Socio-Cognitive Factors Associated With Condom Use, Multiple Sexual Partnerships, and Contraception Use Among Sexually-Active Adolescent Girls in Uganda

Abstract

Many adolescent girls start sexual activity early which exposes them to health risks of HIV and unplanned pregnancies. However, adolescent girls are less likely than boys to initiate discussion or demand use of condoms. Multiple sexual partnerships among girls are reported to be on the rise with eminent transactional sex and pre-marital relationships. The unmet need for contraception among adolescent girls is also high. A cross-sectional survey covering 16 districts in Uganda assessed the socio-cognitive factors associated with condom use, multiple sexual partnerships and contraception use among sexually active adolescent girls (N=255). There were strong associations between feeling confident to discuss contraceptive methods with a partner (OR = 9.41, 95 % CI = 3.54, 25.06), being comfortable to use contraception (OR = 30.61, 95% CI = 4.10, 228.64), discussing contraception use with someone (OR = 10.53, 95% CI = 5.61, 19.78), and contraception use. Whereas knowledge was found to have no significant relationship with service uptake, information services remain important in clearing any misconceptions and addressing any health concerns. It is imperative to explore communication factors including skills development and providing adequate health information to guide dialogue among adolescents and their key influencers.

Application of Core Processes for Understanding Multiple Concurrent Sexual Partnerships Among Adolescents in Uganda

“…Although studies found that males are more likely to have multiple concurrent sexual partners than females, it is still unclear why adolescents with HIV are more likely to be female than male if MCSP increases the risk of contracting HIV (1, 38). It is also not yet clear why adolescents attending family planning clinics are eager to address their reproductive concerns, but appear to be less concerned about STDs (36, 37). This indicates an urgent need to discover why adolescents continue to risk contracting HIV through sexual activity.…”

“…Knowledge of the risks of MCSP among adolescents and their influencers was found to be inadequate and often intertwined with myths and misconceptions (65). Although several studies on adolescent sexual behaviors found that knowledge is weakly associated with the performance of the actual behaviors (36, 65, 67), information services remain important in clearing misconceptions and addressing health concerns. Brainstorming sessions and the literature showed that adolescents have low levels of self-efficacy toward having one sexual partner, often associated with the perception that peers have multiple sexual partners (34, 38).…”

“…Even with the existing empirical literature, there are still unanswered questions and missing links that need to be addressed to increase the understanding of why adolescents engage in MCSP. Not yet known are sexual relationship patterns among adolescents (95, 96), and why adolescents are more concerned about unplanned pregnancy than HIV risk (36, 37). Several studies in Uganda have reported that adolescents are increasingly becoming sexually active, depicted by early sexual debut since many adolescents report starting sex as early as 14 and 15 years (1, 2).…”

“…However, it is not yet clear whether an early sexual debut eventually influences MCSP among adolescents (1, 34, 97, 98). The gap in understanding gender differences in multiple concurrent sexual relationships remains a challenge (36, 39). It is also not yet clear whether relationships in which an adolescent is younger than his or her sexual partner are characterized by violence and sexual coercion.…”

“…It is also not yet clear whether relationships in which an adolescent is younger than his or her sexual partner are characterized by violence and sexual coercion. It is imperative to understand the power balance dynamics in all sexual relationships, including MCSP in the light of married and unmarried adolescents, and those who are in-and-out of school (36, 39, 53, 58). There is inadequate documentation of the sequence and frequency of sexual partners, coupled with underreporting of sexual partners among adolescents (5, 35).…”