Increased sexual risk-taking behaviors, such as early sex debut and inconsistent condom-use, increase the risk of HIV spread. However, most studies on understanding the drivers of sexual risk-taking behaviors target HIV negative adolescents. We explored the factors influencing sexual risk-taking intentions among adolescents living with HIV (ALHIV) in Uganda.
We used baseline data from a five-year cluster-randomized trial (2012 to 2018) among 702 ALHIV, recruited from 39 clinics in Southern Uganda, an area hard-hit by HIV. Participants were aged 10 – 16 years, HIV positive, taking antiretroviral therapy, and living with a family. We fitted hierarchical linear regression models to assess the predictors of sexual risk-taking attitudes. We added blocks of related variables to determine the effect of each block contributed to the total variance explained. Block 1 included individual and family level factors, model 2 included social factors in addition to individual factors (model 1). In model 3 we added economic factors to model 2, and in model 4 we added psychological factors to model 3. We determined increases in R2 for each model. We reported robust cluster-adjusted standard errors to further cater for clustering.
The mean age was 12.4 years, 56% were females, and 33 (5%) had previously had sexual intercourse, of whom 10 did not use a condom. None of the individual factors were significantly associated with sexual risk-taking attitudes. However, social factors including communicating with the guardian about HIV (β= 1.40, 95% CI: 0.60 – 2.20), about sex (β= 1.10, 95% CI: 0.25 – 1.96), and experiencing peer pressure (β= 3.32, 95% CI: 1.78 – 4.86), were associated with increased sexual risk-taking attitudes. Under economic factors, coming from a household where the caretaker is formally employed (β= -0.008, 95% CI: -0.01 – -0.005), and the ALHIV working for pay (β= 1.74, 95% CI: 0.24 – 3.24, p value=0.024), were associated with sexual risk-taking intentions. Among the psychological factors, depression (β= 0.22, 95% CI: 0.11 – 0.33), was associated with increased sexual risk-taking intentions. The model explained 11.87% of the total variance.
These results show that in Uganda, psychosocial and economic influence sexual risk-taking intentions among ALWHIV. There is a need for more research to understand why discussing with guardians about sex increases sexual risk-taking intentions. These findings have significant ramifications in controlling HIV spread among adolescents in low-income settings.