Family Factors and Gender Norms As Protective Factors Against Sexual Risk-Taking Intentions Among Adolescent Girls in Southern Uganda

Background and Purpose: Sexual risk-taking behaviors significantly contribute to the global burden of disease. Risk behaviors, including the practice of unsafe sex, inconsistent use of condoms, having multiple sexual partners, early sexual debut, transactional sex, and high-risk sexual partners, are all major contributors to the sustained spread of HIV among adolescents and young people. In 2018, 1.6 million adolescents between 10-19 years were living with HIV worldwide; out of these 1.4 million were adolescent girls. In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) account for 74% of new HIV infections. In Uganda, the prevalence rate of HIV infection among AGYW is 4 times higher than young men of the same age. Risk factors, such as poverty, harmful traditional gender norms, gender-based violence and lack of educational opportunities, heighten the risk of engaging in sexual risk-taking behaviors. Given the high prevalence of HIV among adolescent girls, it is critical to explore potential protective factors that may reduce sexual risk-taking behaviors among this group. This study examines the protective role of family factors and gender norms in addressing sexual risk-taking intentions among high school adolescent girls in Southern Uganda.

Methods: We analyzed baseline data from a National Institutes of Health funded study called Suubi4Her, addressing risks that expose high school adolescent girls to HIV infection. Adolescents were eligible to participate in the study if they were: 1) female, 2) aged 14–17 years, 3) enrolled in the first or second year of secondary school, and 4) living within a family (broadly defined and not an institution or orphanage). Adolescents were identified and recruited from 47 secondary schools in five geopolitical districts in southern Uganda. Data were collected using a 90-minute interviewer administered survey. Sexual risk-taking intentions were measured by items related to engaging in unsafe sex, sex with a stranger, and coerced sex. Family factors were assessed via the following items: family cohesion, family care and relationships, social support from multiple sources, family communication and child-caregiver support. Gender norms were measured using items adapted from the Attitudes Towards Women Scale for Adolescents. Hierarchical regression models were conducted to determine the predictors of sexual risk-taking intentions.

Results: Controlling for participants’ sociodemographic and household characteristics, family care and relationships (b = -.07, 95% CI= -.12, -.02, p ≤.01), social support from peer/friend (b = -0.06, 95% CI= -0.09, -0.03, p ≤.001), and having more desirable gender norms that give equal consideration to both girls and boys (b=-0.13, 95% CI= -0.25, -0.01, p ≤.05), were all associated with lower levels of sexual risk taking intentions among adolescent girls.

Conclusions and Implications: Findings contribute to the body of knowledge related to the predictors of sexual risk-taking intentions among adolescent girls in SSA. Findings may also inform novel interventions that focus on strengthening family relationships and correcting harmful gender norms that tend to disadvantage girls in favor of boys, limiting their full potential. Moreover, information about sexual risk-taking behavior is essential to the design and assessment of interventions to improve sexual health among adolescents.