ObjectiveThis study sought to determine the prevalence of transactional sex among university students in Uganda and to assess the possible relationship between transactional sex and sexual coercion, physical violence, mental health, and alcohol use.MethodsIn 2010, 1954 undergraduate students at a Ugandan university responded to a self-administered questionnaire that assessed mental health, substance use, physical violence and sexual behaviors including sexual coercion and transactional sex. The prevalence of transactional sex was assessed and logistic regression analysis was performed to measure the associations between various risk factors and reporting transactional sex.ResultsApproximately 25% of the study sample reported having taken part in transactional sex, with more women reporting having accepted money, gifts or some compensation for sex, while more men reporting having paid, given a gift or otherwise compensated for sex. Sexual coercion in men and women was significantly associated with having accepted money, gifts or some compensation for sex. Men who were victims of physical violence in the last 12 months had higher probability of having accepted money, gifts or some compensation for sex than other men. Women who were victims of sexual coercion reported greater likelihood of having paid, given a gift or otherwise compensated for sex. Respondents who had been victims of physical violence in last 12 months, engaged in heavy episodic drinking and had poor mental health status were more likely to have paid, given a gift or otherwise compensated for sex.ConclusionsUniversity students in Uganda are at high risk of transactional sex. Young men and women may be equally vulnerable to the risks and consequences of transactional sex and should be included in program initiatives to prevent transactional sex. The role of sexual coercion, physical violence, mental health, and alcohol use should be considered when designing interventions for countering transactional sex.

In 2010, unmet medical care and sexual health counseling needs were assessed among students at a Ugandan University. Unmet medical care need was associated with poor mental health, experience of sexual coercion, and poor self-rated health. Unmet sexual health counseling need was significantly associated with being female, coming from an urban area, low social participation, poor mental health status, experience of sexual coercion, poor self-rated health, inconsistent condom use, and having multiple sexual partners. Gender differences, poor mental health, sexual coercion, poor self-rated health, and risky sexual behavior must be considered when designing intervention models to reduce unmet health care needs among young people in this setting.

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.

IntroductionUganda, like most Sub-Saharan African countries, has comprehensive HIV prevention campaigns, yet programs tailored to young adults are completely lacking.MethodsIn 2016, 202 18–22 year olds were recruited from across Uganda via Facebook to take part in online, 3 day, asynchronous focus groups (FGs). The aim of the FGs was to understand sexual health decision making to inform HIV prevention content development. The study sample was purposefully balanced on age, district, educational attainment, employment status, and income. Eight FGs were conducted; participants were stratified by sex and sexual behaviour in the past 12 months.ResultsYong adults who were abstinent said they were making this choice because they treasured virginity; and wanted to stay STD-free and avoid pregnancies. There were drawbacks, particularly for women who said that their boyfriends may leave if they did not have sex. Peer pressure and feeling excluded from those who were having sex were also disadvantages. Ugandan young adults talked about the cultural norm of having multiple partners, both for financial gain and social status. Using condoms was universally noted as the right thing to do. At the same time, sexually active youth voiced several barriers to condom use, including: being allergic to rubber, fear of getting cancer with frequent use, and embarrassment.When asked about how confident they were in negotiating condoms, sexually experienced women voiced a range or responses from ‘I can’t at all’ to ‘sometimes’ to ‘always’.Refusing sex was possible: If a woman did not want to have sex, respondents said she could blame it on her period and if a man did not want to have sex, he could say he was ‘tired’. That said, all agreed that the refusal of sex in a relationship could be met with consequences (e.g., distrust by one’s partner, an end to the relationship).ConclusionSeveral important challenges that Uganda young adults faces in making healthy sexual decisions were voiced. These issues need to be directly addressed in HIV prevention programs tailored to this age group.