Between love and fear - determinants of sexual behavior among Ugandan university students

University dissertation from Social Medicine and Global Health

Abstract: Background: More than half of all new HIV infections in sub-Saharan African countries, including Uganda, occur among young people between the ages of 15 and 24, the most sexually active period of their lives. Understanding the contextual determinants of sexual behavior in this group is crucial in combating the pandemic. Aim: The overall aim of this study was to assess the impact of demographic, religious, social capital, mental health, and sexual coercion factors on risky sexual behavior among a student population in Uganda in order to gain a deeper understanding of the forces that shape sexual behavior of young people with the purpose of contributing to policy formulation and implementation of more effective interventions to prevent the spread of HIV/AIDS. Method: In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic, social capital, and religious factors, as well as alcohol use, mental health, experience of sexual coercion, age of sexual debut, number of sexual partners, and condom use. Mental health was assessed using items from the Hopkins Symptoms Checklist-25(HSCL-25) and the Symptom Checklist-90 (SCL-90). Logistic regression analysis was applied as the main analytical tool, and synergistic effects between some of the main determinants were investigated. Results: Thirty-seven percent of the male and 49% of the female students had not previously had sexual intercourse. Of the male and female students with sexual experience, 46% of the males and 23% of the females had had three or more lifetime sexual partners, and 32% of the males and 38% of the females did not consistently use condoms with a new partner. Minor importance of religion in one’s family while growing up was correlated to a statistically significant degree with early sexual debut and having many sexual partners (OR 1.7, 95% CI: 1.2–2.4 and OR 1.6, 95% CI: 1.1–2.3, respectively). Being of Protestant faith interacted with gender among those who had debuted sexually. Protestant female students were more likely to have had three or more sexual partners; the opposite was true for Protestant male students. Non-dominant bridging trust among male students was associated with a higher risk for having had many sexual partners (OR 1.8, 95% CI: 1.2–2.9). Low trust in others was associated with a greater likelihood of sexual debut in men, while the opposite was true in women. A similar pattern was seen regarding a high number of lifetime sexual partners in individuals who were raised in families where religion played a major role. After controlling for potential confounding factors, high scores on depression and a high number of sexual partners were significantly associated among both males (OR 2.0, 95% CI: 1.2–3.3) and females (OR 3.3, 95% CI: 1.3–8.6). Elevated anxiety scores among men were associated with a high number of sexual partners (OR 1.9, 95% CI: 1.1–3.3) and inconsistent condom use (OR 1.9, 95% CI: 1.1–3.6). Experience of sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI: 1.1−2.3), early sexual debut (OR 2.4, 95% CI: 1.5−3.7), as well as with having had a high number of sexual partners (OR 1.9, 95% CI: 1.2−3.0), but not with inconsistent condom use. Good mental health scores, reporting high trust in others, or stating that religion played a major role in one’s family of origin seemed to buffer the effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: Religion, social capital, mental health, and sexual coercion appear to be important determinants of sexual behavior among Ugandan university students. Using such knowledge, one may design and implement more effective programs to prevent the spread of HIV/AIDS. Policy makers would benefit from involving young people in the planning of interventions against HIV/AIDS, and in the formulation and implementation of youth-friendly policies to better understand how strategies should be tailored in relation to the needs of the target group. It would also be desirable to introduce coordinated youth-friendly health services to address both the psychological as well as the sexual and reproductive health-related concerns of young people.