Carolyne Agwau Akello, MBChB, Msc Sexual experiences and HIV risk perception among pregnant adolescents (Hi-4-Tu) Study, Kampala, Uganda Carolyne Agwau Akello, MBChB, Msc

Background Adolescents in Uganda are at high risk of unplanned pregnancies and HIV/STIs Because sexual experiences and HIV risk perception influence HIV acquisition, a better understanding of this is important Data on adolescents’ Knowledge, Attitudes and Practices (KAP) to prevent HIV/STIs, and pregnancy was obtained from the formative phase of the Hi-4-Tu research study

Objective The Hi-4-Tu formative phase assessed adolescent and health care provider KAP regarding adolescent reproductive health and related health services and explored adolescents’ risk perception and motivation to utilize reproductive health services and use of dual protection methods. This analysis explores the HIV risk perception among adolescents and describes their reported sexual experience

Methods 2 Focus Group Discussion (FGDs), I with pregnant adolescents (n=10) and I with postnatal adolescent mothers (n=10) at Mulago National Referral Hospital were conducted FGDs were conducted in Luganda, transcribed and translated into English. Atlas.ti was used for coding and analyzing themes

FGD question topics include: Sex and relationships “How did you get to know about sexual intercourse before you got pregnant? I’d like to hear what information about sex you think is important and where you get it from” Probes asked about what information related to sex is important to them, sources of this information and how reliable they think it is

HIV /STI Risk Perception “I’d like to hear what you think about HIV and other Sexually transmitted infections (STIs)” Probes asked if they felt they were at risk of HIV or STIs, what would put them at risk, is it something they worry for themselves or for their sexual partner, how to prevent HIV and STIs, how these can be detected, treated and from where

Results Knowledge about sex: Adolescents said that they learnt about sex mostly from their friends Movies which they tried out with their boyfriends Older men. A few had formal sex education from teachers (from P6) Parents (mostly mothers) and other relatives - Most of them said that parents don’t usually talk about sex to their children, however mothers were more likely to discuss issues of sex around the time of menarche

Knowledge about sex: “I learnt from my friends. My friends were in higher school level and I was in Primary five. They used to encourage me to get a boyfriend since they already had. They has a lot of money with them and when I asked them they told me that they were given by their boyfriends. They told me it was interesting when it comes to having sex with a boy. That is when I picked interest. They looked around for a boyfriend for me. And when I paid him first visit that is when I learnt all the sexual activities”

Sexual experiences and feelings Most of the pregnant adolescent had first sexual contact with a boyfriend from school, and a few had sex with older men For most of them (17) sex was voluntary however for some (3) it was forced Most reported that the first sexual act was painful and they bled a lot and some got wounds in the vagina, others said it was rough and uncomfortable which made her angry, while others found it an enjoyable experience

Sexual Experience “I felt pain and bled but bleeding wasn’t much. I also got wounds and I had to tell my boyfriend that he had tore my vagina” “To me sex was enjoyable since it was my first time”

HIV and STI Risk Perception Most felt that they were at risk of HIV infection however they feared getting pregnant more than HIV and other STDs Some assumed that their partners were HIV negative and STI free because they were blinded by love Some used condoms because of fear of getting pregnant however some did not use because of fear of it getting stuck in the vagina

HIV and STI Risk Perception (2) None of them used condoms at first sexual contact despite fear of pregnancy or HIV Some sexual partners agreed to use condoms before sex but later took it off during sex and she got pregnant

Condom use “Because I did not want to get pregnant, I asked him to use a condom” “He had put on the condom but I don’t know how he took it off”

Conclusion Adolescents have various sources of information about sex that they consider to be reliable We need to increase access to reliable trusted information to adolescents to potentially address these key knowledge gaps and help influence behavior Through peers Schools Assisting parents to communicate with their children Through accessible health services

Acknowledgement HI-4-TU Study participants Study Staff HI-4-TU is funded by Eunice Kennedy Shriver National Institute of Allergy and Infectious Diseases (NIAID) as a supplement; Grant # 5UM1 AI 069530 

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