Nazarius Mbona Tumwesigye Roger Ingham David Holmes University of Southampton

1. Condom use across and within relationships among young people in Uganda: A case of Kabale and Mukono districts Nazarius Mbona Tumwesigye Roger Ingham David Holmes University of Southampton Contact: nmbonat@yahoo.co.uk BSPS annual conference, 12-14 September 2005, Canterbury

2. Outline • Introduction • Objectives • Literature • Methods • Results • Discussion • Conclusion

3. Introduction • When consistently and correctly used condoms can prevent 90-95% of HIV • Uganda still has high HIV prevalence (6.2%) and unplanned pregnancies • Estimated 192 HIV infections per day, 70170 per year

4. Introduction: Why study dynamics of condom use? • At a relatively high level of condom use, focus on dynamics becomes important –38% in Ghana, 43% Kenya, 58% in Uganda • Indications of high inconsistent condom use in the country- only 4.4% consistently use in Rakai • Lack of data • ABC model spreading to other countries and change of focus

5. Study areas • Highlights regional differences in economy, access to services

6. Objectives • Establish the level and trend of condom use between and within relationships • Identify associated factors

7. Literature review to identify possible associated factors • Decline in condom use with time (Ku et al. 1994) and number of sexual partners (Richter et al. 1993) • Age, education level, casual relationship (Catania et al. 1994 & 1998) • Age at first sex (Tavares et al. 2002) • Alcohol (Ray et al. 1998) • Media and attitudes (Adetunji & Meekers 2001) • Communication with parents (Rodgers,1999)

8. Methods • Stratified cluster sample of 786 unmarried youth aged 15-24, 445 of whom were sexually active • Questions on sexual practices on first, second to latest and latest relationships • Data on all relationships pooled together • Logistic regression for condom use • Multinomial logistic regression for consistency • Used at both 1st & last event, use at one of two events, none use at both events • Checked cluster effect with multilevel model

9. Characteristics of respondents

10. Number of responses

11. Condom use levels in first, second latest and latest relationships

12. Logistic regression: Condom use at anytime in each relationship

13. Logistic regression: Condom use at any time

14. Predicted levels of condom use at each event

15. Correlates of consistent condom use from multinomial logistic model

16. Predicted level and consistency of condom use

17. Discussion • Results not in agreement with those of Ku et al. (1994) and Richter (1993) • Condom use higher among steady partners, unlike in Catania (1994) • Alcohol not a significant factor on use as in Ray et al. (1998) • Foundation of school an important factor • Communication with parent not significant as in Rodgers (1999) • Findings on age,age at 1st sex,attitude as in others studies • More opportunity for influence in first relationship

18. Conclusions and implications • There are significant changes in condom use between and within relationships • The level and consistency in condom use grows with time

19. Conclusion and implications cont’d • Policy and programme may refocus on: • Inequalities in access to sexual health services between districts • Differences in practices by gender, age groups, schooling status • Media as an important tool • Raising attitudes to condom use and steady partnerships • Increasing age at first sex and condom use at first sex through balanced ABC campaigns • Abstinence-only programmes may worsen the already low condom use at first sex

20. Thanks for your attention