Skip to main content
Top
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Experience of sexual coercion and risky sexual behavior among Ugandan university students

Authors: Anette Agardh, Karen Odberg-Pettersson, Per-Olof Östergren

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Growing worldwide evidence shows that the experience of sexual coercion is fairly prevalent among young people and is associated with risky sexual behavior thereafter. The causal mechanisms behind this are unclear but may be dependent on specific contextual determinants. Little is known about factors that could buffer the negative effects of coercion. The aim of this study was to assess the association between the experience of sexual coercion and risky sexual behavior among university students of both sexes in Uganda.

Methods

In 2005, 980 (80%) out of a total of 1,220 students enrolled in Mbarara University of Science and Technology in Uganda participated in a self-administered questionnaire covering socio-demographic and religious factors, social capital, mental health, alcohol use, and sexual behavior. A validated scale of six items was used to assess the experience of sexual coercion. Logistic regression analyses were applied to control for confounders. Potential buffering factors were analyzed by testing for effect modification.

Results

Fifty-nine percent of those who responded had previously had sexual intercourse. Among the male students 29.0%, and among the female students 33.1% reported having had some experience of sexual coercion. After controlling for age, gender, and educational level of household of origin, role of religion and trust in others sexual coercion was found to be statistically significantly associated with previously had sex (OR 1.6, 95% CI; 1.1-2.3), early sexual debut (OR 2.4, 95% CI; 1.5-3.7), as well as with having had a great number of sexual partners (OR 1.9, 95% CI; 1.2-3.0), but not with inconsistent condom use.
Scoring low on an assessment of mental health problems, reporting high trust in others, or stating that religion played a major role in one's family of origin seemed to buffer the negative effect that the experience of sexual coercion had on the likelihood of having many sexual partners.

Conclusion

The findings of this study suggest that the experience of sexual coercion is common among youth/young adults in Uganda and is subsequently associated with risky sexual behavior in both sexes. The existence of individual and contextual factors that buffer the effects mentioned was also demonstrated. In the Ugandan context, this has implications for policy formulation and the implementation of preventive strategies for combating HIV/AIDS.
Appendix
Available only for authorised users
Literature
1.
go back to reference Biglan A, Noell J, Ochs L, Smolkowski K, Metzler C: Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?. J Behav Med. 1995, 18 (6): 549-568. 10.1007/BF01857895.CrossRefPubMed Biglan A, Noell J, Ochs L, Smolkowski K, Metzler C: Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?. J Behav Med. 1995, 18 (6): 549-568. 10.1007/BF01857895.CrossRefPubMed
2.
go back to reference Koenig MA, Zablotska I, Lutalo T, Nalugoda F, Wagman J, Gray R: Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda. Int Fam Plan Perspect. 2004, 30 (4): 156-163. 10.1363/3015604.CrossRefPubMed Koenig MA, Zablotska I, Lutalo T, Nalugoda F, Wagman J, Gray R: Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda. Int Fam Plan Perspect. 2004, 30 (4): 156-163. 10.1363/3015604.CrossRefPubMed
3.
go back to reference George C, Alary M, Otis J: Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. West Indian Med J. 2007, 56 (5): 433-438.PubMed George C, Alary M, Otis J: Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. West Indian Med J. 2007, 56 (5): 433-438.PubMed
4.
go back to reference Garoma S, Belachew T, Wondafrash M: Sexual coercion and reproductive health outcomes among young females of Nekemte Town, South West Ethiopia. Ethiop Med J. 2008, 46 (1): 19-28.PubMed Garoma S, Belachew T, Wondafrash M: Sexual coercion and reproductive health outcomes among young females of Nekemte Town, South West Ethiopia. Ethiop Med J. 2008, 46 (1): 19-28.PubMed
5.
go back to reference Hovsepian SL, Blais M, Manseau H, Otis J, Girard ME: Prior victimization and sexual and contraceptive self-efficacy among adolescent females under Child Protective Services care. Health Educ Behav. 2010, 37 (1): 65-83. 10.1177/1090198108327730.CrossRefPubMed Hovsepian SL, Blais M, Manseau H, Otis J, Girard ME: Prior victimization and sexual and contraceptive self-efficacy among adolescent females under Child Protective Services care. Health Educ Behav. 2010, 37 (1): 65-83. 10.1177/1090198108327730.CrossRefPubMed
6.
go back to reference Murphy EM, Greene ME, Mihailovic A, Olupot-Olupot P: Was the "ABC" approach (abstinence, being faithful, using condoms) responsible for Uganda's decline in HIV?. PLoS Med. 2006, 3 (9): e379-10.1371/journal.pmed.0030379.CrossRefPubMedPubMedCentral Murphy EM, Greene ME, Mihailovic A, Olupot-Olupot P: Was the "ABC" approach (abstinence, being faithful, using condoms) responsible for Uganda's decline in HIV?. PLoS Med. 2006, 3 (9): e379-10.1371/journal.pmed.0030379.CrossRefPubMedPubMedCentral
8.
go back to reference Manopaiboon C, Kilmarx PH, Limpakarnjanarat K, Jenkins RA, Chaikummao S, Supawitkul S, van Griensven F: Sexual coercion among adolescents in northern Thailand: prevalence and associated factors. Southeast Asian J Trop Med Public Health. 2003, 34 (2): 447-457.PubMed Manopaiboon C, Kilmarx PH, Limpakarnjanarat K, Jenkins RA, Chaikummao S, Supawitkul S, van Griensven F: Sexual coercion among adolescents in northern Thailand: prevalence and associated factors. Southeast Asian J Trop Med Public Health. 2003, 34 (2): 447-457.PubMed
9.
go back to reference de Visser R, Smith A, CE R, Richters J, AE G: Sex in Australia: experiences of sexual coercion among a representative sample of adults. Aust N Z J Public Health. 2003, 27 (2): 198-203. 10.1111/j.1467-842X.2003.tb00808.x.CrossRefPubMed de Visser R, Smith A, CE R, Richters J, AE G: Sex in Australia: experiences of sexual coercion among a representative sample of adults. Aust N Z J Public Health. 2003, 27 (2): 198-203. 10.1111/j.1467-842X.2003.tb00808.x.CrossRefPubMed
10.
go back to reference Erulkar AS: The experience of sexual coercion among young people in Kenya. Int Fam Plan Perspect. 2004, 30 (4): 182-189. 10.1363/3018204.CrossRefPubMed Erulkar AS: The experience of sexual coercion among young people in Kenya. Int Fam Plan Perspect. 2004, 30 (4): 182-189. 10.1363/3018204.CrossRefPubMed
11.
go back to reference Ajuwon AJ, Olaleye A, Faromoju B, Ladipo O: Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria. BMC Public Health. 2006, 6: 310-10.1186/1471-2458-6-310.CrossRefPubMedPubMedCentral Ajuwon AJ, Olaleye A, Faromoju B, Ladipo O: Sexual behavior and experience of sexual coercion among secondary school students in three states in North Eastern Nigeria. BMC Public Health. 2006, 6: 310-10.1186/1471-2458-6-310.CrossRefPubMedPubMedCentral
12.
go back to reference de Moraes CL, Cabral CS, Heilborn ML: [Magnitude and characterization of sexual coercion experienced by young adults in three Brazilian state capitals: Porto Alegre, Rio de Janeiro, and Salvador]. Cad Saude Publica. 2006, 22 (7): 1493-1504. 10.1590/S0102-311X2006000700013.CrossRefPubMed de Moraes CL, Cabral CS, Heilborn ML: [Magnitude and characterization of sexual coercion experienced by young adults in three Brazilian state capitals: Porto Alegre, Rio de Janeiro, and Salvador]. Cad Saude Publica. 2006, 22 (7): 1493-1504. 10.1590/S0102-311X2006000700013.CrossRefPubMed
13.
go back to reference Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson D: Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. J Womens Health. 1998, 7 (3): 371-378. 10.1089/jwh.1998.7.371.CrossRefPubMed Kalichman SC, Williams EA, Cherry C, Belcher L, Nachimson D: Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. J Womens Health. 1998, 7 (3): 371-378. 10.1089/jwh.1998.7.371.CrossRefPubMed
14.
go back to reference Cáceres C, Vanoss MB, Sid HE: Sexual coercion among youth and young adults in Lima, Peru. J Adolesc Health. 2000, 26 (5): 361-367. 10.1016/S1054-139X(98)00042-1.CrossRef Cáceres C, Vanoss MB, Sid HE: Sexual coercion among youth and young adults in Lima, Peru. J Adolesc Health. 2000, 26 (5): 361-367. 10.1016/S1054-139X(98)00042-1.CrossRef
15.
go back to reference Jewkes R, Abrahams N: The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med. 2002, 55 (7): 1231-1244. 10.1016/S0277-9536(01)00242-8.CrossRefPubMed Jewkes R, Abrahams N: The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med. 2002, 55 (7): 1231-1244. 10.1016/S0277-9536(01)00242-8.CrossRefPubMed
16.
go back to reference Ajuwon AJ, Olley BO, Akin-Jimoh I, Akintola O: Experience of sexual coercion among adolescents in Ibadan, Nigeria. Afr J Reprod Health. 2001, 5 (3): 120-131. 10.2307/3583330.CrossRefPubMed Ajuwon AJ, Olley BO, Akin-Jimoh I, Akintola O: Experience of sexual coercion among adolescents in Ibadan, Nigeria. Afr J Reprod Health. 2001, 5 (3): 120-131. 10.2307/3583330.CrossRefPubMed
17.
go back to reference Nasta A, Shah B, Brahmanandam S, Richman K, Wittels K, Allsworth J, Boardman L: Sexual victimization: incidence, knowledge and resource use among a population of college women. J Pediatr Adolesc Gynecol. 2005, 18 (2): 91-96. 10.1016/j.jpag.2005.01.002.CrossRefPubMed Nasta A, Shah B, Brahmanandam S, Richman K, Wittels K, Allsworth J, Boardman L: Sexual victimization: incidence, knowledge and resource use among a population of college women. J Pediatr Adolesc Gynecol. 2005, 18 (2): 91-96. 10.1016/j.jpag.2005.01.002.CrossRefPubMed
18.
go back to reference Maharaj P, Munthree C: Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa. J Biosoc Sci. 2007, 39 (2): 231-244. 10.1017/S0021932006001325.CrossRefPubMed Maharaj P, Munthree C: Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa. J Biosoc Sci. 2007, 39 (2): 231-244. 10.1017/S0021932006001325.CrossRefPubMed
19.
go back to reference Baumgartner JN, Waszak Geary C, Tucker H, Wedderburn M: The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica. Int Perspect Sex Reprod Health. 2009, 35 (1): 21-28. 10.1363/3502109.CrossRefPubMed Baumgartner JN, Waszak Geary C, Tucker H, Wedderburn M: The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica. Int Perspect Sex Reprod Health. 2009, 35 (1): 21-28. 10.1363/3502109.CrossRefPubMed
20.
go back to reference Hines DA: Predictors of sexual coercion against women and men: a multilevel, multinational study of university students. Arch Sex Behav. 2007, 36 (3): 403-422. 10.1007/s10508-006-9141-4.CrossRefPubMed Hines DA: Predictors of sexual coercion against women and men: a multilevel, multinational study of university students. Arch Sex Behav. 2007, 36 (3): 403-422. 10.1007/s10508-006-9141-4.CrossRefPubMed
21.
go back to reference van der Straten A, King R, Grinstead O, Serufilira A, Allen S: Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS. 1995, 9 (8): 935-944. 10.1097/00002030-199508000-00016.CrossRefPubMed van der Straten A, King R, Grinstead O, Serufilira A, Allen S: Couple communication, sexual coercion and HIV risk reduction in Kigali, Rwanda. AIDS. 1995, 9 (8): 935-944. 10.1097/00002030-199508000-00016.CrossRefPubMed
22.
go back to reference Moore AM, Biddlecom AE, Zulu EM: Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Afr J Reprod Health. 2007, 11 (3): 44-61. 10.2307/25549731.CrossRefPubMedPubMedCentral Moore AM, Biddlecom AE, Zulu EM: Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. Afr J Reprod Health. 2007, 11 (3): 44-61. 10.2307/25549731.CrossRefPubMedPubMedCentral
23.
go back to reference Polis CB, Lutalo T, Wawer M, Serwadda D, Kigozi G, Nalugoda F, Kiwanuka N, Gray R: Coerced sexual debut and lifetime abortion attempts among women in Rakai, Uganda. Int J Gynaecol Obstet. 2009, 104 (2): 105-109. 10.1016/j.ijgo.2008.10.002.CrossRefPubMed Polis CB, Lutalo T, Wawer M, Serwadda D, Kigozi G, Nalugoda F, Kiwanuka N, Gray R: Coerced sexual debut and lifetime abortion attempts among women in Rakai, Uganda. Int J Gynaecol Obstet. 2009, 104 (2): 105-109. 10.1016/j.ijgo.2008.10.002.CrossRefPubMed
24.
go back to reference Stoneburner RL, Low-Beer D: Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004, 304 (5671): 714-718. 10.1126/science.1093166.CrossRefPubMed Stoneburner RL, Low-Beer D: Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004, 304 (5671): 714-718. 10.1126/science.1093166.CrossRefPubMed
25.
go back to reference Muriisa R: The AIDS Panademic in Uganda, Social Capital and the Role of NGOs in Alleviating the Impact of HIV/AIDS. VDM Verlag Dr Muller. 2009 Muriisa R: The AIDS Panademic in Uganda, Social Capital and the Role of NGOs in Alleviating the Impact of HIV/AIDS. VDM Verlag Dr Muller. 2009
26.
go back to reference Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L: The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974, 19 (1): 1-15. 10.1002/bs.3830190102.CrossRefPubMed Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L: The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974, 19 (1): 1-15. 10.1002/bs.3830190102.CrossRefPubMed
27.
go back to reference Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull. 1973, 9 (1): 13-28.PubMed Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull. 1973, 9 (1): 13-28.PubMed
28.
go back to reference Kaaya SF, Fawzi MC, Mbwambo JK, Lee B, Msamanga GI, Fawzi W: Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002, 106 (1): 9-19. 10.1034/j.1600-0447.2002.01205.x.CrossRefPubMed Kaaya SF, Fawzi MC, Mbwambo JK, Lee B, Msamanga GI, Fawzi W: Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002, 106 (1): 9-19. 10.1034/j.1600-0447.2002.01205.x.CrossRefPubMed
29.
go back to reference Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT: Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Int J Soc Psychiatry. 2008, 54 (1): 7-20. 10.1177/0020764006074995.CrossRefPubMed Lee B, Kaaya SF, Mbwambo JK, Smith-Fawzi MC, Leshabari MT: Detecting depressive disorder with the Hopkins Symptom Checklist-25 in Tanzania. Int J Soc Psychiatry. 2008, 54 (1): 7-20. 10.1177/0020764006074995.CrossRefPubMed
30.
go back to reference Lundberg P, Cantor-Graae E, Rukundo G, Ashaba S, Ostergren PO: Urbanicity of place of birth and symptoms of psychosis, depression and anxiety in Uganda. Br J Psychiatry. 2009, 195 (2): 156-162. 10.1192/bjp.bp.108.051953.CrossRefPubMed Lundberg P, Cantor-Graae E, Rukundo G, Ashaba S, Ostergren PO: Urbanicity of place of birth and symptoms of psychosis, depression and anxiety in Uganda. Br J Psychiatry. 2009, 195 (2): 156-162. 10.1192/bjp.bp.108.051953.CrossRefPubMed
31.
go back to reference Subramanian SV, Kim DJ, Kawachi I: Social trust and self-rated health in US communities: a multilevel analysis. J Urban Health. 2002, 79 (4 Suppl 1): S21-34.CrossRefPubMedPubMedCentral Subramanian SV, Kim DJ, Kawachi I: Social trust and self-rated health in US communities: a multilevel analysis. J Urban Health. 2002, 79 (4 Suppl 1): S21-34.CrossRefPubMedPubMedCentral
32.
go back to reference Lewin B: Sex i Sverige. Om sexuallivet i Sverige. Edited by: Lewin B. 1999, Stockholm: Statens folkhalsoinstitut, 1996 (Sex in Sweden. About sexual life in Sweden) Lewin B: Sex i Sverige. Om sexuallivet i Sverige. Edited by: Lewin B. 1999, Stockholm: Statens folkhalsoinstitut, 1996 (Sex in Sweden. About sexual life in Sweden)
33.
go back to reference Rothman KJ: Modern epidemiology. 1986, Boston: Little, Brown Rothman KJ: Modern epidemiology. 1986, Boston: Little, Brown
34.
go back to reference Moore AM, Awusabo-Asare K, Madise N, John-Langba J, Kumi-Kyereme A: Coerced first sex among adolescent girls in sub-Saharan Africa: prevalence and context. Afr J Reprod Health. 2007, 11 (3): 62-82. 10.2307/25549732.CrossRefPubMedPubMedCentral Moore AM, Awusabo-Asare K, Madise N, John-Langba J, Kumi-Kyereme A: Coerced first sex among adolescent girls in sub-Saharan Africa: prevalence and context. Afr J Reprod Health. 2007, 11 (3): 62-82. 10.2307/25549732.CrossRefPubMedPubMedCentral
35.
go back to reference Seto MC, Kjellgren C, Priebe G, Mossige S, Svedin CG, Langstrom N: Sexual coercion experience and sexually coercive behavior: a population study of Swedish and Norwegian male youth. Child Maltreat. 2010, 15 (3): 219-228. 10.1177/1077559510367937.CrossRefPubMed Seto MC, Kjellgren C, Priebe G, Mossige S, Svedin CG, Langstrom N: Sexual coercion experience and sexually coercive behavior: a population study of Swedish and Norwegian male youth. Child Maltreat. 2010, 15 (3): 219-228. 10.1177/1077559510367937.CrossRefPubMed
Metadata
Title
Experience of sexual coercion and risky sexual behavior among Ugandan university students
Authors
Anette Agardh
Karen Odberg-Pettersson
Per-Olof Östergren
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-527

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue