Transcript Condom use between and within relationships among young people in Kabale and Mukono districts in Uganda

Condom use across and within
relationships among young people
in Uganda: A case of Kabale and
Mukono districts
Nazarius Mbona Tumwesigye
Roger Ingham
David Holmes
University of Southampton
Contact: [email protected]
BSPS annual conference, 12-14 September 2005, Canterbury
Outline
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Introduction
Objectives
Literature
Methods
Results
Discussion
Conclusion
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Introduction
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When consistently and correctly used
condoms can prevent 90-95% of HIV
Uganda still has high HIV prevalence (6.2%)
and unplanned pregnancies
Estimated 192 HIV infections per day, 70170
per year
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Introduction: Why study dynamics of
condom use?
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At a relatively high level of condom use, focus on
dynamics becomes important –38% in Ghana, 43%
Kenya, 58% in Uganda
Indications of high inconsistent condom use in the
country- only 4.4% consistently use in Rakai
Lack of data
ABC model spreading to other countries and change
of focus
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Study areas
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Highlights regional differences in economy, access to services
Sudan
DRC
Mukono
Kampala
Kenya
Kabale
Tanzania
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Objectives
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Establish the level and trend of condom use
between and within relationships
Identify associated factors
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Literature review to identify possible
associated factors
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Decline in condom use with time (Ku et al. 1994)
and number of sexual partners (Richter et al. 1993)
Age, education level, casual relationship (Catania et
al. 1994 & 1998)
Age at first sex (Tavares et al. 2002)
Alcohol (Ray et al. 1998)
Media and attitudes (Adetunji & Meekers 2001)
Communication with parents (Rodgers,1999)
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Methods
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Stratified cluster sample of 786 unmarried youth
aged 15-24, 445 of whom were sexually active
Questions on sexual practices on first, second to
latest and latest relationships
Data on all relationships pooled together
Logistic regression for condom use
Multinomial logistic regression for consistency
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Used at both 1st & last event, use at one of two events,
none use at both events
Checked cluster effect with multilevel model
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Characteristics of respondents
Characteristics
Percentages
Sex
male: 47; female: 53
District
Kabale: 43; Mukono: 59
Age group
15-16: 28;17-18: 28; rest: 44
Education
None: 4; Primary: 34; Secondary: 62
In school
51
1st sex partner
steady: 70; casual: 30
First sex
<1yr: 48; 2-5yrs: 34; >5yrs: 18
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Number of responses
No. of
First relationship
relationships
first
last
Second latest
relationship
Latest relationship
first
last
first
last
One
220
205
--
--
--
--
Two
139
131
--
--
139
138
Three
86
76
86
73
86
83
Total
445
412
86
73
225
221
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Condom use levels in first, second
latest and latest relationships
80.0
70.0
60.0
Percent
50.0
40.0
30.0
20.0
10.0
0.0
First sex
Last sex
First
First sex
Last sex
Second latest
First sex
Last sex
Latest
Relationships
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Logistic regression: Condom use at
anytime in each relationship
Variable
First
Second
Latest
District (Mukono/Kabale)
***
***
**
Gender (women/men)
***
Age group (22-23,21-22,19-20,17-18,15-16)
**
In school (yes/no)
***
Sec. Educ (yes/no)
Age 1st sex (15+/<15 years)
**
***
Type of school (public/religion/private)
*
Positive attitude (high/medium)
**
Condom use at 1st sex (yes/no)
---
Listens to radio (yes/no)
*
*
**
*
*
***
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Logistic regression: Condom use at any time
Variable
Significance
District (Mukono/Kabale)
***
Gender (women/men)
***
Age group (22-23,21-22,19-20,17-18,15-16)
**
In school (yes/no)
***
Sec. Educ (yes/no)
**
Age 1st sex (15+/<15 years)
***
Type of school (public/religion/private)
*
Positive attitude (high/medium)
**
Condom use at 1st sex (yes/no)
***
Radio (yes/no)
*
Type of partner (steady/casual)
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Time since first sex (1/2-5/5+years)
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Sex event (first in 1st of 3 relationships……….last in one relationship).
***
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Predicted levels of condom use at each
event
80
72
70
64
64
63
61
60
56
54
54
Percent
50
44
43
42
40
36
30
20
10
0
Last sex
First sex
First sex
Last sex
Second last
First
Last sex
First sex
Latest
Relationships
Three
Tw o
One
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Correlates of consistent condom use
from multinomial logistic model
Variable
Consistent
Inconsistent
District (Mukono/Kabale)
***
***
Gender (women/men)
**
In school (Yes/no)
*
Education (Sec/Primary)
**
Age at first sex (15+/<15)
***
***
Relationship (3rd /2nd/1st)
**
**
Length of relationship
(2+/1/<1 years)
*
***
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Predicted level and consistency of
condom use
80.0
72
70.0
64
Percentage
60.0
50.0
60
62
55
51
49
43
40.0
48
30.0
20.0
21
17
16
10.0
0.0
First sex
Last sex
First
First sex
Last sex
Second last
First sex
Last sex
Latest
Relationship
Consistent use
Inconsistent use
Condom use at each event
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Discussion
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Results not in agreement with those of Ku et al. (1994)
and Richter (1993)
Condom use higher among steady partners, unlike in
Catania (1994)
Alcohol not a significant factor on use as in Ray et al.
(1998)
Foundation of school an important factor
Communication with parent not significant as in Rodgers
(1999)
Findings on age,age at 1st sex,attitude as in others
studies
More opportunity for influence in first relationship
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Conclusions and implications
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There are significant changes in condom use
between and within relationships
The level and consistency in condom use grows
with time
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Conclusion and implications cont’d
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Policy and programme may refocus on:
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Inequalities in access to sexual health services
between districts
Differences in practices by gender, age groups,
schooling status
Media as an important tool
Raising attitudes to condom use and steady
partnerships
Increasing age at first sex and condom use at first sex
through balanced ABC campaigns
Abstinence-only programmes may worsen the
already low condom use at first sex
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Thanks for your attention