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AIDS and Behavior

, Volume 23, Issue 6, pp 1375–1386 | Cite as

Factors Influencing the Risk of Becoming Sexually Active Among HIV Infected Adolescents in Kampala and Kisumu, East Africa

  • Sabrina Bakeera-KitakaEmail author
  • Tom Smekens
  • Vicky Jespers
  • Eric Wobudeya
  • Jasna Loos
  • Robert Colebunders
  • Daniel Adipo
  • Adeodata Kekitiinwa
  • Philippa Musoke
  • Anne Buve
  • Christiana Nöstlinger
Original Paper

Abstract

About 2.1 million adolescents aged 10–19 years are living with HIV, 80% of them in sub-Saharan Africa. Early sexual activity remains an important risk factor for HIV transmission and potentially result in negative health consequences including onward transmission of sexually transmitted infections. Cross-sectional data of 580 adolescents living with HIV (ALHIV) aged 13–17 years (317 girls and 263 boys) from Kenya and Uganda were analyzed to assess factors associated with risk to become sexually active. Factors associated with risk of sexual intercourse were identified using Kaplan–Meier survival curves and Cox regression with gender-stratified bi-and multivariable models. Slightly more females (22%) than males (20%) reported they have had sex. Multivariable models showed that being aware of one’s own HIV infection, and receiving antiretroviral treatment were negatively associated with risk of becoming sexually active, while subjective norms conducive to sexuality, and girls’ poor health experience increased the risk. In the final multi-variable models, schooling was protective for girls, but not for boys. Being more popular with the opposite sex was negatively associated with the outcome variable only for girls, but not for boys. This study expands the knowledge base on factors associated with onset of sexual activity among ALHIV, potentially informing positive prevention interventions.

Keywords

Adolescents HIV Sexual activity Sexual risk behavior Eastern Africa 

Resumen

Alrededor de 2.1 millones de adolescentes de entre 10 y 19 años viven con el VIH, el 80% de ellos residen en el África subsahariana. La actividad sexual precoz sigue siendo un factor de riesgo importante para la transmisión del VIH y puede tener consecuencias negativas para la salud, incluida la transmisión de infecciones de transmisión sexual. Los datos transversales de 580 adolescentes entre los 13–17 años (317 niñas y 263 niños) viviendo con el VIH y originarios de Kenia y Uganda fueron analizados para evaluar los factores asociados con el riesgo de volverse sexualmente activos. Los factores asociados con el riesgo de tener relaciones sexuales se identificaron usando las curvas de supervivencia de Kaplan–Meier y la regresión de Cox con modelos bi y multivariables estratificados por género. Un poco más de mujeres adolescentes (22%) que de hombres adolescentes (20%) informaron haber tenido relaciones sexuales. Los modelos multivariables mostraron que ser conscientes de la propia infección por VIH y recibir tratamiento antiretroviral se asociaron negativamente con el riesgo de volverse sexualmente activos, mientras que las normas subjetivas promoviendo la sexualidad y la mala salud experimentada por las mujeres adolescentes aumentaron el riesgo. En los modelos finales de variables múltiples, la escolarización resulto ser un factor de protección para las mujeres, pero no para los hombres adolescentes. Ser más popular con el sexo opuesto se asoció negativamente con la variable de resultado pero solo para las mujeres, no para los hombres adolescentes. Este estudio amplía la base de conocimientos sobre los factores asociados con el inicio de la actividad sexual en el VIH lo que podría contribuir a las intervenciones de prevención positivas.

Notes

Acknowledgements

All patients, care givers and the research team on the Brighter Future Study in Kenya and Uganda, and Melissa Stockwell for her constructive review of this manuscript.

Author Contribution

SBK, CN, JL and AB participated in the design of the study. SBK, DA implemented the study. VJ, EW analyzed the data. SBK, CN and VJ jointly wrote the first manuscript. All authors contributed to the subsequent drafts. The final version was read and approved by all authors. TS conducted the analysis for the revision of the manuscript. All authors contributed to the revised version of the manuscript.

Funding

AIDS Fonds, the Netherlands, Belgian Government through the framework agreement with the Belgian Developmental Cooperation.

Compliance with Ethical Standards

Conflict of interest

All authors have no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study obtained ethical clearance from the Kenya Medical Research Institute (KEMRI) Ethical Review Committee, Makerere University College of Health Sciences Ethical Review Committee, Baylor College of Medicine Ethical Review Board, Uganda National Council of Science and Technology, the Institutional Review Board of the Institute of Tropical Medicine, Antwerp and the University of Antwerp, Belgium. All participants were recruited through an informed consent process.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sabrina Bakeera-Kitaka
    • 1
    • 2
    Email author
  • Tom Smekens
    • 3
  • Vicky Jespers
    • 3
  • Eric Wobudeya
    • 1
  • Jasna Loos
    • 3
  • Robert Colebunders
    • 4
  • Daniel Adipo
    • 5
    • 6
  • Adeodata Kekitiinwa
    • 1
  • Philippa Musoke
    • 2
  • Anne Buve
    • 3
  • Christiana Nöstlinger
    • 3
    • 7
  1. 1.Baylor-UgandaKampalaUganda
  2. 2.Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
  3. 3.Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
  4. 4.Global Health InstituteUniversity of AntwerpAntwerpBelgium
  5. 5.Kenya Medical Research InstituteKisumuKenya
  6. 6.IMPACT Research and Development Organization, Tuungane Youth ProjectKisumuKenya
  7. 7.Faculty of PsychologyUniversity of ViennaViennaAustria

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