HIV and AIDS Health Knowledge, and Attitudes Among Adolescents Living with HIV in Southwestern Uganda: Does Gender Matter?

Background: Adolescent girls and young women are disproportionately affected by HIV and AIDS. According to UNAIDS, about 80% of adolescent girls and young women living with HIV are in Sub-Saharan Africa (SSA). In Uganda, the prevalence rate is four times higher in girls compared to boys. Lack of comprehensive HIV prevention knowledge is one of the main reasons cited for the high prevalence of HIV among adolescent girls. A person with comprehensive HIV knowledge is defined as someone who is aware of two major ways of HIV transmission and can reject two most common myths about HIV. Previous studies indicate that HIV health knowledge and attitudes are instrumental to the practice of safe sex and other HIV-risk reduction behaviors among adolescents. Indeed, comprehensive HIV knowledge is essential for reduction of potential super-infection among adolescents living with HIV. However, HIV comprehensive knowledge is limited in many Sub-Saharan countries especially among adolescents. For instance, UNICEF reported that only 26% of adolescent girls and 33 % of adolescent boys aged 15-19 had comprehensive knowledge of HIV. The way adolescents living with HIV navigate the prevention of HIV superinfection varies by gender. However, there is paucity of literature that examines the gender differences on HIV knowledge and attitudes among adolescents living with HIV and AIDS. This study seeks to examine gender differences on 1) HIV prevention attitudes and 2) HIV/AIDS knowledge among adolescents living with HIV.

Methods: We analyzed baseline and 12-months post baseline data from Suubi+Adherence study, a five-year randomized longitudinal trial (2012-2017). We recruited 702 adolescents living with HIV with mean age of 12.4 years, receiving care from 39 health clinics in southern Uganda. To examine gender differences in HIV knowledge and HIV prevention attitudes, we conducted Ordinary Least Squares models that adjust for clustering of adolescents within health clinics.

Results: Both boys and girls reported similar levels of HIV knowledge and prevention attitudes at baseline. At 12 months post baseline, boys were more likely than girls to report positive HIV prevention attitudes [b=1.57; 95%CI; 0.83, 2.33] and higher HIV knowledge [b=0.46; 95%CI; 0.18, 0.75]. In addition, age was associated with positive HIV prevention attitudes [b=0.82, 95%CI; 0.61, 0.1.03] and higher HIV prevention knowledge [b=0.25; 95%CI; 0.18, 0.32].

Conclusion: In Uganda, HIV prevalence rates among adolescent girls are rapidly increasing. The estimated prevalence rate is four times higher in girls compared to boys. Thus, to avert public health consequences, it is important to provide comprehensive and correct HIV knowledge and positive prevention attitudes to adolescent girls. Our results indicate that males have higher scores compared to females. Therefore, there is need to develop or tailor existing programs and interventions that equip adolescent girls with positive attitudes and appropriate HIV prevention knowledge.