Despite nationwide efforts to increase HIV awareness and common fears of unplanned pregnancy, young, sexually active Ugandans continue to have risky sex without using condoms consistently, spurring new measures to promote the prophylactic.
Only 36.2 percent of women and 52.9 percent of men between 20 and 24 used a condom during their last sexual intercourse in the past 12 months, according to the National AIDS Indicator Survey, launched on 18 September. Among those who had more than two partners in the past 12 months, only 23.4 percent of women and 30 percent of men reported using a condom during their last intercourse. The research also reveals that a majority of young Ugandans lack comprehensive knowledge about HIV; just 39 percent of men and women aged 15 to 24 have all the facts on how HIV is spread and how it can be prevented.
The country's HIV prevention strategies have been called into question following a rise in HIV prevalence from 6.4 percent to 7.3 percent over the past five years.
Uganda has long relied on the ‘ABC-plus’ model, which includes abstinence, being faithful and condom use, as well as measures to prevent the mother-to-child-transmission of HIV and, more recently, methods such as medical male circumcision. Government officials say there is a need for more focus on condom use for young people.
"The students should go for protected sex... It's the only way to reduce HIV prevalence rates in the country," David Kihumuro Apuuli, director general of the Uganda AIDS Commission, told IRIN/PlusNews.
Greater fear of pregnancy
Some students at Kampala's Makerere University seem more concerned about pregnancy than about contracting sexually transmitted infections. Even so, many do not use condoms.
"Of course I trust my boyfriend, [but] I fear getting pregnant because my parents will refuse to pay my tuitions fees," Sharon Nalule, a Makerere student, told IRIN/PlusNews. "We would rather continue using morning after pills."
|HIV/AIDS: Ten condom commandments|
|KENYA: Condom recycling highlights gaps in HIV prevention programming|
|INDONESIA: Condom controversy continues|
|UGANDA: Public irritated by yet another condom shortage|
Pharmacies around Makerere do a brisk trade in "morning after" pills every weekend. "We normally sell those drugs throughout the week, however, the sales are higher over the weekend," said Lorna, a nurse at a pharmacy near the university. "It's when students have more time to drink, party and enjoy… they go for it [sex] - some without protection."
Emergency contraceptive pills retail for about US$4, compared to condoms, which cost between $0.25 and $2 for a pack of three. But for many young couples, condom use stops after a certain comfort level is reached within a relationship.
"I have always had unprotected sex with my girlfriend after an HIV/AIDS test. I trust her. However, I fear her getting pregnant. So at times I advise her to get morning after pills," Peter Okello, a second-year student at Makerere University, said.
Emergency contraceptive pills contain high doses of hormones that disrupt the normal menstrual cycle and can be taken up to five days after unprotected sex to prevent pregnancy. They are not intended for regular use, and taking them frequently may cause the menstrual cycle to become irregular.
There is no formal education about the morning after pill in Uganda, which most girls learn about from their friends. "The youths at university are at their prime stage. They are very inquisitive... They engage in drugs and alcoholism, and indulge in unprotected sex, which sometimes leads to contracting HIV/AIDS, sexually transmitted infections and unwanted pregnancies," said Alex Craig Kiwanuka, youth project officer at the NGO Reproductive Health Uganda (RHU).
When the current semester at Makerere started in August, RHU launched an HIV prevention campaign that includes the distribution of free condoms and other contraceptives by students to their peers at Makerere University and the Mulago Paramedical School. The students also distribute T-shirts, stickers and flyers with accurate information about the proper use of the morning after pill.
"We were trained and equipped. We don't just give the condoms and contraceptives. We first teach and demonstrate to… [the students] how to use them. Many of the students lack correct information," James Bukenya, a peer educator, told IRIN/PlusNews. "Extending these services to where students are staying increases… utilization of... condoms and contraceptives." The campaign aims to ensure that students engage in "satisfying, pleasurable and risk-free sexual intercourse".
"This is a pilot project targeting at least 5,000 students this year. Depending on its success and availability of funds... we may be able to roll it out to all institutions of higher learning in the country," said RHU’s Kiwanuka. "Our team will educate, counsel and refer their colleagues for testing, safe male circumcision and treatment at health facilities."
Angel Nakimbugwe, a social sciences student and peer educator, told IRIN/PlusNews, "The campaign should be extended to other institutions of higher learning. There are many students who lack information and need these services."