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AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20

Sexual behaviour and use of the condom among Ugandan students a

G. S. Lule & L. D. Gruer

b

a

Department of Public Health , University of Glasgow and Department of Public Health, Makerere University , Uganda b

Director, HIV and AIDS Resource Centre, Ruchill Hospital , Glasgow, Scotland UK Published online: 25 Sep 2007.

To cite this article: G. S. Lule & L. D. Gruer (1991) Sexual behaviour and use of the condom among Ugandan students, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 3:1, 11-19, DOI: 10.1080/09540129108253043 To link to this article: http://dx.doi.org/10.1080/09540129108253043

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AIDS CARE, VOL. 3, NO. 1,1991

11

Sexual behaviour and use of the condom among Ugandan students G. S. LULE81 L. D. GRUER~

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Department of Public Health, University of Glasgow and Department of Public Health, Makerere University, Uganda, and 'Director, HIV and AIDS Resource Centre, Ruchill Hospital, Glasgow, Scotland, UK

Abstract HIV infection is widespread in Uganda. Have its university students, the country's leaders of tomorrow, taken appropriate action? A questionnaire was completed by 661 men and 270 women in a one-in-four sample of Makerere University undergraduates (93% response rate). More than 60% of the men and 36% of the women reported ar least two sexual partners in the past year. Over 18% of respondents reported at least one episode of sexually transmitted disease in the past year. Most respondents correctly identified rhe main routes of HIV transmission but risk was also ofen incorrectly associated with non-penetrative sex. Only a minority saw the condom as an eflective preventive method: most saw it as unsafe or an encouragement to promiscuity. Condoms had been used by 35% of men and 24% of women but were currently always used by only 9% of men and 11% of women. The condom was approved of by only one quarter of respondents. Condom use increased with the number of sexual partners but was less likely if the respondent had seen ofJicial publicity about the condom. Wzilst there were some encouraging signs of behaviour change, opportunitiesfor the spread of HIV continue to abound in this important group. More positive promotion of the condom is urgent& required. Introduction Uganda has the largest total of reported AIDS cases of any African country (Toomey, 1989). By February 1990, over 12,400 cases had been reported, most of whom were heterosexual men and women (World Health Organization Weekly Epidemiological Record 1990). Serological surveys have revealed that HIV infection is now prevalent in many parts of Uganda, both urban and rural. The prevalence of HIV among, adults in Kampala, the capital, is estimated at between 5 and 20% (Toomey, 1989, Centre for Communication Programmes, Population Reports 1989). In a recent study of semi-rural areas near Kampala, 10.8% of adults tested were HIV positive (Konde-Lule et al., 1989). Should the spread of HIV infection continue unchecked, Uganda faces the prospect of .massive loss of life, with consequent economic, social and political collapse.

Address for correspondence to: Dr L. D. Gruer, Director, HIV and AIDS Resource Centre, Ruchill Hospital, Glasgow G20 9NB, Scotland, UK.

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G. S. LULE & L. D. GRUER

Though gravely short of resources to deal with the epidemic, the government of Uganda has addressed the problem with commendable openness. It was the first African country to have a well-developed national AIDS control programme (Kingman, 1989). Television and radio broadcast messages urge people to ‘love carefully’ and to avoid indiscriminate sexual relations. Posters and leaflets are also widely used to convey similar messages. A study of almost 4,000 adults in two semi-rural areas close to Kampala showed that 92% of respondents knew that HIV could be sexually transmitted and 89% thought that reducing the number of sexual partners could help avoid infection with HIV. A study in the Rakai district, near the Tanzanian border, revealed a similar level of knowledge (Serwadda et al., 1989). In developed countries, condoms have generally been accepted as having a central role in preventing the sexual transmission of HIV. In developing countries, condoms are not always acceptable or available. Though condoms are available in Uganda, mainly through the Uganda Family Planning Association, they have not been heavily promoted. The Ugandan Government has so far appeared uncommitted to the condom, arguing that its use may not be consistent with local cultural attitudes and practices (Okware, 1988). More importance is attached to self discipline: ‘just say no’ is the politically popular advice. As tomorrow’s leaders, university students are a key group in Uganda’s fight against HIV. Should many become infected, the country’s future will be bleak. Have they understood the risks of HIV infection? Have they taken appropriate action? In an attempt to answer these questions, this study examined reported sexual behaviour, knowledge about HIV, and attitudes to and use of condoms among Ugandan undergraduate students. Because effective use of the condom involves both partners, the study focused on possible differences in response between males and females.

Subjects and methods The study population included all undergraduate students in residence at Makerere University, which until two years ago was the only university in the country. A sample size of 1,000 was chosen, with the aim of including around 300 women. This gave the study 90% power at the 0.02 level of statistical significance to detect a real difference of 15% between male and female responses. The sample was selected by taking every fourth name on an alphabetical list of each of the University’s ten halls of residence. The study was carried out in February and March 1989. The information was collected by means of a questionnaire which contained 50 questions and took about 20 minutes to complete. The questionnaire was based on one developed by a Ugandan national (GSL) for use in similar studies in the United Kingdom. Questions directly related to HIV came at the end of the questionnaire in order to avoid their possible influence on responses to questions about sexual behaviour and the condom. Questionnaires were handed to individual students by the researcher (GSL) in their rooms. They were clearly informed that the purpose of the survey was to find out about the use of the condom and that their responses would be totally anonymous. Each student was requested to complete the questionnaire or indicate that he or she did not wish to do so. In either case, they were asked to put it in the envelope provided and hand it back to the researcher within approximately half an hour. All data were coded, and analysed using the Statistical Package for Social Scientists-x (SPSS-x), and BioMeDical Programme (BMDP) software. Following calculation of Mantel Haenszel chi-square statistics, a multivariate analysis was conducted on those variables which had a high statistical significance of association with use of the condom. A logisticregression model was used to determine the independent contribution to condom use of 11

SEXUAL BEHAVIOUR AND CONDOM USE IN UGANDA

13

variables covering high risk sexual behaviour, HIV knowledge and attitude to, and knowledge of the condom.

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Results

The questionnaire was fully completed by 661 of the 700 male students (94%) and 270 of the 300 female students (90%) to whom it was offered, giving a nia1e:female ratio of 2.4:l. The male respondents had a mean age of 23.9 years (SD2.5) and the females 22.3 years (SD 2.2). All 12 faculties and all the possible five years of undergraduate study were represented. Over 90% of males and 93% of females reported previous sexual intercourse. The mean age of first sexual intercourse was 15.3 years (SD 2.9) for men and 17.4 years (SD 3.3) for women. More than 2% of respondents reported intercourse before the age of 10. Less than 10% of the men and about 30% of the women had not had intercourse by the age of 20 years. The lifetime total of different sexual partners reported by respondents is shown in Table 1.A much higher proportion of men had had multiple sexual partners, with more than one-third of the men but only 2% of the women reporting more than 10 partners. Less than 20% of all respondents had had only one sexual partner. More than 60% of the men reported having had at least two sexual partners in the past 12 months, compared with less than 40% of the women (Table 2). Over 57% of men and 55% of women reported having sexual partners suspected by the respondent of having sex with more than one person. About 7% of the men and 6% of the women reported having directly exchanged money for sex in the past 12 months. Table 1. The lifetime total of sexual partners reported by respondenrs (row percentage in brackets) Number of partners 2-5 6-10 Over 10

Total

0

1

Male

29 (4.4)

59 (8.9)

149 (22.5)

197 (29.8)

227 (34.3)

661

Female

18 (6.7)

94 (34.8)

128 (47.4)

25 (9.3)

5 (1.9)

270

Total

47 (5.0)

153 (16.4)

277 (29.8)

222 (23.8)

232 (24.9)

931

~ = 2 3 5 . 1 3(4 df)pt0.00001.

Table 2. Number of sexual partners in the last 12 montlis (row percentage in brackets)

Number of partners 2-5 6-10 over 10

0

1

Male

116 (17.5)

129 (19.5)

323 (48.9)

73 (11)

20 (3.0)

66 I

Female

92 (34.1)

79 (29.3)

94 (34.8)

3 (1.1)

2 (0.7)

270

Total

208 (22.3)

208 (22.3)

417 (44.8)

76 (8.2)

22 (2.4)

931 100

x2=67.43 (4 d f ) ptO.OOO1.

Total

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G. S. LULE & L. D. GRUER

About 19% of the male respondents and 17% of the females admitted to at least one episode of a sexually transmitted disease in the past 12 months. Twenty-two per cent of the male respondents but only 7% of the females thought they were at risk of catching HIV due to their behaviour (x2=28.84, p

Sexual behaviour and use of the condom among Ugandan students.

HIV infection is widespread in Uganda. Have its university students, the country's leaders of tomorrow, taken appropriate action? A questionnaire was ...
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