1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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”

10. 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

11. 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”

12. 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

13. 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

16. 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”

17. 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

18. 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  

20. Questions??