Among youth aged 15–24 in Uganda, sexual and reproductive health knowledge, knowledge of reproductive health services and reports of sexual risk behaviors improved between 2003–2004 and 2012.1 Between the two time points, the proportion of youth ever tested for HIV rose from 8% to 48% among males and from 10% to 64% among females. Increased age and level of education were associated with a positive change in most of the indicators examined. However, in 2012, relative to 2003–2004, males were less likely to know where to obtain condoms (odds ratio, 0.7) and to report sexual debut before age 15 (0.8). Despite overall increases in knowledge, knowledge of STI symptoms and of what to do in the event of an STI remained low for both sexes (36–51%).
To assess where resources should be directed to improve the health outcomes of young people in Uganda, researchers examined changes in youths’ sexual and reproductive health knowledge, access to services and sexual risk behaviors between 2003–2004 and 2012 using secondary data from cross-sectional, district-level community surveys. The sample was restricted to youth aged 15–24; measures included youths’ social and demographic characteristics, their sexual and reproductive health knowledge (the benefits of HIV testing, the signs and symptoms of STIs, actions to take in the event of an STI) and knowledge of services (where to get tested for HIV and where to obtain condoms), as well as their age at first sex and whether they had ever been tested for HIV. Logistic regression was used to assess the changes in the indicators between the two time periods and the characteristics associated with these indicators, stratified by sex.
Between 2003–2004 and 2012, there were improvements in almost all of the indicators, although there were some differences by sex. The biggest improvement was seen in the proportion of youth who had ever been tested for HIV—from 8% to 48% for males and from 10% to 64% for females. In 2003–2004, 79% of males and 72% of females knew one or more benefit of HIV testing; in 2012, the proportions rose to 90% for each. For young men and women, the proportions knowing two or more symptoms of STIs doubled (from 22% to 51% for males and 22% to 47% for females), as did those for knowing where to get an HIV test (from 38% to 85% for males and 35% to 85% for females). The proportion of young women who knew what to do in the event of an STI rose from 28% to 37%, and the proportion who knew where to get a condom rose slightly, from 83% to 85%; the proportion of young men reporting early sexual debut decreased from 15% to 12%.
In multivariate analyses in which the reference group was same-sex 20-year-old youth with a primary education in 2003–2004, young men in 2012 were more likely to know the benefits of HIV testing and to know STI symptoms (odds ratios, 2.4 and 3.8, respectively). In addition, males aged 24 in 2012 had increased odds of knowing the benefits of HIV testing, the symptoms of STIs and what to do in the event of an STI (1.3–1.7); males aged 15 in 2012 had decreased odds for the three knowledge indicators (0.5–0.7). Also, young men with secondary or tertiary education were more likely to report greater knowledge on all three knowledge indicators (secondary, 1.6–2.2; tertiary, 1.6–5.6). Results for females followed the same general pattern with a few exceptions: Young women in 2012 were more likely than those in 2003–2004 to know what to do in the event of an STI (1.5), and having a tertiary education was associated only with increased knowledge of STI symptoms (2.7).
In terms of the knowledge of services indicators, age and education continued to be associated with greater knowledge for both sexes. Young men and women in 2012 were more likely than those in 2003–2004 to know where to get an HIV test (odds ratios, 10.5 and 11.3, respectively), as were older respondents (relative to younger ones, 1.5 and 1.9) and those with secondary or tertiary education (relative to those with primary education, 1.8–2.5). Younger respondents of both sexes were less likely to know where to go for HIV testing (0.6 for males and 0.5 for females). These patterns held for knowledge of where to obtain a condom, with a few differences by sex: In 2012, males were less likely to know a place to get condoms (0.7), and the differences between males with primary education and those with tertiary education were not statistically significant for this indicator. For both males and females, relative to those who were unmarried, those who were single with a partner were more likely to know where to get condoms (4.7 and 1.3, respectively).
In comparison with youth in 2003–2004, young men—but not women—in 2012 were less likely to report sexual debut before age 15 (odds ratio, 0.8); older respondents were also less likely to report early debut (0.8 for males and 0.6 for females). For both sexes, being younger (males, 1.3; females, 2.0), having no education (males, 2.3; females, 2.0) and being single with a partner (1.9 for males, 2.7 for females) were all associated with higher odds of reporting early sex; for females, ever being married also was associated with increased odds of early debut (2.5). Results for having ever been tested for HIV were similar for both sexes: Respondents in 2012, older respondents, those with secondary or tertiary education, single respondents with partners and those who had ever been married were more likely to have ever been tested for HIV (1.6–24.1). Young women with no education were less likely than those with primary education to have ever had an HIV test (0.5); the difference was not significant for young men.
The researchers note that although the data are representative of the districts covered by the survey, they are not nationally representative. They conclude that "further efforts are required to ensure universal access and sufficient health education to facilitate the continued improvement of safe sexual behaviors among youth aged 15–24 years."
—L. Melhado
REFERENCE
1. Crossland N et al., Sexual and reproductive health among Ugandan youth: 2003–04 to 2012, Journal of Adolescent Health, 2015, doi: 10.1016/j.jadohealth.2015.06.015.