Abstract
BackgroundAdolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The objective of this study was to determine factors associated with prior engagement in high-risk sexual behaviours among adolescents (10–19 years) in Karamoja sub-region, a pastoralist and post-conflict community in North-eastern Uganda.MethodsBetween August and September 2016, we conducted a cross-sectional study among 1439 adolescents receiving primary healthcare services at nine public health facilities located in five of the seven districts that make up Karamoja sub-region. High-risk sexual behaviour was defined as engaging in sex with two or more (2+) sexual partners in the 6 months preceding the survey or exchanging sex for money or gifts with no or inconsistent use of condoms over the same period of time. Factors associated with prior engagement in high-risk sexual behaviours were analysed using a modified Poison regression model with log-link and Poisson-family via a generalized linear model.ResultsEighty-two percent (81.8%, n = 1177) of the respondents had ever tested for HIV while 62 % (61.5%, n = 885) had ever had sex. Of those that had ever had sex, 11.4% (n = 101) reported prior engagement in high-risk sexual behaviours. Prior engagement in high-risk sexual behaviours was lower among men than women (adjusted prevalence ratio (adj. PR) = 0.46; 95% Confidence Interval (95% CI): 0.33, 0.62) and those whose sex debut was above 14 years (adj.PR = 0.63; 95% CI: 0.57, 0.69). However, prior engagement in high-risk sexual behaviours was significantly higher in adolescents who were not aware of their recent sexual partner’s HIV status (adj.PR = 2.43; 95% CI: 1.68, 3.52) and those who used illicit drugs (adj.PR = 2.76; 95% CI: 1.88, 4.05).ConclusionPrior engagement in high-risk sexual behaviours was significantly associated with having sex with partners of unknown HIV sero-status and use of illicit drugs. These findings suggest a need for targeted interventions to improve mutual HIV status disclosure between sexual partners while minimizing their use of illicit drugs/substances.
Highlights
Adolescent sexual risky behaviours continue to be significant drivers of the Human immunodeficiency virus (HIV) epidemic globally
We found that young women had a lower probability of reporting prior engagement in high-risk sexual behaviours than their male counterparts [adj.Prevalence ratio (PR) = 0.46]
We found that young women were less likely to report prior engagement in high-risk sexual behaviours than their male counterparts as were adolescents who reported that they initiated sex at or after the age of 15 years
Summary
Adolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The global fight against the HIV epidemic is pivoted on reducing sexual risky behaviours among young people, including adolescents. Despite global estimates showing a declining trend in HIV incidence in all ages, the decline among young girls and women in sub-Saharan Africa including Uganda remains pretty slow [1,2,3,4]. Despite an increased vulnerability to HIV acquisition, evidence indicates that a large proportion of young people aged 15–24 years remain unaware of their HIV status [7] and continue to engage in risky sexual behaviours [8, 9]. With 80% of the global adolescents living with HIV/AIDS residing in sub-Saharan Africa [17, 18], adolescents in post-conflict and pastoralist communities present a double-barrelled challenge in the fight against the epidemic
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