Between love and fear - determinants of sexual behavior among Ugandan university students

Background: More than half of all new HIV infections in sub-Saharan African countries, including Uganda, occur among young people between the ages of 15 and 24, the most sexually active period of their lives. Understanding the contextual determinants of sexual behavior in this group is crucial in combating the pandemic. Aim: The overall aim of this study was to assess the impact of demographic, religious, social capital, mental health, and sexual coercion factors on risky sexual behavior among a student population in Uganda in order to gain a deeper understanding of the forces that shape sexual behavior of young people with the purpose of contributing to policy formulation and implementation of more effective interventions to prevent the spread of HIV/AIDS. Method: In 2005, 980 Ugandan university students responded to a self-administered questionnaire (response rate 80%) that assessed socio-demographic, social capital, and religious factors, as well as alcohol use, mental health, experience of sexual coercion, age of sexual debut, number of sexual partners, and condom use. Mental health was assessed using items from the Hopkins Symptoms Checklist-25(HSCL-25) and the Symptom Checklist-90 (SCL-90). Logistic regression analysis was applied as the main analytical tool, and synergistic effects between some of the main determinants were investigated. Results: Thirty-seven percent of the male and 49% of the female students had not previously had sexual intercourse. Of the male and female students with sexual experience, 46% of the males and 23% of the females had had three or more lifetime sexual partners, and 32% of the males and 38% of the females did not consistently use condoms with a new partner. Minor importance of religion in one’s family while growing up was correlated to a statistically significant degree with early sexual debut and having many sexual partners (OR 1.7, 95% CI: 1.2–2.4 and OR 1.6, 95% CI: 1.1–2.3, respectively). Being of Protestant faith interacted with gender among those who had debuted sexually. Protestant female students were more likely to have had three or more sexual partners; the opposite was true for Protestant male students. Non-dominant bridging trust among male students was associated with a higher risk for having had many sexual partners (OR 1.8, 95% CI: 1.2–2.9). Low trust in others was associated with a greater likelihood of sexual debut in men, while the opposite was true in women. A similar pattern was seen regarding a high number of lifetime sexual partners in individuals who were raised in families where religion played a major role. After controlling for potential confounding factors, high scores on depression and a high number of sexual partners were significantly associated among both males (OR 2.0, 95% CI: 1.2–3.3) and females (OR 3.3, 95% CI: 1.3–8.6). Elevated anxiety scores among men were associated with a high number of sexual partners (OR 1.9, 95% CI: 1.1–3.3) and inconsistent condom use (OR 1.9, 95% CI: 1.1–3.6). Experience of sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI: 1.1−2.3), early sexual debut (OR 2.4, 95% CI: 1.5−3.7), as well as with having had a high number of sexual partners (OR 1.9, 95% CI: 1.2−3.0), but not with inconsistent condom use. Good mental health scores, reporting high trust in others, or stating that religion played a major role in one’s family of origin seemed to buffer the effect that the experience of sexual coercion had on the likelihood of having many sexual partners. Conclusion: Religion, social capital, mental health, and sexual coercion appear to be important determinants of sexual behavior among Ugandan university students. Using such knowledge, one may design and implement more effective programs to prevent the spread of HIV/AIDS. Policy makers would benefit from involving young people in the planning of interventions against HIV/AIDS, and in the formulation and implementation of youth-friendly policies to better understand how strategies should be tailored in relation to the needs of the target group. It would also be desirable to introduce coordinated youth-friendly health services to address both the psychological as well as the sexual and reproductive health-related concerns of young people

Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana

Introduction: The fight against maternal deaths has gained attention as the target date for Millennium Development Goal 5 approaches. Induced-abortion is one of the leading causes of maternal deaths in developing countries which hamper this effort. In Ghana, alcohol consumption and unwanted pregnancies are on the ascendancy. We examined the association between alcohol consumption and maternal mortality from induced-abortion. We further analyzed the factors that lie behind the alcohol consumption patterns in the study population. Method: The data we used was extracted from the Ghana Maternal Health Survey 2007. This was a national survey conducted across the 10 administrative regions of Ghana. The survey identified 4203 female deaths through verbal autopsy, among which 605 were maternal deaths in the 12 to 49 year-old age group. Analysis was done using Statistical software IBM SPSS Statistics 20. A case control study design was used. Cross-tabulations and logistic regression models were used to investigate associations between the different variables. Results: Alcohol consumption was significantly associated with abortion-related maternal deaths. Women who had ever consumed alcohol (ORadjusted 2.6, 95% CI 1.38-4.87), frequent consumers (ORadjusted 2.6, 95% CI 0.89-7.40) and occasional consumers (ORadjusted 2.7, 95% CI 1.29-5.46) were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. Maternal age, marital status and educational level were found to have a confounding effect on the observed association. Conclusion: Policy actions directed toward reducing abortion-related deaths should consider alcohol consumption, especially among younger women. Policy makers in Ghana should consider increasing the legal age for alcohol consumption. We suggest that information on the health risks posed by alcohol and abortion be disseminated to communities in the informal sector where vulnerable groups can best be reached

Spatial analysis of skilled birth attendant utilization in ghana.

Maternal mortality is a major health problem in most resource-poor settings, especially in sub-Saharan Africa. In Ghana, maternal mortality remains high and births attended by skilled health professionals are still low despite the introduction, in 2005, of free maternal health care for all women seeking care in public health facilities

Youth, Sexual Risk-Taking Behavior, and Mental Health: a Study of University Students in Uganda

BACKGROUND: Little focus has been paid to the role of mental health among young people with regard to risky sexual behavior and HIV prevention in sub-Saharan Africa. The aim of this study was to investigate the relationship between poor mental health and risky sexual behavior (HIV/AIDS) among a population of university students in Uganda. METHODS: In 2005, 980 Ugandan university students completed a self-administered questionnaire (response rate 80%) assessing sociodemographic and religious background factors, mental health, alcohol use, and sexual behavior. Mental health was assessed using items from the Hopkins Symptoms Checklist-25 and the Symptom Checklist-90. RESULTS: High scores on depression and high numbers of sexual partners among both males (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2-3.3) and females (OR 3.3, 95% CI 1.3-8.6) were significantly associated. Elevated anxiety scores among men were associated with high numbers of sexual partners (OR 1.9, 95% CI 1.1-3.3) and inconsistent condom use (OR 1.9, 95% CI 1.1-3.6). Psychoticism was also significantly associated with high numbers of sexual partners among men. The associations remained statistically significant after controlling for sociodemographic factors and level of alcohol consumption. CONCLUSION: These findings indicate that previous conclusions on the association between sexual behavior and mental health from high- and middle-income countries also are valid in a low-income setting, such as in Uganda. This knowledge has implications for policy formation and HIV/AIDS preventive strategies. Coordinated youth-friendly mental health and sexual and reproductive health services to meet the needs of young people would be desirable

Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students.

As reflected in elevated rates of sexually transmitted infections, there is a high prevalence of risky sexual behavior among Ugandan university students. It has been assumed that alcohol contributes to risky sexual behavior. However, perhaps owing to methodological issues, this relationship has found only mixed support in empirical research. The present study analyzes the association between alcohol use and risky sexual behavior at the global, situational, and event level among Uganda university students with sexual experience

Association between Self-Reported Academic Performance and Risky Sexual Behavior among Ugandan University Students- A Cross Sectional Study.

Little is known about the association between self-reported academic performance and risky sexual behaviors and if this differs by gender, among university students. Academic performance can create psychological pressure in young students. Poor academic performance might thus potentially contribute to risky sexual behavior among university students. The aim of this study was to investigate the association between self-reported academic performance and risky sexual behaviors, and whether gender affects this relationship among Ugandan university students. In 2010, 1,954 students participated in a cross-sectional survey, conducted at Mbarara University of Science and Technology in southwestern Uganda (72% response rate). Multivariate logistic regression analysis was used for the analysis. 1,179 (60.3%) students in our study sample reported having debuted sexually. Of these 440 (42.2%) used condoms inconsistently with new sexual partners, and 344 (33.6%) had had multiple sexual partners. We found a statistically significant association between poor academic performance and inconsistent condom use with a new sex partner and this association remained significant even after adjusting for all the potential confounders. There was no such association detected regarding multiple sexual partners. We also found that gender modified the effect of poor academic performance on inconsistent condom use. Females, who were poor academic performers, were found to be at a higher risk of inconsistent condom use than their male counterparts. Interventions should be designed to provide extra support to poor academic performers, which may improve their performance and self-esteem, which in turn might reduce their risky sexual behaviors

The Invisible Suffering: Sexual Coercion, Interpersonal Violence, and Mental Health - A Cross-Sectional Study among University Students in South-Western Uganda.

Despite a history of conflicts and widespread human rights violation in sub-Saharan Africa, little is known about the prevalence of interpersonal violence among the population in this region. Evidence from high-income countries suggests that exposure to violence has mental health consequences and violence also has associations with experiences of sexual coercion

Global health education in Swedish medical schools.

Global health education is increasingly acknowledged as an opportunity for medical schools to prepare future practitioners for the broad health challenges of our time. The purpose of this study was to describe the evolution of global health education in Swedish medical schools and to assess students' perceived needs for such education