Psychosocial predictors of sexual risk behaviour among HIV infected and affected adolescents living in HIV affected homes of Uganda

Abstract

Despite the growing research into adolescent health, there is little empirical evidence about the extent and relationships among the psychosocial and sexual experiences of the adolescents who live in homes continuously exposed to HIV infection and its effects in Uganda. To expound theory in this area and provide empirical evidence for proper policy development, this study assessed the extent, associations and pathways of these experiences in this group of adolescents. A structured questionnaire was used to collect data from 289 HIV-infected, 756 HIV-uninfected and 392 HIV-unaware adolescents who reside in 691 HIV-affected homes that were randomly selected from HIV-burdened parishes in the Lira, Rukungiri and Kayunga districts. The questionnaire and data were verified for precision, stability and reliability using factor analysis. Adolescent’s scores on the observed variables were computed and compared using univariate and variance tests, Kruskal-Wallis’s equality-of-population rank test, and Cohen’s strength-of-effect test. The psychosocial factors influencing sexual risk behaviour were examined using general linear model tests while the strengths, directions and pathways by which they influenced their sexual risk behaviour were assessed using structural equation modelling path tests. Whereas the three groups experienced noteworthy levels of the observed psychosocial and sexual factors, the adolescents living with HIV were most prone to the risk factors notably, low post-primary education attainment, double orphanhood, home instability, working as home/bar tenders, and living with many sick people and with caregivers who were relatives, or HIV-negative, or alcohol users. They also showed significantly higher rates of receiving HIV/psychosocial care, negative peer influence, poverty, personal threats, interpersonal problems, psychosocial distress, sexual risk behaviour, and low ability to cope with adversities using constructive methods such as self-control and seeking social support than the other adolescent groups. This implies that despite being more enrolled in school and HIV care programmes, this group could be experiencing poorer family care and more psychosocial problems which result in sexual risk behaviour than their siblings in the same household. The main factors that increased sexual risk behaviour in the adolescents who participated in this study included susceptibility to negative sociocultural norms especially among the younger girls of the Baganda and Lango tribes, single parenting, sexuality discussions from caregivers, negative effects of receiving HIV/psychosocial care, negative peer influence, personal threats, interpersonal problems, psychosocial distress, and coping by deflecting problems. Besides these sociodemographic circumstances, personal HIV status, involvement in work that provides unreliable income such as farming, and living in one home or with caregivers who are HIV-positive or negative, moderated the relationships between the other psychosocial factors and sexual risk behaviour by increasing risks. These risk factors may have prevented the development of protective skills like assertiveness, facilitated negative social relationships that evoked sexual curiosity and carelessness, raised optimism regarding the achievement of sexual life goals, created a conviction that the problems being faced were minor and lowered their risk perception, which could have resulted in sexual risk behaviour. The results also showed that the sexual risk behaviour in this group of adolescents could to some extent be avoided by school attendance, religious conviction, experiencing orphanhood for a shorter time and parenting from two caregivers, sharing a home with only a few people and receiving constructive social support and socialisation, and experiencing poverty, HIV stigma, inattention, depression and aggression. Besides these sociodemographic protective factors, death of the mother, caregivers’ unemployment and adherence to sociocultural norms that promote sexual sanctity, moderated the relationships between the psychosocial factors and sexual risk behaviour of these adolescents by reducing risks. These factors could have led some adolescents to receiving protection and life skills from their caregivers or school or community, recalling their bad memories and experiencing feelings of despair especially soon after a parental death, which could have improved their risk perception, morals and discipline, and helped them to refrain from sexual risk behaviour. The sociodemographic factors and community stressors, mainly interacted with coping methods via psychosocial distress to predict sexual risk behaviour in these adolescents. Community stressors mainly reduced their ability to positively cope with adversities and this not only amplified psychosocial distresses which then increased vulnerability to risky sexual behaviour especially in the HIV infected and unaware adolescents, but also reduced the effects of other negative circumstances in the Lira area, which then reduced their sexual risk behaviour. In all groups, deflection was the most prominent coping method and specifically exacerbated distresses, which then increased sexual risk behaviour among them. The findings highlight the centrality of personal and family factors, psychosocial distress and coping in predicting sexual risk behaviour among these adolescents. They also support and enrich the existing theories by clarifying the directions and pathways in which these factors interact to predict sexual risk behaviour. Interventions by the families, schools and communities are needed to prevent and mitigate the personal, familial, societal, psychological, coping and sexual risks identified in this study, especially among adolescents living with HIV who live in HIV-affected homes.