Syndemic Effects of Climate Change-Related Extreme Weather, Food Insecurity, and Mental Health Stressors Among Youth Living with HIV In Uganda

Background: Sub-Saharan Africa has experienced 48 consecutive years of above-average temperatures, with 2024 recorded as the warmest year to date (NOAA, 2025). In addition to rising temperatures, climate change has intensified extreme weather events (EWE), including heatwaves and altered rainfall patterns, which pose significant risks for people living with HIV (PLHIV). Climate change-related heat stress can exacerbate inflammation and impair immune function, an especially critical concern for PLHIV, who often experience chronic immune activation even while receiving antiretroviral therapy (Woolley et al., 2024). Uganda faces a compounded crisis in which the escalating impacts of climate change and the ongoing HIV epidemic jointly strain an already overburdened public health system (Logie et al., 2025). Against this backdrop, this study examines the associations between extreme weather events and perceived food insecurity and mental health outcomes among youth living with HIV (YLHIV).

Methods: This pilot study included 159 youth living with HIV (YLHIV) receiving HIV care services at the Bukedi Prevention Institute in Mbale, Uganda, between 2024 and 2025. Ethical approval was obtained from the Mbale ethics review board and the principal investigator’s affiliated university, and all participation was voluntary. Participants completed a structured survey assessing HIV-related health factors, perceived food insecurity, mental health outcomes, exposure to extreme temperatures, and sociodemographic characteristics. Descriptive statistics and multivariable linear regression analyses were conducted to examine associations among key variables using RStudio (Version 2026.01.1+403).

Results: The sample comprised youth aged 18-26 years, of whom 51.9% identified as male and 48.1% as female. Most participants identified as heterosexual (83.5%), while 16.5% identified as lesbian, gay, or bisexual (LGB). Results indicated that higher temperatures were significantly associated with increased mental health stress (β = 0.31, p = .009), as were stressors related to increased humidity (β = 0.19, p = .035). Additionally, disruptions to food production resulting from altered rainfall patterns (β = 0.19, p = .019) and increased challenges related to food storage (β = 0.22, p = .003) were independently associated with temperature-related mental health stress. Overall, the model explained 25% of the variance in mental health stress outcomes (R² = 0.25), indicating moderate explanatory power. Variance inflation factors (VIFs) ranged between 1 and 2, suggesting no concerns regarding multicollinearity.

Discussion/Conclusion: Our findings indicate that climate-related stressors exacerbate environmental and social determinants that heighten HIV vulnerability among marginalized youth. Grounded in a social work person‑in‑environment framework, these results highlight how extreme weather events intensify food insecurity, economic instability, and mental health distress, thereby undermining HIV care engagement and overall well-being. From a research perspective, this study underscores the need for interdisciplinary, climate-informed social work research that examines structural drivers of health inequities and calls for informed evidence-based interventions. Advancing rigorous inquiry and strengthening policies, research, advocacy, and climate-responsive HIV service models are essential to mitigate EWE related social determinants of HIV and prevent future public health crises.