Condom use across and within relationships among young people in Uganda: A case of Kabale and Mukono districts Nazarius Mbona Tumwesigye Roger Ingham David Holmes University of Southampton Contact: BSPS annual conference, September 2005, Canterbury

2 Outline Introduction Objectives Literature Methods Results Discussion Conclusion

3 Introduction When consistently and correctly used condoms can prevent 90-95% of HIV Uganda still has high HIV prevalence (6.2%) and unplanned pregnancies Estimated 192 HIV infections per day, per year

4 Introduction: Why study dynamics of condom use? At a relatively high level of condom use, focus on dynamics becomes important –38% in Ghana, 43% Kenya, 58% in Uganda Indications of high inconsistent condom use in the country- only 4.4% consistently use in Rakai Lack of data ABC model spreading to other countries and change of focus

5 Study areas Highlights regional differences in economy, access to services

6 Objectives Establish the level and trend of condom use between and within relationships Identify associated factors

7 Literature review to identify possible associated factors Decline in condom use with time (Ku et al. 1994) and number of sexual partners (Richter et al. 1993) Age, education level, casual relationship (Catania et al & 1998) Age at first sex (Tavares et al. 2002) Alcohol (Ray et al. 1998) Media and attitudes (Adetunji & Meekers 2001) Communication with parents (Rodgers,1999)

8 Methods Stratified cluster sample of 786 unmarried youth aged 15-24, 445 of whom were sexually active Questions on sexual practices on first, second to latest and latest relationships Data on all relationships pooled together Logistic regression for condom use Multinomial logistic regression for consistency  Used at both 1 st & last event, use at one of two events, none use at both events Checked cluster effect with multilevel model

9 Characteristics of respondents CharacteristicsPercentages Sexmale: 47; female: 53 DistrictKabale: 43; Mukono: 59 Age group15-16: 28;17-18: 28; rest: 44 EducationNone: 4; Primary: 34; Secondary: 62 In school51 1 st sex partnersteady: 70; casual: 30 First sex 5yrs: 18

10 Number of responses No. of relation- ships First relationshipSecond latest relationship Latest relationship firstlastfirstlastfirstlast One Two Three Total

11 Condom use levels in first, second latest and latest relationships

12 Logistic regression: Condom use at anytime in each relationship VariableFirstSecondLatest District (Mukono/Kabale)*** ** Gender (women/men)*** Age group (22-23,21-22,19-20,17-18,15-16) *** In school (yes/no)*** Sec. Educ (yes/no)** Age 1 st sex (15+/<15 years)*** Type of school (public/religion/private) * Positive attitude (high/medium)*** Condom use at 1 st sex (yes/no)---**** Listens to radio (yes/no)*

13 Logistic regression: Condom use at any time VariableSignificance District (Mukono/Kabale)*** Gender (women/men)*** Age group (22-23,21-22,19-20,17-18,15-16)** In school (yes/no)*** Sec. Educ (yes/no)** Age 1 st sex (15+/<15 years)*** Type of school (public/religion/private)* Positive attitude (high/medium)** Condom use at 1 st sex (yes/no)*** Radio (yes/no)* Type of partner (steady/casual)*** Time since first sex (1/2-5/5+years)*** Sex event (first in 1 st of 3 relationships……….last in one relationship).***

14 Predicted levels of condom use at each event

15 Correlates of consistent condom use from multinomial logistic model VariableConsistentInconsistent District (Mukono/Kabale)*** Gender (women/men)** In school (Yes/no)* Education (Sec/Primary)** Age at first sex (15+/<15)*** Relationship (3 rd /2 nd /1 st )** Length of relationship (2+/1/<1 years) ****

16 Predicted level and consistency of condom use

17 Discussion Results not in agreement with those of Ku et al. (1994) and Richter (1993) Condom use higher among steady partners, unlike in Catania (1994) Alcohol not a significant factor on use as in Ray et al. (1998) Foundation of school an important factor Communication with parent not significant as in Rodgers (1999) Findings on age,age at 1 st sex,attitude as in others studies More opportunity for influence in first relationship

18 Conclusions and implications There are significant changes in condom use between and within relationships The level and consistency in condom use grows with time

19 Conclusion and implications cont’d Policy and programme may refocus on:  Inequalities in access to sexual health services between districts  Differences in practices by gender, age groups, schooling status  Media as an important tool  Raising attitudes to condom use and steady partnerships  Increasing age at first sex and condom use at first sex through balanced ABC campaigns Abstinence-only programmes may worsen the already low condom use at first sex

Thanks for your attention