Socio-cultural and economic antecedents of adolescent sexual decision-making and HIV-risk in rural Uganda

Abstract

With more than half of new infections occurring among youth, HIV/AIDS remains a major contributor to morbidity and mortality in Uganda. Semi-structured interviews were performed with 48 adolescents and 15 adult key informants in a rural Ugandan community to identify influences on adolescent sexual decision-making. Inductive data analytic methods revealed five thematic influences: (1) social pressure, (2) decline of the Senga (a familial figure who traditionally taught female adolescents about how to run a household), (3) cultural barriers to condom use, (4) knowledge of HIV transmission and modes of prevention, and (5) a moral injunction against sex before marriage. Influences were classified as HIV/AIDS risk and protective factors and organized to form an explanatory framework of adolescent sexual risk-taking. Risk factors pull youth toward risky behavior, while protective factors push them away. Predominance of risk over protective influences explains persistent sexual risk-taking by Ugandan youth. HIV prevention programs designed for Ugandan adolescents should take competing factors and sociocultural and economic influences into account.

Keywords:

• HIV prevention
• adolescents
• Uganda
• sexual risk-taking

Acknowledgements

The authors wish to thank Alan Scott for his invaluable assistance with the design of the explanatory model. The authors also thank Ruth Birungi and Abdon Birungi, who contributed to data collection, and to study participants.

Notes

These data were presented at the 2010 International AIDS Society Meeting in Vienna in a poster format.

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