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Munezero1 TJB and Mfitumukiza1 V

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Citation:

Munezero TJB and Mfitumukiza V. Utilization of HIV/AIDS Interventions and associated factors among young people aged 15-30 in Bushenyi District Uganda. Special Journal of Public Health, Nutrition, and Dietetics. 2021, 2(1): 1-15

Highpoints

  • A cross-sectional survey with Triangulation of both qualitative and quantitative approaches was employed on 341 respondents and 8 key informants to assess utilization of HIV/AIDS interventions and associated factors among sexually active young people aged 15-30 in the Bushenyi District. essence
  • The study focused on the assessment of interventions to prevent HIV/AIDS and associated factors in young people.
  • The findings revealed poor utilization of HIV/AIDS prevention interventions among young people aged 15-30 in the Bushenyi District.

 Abstract

Background:

There is a bulk of new AIDS cases among young people; aged 15-30 and females are disproportionately affected. Clarifying the underlying factors of this gender disparity may have policy implications in the design and implementation of effective intervention

Objective:

The purpose of this study was to assess the Utilization of HIV/AIDS Interventions and associated factors among young people aged 15-30 in Bushenyi District Uganda 

Methods:

A cross-sectional survey was employed on 341 respondents and 8 key informants. Triangulation of both qualitative and quantitative data collection methods was used.

Results.

This study depicts 23% were sexual abstinence, 77% sexually active population, 21% had sex before 15 years, 68 % by 19 years, 48.7% had never used condoms, and 32% had multiple sexual partners, 24% males were circumcision and 55% knew their HIV status.  Religious disapproval of condom use and male medical circumcision, HCT seeking behaviour, and trusting of sexual partners regarding condoms use were remarkable factors reported.

Conclusions:

Poor utilization of abstinence, condom, HCT, and Male circumcision in HIV/AIDS prevention among the young people and early sex debut before 15 years impacted HIV transmission among this population

Keywords:  young people, HIV/AIDS, prevention, Sexual behavior, Prevalence

 Address

  1. School of Medicine, Department of Nursing Sciences, Kabale University, Box 317 Kabale, Uganda

Address Correspondence 

The corresponding author: Munezero Tamu John Bosco Email address: tmunezero@kab.ac.ug/munezerotamu@gmail.com         Tel:     +256779904787

Article history:

Received September 18, 2021: Accepted: November 3rd, 2021:  Published:  10th November 2021

 Distribution and usage license:

This open-access article is distributed by the terms and conditions of the Creative Commons Attribution 4.0 International License seen in this link (http://creativecommons.org/licenses/by/4.0/ ). You are free to use, distribute, and reproduce this article in any medium, provided you give correct credit to the original author(s) and the source, including the provision of a link to the Creative Commons license website. Pls show any modification’s

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Background

Globally, the majority of new HIV infections among young people young than 22 years occur through sexual activity.[1] HIV/AIDS is the fourth leading cause of death and the human toll from the epidemic remains unacceptably large. Human sexual behavior and HIV prevention remain one of the world’s most important priorities. [1, 2]

In sub–Saharan Africa, Studies are done indicating that School-based interventions are suggested to increase young people’s knowledge of sexuality, reproductive health, and HIV prevention.[3] Assessing sexual health and HIV has continued to be at the forefront of policies, guidelines, and initiatives, for ascertaining what works in the field of HIV prevention. [4].In Uganda, it is now 3 decades ago since HIV/AIDS epidemic was confirmed in 1982.[5]. However, until today, it has continued to pose serious public health and social development challenges and has remained a complex and devastating disease.[1]

The first AIDS Control Programme was launched in 1987 to educate the public about how to avoid becoming infected with HIV. The program included robust HIV prevention campaigns promoted as ABC approach that is; Abstinence, Faithfulness/partner reduction that was often covered in combination with the “zero grazing” concept and Condom use [5,6]. The campaign was led by community-based organizations known as the AIDS Support Organization (TASO), which was run by sixteen volunteers who had been personally affected by HIV/AIDS. [6]

Uganda maintained its ground and accelerated HIV/AIDS prevention through a number of preventive interventions at both national, community levels, and individual levels. [7,8]. The preventive interventions included promotion of safe sex practices through ABC messages; delayed sex initiation emphasized by the churches and promoted by PEPFAR an American organization that also extended abstinence messages in schools through straight talk Foundation and provision of male medical circumcision at all HC IV and Hospitals. This led to a success story for Uganda in the history of HIV/AIDS prevention in the world. [7]

According to Gray et al [8], Uganda’s HIV prevalence steadily increased until about 1991, when it peaked at about 15% (30% among pregnant women in urban areas) and then turned sharply down through the mid-1990s and reached 5% (14% for pregnant urban women). HIV education promoted by UHMG, religious, and community-based institutions, Uganda went beyond ABC-Delayed sex-EF to provide HIV testing, and surprisingly Uganda was the first country in sub-Saharan Africa to open a voluntary counseling and testing (VCT) clinic in the mid-1990s. [9]. HIV prevalence and incidence in rural Uganda appear to increase since 2000 vanishing Uganda’s prevention efforts in the previous years. [10]

Since 2002, general HIV prevalence stagnated over the last 5-9 years at a rate between 6.2% and 6.5% and now it is on increase in some parts of the country and in specific population groups.[10, 11]. The proportion of Ugandans aged 15-49 who are infected has risen and now stands to 7.3 % and even higher in women at 8.3%. [12]

Young people are more vulnerable to HIV infection yet if given the tools and support to prevent it, are the window of hope for changing the course of the epidemic. [13]. Altogether, 50% of HIV transmission takes place among those aged 15–24, and about 6,000 young people become infected every day [13, 14].  Factors influencing the recent trends of the epidemic are not yet clear, but there are indications that the observed changes in trend may be partly explained by increased sexual risk behavior.[11]

The AIDS burden in the Bushenyi district stands at 8.31% and the trading centres in the district are believed to have the highest HIV prevalence rates. It is the fourth leading disease burden in the district. [15]. Sexual transmission continues to contribute to about 76% of new infections, which could be prevented with condom use, male medical circumcision, and safe sex practices intervention like abstinence and partner reduction/faithfulness.[16]. However, literature about utilization and factors influencing HIV/AIDS prevention is limited and little documented about Bushenyi district.

Objectives

Utilization of HIV/AIDS Interventions and associated factors among young people aged 15-30 in Bushenyi District Uganda 

Materials and Methods

Setting:

The study was conducted in the Bushenyi district, the district, as configured after July 2010, had a population of about 251,400 as of 2010.[15].  The district lies between 00 N and 0046S of the equator and 29041’ East and 30030’ East of Greenwich.  The district had a total of 38 health facilities comprising of government, NGOs, and private ownerships with the breakdown as follows; Hospitals-3 (all private), HC IV-2 (government), HC III- 7 (government 5, Private 2), HC II-26.

There are 3 HIV centers (Ishaka Adventist Hospital, Kampala international Hospital, and kyabugimbi HC IV). A Cross-sectional survey was employed and both qualitative and quantitative data collection methods were used. The study population included young People aged 15 –30 years both in school/institution and out of school/institution and key informants who included HIV/AIDS prevention program officers, HCT counselors, and ART clinic/department health in charges

Sample size determination

The sample size for study participants for individual interviews was calculated using Kish and Leslie’s formula (Kish, 1965)

n =   z2 (1-p) 2/   d2    Where, n = sample size, z = standard normal distribution taken at 1.96 that corresponds to 95% confidence interval. p =estimated proportion of young people between ages 15-30 years who have received one of HIV/AIDS prevention interventions. According to Bushenyi district 2010 population estimations, the proportion of people aged 15 above who have at least received one HIV/AIDS prevention intervention was estimated at 52.8%, d = margin of errors on (p) that corresponds to 0.05 error. When calculated gives a total of n= 341

Sampling procedure:

Two Secondary schools, 3 institutions/colleges (two Institutions and one nursing school) were selected using simple random sampling.  240(139 females and 101 males) were systematically sampled using the class lists from both 2 secondary schools and 3 institutions.  In secondary schools, 10(6 females and 4 males) were included from each form, from form 1-form 6 to have proportional gender balance and 40(21 females and19 males) were conveniently from institution/colleges

The remaining 101 participants were conveniently sampled from the 4 wards of Ishaka- Bushenyi municipality to represent those not in schools. 25(13 females and 12 males) in each of 3 wards and 26(14 females and 12 males) in the 4th ward were selected. All the sampled participants were given a structured self-administered questionnaire. The 8 Key Informants were sampled purposively from different centers randomly selected as follows 2 from Kyabugimbi HC IV, 4 from Ishaka Adventist Hospital, 2 from KIU-TH.

Data collection

Data were collected by the use of triangulation of data collections methods (quantitative and qualitative) that employed the following tools.

  1. The tool I; A structured self-administered questionnaires with young people aged between 15-30 years. The questionnaire was structured which made it easier for respondents to fill the questions completely since only ticking/selecting the optional responses was required.
  2. Tool II; A pre-designed interview guide was used to collect qualitative data from the key informants in which guided the interview and the responses were audio-recorded using a digital camera, to ensure every response is recorded.

Data analysis.

SPSS 16.0 was used for statistical analysis. Descriptive statistics and frequencies were determined.  T-test and chi-square test was done to determine statistical significance at P-values of (p<0.005) and 95% CI within +2 or -2 SD. Analysis of qualitative data was done by verbatim transcribing recorded voices into written form. The raw data from the voices were transformed into an organized set of information in form of written soft copy. After the transformations ordering was done in relation to the discussion topics and presented in a text form.

 Ethical consideration.

The Institutional Review Board of Kampala International University-WC approved the study and both District Education Office and District Health Office endorsed it. Informed consent was sought from the headteachers and principals of the schools and principals respectively.  In this study, informed consent was obtained from every respondent of legal age (18 years and above) before enrollment into the study.  Participation was absolutely voluntary and there were neither benefits nor side effects anticipated to the study participants. Confidentiality and anonymity of the participant’s identity were highly ensured to ensure the privacy of information and enhance truthfulness in responses.

Study limitations

Most of the data collected were quite sensitive and it was likely to be a little challenging to get the most accurate information. The researcher, therefore, had to emphasize the issue of confidentiality and privacy of data collected by designing a self-administered structured questionnaire that improved truthfulness (accuracy) in responses. The researcher also briefed the participants and requested their cooperation in recording their sensitive data accurately.

 Results

 Sexual activity and age of sexual debut of respondents.

The results show in Table 1 77% (87.3% males, 68% females) of respondents were sexually active and only 23 % (12.56% males, 32% females) were still abstaining. key informants indicated that there is a high risk of contracting STIs due to increased sexual activity, “especially young girls who work for some men and the men try to take advantage of them because of the employment to have sex with them”.

Interestingly almost a quarter 21% (18.9 % males, 23.9% females) of respondents reported to have had their first sexual debuts before 15 years and 68% (65.3% males, 71.7% females) had their first sex by 19 years. Key informants reported that young people nowadays are more exposed to pornography accessed from video libraries and the Internet. They stay late in bars and disco joints and some come for Post Exposure Prophylaxis (PEP) reporting that they were raped on their way from discos, others that there were drunk and got involved in sex with unknown people”.

 Determinants of sexual activity of the participants

In Table 2 Sexual activity was affected by Sex of respondents (p=0.000<0.005), 87.3% of males were sexually active and 68% of the females were sexually active. The level of education completed was also found to be a statistically significant (p=0.002<0.005) determinant of sexual activity. Sexual activity increased with levels of education as the proportion of young people abstaining reduced with levels of education from primary (37.9%) through the secondary level (28.6%) to college (10.2%) although low abstaining levels existed in respondents with no formal education at 12.5%. The findings also indicated a statistically significant relationship (p=0.001<0.005), between the employment status and the sexual activity of the respondents.

Condom use and number of sexual partners

It was found that 32% (39.5% of males, 25.7% females) of the sexually active had more than one sexual partner, 22 % had unidentifiable sexual partners and 45% had one sexual partner. The Chi-square test revealed a very statistically significant association (p=0.0001<0.05) between respondents’ gender and the number of sexual partners.  39.5 males compared to 25.7% of females had more than one sexual partner.

Determinants for condom use and consistency among young people

Less than a quarter, 24.3% (22.9% males, 25.75% females) had consistent use of condoms, and almost a half, 48.7% (47.6% males, 49.7% females) had never used condoms. In table 3, factors whose standard deviations (SD) were within +2 or -2 were considered significant according to the empirical rule of (95% Confidence Interval of falls with +2 or -2 SD for normally distributed data to affect condom use. Factors identified to affect condom use included accessibility challenges, trust of sexual partners especially the casual ones, inability to use a condom, and Overwhelming passion for sex.

The key informants reported that, “The young people are very shy from asking for condoms and others do not even want to be identified in centers where they could access condoms for fear of being stigmatized”, Key informants also reported religious leaders to discourage the use of condoms and uptake of male medical circumcision that, “Both condoms and male medical circumcision impose a belief in the young people’s minds that they are protected from HIV infection and become more sexually active hence becoming more promiscuous”.

  HIV testing and male medical circumcision.

Only 55% knew their HIV status and 6.7 % of them had a positive HIV test.  Merely 36% of the sexually active respondents knew their HIV status. The Chi-square test indicated a statistically significant (P=0.004<0.005) HIV testing and sex of the respondents.  Key informants reported that the counseling and testing services are not offered in young peoples’ friendly settings.

 Medical male circumcision and factors reported to hind it.

Only 24% of 161 males reported having undergone male medical circumcision. In table 4, factors whose standard deviations (SD) were within +2 or -2 were considered significant according to the empirical rule of (95% Confidence Interval of falls with +2 or -2 SD for normally distributed data to hinder male medical circumcision. Factors that were found to influence male medical circumcision included Christian leaders’ disapproval, pain associated with the procedure, low awareness, and fear that it may reduce promote promiscuity and sexual activity.

Key informants reported that “some young men fear to come that they are going to be tested for HIV first before circumcision”. Others argued that “how could it be effective yet many Moslems who are circumcised even when they are young have gotten infected and died of HIV/AIDS”.

Knowledge of HIV/AIDS, HIV transmission/art, and HIV/AIDS stigma.

In table 5: The majority of respondents (39.3%) still fear being stigmatized and this influences their response to some interventions and affects outcomes such as HIV counseling and testing. More than a third of the respondents (36.2%) perceive HIV/AIDS as any other disease, no longer a death sentence anymore hence complacency. Worse still more than a third of respondents (34.7 %) reported that HIV could not be transmitted once someone is on ARVs.

Table 1: Respondents’ demographic characteristics, sexual activity, and age at first sex.
  Frequency(n=341)Percentages (%)
AGE CATEGORY(n=341)15-19 YEARS1560.4575
20-24-19 YEARS1380.4047
25-30 YEARS470.1378
GENDER (n=341)MALES 1750.51
FEMALES 1660.49
Sexual activity(n=341) Sexually active 26477%(87.3 males, 68% females)
Abstaining 7723%(12.56% males, 32% females)
Level of education(n=341) Informal education 82.3%(87.5% sexually active,12.5% abstaining )
Primary 298.5%(62.06% sexually active,37.9% abstaining)
Secondary 17551.3% (71.4% sexually active, 28.6% abstaining)
College6920.2 % (89.8% sexually active,10.2% abstaining)
University 6017.6% (86.7% sexually active, 13.3% abstaining)
Employment status(n=341)unemployed185.27% (100% sexually active)
Self employed247.03% (62.5% sexually active, 37.5% abstaining)
Salary earners5415.83% (92.59% sexually active, 7.4% abstaining)
Still in school 24571.84% (73.87% sexually active, 26.12% abstaining)
Age at first sex (n=263)Below 15 years5521 % ( 18.9% males, 23.9% females)
By 19 years 17968% (65.3% males, 71.7% females)
Table 2: Shows the association of independent variables and sexual activity
Dependent variable: Sexual activity
Independent variable P-value Significance
Age 0.608 Not significant hence no association between age and being sexually active.
sex 0.000 Very significant, hence there exists a relationship between the sex of respondents and being sexually active.
level of education completed 0.002 Significant, hence there exists a relationship between the respondents’ level of education completed and being sexually active
Employment status 0.001 Significant, hence there exists a relationship between the Employment status of respondents and being sexually active

Table 3: shows condom use and determinants for consistent use of condoms.

Descriptive statistics
Descriptive statistics
Reasons affecting consistent condom use. t df Sig. (2-tailed) Mean Difference 95% Confidence Interval (CI) of the Difference
Lower Upper
Do not know where to get them from 12.663 49 .000 1.200 1.01 1.39
I trusted my sexual partner 156.512 156 .000 1.975 1.95 2.00
No need with casual sexual partners 46.334 58 .000 2.898 2.77 3.02
Do not know how to use a condom 47.597 46 .000 3.894 3.73 4.06
Overwhelmed by too much passion 32.165 42 .000 4.767 4.47 5.07
Table 4: shows significant factors reported to hinder circumcision
Descriptive statistics
Factors reported hindering circumcision. t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
Christian leaders disapproval and are against it 51.807 97 .000 1.041 1.00 1.08
It is painful 56.000 56 .000 1.965 1.89 2.04
Do not agree with risk reduction associated with it 61.869 50 .000 2.922 2.83 3.02
Have not heard about it 62.313 21 .000 3.909 3.78 4.04
It may change/reduce belief and response to other 42.615 46 .000 5.787 5.51 6.06

 

Table 4: shows significant factors reported to hinder circumcision
Descriptive statistics
Factors reported to hinder circumcision. t df Sig. (2-tailed) Mean Difference 95% Confidence Interval of the Difference
Lower Upper
Christian leaders’ disapproval and are against it 51.807 97 .000 1.041 1.00 1.08
It is painful 56.000 56 .000 1.965 1.89 2.04
Do not agree with the risk reduction associated with it 61.869 50 .000 2.922 2.83 3.02
Have not heard about it 62.313 21 .000 3.909 3.78 4.04
It may change/reduce belief and response to other 42.615 46 .000 5.787 5.51 6.06

  Table 5: Knowledge of HIV/AIDS, transmission/ART, and stigma  

Response Factors and % Age of respondents 
not at all 34.7 39.3 37.9
a little 12.5 18.2 14.9
Quite 6.4 14.1 11.0
Extremely 46.3 28.4 36.2
Total 100.0 100.0 100.0

 Discussion.

 Utilization of HIV/AIDS prevention by young people studied

 Intermediate outcomes of HIV/AIDS prevention were assessed and these included (sexual activity, the use of condoms, male medical circumcision, and HIV testing) This section addresses the research results pertaining to participants’ characteristics that are significant and relevant to the study such as age, gender (sex), education level completed and occupation status.

 Sexual activity and age at first sex

The high proportion for sexual activity (table 1) could be due to poor access to information and life skills to reduce their sexual activity, an increasing number of sexual exposures, sexually explicit materials through the internet, peer influence, and inadequate Sex education to provide HIV/AIDS information and life-skills education. According to [17] integration of  HIV education within classroom subjects in schools HIV intervention in Kenya revealed an increase in condom use among boys and girls was more likely to decrease or delay sexual activity.

Young people especially adolescents who begin sexual activity early (Table 1) are at a higher risk of becoming infected with HIV.  Delaying the age at which young people have their sexual debuts is likely to be protective from HIV infection. This is because the psychosocial factors (such as self-efficacy, perceived risk, HIV/AIDS knowledge, intentions to adopt risk-reduction behaviors) are affected by one’s age.

These findings concur with [18,19] findings from studies done in Zimbabwe and South Africa which indicated that Sexual activity begins in adolescence for the majority of people, and in some countries, it starts for young women before they are 15 years old. The finding concurs also with [20, 21] findings from studies done among young men aged 15–19 years in Haiti, Kenya, Malawi, Namibia, and Zambia, which reported that more than one quarter reported having had sex before they were 15 years old.

Condom use among young people

Low condom use with multiple and unidentifiable sexual partners is a very risky behavior that poses a great risk of exposure to HIV infection as it creates a sex link chain that is more likely to increase HIV transmission. Factors reported hindering condom use included not accessibility challenges and trust of their sexual partner to be HIV negative among others (Table 3).  These findings concur with findings by [22] who noted that the main services necessary to prevent HIV and other STIs include providing access to information and condoms to ensure efficient and consistent condom use.   Similarly, Access to these services remains insufficient in most countries, young people’s access to condoms and other effective health services for adolescents.[23]

HIV Testing

Young people who know their status are more likely to protect themselves and others from HIV transmission. Many different factors affect access, knowing where testing and counseling are offered and whether it’s young people friendly or tailored is clearly an essential first step in ensuring testing for young people which has been highlighted by the key informants as inadequate.

This concurs with [24] in a survey that, indicated that in 25 of 39 countries surveyed in Africa, less than 50% of young people aged 15–24 knew where they could go to be tested for HIV. This finding is also matching with [9] finding that counseling and testing services may be still inaccessible to young people because clinics are far away or have limited or inconvenient and appropriate opening hours to young people.

Male Circumcision

Considering the HIV transmission protective effects, male circumcision from this study is still low which could still be a key risk factor in the transmission of HIV.  The finding also concurs with [8] in their study of the impact of male circumcision in the incidence of HIV in Uganda that; the evidence linking lack of circumcision with increased risk of HIV transmission is overwhelming.

 Factors influencing HIV/AIDS prevention.

Age of the respondents

Age is a demographic factor that could affect in terms of exposure, comprehension of HIV/AIDS preventive education, response, and uptake of the preventive interventions. The age ranges were chosen because the great majority of annual new HIV infections in the world are among young people young than 22-30 years and they occur through sexual activity. More than half of the respondents are in this category (Table 1).

Considering the age at which most of the respondents had sexual intercourse (table 1), they  are particularly vulnerable to HIV infection, yet  according to [26] they are the window of hope for changing the course of the epidemic if they are given the tools and support to do so

These groups were more vulnerable to HIV infection because of sexual exploration and high sexual activity. This confers with [26] who indicated that Young people are vulnerable to HIV and 50% of HIV transmission takes place among those aged 15–24, and 5 000–6 000 young people become infected every day.

Sex (gender) of respondents

Sex is a significant factor that could affect the utilization of HIV/AIDS prevention in terms of vulnerability, number of sexual partners, and use of condoms. The study indicated (table 2) that gender could have affected sexual activity, a number of sexual partners HIV testing and males were more sexually active than females. This concurs with the [27] which also indicates that men were sexually active than women.

This finding indicates that males could be engaging in higher-risk sexual relationships than females. This is similar to [27] finding that indicated that 35 percent of men had higher-risk sexual intercourse (sexual intercourse with someone other than a spouse or cohabiting partners) compared to 16 percent of women among respondents who engaged in higher-risk sexual intercourse.  Similarly, Only 24 percent of women in western Uganda compared to 21 percent of men have comprehensive knowledge of HIV/AIDS [27]

This finding also indicates that females could be having a more accepting attitude towards HIV information and HIV testing outcome.  This finding does not concur with the findings of the [27] that indicate that men had a more accepting attitude towards HIV testing and information, 36 percent among men and 26 percent among women have accepting attitudes.

This finding however does not concur with the survey done by [27]) which indicated an association between the two where males reported condom use more than females, 35 percent of women compared to 57 percent of men reported condom use.

Employment status of the respondents.

The employment status is an integral part can have both positive and negative impacts on their vulnerability to HIV infection.  Lower socioeconomic status may result in lower educational attainment, which may result in gaining less information and skills to protect oneself from HIV [28]

The employment status affects the sexual activity of the respondents (Table 1). This could be due to sexual coercion from people promising to give them employment and other financial gifts due to low self-reliance. This finding does not concur with findings of a study done in Tanzania that, young people aged 15–24 years in the highest wealth quintile were more likely to engage in higher-risk sexual activities (such as having sex with a non-marital non-cohabiting partner) than those in the lowest quintile. [29]

Others could have been abused due to the poor socioeconomic environment they could be living in as was reported from key informants. This concurs with [30] who reported that Lower socioeconomic status may also provide a reason for engaging in sexual relationships in exchange for financial compensation or support.

Employment status did not affect condom use in this study which differs from finding from the united republic of Tanzania that found out that, the young people in the highest income quintile were more than twice more likely to have used a condom during their last episode of higher risk sexual activity than the young people in the lowest income quintile. [29]

Religious disapproval.

The key informants highlighted that Religious leaders argue that both condoms and male medical circumcision inflict a belief in the young people’s minds that they are protected from HIV infection and become more sexually active hence becoming more promiscuous. This concurs with the BBC News report [31] about Pope’s statement concerning religious disapproval where he stated that condoms actually increase the problem of AIDS. This is a high-risk factor for the HIV/AIDS prevention of young people in that it confuses sexually active young people.

 Knowledge and Perception of the HIV/AIDS threat, stigma and transmission.

Young people’s responses towards HIV/AIDS prevention in this regard are quite mixed due to different perceptions of threat, the stigma associated (Table 5. More than a third of the respondents perceive HIV/AIDS no longer as a death sentence.   This concurs with [11] findings that suggested that ARVS and condoms have changed the perception of AIDS from a death sentence to a treatable, manageable disease; this may have reduced the fear surrounding HIV, and in turn, reduced the response to HIV/AIDS prevention.

 Conclusions.

From the study, it has been revealed that HIV/AIDS prevention interventions (Abstinence, condom use, and HCT and Male circumcision) among young people (15-30 years) in Bushenyi District are still wanting.

Contributed to knowledge

Young people are at the center of the global, regional, national, and local levels of the AIDS epidemic, both in terms of new infections and opportunities for halting the transmission of HIV.  The majority of young people continue to start sexual activity during adolescence and about a quarter even before they turn 15 years of age, have multiple sexual partners, very low abstinence levels, and low condom use all of which are risky behaviours.

Large numbers of young people continue to lack the basic information and skills they need to protect themselves. Given that about half of all new infections occur among those aged 15–24, and that young people account for a substantial proportion of the groups who are at particularly high risk of acquiring HIV. Without the focus on young people, then no one’s great desire to halt HIV/AIDS epidemic is likely to be met, and the number of new infections could increase further.

 Implications to policy.

Based on the study findings, the following recommendations for policy-makers, Programme officers, service providers, and young people were made.

  1. There is a great need for strengthening of school-based HIV/AIDS prevention that incorporates Sex and HIV/AIDS education to enhance young people’s knowledge, skills, attitudes, and behaviors that equips them with HIV/AIDS preventive life skills hence reducing their vulnerability to HIV infection.
  2. HIV counseling and testing in schools and peer or group counseling led by an adult (school counselor/nurse) in the schools to substantively reduce sexual risk behavior and increase knowledge of HIV/AIDS prevention.
  3. Ensuring and improving access to youth-friendly health services as an integral part of any HIV/AIDS prevention Programme.

 Implications to practice

  1. HIV/AIDS prevention providers should undertake activities such as outreach services to obtain community support that can increase young people’s use of health services that provide HIV counseling and testing, condoms, medical male circumcision, and other reproductive health services.
  2. In addition, social background issues such as HIV social risk factors (gender and sexual coercion, poverty, and alcohol) should be addressed to ensure that young people grow up in a safe and protective environment that reduces their vulnerability to HIV/AIDS.

 Future research.

  1. There is a need to conduct research about the effectiveness of the different HIV/AIDS prevention interventions to identify specific ones that are more effective than others.
  2. Research to identify conditions for the effectiveness of HIV/AIDS prevention among various populations (such as young men and young women) and locations (such as rural or urban areas) is highly recommended.

References

  1. WHO. Adolescent Friendly Health Services: An Agenda for Change with sexual behaviour and condom use among teenage men. Family Planning 2002. WHO/FCH/CAH/02.14.
  2. Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D, Bajos N. Sexual behaviour in context: a global perspective. Lancet 2006, 368(9548):1706-28.
  3. Ross D, Dick B, and Ferguson J. Preventing HIV/AIDS in Young People: A Systematic Review of the evidence from developing countries. In Report of the UNAIDS Inter-agency Task Team on Young People 2006. World Health Organization Technical Report Series 938.
  4. Ellis S, Barnett-PageE, MorganA. HIV prevention: a review of reviews assessing the effectiveness of interventions to reduce the risk of sexual transmission.2003.London: Health Development Agency (now the National Institute for Health and Clinical Excellence).
  5. Singh S. “A, B and C in Uganda: The Roles of Abstinence, Monogamy and Condom Use In HIV Decline” The Alan Guttmacher Institute, Occasional Report. 2003. No. 9.Transmission and Prevention
  6. Kirby D, Laris B A, Rolleri LA. Sex and HIV Education Programs: Their Impact on Sexual Behaviours of Young People throughout the World. J Adolesc Health. 2007. 40:206-17.
  7. UNAIDS. ‘UNAIDS report on the global AIDS epidemic. 2010.
  8. Gray RH, Li X, Kigozi G, Serwadda D, Nalugoda F, Watya S, Reynolds SJ, Wawer M. The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda. 2010. 21(7):845-50.
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Utilization of HIV/AIDS Interventions and associated factors among young people aged 15-30 in Bushenyi District Uganda

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