Sexual risk-taking common among young people in Ugandan fishing communities
Research suggests that 97% are engaging in at least one sexual risk that makes them vulnerable to HIV – and half are engaging in three or more
An investigation into the link between alcohol use, intimate partner violence (IPV), and HIV-related sexual risks among young people in Ugandan fishing communities suggests that nearly all are engaged in behaviours that make them vulnerable to HIV.
The study involving around 500 young people (ages 15-24) found that 97% are engaging in at least one HIV sexual risk behaviour, and half are engaging in three or more.
HIV prevalence in Ugandan fishing communities is thought to be 5-7 times higher than the national prevalence. Despite the need, HIV prevention and treatment strategies are not effectively reaching all those at higher risk of HIV in fishing communities, particularly young people.
For the study, published recently by BMC Public Health, researchers surveyed and interviewed sexually active young people living in Mukono and Namayingo on Lake Victoria between March and July 2020.
More than half (61%) were female, and three-quarters (75%) were age 20–24. Just under half (45%) had primary education and 65% were employed in the last 12 months, although fishing was not the dominant occupation. More than half (70%) were married and two-thirds were parents.
Nearly four in ten (39%) were alcohol drinkers. Of these, 12% were classified as risky drinkers.
Experiences of IPV in the last 12 months were measured using three different scales. The first (HITS scale) suggests 21% had experienced IPV, the second (WAST scale) that 40% had, and the third (AAS scale) that 63% had.
Nearly all respondents (99%) had comprehensive knowledge of HIV, and 64% had used two or more strategies to prevent HIV in the last three months.
But, despite this, 97% reported one or more sexual HIV-risk and 54% reported three or more. The most common HIV risks were not using condoms or using them inconsistently (80%), being sexually active (70%), having a sexually transmitted infection (STI) (40%), having multiple sexual partnerships – reported by one in four (28%) – and a partner reporting an STI (22%).
Further analysis found that alcohol use, working for cash or kind, being married, and having multiple sexual partners increased the odds of HIV risk behaviour.
But IPV was not associated with increased odds of risk behaviour. This contradicts a strong body of evidence, which suggests that abused partners (most commonly women) find it difficult to negotiate safer sex and are more likely than others to have sex in exchange for money or goods. In this study, alcohol use – which affects judgement and reduces the ability to negotiate for safer sex – is a stronger predictor of HIV sexual risk.
A possible reason for this surprising finding could be because data was self-reported. This may mean that participants underreported IPV. They may have also underreported other factors, such as having multiple sexual partners.
The study is based on cross-sectional data, which means conclusions on direct causes and effects relating to alcohol use, IPV, and HIV risk cannot be made.
But despite this, the findings suggest that interventions to promote consistent condom use and fewer sexual partnerships, and youth-friendly STI treatment services, are urgently needed for young people in the Ugandan fishing communities. Initiatives to reduce alcohol use may also prove useful at reducing these young people’s HIV risk.