Multifaceted Interventions and HIV Risky Sexual Behaviours among Adolescent Girls and Young Women: A Case Study of the DREAMS Partnership in Mubende Region, Uganda
Abstract:
Risky sexual behaviour among Adolescent Girls and Young Women (AGYW) is a global health challenge resulting in new cases of HIV infection, sexually transmitted Infections (STIs), unwanted pregnancies and unsafe abortions. This study aimed at examining the effectiveness of multifaceted interventions on reduction of risky sexual behaviours (RSBs) among AGYW in Mubende region, Uganda. The study adopted a descriptive cross-sectional design for both qualitative and quantitative data collection and analysis. Quantitative data was gathered through pre-tested structured questionnaires from 385 randomly selected participants, while qualitative data was collected via focus group discussions and key Informant interviews with purposively selected respondents. Quantitative data was analyzed using STATA 18.0 software, while qualitative data was transcribed verbatim and analyzed using NVIVO software. The findings revealed that 92.5% of the target population was reached by DREAMS interventions. Marital status (AOR = 0.17, 95% CI: 0.04–0.64, p = 0.01), Education status (AOR = 0.001,95% CI: 0.00-0.00, p<0.001 ), Age at enrollment (AOR = 49.52,95% CI:1.24-1981.93, p= 0.038), Journeys plus (AOR=22.75, 95% CI: 1.26-409.98, p= 0.034), employment after graduation (AOR=14.57, 95% CI: 1.15-184.00, p=0.038), marriage after graduation (AOR=15.95, 95% CI: 1.11-229.21, p=0.042) and starting own business after graduation (AOR=15.32, 95% CI: 1.66-141.33, p=0.016), were the independent variables significantly associated with RSBs. HIV prevention and sexual health, economic empowerment, behaviour change, employment opportunity, reduced unintended pregnancies, retention in school and asset building were identified as the major outcomes achieved by the program. Education status, Marital status, age enrollment, Journeys plus curriculum, employment, marriage and starting own business after graduation positively influenced RSBs.References:
[1].
Keto T, Tilahun
A, Mamo A. Knowledge, attitude and practice towards risky sexual behaviors
among secondary and preparatory students of Metu town, southwestern Ethiopia.
BMC Public Health. 2020;20:1186. https://doi.org/10.1186/s12889-020-09371-4
[2].
Centers for
Disease Control and Prevention. Sexual risk behaviors: reducing health risks
among youth. Available from:
https://www.cdc.gov/youth-behavior/risk-behaviors/sexual-risk-behaviors.html
[3].
World Health
Organization. Report on global sexually transmitted infection surveillance
2018. South Med J. 2018;70:1-58.
[4].
Cassim N,
Coetzee LM, da Silva MP, Glencross DK, Stevens WS. Assessing very advanced HIV
disease in adolescent girls and young women. SAHARA J. 2023;24.
https://doi.org/10.4102/sajhivmed.v24i1.1501
[5].
UNAIDS. HIV and
adolescent girls and young women: thematic briefing note. 2024 Global AIDS
Update. Geneva: UNAIDS; 2024.
[6].
UNAIDS. In
danger: UNAIDS Global AIDS Update 2022. Geneva: UNAIDS; 2022.
[7].
Ewemooje OS.
Risky sexual behaviour among adolescent girls and young women in Nigeria:
persistent driver of HIV infections. J Interv Epidemiol Public Health. 2023;6.
https://doi.org/10.37432/jieph.2023.6.4.91
[8].
Madiba S,
Ngwenya N. Cultural practices, gender inequality and inconsistent condom use
increase vulnerability to HIV infection: narratives from married and cohabiting
women in rural communities in Mpumalanga Province, South Africa. Glob Health
Action. 2017;10(1):1341597. https://doi.org/10.1080/16549716.2017.1341597
[9].
Petroni S.
Advancing the evidence base on child marriage and HIV. 2019.
[10]. Matovu JKB, Bukenya JN, Kasozi D, Kisaka S, Kisa R,
Nyabigambo A, et al. Sexual-risk behaviours and HIV and syphilis prevalence
among in- and out-of-school adolescent girls and young women in Uganda: a
cross-sectional study. PLoS One. 2021;16(9):e0257321.
https://doi.org/10.1371/journal.pone.0257321
[11]. Uganda AIDS Commission. The Uganda HIV and AIDS
Country Progress Report. Kampala: Uganda AIDS Commission; 2015.
[12]. Saul J, Bachman G, Allen S, Toiv NF, Cooney C,
Beamon T. The DREAMS core package of interventions: a comprehensive approach to
preventing HIV among adolescent girls and young women. PLoS One.
2018;13(12):e0208167. https://doi.org/10.1371/journal.pone.0208167
[13]. Uganda Bureau of Statistics. Statistical Abstract
2013. Kampala: Uganda Bureau of Statistics; 2013.
[14]. Varkevisser CM, Pathmanathan I, Brownlee AT.
Designing and conducting health systems research projects.
[15]. Murewanhema G, Musuka G, Moyo P, Moyo E, Dzinamarira
T. HIV and adolescent girls and young women in sub-Saharan Africa: a call for
expedited action to reduce new infections. IJID Reg. 2022;5:30-2.
https://doi.org/10.1016/j.ijregi.2022.08.009
[16]. Komuhangi A, Muhumuza A, Kasozi W. Prevalence of
risky sexual behavior and its associated factors among adolescent girls and
young women in Moroto District, Karamoja Region, Uganda. Texila Int J Public
Health. 2025;13. https://www.texilajournal.com/v2/thumbs/article/38_TJ3120.pdf
[17]. Namukasa S. Factors that contribute to teenage
pregnancy during COVID-19 in Uganda: a study of Bugiri Municipal Council in
Bugiri District. 2021.
[18]. Mohapi BJ, Pitsoane EM. Life skills as a behaviour
change strategy in the prevention of HIV and AIDS: perceptions of students in
an open and distance learning institution. SAHARA J. 2017;14(1):77-84.
https://doi.org/10.1080/17290376.2017.1374878
[19]. Nkhoma DE, Lin CP, Katengeza HL, Soko CJ,
Estinfort W, Wang YC, et al. Girls'
empowerment and adolescent pregnancy: a systematic review. Int J Environ Res
Public Health. 2020;17(5):1664. https://doi.org/10.3390/ijerph17051664
[20]. Gangaramany A, Balvanz P, Gichane MW, Goetschius S,
Sharma S, Sharma K, et al. Developing a framework for cash transfer programs
that foster sustained economic empowerment to reduce sexual risk among
adolescent girls and young women: a qualitative study. BMC Public Health.
2021;21(1):122. https://doi.org/10.1186/s12889-020-10130-8
[21]. Ssewamala FM, Han CK, Neilands TB, Ismayilova L,
Sperber E. Effect of economic assets on sexual risk-taking intentions among
orphaned adolescents in Uganda. Am J Public Health. 2010;100(3):483-8.
https://doi.org/10.2105/AJPH.2008.158840
[22]. Omona K, Bwire GW, Mugisa G, Tolit Akullu J. Drivers
of risky sexual behaviours among adolescents in Nebbi Municipality, Uganda:
analytical cross-sectional study. Crit Public Health. 2026;36.
https://doi.org/10.1080/09581596.2025.2604882
[23]. Misinde C, Nansubuga E, Nankinga O. Out-of-school
female adolescent employment status and sexually transmitted infections risk in
Uganda: is it a plausible relationship? BMC Public Health. 2018;18(1):1173.
https://doi.org/10.1186/s12889-018-6094-1
[24]. Bradley JE, Bhattacharjee P, Ramesh BM, Girish M, Das AK. Evaluation of Stepping Stones as a tool for changing knowledge, attitudes and behaviours associated with gender, relationships and HIV risk in Karnataka, India. BMC Public Health. 2011;11:496. https://doi.org/10.1186/1471-2458-11-496
