1. HIV/AIDS Transmission Knowledge (5) HIV/AIDS Treatment Knowledge (5)
Reproductive and Sexual Health Knowledge Among Northern Ugandan Adolescents
Simone St. Claire1, Ray Wipfli1, Winnie Alobo2, Ralph Wipfli1, Heather Wipfli3
1. Ray United FC 2. Global Health Network Uganda 3. University of Southern California
Background
Despite the large influx of international funding and health programming aimed at HIV/AIDS prevention and response in Uganda, HIV remains a significant health challenge, particularly for communities in northern Uganda. 4% of young people aged between 15 and 24 years are HIV positive and 1 in 4 new infections among women occur in adolescents and young women aged years old.1 However, most data collected related to sexual health and HIV knowledge in Uganda has been measured with adult populations. Our study aimed to evaluate youth attitudes towards, and knowledge of, safe sex practices, pregnancy intensions, and prevention of HIV. We aim to highlight the need for more adolescent-targeted sexual health and HIV programming in the Lango region and throughout Uganda.
Methods
A structured interviewer-administered questionnaire was administered in June 2018 to a convenience sample of primary and secondary school students in the Longo region attending the RUFC Youth Camp, a health education program reaching 1,000 pupils annually. Data was entered into a tablet at the time the interview and the data were uploaded through a Wi-Fi network to a secure database using Kobo software. Data were analyzed using SPSS Statistics Version 24. Descriptive statistics were used to summarize the sociodemographic characteristics of participants and a nominal logistic regression model was used to determine variables that influenced outcomes of interest.
Results
A total of 242 (143 females and 95 males) students participated in the study with the mean age of (SD ± 1.94) (Table 1). The majority of students understood that using a condom is an effective way to prevent pregnancy, however, misperceptions regarding other forms of pregnancy prevention were present (Table 2). Knowledge of HIV treatment was low and significantly related to increased stigma (Tables 3 and 4).
Table 1. Demographics
Table 2. Reproduction Knowledge
Table 3. HIV Knowledge and Stigma
Count %
Sex
Female
147
60.7%
Male 95
39.3%
Age 11 4
1.7% 12 21
8.7% 13 64
26.4% 14 19
7.9% 15 27
11.2% 16 43
17.8% 17 52
21.5% 18 8
3.3%
Years of schooling 5
2.1%
1-3 years
6.2%
4-6 years 67
27.7%
7-10 years 86
35.5%
10+ years 69
28.5%
Parents’ job
Agriculture
157
64.9%
Business 25
10.3%
Health Professional 7
2.9%
Teacher 28
11.6%
Other
Last doctor's visit
Never
21.6%
Past year
172
71.4%
2-10 years
5.4%
Enough to eat on most days No 49
20.2%
Yes
193
79.8%
Female
Male
Desired # of children
1-2
22.2%
22.3%
3-5
72.9%
70.2%
>5
4.9%
7.4%
Desired age of first child
15-18
3.5%
3.2%
19-22
23.1%
11.7%
23-26
42.0%
38.3%
After 26
31.5%
46.8%
Pregnancy is prevented by:
Pouring soda on female genitalia before/after sex
7.1%
5.5%
Girls quickly urinating after sex
6.4%
1.1%
Girls jumping up and down after sex
8.5%
3.3%
Covering male genitalia with any barrier such as plastic bags
12.1%
9.9%
Using a condom
93.6%
96.7%
Preference for Pregnancy Care
Local health clinic
97.9%
94.6%
Traditional birth attendant
2.1%
2.7%
Giving birth in the community is…
Dangerous
83.0%
89.9%
Safe
17.0%
10.1%
Female
Male
Can you get a STD when you’re married? No
14.3%
17.9%
Yes
85.7%
82.1%
HIV/AIDS spread through
Sharing Food
2.7%
3.2%
Hugging
4.8%
2.1%
Sharing bathroom
6.8%
6.3%
Kissing
24.7%
15.8%
Mother to Child
66.4%
58.9%
Sex
95.2%
100.0%
Is HIV/AIDS treatable?
78.8%
86.3%
21.2%
13.7%
How embarrassed would you be to tell your family you were HIV positive?
Not at all
51.7%
Very little
8.3%
12.6%
Somewhat
13.1%
11.6%
Very much
26.9%
16.8%
Are you/would you be friends with an HIV+ individual?
29.5%
26.3%
70.5%
73.7%
Table 4. Variables Related to Knowledge of HIV Transmission, Treatment, and Stigma
HIV/AIDS Transmission Knowledge (5)
HIV/AIDS Treatment Knowledge (5)
HIV+ Friend
Reference: All 6 transmission answers correct
Reference: HIV/AIDS treatment answer correct
Reference: Answered ’Yes’ to ‘Would you be Friends with an HIV+ Individual’ question
Predictor B
Sig. OR
95% CI
Female (1)
0.103
0.716
1.109
-0.517
0.163
0.596
0.116
0.721
1.122
Age (2)
0.777
0.021
2.175
0.263
0.512
1.301
0.392
0.357
‘1.480
Years in School 1-6 years (3)
0.818
0.010
2.266
0.486
0.238
1.626
0.753
0.028
2.124
Parent Occupation (4)
Professional
-1.334
0.001
-0.853
0.044
0.426
0.302
0.476
1.352
Government
-0.213
0.773
0.808
-0.601
0.399
0.548
0.080
3.030
Other
-0.708
0.275
0.493
0.539
0.617
1.714
1.071
0.101
2.918
HIV/Transmission Transmission (6)
2.608
13.573
Model Fitting Chi-Square
28.419
9.532
33.538
Model Fitting Sig
0.000
0.146
’0.000
Pseudo R (Cox and Snell)
0.111
0.039
‘0.130
Compared Men; (2) Compared with Age 14-19; (3) Compared with 7+ years in school; (4) Compared with Self-employed; (5) Predictor Reference Category is All Questions Correct; (6) Predictor Reference Category is “Yes’
Discussion and Future Plans
Considering the current legal framework, which bans comprehensive sex education in Uganda’s schools, it is not surprising that knowledge regarding pregnancy prevention and HIV among Ugandan youth remains a challenge. The survey results point to a large gap between family planning intensions and results. The average live births per women in the Longo region is 7.1, far above the 2-5 children that 9 out of 10 students indicated they eventually wanted to have.1 They also prefer to have their first child after 23 years of age, long after the current average age of first birth in Uganda (18 years).1 While most students correctly identified condoms as an effective contraceptive, misconceptions related to other forms of pregnancy prevention and HIV transmission were present. These misconceptions contribute to HIV stigma in the community. The lack of knowledge of HIV treatment available is problematic given that treatment is linked to longer, healthier lives, prevents mother –to-child transmission, and reduces risk of transmission to other sexual partners. The study results indicate that additional adolescent-targeted reproductive health and STD prevention education is needed in Lango and throughout Uganda.
Reference: 1. Uganda Bureau of Statistics (UBOS) and ICF Uganda Demographic and Health Survey 2016: Key Indicators Report. Kampala, Uganda: UBOS, and Rockville, Maryland, USA: UBOS and ICF.
*The study was approved by the University of Southern California Institutional Review Board (#HS ) and the Ugandan Research Council.