link drop-in centre. Multinomial logistic regression was used to determine the odds of being classified in 7 different categories of GBV, HIV, and alcohol use. Typologies were analysed for associations with risk and protective factors. GBV was operationalized as both perpetration and victimisation.

Results Risk and protective factors in the analyses (i.e., age, commercial sex work, observing parental abuse of each other, depression/suicidality, and parental living status) were all statistically significantly associated with self-reported SAVA. The overall effects of depression and suicidality were mostly associated with classification in categories distinguished by GBV and alcohol use. Engaging in commercial sex work was associated with alcohol use. Observing parental abuse was associated with various combinations of the syndemic, mostly categorised by GBV and alcohol use, as well as experiencing all three, alcohol, HIV, and GBV (AOR: 7.32; 95% CI: 3.09, 17.37). Additionally, the model estimated with all risk factors and no protective factors yielded the highest probabilities of belonging to categories characterised by alcohol use.

Conclusions Given the high prevalence of GBV, HIV, and alcohol use among youth in this population, prevention and interventions to reduce these outcomes are needed.