Is sexual risk taking behaviour changing in rural south-west Uganda? Behaviour trends in a rural population cohort 1993–2006
- S Biraro1,
- L A Shafer1,
- I Kleinschmidt2,
- B Wolff1,
- A Karabalinde1,
- A Nalwoga1,
- J Musinguzi3,
- W Kirungi3,
- A Opio3,
- J Whitworth4,
- H Grosskurth1
- 1Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda
- 2London School of Hygiene and Tropical Medicine, London, UK
- 3Ministry of Health, Government of Uganda
- 4Wellcome Trust
- Dr L A Shafer, MRC/UVRI Uganda Research Unit on AIDS, P O Box 49, Entebbe, Uganda;
- Accepted 19 January 2009
Objective: To describe sexual behaviour trends in a rural Ugandan cohort in the context of an evolving HIV epidemic, 1993–2006.
Methods: Sexual behaviour data were collected annually from a population cohort in which HIV serological surveys were also conducted. Behaviour trends were determined using survival analysis and logistic regression. Trends are reported based on the years in which the respective indicators were collected.
Results: Between 1993 and 2006, median age at first sex increased from 16.7 years to 18.2 years among 17–20-year-old girls and from 18.5 years to 19.9 years among boys. Both sexes reported a dip in age at sexual debut between 1998 and 2001. One or more casual partners in the past 12 months among men rose from 11.6% in 1997 to 12.7% in 2004 and then declined to 10.2% in 2006. Among women it increased from 1.4% in 1997 to 3.7% in 2004 and then reduced to 1.4% in 2006. The rise in casual partners between 1997 and 2004 was driven mainly by older age groups. Trends in condom use with casual partners varied by age, increasing among those aged 35+ years, declining in the middle age groups and presenting a dip and then a rise in the youngest aged group (13–19 years).
Conclusion: Among youth, risky behaviour declined but increased in the late 1990s/early 2000s. Among those aged 35+ years, condom use rose but casual partners also rose. Several indicators portrayed a temporary increase in risk taking behaviour from 1998 to 2002.
Contributors: SB and LAS conducted literature review and wrote the manuscript. LAS and IK conducted statistical analyses. BW, a social scientist, advised on aspects of the paper such as which combination of sexual behaviour indicators to analyse. AK and AN are the team leaders, overseeing data collection and field activity within the cohort described in this paper; they both contributed with a deep understanding of the community norms and values. JM, WK and AO provided useful input from the side of the Ugandan MoH, such as trends in MoH antenatal clinics and trends in sexual behaviour found in the MoH serobehavioural survey. JW was the director of the Medical Research Council Programme on AIDS (Uganda) from 1995 to 2001 and HG has been the director since 2002. All co-authors contributed to decisions on the content of the paper and all co-authors commented on drafts of the paper.
Funding: Funded by the UK Medical Research Council.
Competing interests: None.
Ethics approval: The study was approved by the Science and Ethics Committee of the Uganda Virus Research Institute and the Uganda National Council of Science and Technology.