Using Hierarchical Regression to Examine the Predictors of Sexual Risk-Taking Attitudes among Adolescents Living with Human Immunodeficiency Virus in Uganda

Abstract

PurposeWe explored the factors influencing sexual risk-taking attitudes—defined as beliefs and values regarding sexual activity—among adolescents living with human immunodeficiency virus (ALHIV) in Uganda. MethodsThe study used baseline data from a five-year cluster-randomized control trial (2012–2018) among 702 ALHIV in Uganda. Participants were aged 10–16 years, HIV-positive, taking antiretroviral therapy, and living within a family. We fitted hierarchical regression models to assess the demographic, economic, psychological, and social predictors of sexual risk-taking attitudes. Using R2, the final model explained 11.4% of the total variance. ResultsUnder economic factors, caregiver being formally employed (β = −0.08, 95% confidence interval [CI]: −0.10–0.06, p < .001), and the ALHIV working for pay (β = 1.78, 95% CI: 0.28–3.29, p = .022), were associated with sexual risk-taking attitudes. Among the psychological factors, more depressive symptoms (β = 0.22, 95% CI: 0.11–0.32, p < .001) were associated with more approving attitudes toward sexual risk-taking. Family and social factors including communicating with the caregiver about HIV (β = 1.32, 95% CI: 0.56–2.08, p = .001), sex (β = 1.09, 95% CI: 0.20–1.97, p = .017), and experiencing peer pressure (β = 3.37, 95% CI: 1.85–4.89, p < .001) were also associated with more approving attitudes toward sexual risk-taking. The final model explained 11.54% of the total variance. DiscussionEconomic, psychological, and social factors influence sexual risk-taking attitudes among ALHIV. There is a need for more research to understand why discussing sex with caregivers improves adolescents' positive attitudes toward sexual risk-taking. These findings have significant ramifications in preventing sexual transmission of HIV among adolescents in low-income settings.