Abstract

Introduction: In sub-Saharan Africa adolescents account for 30% of new infections and are a priority population for HIV control. Adolescence is a critical stage of life characterized by profound physical, emotional, and social changes, including the exploration of one's sexuality. Adolescents face unique challenges and opportunities as they make choices that impact their sexual health. However, little is known about how household structure impacts these behaviors.
Methods: We used cross-sectional data collected between June 2018 and November 2020 from the Rakai Community Cohort Study (RCCS), a population-based HIV surveillance cohort in south-central Uganda. Household structure was defined as living in the same household with both parents, both out of home, both dead, resident mother/deceased father, resident father/deceased mother, resident mother/non-resident father, resident father/non-resident mother, non-resident mother/deceased father, non-resident mother/deceased father, non-resident father/deceased mother. Sexual risk behaviors evaluated included self-report of having >=1 non-marital sexual partner, multiple sexual partners in the past 12 months, unprotected sex with a non-marital partner, and engaging in transactional sex. We used modified Poisson regression to estimate prevalence ratios for each risk behavior while adjusting for sex, age, education level, community of residence, and schooling status.
Results: Over one-third (35%) were living with both parents, 23.8% (n=850) with both parents not in the home and 2.5% (n=89) were double orphans. 17.5% (n=624) of adolescents self-reported a non-marital sexual partner, 10.5% with multiple sexual partners, and 11.5% reported transactional sex in the past year. The proportion of adolescents living with no parents increased with age. Adolescents whose mother was resident and non-resident father had increased prevalence of having a non-marital partner (aPR=1.46 95%CI: 1.18-1.80), having unprotected sex with a non-marital partner (aPR=1.23 95%CI: 1.00-1.51) as compared to those living with both parents. Adolescents with both parents outside the home had an increased prevalence of having multiple sexual partners (aPR=1.35 95%CI: 1.04-1.75) and engaging in transactional sex (aPR=1.51 95%CI: 1.11-2.05) as compared to those living with both parents.
Conclusion: Household structure plays a significant role in shaping the sexual behaviors of adolescents. Those living with both parents tend to have different outcomes compared to those living with one or both parents absent from the home.