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Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology

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Abstract

Background

Adolescent girls in Uganda have four-fold HIV infections than adolescent boys. Several barriers to accessing comprehensive sexual health education exist for adolescent girls in Uganda, including unequal, social, and economic statuses, limited access to education and health care services, discrimination, and violence.

Objective

This study qualitatively examines sexual health behaviors and literacy among Ugandan adolescent girls and explores how technology may be leveraged to improve sexual and reproductive health outcomes in this population.

Methods

Four focus group discussions (FGDs) were conducted among 32 adolescent girls aged 14–17 years enrolled in Suubi mHealth. Participants were randomly selected from four secondary schools participating in a randomized clinical trial known as Suubi4Her (N = 1260). FGDs were conducted in the local language, audio-recorded, transcribed verbatim, and translated. Translated transcripts were imported into Dedoose for data management and coding. Emerging themes included Influences for Sex/Relationships, HIV Knowledge, and Sources of Sexual Health Information.

Results

Participants reported common influences for sexual engagement included seeking resource security, limited parental communication, and peer influences. Participants also demonstrated knowledge gaps, requesting information such as how to prevent unplanned pregnancies and HIV, endorsing sexual health myths, and describing limitations to accessing sexual health information.

Conclusions

Noticeable inconsistencies and limited access to information and resources regarding basic sexual health knowledge were reported, which inevitably increases adolescent girls’ risks for adverse sexual and reproductive health outcomes. Developing culturally appropriate interventions may help advance the sexual and reproductive health needs of Ugandan adolescent girls.

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Data Availability

Data used in this study is available from the corresponding author upon reasonable request.

References

  • Ayalew, M., Mengistie, B., & Semahegn, A. (2014). Adolescent-parent communication on sexual and reproductive health issues among high school students in Dire Dawa, Eastern Ethiopia: A cross sectional study. Reproductive Health, 11(1), 1–8.

    Article  Google Scholar 

  • Bankole, A., Biddlecom, A., Guiella, G., Singh, S., & Zulu, E. (2007). Sexual behavior, knowledge and information sources of very young adolescents in four sub-Saharan African countries. African Journal of Reproductive Health, 11(3), 28.

    Article  PubMed  PubMed Central  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Article  Google Scholar 

  • Cavazos-Rehg, P., Byansi, W., Doroshenko, C., Neilands, T. B., Anako, N., Sensoy Bahar, O., Kasson, E., Nabunya, P., Mellins, C. A., & Ssewamala, F. M. (2021). Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda. Social Science & Medicine, 280, 113946. https://doi.org/10.1016/j.socscimed.2021.113946

    Article  Google Scholar 

  • Cavazos-Rehg, P., Byansi, W., Xu, C., Nabunya, P., Bahar, O. S., Borodovsky, J., Kasson, E., Anako, N., Mellins, C., & Damulira, C. (2021). The impact of a family-based economic intervention on the mental health of HIV-infected adolescents in Uganda: Results from Suubi+ adherence. Journal of Adolescent Health, 68(4), 742–749.

    Article  Google Scholar 

  • Dellar, R. C., Dlamini, S., & Karim, Q. A. (2015). Adolescent girls and young women: Key populations for HIV epidemic control. Journal of the International AIDS Society, 18, 19408.

    Article  PubMed  PubMed Central  Google Scholar 

  • Erkut, S., Grossman, J. M., Frye, A. A., Ceder, I., Charmaraman, L., & Tracy, A. J. (2013). Can sex education delay early sexual debut? The Journal of Early Adolescence, 33(4), 482–497.

    Article  Google Scholar 

  • Fisher, J. D., Fisher, W. A., Bryan, A. D., & Misovich, S. J. (2002). Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychology, 21(2), 177.

    Article  PubMed  Google Scholar 

  • Fisher, J. D., Fisher, W. A., Misovich, S. J., Kimble, D. L., & Malloy, T. E. (1996). Changing AIDS risk behavior: Effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population. Health Psychology, 15(2), 114.

    Article  PubMed  Google Scholar 

  • Humphries, H., Osman, F., Knight, L., & Karim, Q. A. (2019). Who is sexually active? Using a multi-component sexual activity profile (MSAP) to explore, identify and describe sexually-active high-school students in rural KwaZulu-Natal, South Africa. BMC Public Health, 19(1), 1–13.

    Article  Google Scholar 

  • ICF. (2016). Uganda- Demographic and Health Survey. Retrieved from Kampala, Uganda: https://dhsprogram.com/pubs/pdf/FR333/FR333.pdf.

  • Kalembo, F. W., Zgambo, M., & Yukai, D. (2013). Effective adolescent sexual and reproductive health education programs in sub-Saharan Africa. Californian Journal of Health Promotion, 11(2), 32–42.

    Article  Google Scholar 

  • Kemigisha, E., Bruce, K., Nyakato, V. N., Ruzaaza, G. N., Ninsiima, A. B., Mlahagwa, W., Leye, E., Coene, G., & Michielsen, K. (2018). Sexual health of very young adolescents in South Western Uganda: A cross-sectional assessment of sexual knowledge and behavior. Reproductive Health, 15(1), 1–8.

    Article  Google Scholar 

  • Kilembe, W., Wall, K. M., Mokgoro, M., Mwaanga, A., Dissen, E., Kamusoko, M., Phiri, H., Sakulanda, J., Davitte, J., & Reddy, T. (2015). Knowledge of HIV serodiscordance, transmission, and prevention among couples in Durban, South Africa. PLoS One, 10(4), e0124548.

    Article  PubMed  PubMed Central  Google Scholar 

  • Luster, T., & Small, S. A. (1994). Factors associated with sexual risk-taking behaviors among adolescents. Journal of Marriage and the Family, 56, 622–632.

    Article  Google Scholar 

  • Majelantle, R., Keetile, M., Bainame, K., & Nkawana, P. (2014). Knowledge, opinions and attitudes towards HIV and AIDS among youth in Botswana. Journal of Global Economics. https://doi.org/10.4172/economics.1000108

    Article  Google Scholar 

  • Maly, C., McClendon, K. A., Baumgartner, J. N., Nakyanjo, N., Ddaaki, W. G., Serwadda, D., Nalugoda, F. K., Wawer, M. J., Bonnevie, E., & Wagman, J. A. (2017). Perceptions of adolescent pregnancy among teenage girls in Rakai, Uganda. Global Qualitative Nursing Research, 4, 2333393617720555.

    Article  PubMed  PubMed Central  Google Scholar 

  • Manu, A. A., Mba, C. J., Asare, G. Q., Odoi-Agyarko, K., & Asante, R. K. O. (2015). Parent–child communication about sexual and reproductive health: Evidence from the Brong Ahafo region, Ghana. Reproductive Health, 12(1), 1–13.

    Article  Google Scholar 

  • McMahon, J., Wanke, C., Terrin, N., Skinner, S., & Knox, T. (2011). Poverty, hunger, education, and residential status impact survival in HIV. AIDS and Behavior, 15(7), 1503–1511.

    Article  PubMed  PubMed Central  Google Scholar 

  • Melesse, D. Y., Cane, R. M., Mangombe, A., Ijadunola, M. Y., Manu, A., Bamgboye, E., Mohiddin, A., Kananura, R. M., Akwara, E., & du Plessis, E. (2021). Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa. Reproductive Health, 18(1), 1–15.

    Google Scholar 

  • Miller, B. C., Benson, B., & Galbraith, K. A. (2001). Family relationships and adolescent pregnancy risk: A research synthesis. Developmental Review, 21(1), 1–38.

    Article  Google Scholar 

  • Ministry of Health, U. S. (2017). Uganda Population-based HIV Impact Assessment (UPHIA) 2016-2017: Final Report. Kampala: Ministry of Health; July, 2019. Accessed from: http://phia.icap.columbia.edu

  • Muhwezi, W. W., Katahoire, A. R., Banura, C., Mugooda, H., Kwesiga, D., Bastien, S., & Klepp, K.-I. (2015). Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda. Reproductive Health, 12(1), 1–16.

    Article  Google Scholar 

  • Murphy, E. M., Greene, M. E., Mihailovic, A., & Olupot-Olupot, P. (2006). Was the “ABC” approach (abstinence, being faithful, using condoms) responsible for Uganda’s decline in HIV? PLoS Medicine, 3(9), e379.

    Article  PubMed  PubMed Central  Google Scholar 

  • Neal, S. E., Chandra-Mouli, V., & Chou, D. (2015). Adolescent first births in East Africa: Disaggregating characteristics, trends and determinants. Reproductive Health, 12(1), 1–13.

    Article  Google Scholar 

  • Ninsiima, A. B., Leye, E., Michielsen, K., Kemigisha, E., Nyakato, V. N., & Coene, G. (2018). “Girls have more challenges; they need to be locked up”: A qualitative study of gender norms and the sexuality of young adolescents in Uganda. International Journal of Environmental Research and Public Health, 15(2), 193.

    Article  PubMed  PubMed Central  Google Scholar 

  • Paul-Ebhohimhen, V. A., Poobalan, A., & Van Teijlingen, E. R. (2008). A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa. BMC Public Health, 8(1), 1–13.

    Article  Google Scholar 

  • Penner, F., Sharp, C., Marais, L., Shohet, C., Givon, D., & Boivin, M. (2020). Community-based caregiver and family interventions to support the mental health of orphans and vulnerable children: Review and future directions. New Directions for Child and Adolescent Development, 2020(171), 77–105.

    Article  PubMed  Google Scholar 

  • Rabbitte, M., & Enriquez, M. (2019). The role of policy on sexual health education in schools. The Journal of School Nursing, 35(1), 27–38.

    Article  PubMed  Google Scholar 

  • Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., Tabor, J., Beuhring, T., Sieving, R. E., & Shew, M. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Jama, 278(10), 823–832.

    Article  PubMed  Google Scholar 

  • Sani, A. S., Abraham, C., Denford, S., & Ball, S. (2016). School-based sexual health education interventions to prevent STI/HIV in sub-Saharan Africa: A systematic review and meta-analysis. BMC Public Health, 16(1), 1–26.

    Article  Google Scholar 

  • Shato, T., Nabunya, P., Byansi, W., Nwaozuru, U., Okumu, M., Mutumba, M., Brathwaite, R., Damulira, C., Namuwonge, F., & Bahar, O. S. (2021). Family economic empowerment, family social support, and sexual risk-taking behaviors among adolescents living with HIV in Uganda: The Suubi+ adherence study. Journal of Adolescent Health., 69, 406–413.

    Article  Google Scholar 

  • Shiferaw, K., Getahun, F., & Asres, G. (2014). Assessment of adolescents’ communication on sexual and reproductive health matters with parents and associated factors among secondary and preparatory schools’ students in Debremarkos town, North West Ethiopia. Reproductive Health, 11(1), 1–10.

    Article  Google Scholar 

  • Ssewamala, F. M. (2015). Optimizing the “demographic dividend” in young developing countries: The role of contractual savings and insurance for financing education. International Journal of Social Welfare, 24(3), 248–262.

    Article  PubMed  Google Scholar 

  • Ssewamala, F. M., Bermudez, L. G., Neilands, T. B., Mellins, C. A., McKay, M. M., Garfinkel, I., Sensoy Bahar, O., Nakigozi, G., Mukasa, M., & Stark, L. (2018). Suubi4Her: a study protocol to examine the impact and cost associated with a combination intervention to prevent HIV risk behavior and improve mental health functioning among adolescent girls in Uganda. BMC Public Health, 18(1), 693.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ssewamala, F. M., Dvalishvili, D., Mellins, C. A., Geng, E. H., Makumbi, F., Neilands, T. B., McKay, M., Damulira, C., Nabunya, P., & Sensoy Bahar, O. (2020). The long-term effects of a family based economic empowerment intervention (Suubi+ Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial. PLoS One, 15(2), e0228370.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stoebenau, K., Heise, L., Wamoyi, J., & Bobrova, N. (2016). Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Social Science & Medicine, 168, 186–197.

    Article  Google Scholar 

  • Tesso, D. W., Fantahun, M. A., & Enquselassie, F. (2012). Parent-young people communication about sexual and reproductive health in E/Wollega zone, West Ethiopia: Implications for interventions. Reproductive Health, 9(1), 1–13.

    Article  Google Scholar 

  • UNAIDS. (2019). Women and HIV: A spotlight on adolescent girls and young women. Retrieved from https://www.unaids.org/sites/default/files/media_asset/2019_women-and-hiv_en.pdf.

  • UNAIDS. (2020). Fact sheet: Latest global and regional statistic. Retrieved from https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf.

  • UNAIDS. (2021). About UNAIDS: Saving lives, leaving no one behind. Retrieved from https://www.unaids.org/en/whoweare/about.

  • Vanwesenbeeck, I., Westeneng, J., de Boer, T., Reinders, J., & van Zorge, R. (2016). Lessons learned from a decade implementing comprehensive sexuality education in resource poor settings: The world starts with me. Sex Education, 16(5), 471–486.

    Article  Google Scholar 

  • Wamoyi, J., Fenwick, A., Urassa, M., Zaba, B., & Stones, W. (2010). Parent-child communication about sexual and reproductive health in rural Tanzania: Implications for young people’s sexual health interventions. Reproductive Health, 7(1), 1–18.

    Article  Google Scholar 

  • WHO. (2010). Developing sexual health programmes: a framework for action. Retrieved from https://apps.who.int/iris/handle/10665/70501.

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Acknowledgements

We are grateful to colleagues at the International Center for Child Health and Development (ICHAD) for their respective contributions to the study design and implementation. We thank the study participants for their insight.

Funding

The study was funded by National Institutes of Health (NIH) Grant K02 DA043657 (PI: Dr. Patricia Cavazos-Rehg), the National Institute of Mental Health (NIMH) under Grant 1R01MH113486-01 (PI: Dr. Fred M. Ssewamala), National Institute of Mental Health under Grant R25MH118935 (PI: Dr. Ssewamala, Dr. Mary McKay and Dr. Sean Joe), and the National Institute on Minority Health and Health Disparities grant T37MD014218 (PI: Dr. Cavazos-Rehg, Dr. Ssewamala) The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NIMH, or NIMHD.

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Authors and Affiliations

  1. Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA

    William Byansi

  2. Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA

    Tyriesa Howard Howell, Lindsey M. Filiatreau, Proscovia Nabunya & Fred M. Ssewamala

  3. Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, Saint Louis, MO, 63110, USA

    Lindsey M. Filiatreau, Nina Kaiser, Erin Kasson & Patricia Cavazos-Rehg

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  1. William Byansi
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Correspondence to William Byansi.

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Ethical Approval

Institutional Review Board approval for both the parent grant and the supplement were obtained from Washington University in St. Louis (IRB- #201703102) and the Uganda Virus Research Institute (GC/127/17/07/619). Per approved protocols, written informed consent was obtained from caregivers and written informed assent was obtained separately from the adolescents.

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Appendix 1

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Byansi, W., Howell, T.H., Filiatreau, L.M. et al. Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology. Child Youth Care Forum 52, 1227–1247 (2023). https://doi.org/10.1007/s10566-023-09730-3

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