Abstract:

Understanding factors influencing risky sexual behavior is crucial for developing effective interventions that reduce risky sexual behavior. We explored contextual factors influencing the implementation of community-based peer-led sexual and reproductive health education aimed at reducing risky sexual behavior among adolescent girls and young women in Moroto District. Using qualitative methods, data were collected through six focus group discussions with 51 adolescent girls and young women (15-24 years) and in-depth interviews with five key informants, including district health officials and health workers. A constructivist approach guided the study, and analysis followed the guidelines for systematic reporting. Participants were predominantly aged 15-17 (41.2%), single (62.7%), out of school (52.9%), and unemployed (84.3%). Most had 1-2 children (54.9%) and identified as Christian (78.4%). Facilitators for the intervention included strong peer trust and access to services through hospitals, schools, and teenage centers. Barriers included stigma surrounding family planning and abortion, cultural norms favoring early marriage, misinformation, restrictive family dynamics, time constraints, and inadequate health worker training. Despite the intervention’s acceptability, these challenges may hinder its effectiveness in reducing risky sexual behavior among adolescent girls and young women. Addressing stigma, power dynamics, cultural norms, and misinformation, alongside improving health worker training, is crucial for creating an empowering environment for informed decision-making. This will enhance the intervention's potential to improve health outcomes. The community-based peer-led sexual and reproductive health education intervention has potential to reduce risky sexual behavior among adolescent girls and young women. However, its effectiveness hinges on addressing key contextual barriers.

References:

[1]. Adrawa, J., 2023, Risky sexual behaviors and their health implications. Journal of Sexual Health, 14(3), 234-245.

[2]. Yadegarfard, M., 2020, Biopsychosocial predictors of risky sexual behaviours among the gay men in the UK.

[3]. Jones, K. G., et al., 2015, The prevalence of, and factors associated with, paying for sex among men resident in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)’, Sexually Transmitted Infections, 91(2), pp. 116–123.

[4]. Maguen, S., Nichter, B., Norman, S. B., & Pietrzak, R. H., 2023, Moral injury and substance use disorders among US combat veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study. Psychological medicine, 53(4), 1364-1370.

[5]. Reynolds, B. W., et al., 2019, Executive function, impulsivity, and risky behaviors in young adults. Neuropsychology, 33(2), p. 212.

[6]. Alsubaie, A. S. R., 2019, Exploring sexual behaviour and associated factors among adolescents in Saudi Arabia: a call to end ignorance’, Journal of Epidemiology and Global Health, 9(1), p. 76.

[7]. Scull, T. M., et al., 2020, The understudied half of undergraduates: risky sexual behaviors among community college students’, Journal of American college health, 68(3), pp. 302–312.

[8]. Darteh, E. K. M., Dickson, K. S., and Amu, H., 2020, Understanding the socio-demographic factors surrounding young peoples’ risky sexual behaviour in Ghana and Kenya’, Journal of Community Health, 45(1), pp. 141–147.

[9]. Adimora, A. A., & Schoenbach, V. J., 2005, Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. The Journal of Infectious Diseases, 191(Supplement_1), S115-S122.

[10]. Lehrer, J. A., Lehrer, E. L., & Koss, M. P., 2013, Unwanted sexual experiences in young men: Evidence from a survey of university students in Chile. Archives of sexual behavior, 42, 213-223.

[11]. Higgins, J. A., & Smith, N. K., 2016, The sexual acceptability of contraception: reviewing the literature and building a new concept. The Journal of Sex Research, 53(4-5), 417-456.

[12]. Ministry of Health. 2024, High rates of teenage pregnancy; Director General Health Services, highlights strategies to curb this growing burden. Available at: https://www.health.go.ug/2024/02/27/high-rates-of-teenage-pregnancy-director-general-health-services-dr-henry-g-mwebesa-highlights-strategies-to-curb-this-growing-burden/

[13]. Ssebunya, R. N., et al., 2018, Prevalence and correlates of HIV testing among adolescents 10–19 years in a post-conflict pastoralist community of Karamoja region, Uganda, BMC public health, 18(1), pp. 1–8.

[14]. Uganda Bureau of Statistics. 2014, Human Poverty Index and Administrative Divisions in Moroto District. Kampala: Uganda Bureau of Statistics.

[15]. Uganda Health Sector Performance Report. 2020/2021. Available at: https://library.health.go.ug/sites/default/files/resources/Annual%20Health%20Sector%20Performance%20Report%202020-21-1.pdf

[16]. Desrosiers, A., Betancourt, T., Kergoat, Y., Servilli, C., Say, L., & Kobeissi, L., 2020, A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings. BMC public health, 20, 1-21.

[17]. Ministry of Education and Sports. 2018, National Sexuality Education Framework. Available at https://scorecard.prb.org/wp-content/uploads/2019/06/Uganda-National-Sexuality-Education-Framework.pdf.

[18]. Bryman, A., 2016, Social research methods. Oxford university press.

[19]. Hensen, B., Floyd, S., Phiri, M. M., Schaap, A., Sigande, L., Simuyaba, M., & Ayles, H., 2023, The impact of community-based, peer-led sexual and reproductive health services on knowledge of HIV status among adolescents and young people aged 15 to 24 in Lusaka, Zambia: The Yathu Yathu cluster-randomised trial. PLoS Medicine, 20(4), e1004203.

[20]. Kteily-Hawa, R., Hari, S., Wong, J. P. H., Chikermane, V., & Chambers, L. A., 2019, Development and implementation of peer leader training for community-based participatory sexual health research. Progress in Community Health Partnerships: Research, Education, and Action, 13(3), 303–319

[21]. Zuma, T., Busang, J., Hlongwane, S., Chidumwa, G., Gumede, D., Luthuli, M., & Shahmanesh, M., 2024, A mixed methods process evaluation: Understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa. Trials, 25(1), 448.

[22]. Zuurmond, M. A., Geary, R. S., & Ross, D. A., 2012, The effectiveness of youth centers in increasing use of sexual and reproductive health services: A systematic review. Studies in Family Planning, 43(4), 239–254.

[23]. Pound, P., Langford, R., & Campbell, R., 2016, What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people's views and experiences. BMJ Open, 6(9), e011329

[24]. Tam, A., 2019, The negotiation and management of sexual and reproductive health behaviour in marital relationships in rural south-western Uganda (Doctoral dissertation, University of East Anglia).

[25]. Ouahid, H., Mansouri, A., Sebbani, M., Nouari, N., Khachay, F. E., Cherkaoui, M., & Adarmouch, L., 2023, Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: A qualitative study. BMC Pregnancy and Childbirth, 23(1), 407.

[26]. Muhanguzi, F. K., Bantebya-Kyomuhendo, G., & Watson, C., 2017, Social institutions as mediating sites for changing gender norms: Nurturing girl’s resilience to child marriage in Uganda. Agenda, 31(2), 109–119.

[27]. Sommer, M., & Mmari, K., 2015, Addressing structural and environmental factors for adolescent sexual and reproductive health in low-and middle-income countries. American Journal of Public Health, 105(10), 1973–1981.

[28]. Ankomah, A., Anyanti, J., & Oladosu, M., 2011, Myths, misinformation, and communication about family planning and contraceptive use in Nigeria. Open Access Journal of Contraception, 95–105.

[29]. Rwabukwali, C. B., Achen, S., & Atekyereza, P., 2018, Sexual and reproductive health of adolescent girls in Karamoja in Uganda: A socio-cultural perspective. Journal of Emerging Trends in Economics and Management Sciences, 9(6), 325–335.

[30]. Achen, S., Atekyereza, P., & Rwabukwali, C. B., 2021, The role of culture in influencing sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda. Pastoralism, 11(1), 25.

[31]. Haddad, L. B., & Nour, N. M., 2009, Unsafe abortion: Unnecessary maternal mortality. Reviews in Obstetrics and Gynecology, 2(2), 122.