Determinants of risky sexual behaviours among adolescents living with HIV and AIDS attending the ART clinic at Aber Hospital, Oyam District

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Specifically, it determined the prevalence of risky sexual behaviours and examined individual, environmental, and psychosocial factors associated with these behaviours. Methods A community-based cross-sectional study using quantitative methods was conducted among adolescents aged 10–19 years. A total of 170 respondents were selected using systematic random sampling. Data were collected using researcher-administered questionnaires and analyzed using SPSS version 26. Binary logistic regression was used to determine associated factors, with Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) used to assess statistical significance. Results Of the 170 respondents, 63 (37%) reported engaging in risky sexual behaviours, while 107 (63%) did not. Individual factors significantly associated with risky sexual behaviours included sex, level of education, delayed HIV testing (AOR=19.37, p=0.048), having more than one sexual partner in the past six months (AOR=41.16, p<0.001), and non-use of condoms during the last sexual intercourse (AOR=10.01, p10 km: AOR=87.53, p=0.002). Psychosocial factors included low confidence in expressing sexual boundaries (AOR=6.53, p=0.032), HIV-related stigma (AOR=0.02, p=0.004), and lack of sexual health counseling (AOR=41.30, p=0.015). Conclusion Risky sexual behaviours remain prevalent among adolescents living with HIV at Aber Hospital and are influenced by multiple individual, environmental, and psychosocial factors. Strengthening counseling services, improving access to HIV care, and enhancing sexual health education may help reduce these behaviours. Risky sexual behaviours Adolescents living with HIV/AIDS Antiretroviral therapy (ART) clinic Determinants HIV prevention Uganda Figures Figure 1 Background Risky sexual behaviours are defined as sexual practices that increase the likelihood of HIV transmission and other adverse sexual and reproductive health outcomes. These behaviours include unprotected sexual intercourse, having multiple sexual partners, early sexual debut, transactional sex, and engaging in sexual activity under the influence of alcohol or other substances (Keto et al., 2020). Among adolescents living with HIV/AIDS (ALHIV), such behaviours not only heighten the risk of secondary HIV transmission but also compromise treatment adherence, mental health, and long-term reproductive health outcomes (Birdthistle et al., 2019). Globally, approximately 38 million people are living with HIV/AIDS, including about 1.7 million adolescents aged 10–19 years (UNAIDS, 2023; Tafere et al., 2023). Adolescence is a critical developmental stage characterized by experimentation, identity formation, and risk-taking behaviours, which may increase vulnerability to unsafe sexual practices (Girmay & Mariye, 2019). The World Health Organization reports that nearly one-third of new HIV infections occur among young people, while rates of teenage pregnancy and sexually transmitted infections (STIs) remain high in many regions. Risky sexual behaviours during adolescence can therefore lead to severe long-term consequences, including unintended pregnancies, STI transmission, and further spread of HIV infection. Evidence from different regions indicates that adolescents continue to engage in unsafe sexual practices despite ongoing prevention efforts. For example, the 2017 United States National Youth Risk Behavior Survey reported that 39.5% of high school students had engaged in sexual intercourse, although this represented a decline from 47.8% in 2007 (Centers for Disease Control and Prevention [CDC], 2018). However, condom use during the last sexual encounter also declined from 61.5% in 2007 to 46.2% in 2017, while approximately 70.6% of sexually active adolescents reported not using any form of birth control before intercourse (CDC, 2018). Similar trends have been observed in other settings; in Hong Kong, HIV infections increased from 181 cases in 1997 to 692 cases in 2016, accompanied by a rise in premarital pregnancies (Legislative Council Secretariat, 2018). Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. The region accounts for approximately 75% of global HIV/AIDS prevalence and represents nearly 89% of adolescents living with HIV worldwide (Odugbesan & Rjoub, 2019; UNICEF, 2024). Adolescent girls in the region are particularly vulnerable and are newly infected at rates up to four times higher than adolescent boys. Furthermore, Acquired Immunodeficiency Syndrome (AIDS) remains one of the leading causes of death among adolescents in sub-Saharan Africa (Gabre et al., 2024). Despite ongoing prevention strategies, studies indicate that between 10% and 60% of seropositive individuals continue to engage in unprotected sexual behaviours, thereby increasing the risk of onward HIV transmission (Wondmeneh & Wondmeneh, 2023). Cultural norms and social dynamics also influence adolescents’ sexual behaviour across different African settings. In some countries such as South Africa, sexual relationships have historically been embedded within broader social structures that regulate sexual expression, while in other contexts such as the Democratic Republic of Congo, premarital relationships among youth have been culturally tolerated in certain forms (Birdthistle et al., 2019; Stover et al., 2021). These socio-cultural factors, combined with limited access to youth-friendly health services, have contributed to persistent HIV transmission rates among adolescents in the region. For example, in Kenya, adolescents living with HIV have reported difficulties disclosing their HIV status to sexual partners, despite their desire to maintain normal intimate relationships (Kinoti et al., 2022). In Uganda, adolescents and young people remain significantly affected by the HIV epidemic. In 2021, approximately 14,000 youths aged 15–24 years were living with HIV/AIDS, accounting for about 37% of the total HIV burden in the country (Uganda AIDS Commission, 2021). Risky sexual behaviours among young people, including unprotected sex, multiple sexual partnerships, and sexual activity under the influence of alcohol or other substances, remain prevalent, with over 22% of youths aged 15–24 reportedly engaging in such practices (Anyanwu & Tamwesigire, 2023). These behaviours not only increase the risk of HIV transmission but also contribute to poor treatment outcomes among adolescents living with HIV. Adolescents living with HIV/AIDS remain a particularly vulnerable population. Risky sexual behaviours among this group contribute to secondary HIV transmission, poor adherence to antiretroviral therapy (ART), and adverse reproductive health outcomes (Ssewanyana et al., 2018). In Oyam District, approximately 31% of adolescents living with HIV reportedly engage in risky sexual behaviours such as unprotected sex and having multiple sexual partners (MARPI, 2024). Similar patterns have been reported in other parts of Uganda. For example, a cross-sectional study conducted in Mbarara Municipality found that 18.8% of adolescents engaged in high-risk sexual behaviours, including sex under the influence of alcohol and inconsistent condom use (Anyanwu & Tamwesigire, 2023). In the Karamoja sub-region, 11.4% of adolescents living with HIV were found to engage in high-risk sexual practices despite being aware of their HIV status (Ssebunya et al., 2019). The Ministry of Health recommends that adolescents living with HIV receive comprehensive sexuality education, consistent access to antiretroviral therapy, and routine psychosocial counselling (Ministry of Health, 2022). However, these services remain fragmented or underutilized in many districts. Failure to adequately address the needs of adolescents living with HIV may result in increased HIV transmission, treatment failure, psychological distress, and increased strain on already limited health care resources (Worede et al., 2022; Ewemooje & Adebola, 2023). Despite the growing burden of risky sexual behaviours among adolescents living with HIV in Uganda, limited research has specifically examined the determinants of these behaviours at the district level. Understanding these determinants is essential for designing targeted interventions that promote safer sexual practices and improve treatment outcomes among adolescents living with HIV. Therefore, this study aimed to assess the determinants of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital in Oyam District, Uganda. Methods Study setting and design This study employed an analytical cross-sectional design to assess the determinants of risky sexual behaviours among adolescents living with HIV/AIDS attending the antiretroviral therapy (ART) clinic at Aber Hospital in Oyam District, Northern Uganda. Aber Hospital is a private not-for-profit facility under the Uganda Catholic Medical Bureau that provides comprehensive health services, including HIV counselling, testing, and ART care. The hospital serves a large rural and peri-urban catchment population and offers specialized HIV services for adolescents, including routine follow-up visits, ART refills, adherence counselling, and psychosocial support. The cross-sectional design was considered appropriate because it allowed the assessment of the prevalence of risky sexual behaviours and their associated factors among adolescents receiving HIV care at a specific point in time. Sample size and sampling procedure The sample size was determined using the Leslie Kish formula for cross-sectional studies (n=Z 2 pq/d 2 ), assuming a 95% confidence level (Z=1.96), a prevalence of risky sexual behaviour among adolescents living with HIV of p=0.114 based on Ssebunya et al. (2019), and a margin of error of d=0.05. The calculated minimum sample size was 155 participants. After adjusting for a 10% non-response rate, the final sample size was 171 adolescents. Participants were selected using systematic random sampling from the ART clinic register, which listed approximately 500 adolescents receiving ART at Aber Hospital. The sampling interval was calculated as k=N/n=500/171=2. A random starting point between 1 and 2 was selected, after which every second adolescent on the register was recruited until the required sample size was achieved. Data collection and quality control Data were collected using interviewer-administered structured questionnaires and key informant interviews. The structured questionnaire was used to obtain quantitative data on socio-demographic characteristics, individual factors, psychosocial factors, environmental influences, and sexual behaviours among adolescents living with HIV/AIDS. In addition, semi-structured key informant interviews were conducted with selected health workers to obtain qualitative insights into contextual and health system factors influencing adolescents’ sexual behaviours. To ensure data quality, research assistants were trained on the study objectives, ethical considerations, and data collection procedures prior to data collection. The questionnaire was translated from English into Langi and back-translated to ensure linguistic accuracy and cultural appropriateness. The tools were pre-tested among adolescents with similar characteristics at a health facility outside the study area, and necessary adjustments were made to improve clarity and reliability before the main data collection. Data analysis Quantitative data were entered, cleaned, and analyzed using statistical software. Descriptive statistics were used to summarize participants’ characteristics and were presented using frequencies, percentages, means, and standard deviations. Bivariate analysis using chi-square tests was conducted to assess associations between independent variables and risky sexual behaviour. Variables with p-values less than 0.05 were considered statistically significant. Variables that were significant at bivariate analysis (p < 0.05), together with potential confounders (p < 0.15), were included in a binary logistic regression model to identify independent predictors of risky sexual behaviours. Results from the multivariate analysis were presented as Adjusted Odds Ratios (AORs) with corresponding 95% confidence intervals (CIs). Qualitative data from key informant interviews were transcribed verbatim and analyzed using thematic content analysis. Codes were generated from the transcripts, grouped into categories, and organized into themes that described contextual and psychosocial factors influencing risky sexual behaviours among adolescents living with HIV/AIDS. Results Prevalence of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital, Oyam District Out of the 170 respondents that participated in this study; 63 (37%) had risky sexual behaviours while 107 (63%) never had risky sexual behaviours. The details are shown in figure 2 below. Table 1 Individual factors of respondents Variable Category Frequency Percentage Age (in years) 10-13 years 20 11.8% 14-16 years 51 30.0% 17-19 years 99 58.2% Sex Females 96 56.5% Males 74 43.5% Education Level No formal education 22 12.9% Primary 70 41.2% secondary education 42 24.7% Tertiary education 36 21.2% Religion Catholic 87 51.2% Protestant 46 27.1% Muslim 15 8.8% Other Anglican faiths 15 8.8% Indigenous religion 7 4.1% Marital Status Singles 124 72.9% Married 28 16.5% Divorced 12 7.1% Widows 6 3.5% Source: Primary Data Table 1 shows that the majority of respondents were aged 17–19 years, 99 (58.2%), followed by those aged 14–16 years, 51 (30.0%), while only 20 (11.8%) were aged 10–13 years. Females constituted 96 (56.5%) of the respondents, compared to 74 (43.5%) males. In terms of education level, most adolescents had attained primary education, 70 (41.2%), while 42 (24.7%) had secondary education and 36 (21.2%) had tertiary education. However, 22 (12.9%) had no formal education. The majority of respondents were single, 124 (72.9%), although 28 (16.5%) were married. Table 2 Factors factors on risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital Variable Category AOR (95%) CI P-value Individual factors Sex Females 1 Males 0.02 (0.001-0.38) 0.008** Education Level No formal education 1 Primary 0.01(0.0001-0.042) 0.018** Secondary education 0.01 (0.0001-0.42) 0.017** Tertiary education 0.002 (0.0001-0.14) 0.004** Duration since HIV Diagnosis 24 months 19.37 (1.03-363.37) 0.048** Number of sexual partners in the past 6 months None 1 One partners 41.16 (23.66-822.74) <0.001** Used a condom during last sex Yes 1 No 10.01 (1.01-20.08) <0.001** Frequency of using condoms Always 1 Never 14.60 (1.34-159.01) 0.028** Environmental factors Watched sexually explicit media Yes 1 No 0.12 (0.02-0.84) 0.032** Ever used alcohol or drugs Yes 1 N o 0.07 (0.01-0.61) 0.016** Distance to health facility 10km 87.53 (5.35-143.06) 0.002** Psychosocial Factors Felt confident in expressing sexual boundaries Yes 1 N o 6.53 (1.18-36.16) 0.032** Experienced HIV-related stigma Yes 1 N o 0.02 (0.002-0.29) 0.004** Received sexual health counseling Yes 1 N o 41.30 (2.05-830.88) 0.015** Table 2 presents the results of the multivariate logistic regression analysis identifying independent factors associated with risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital. After adjusting for potential confounders, sex remained significantly associated with risky sexual behaviour. Male adolescents were significantly less likely to engage in risky sexual behaviours compared to females (AOR = 0.02; 95% CI: 0.001–0.38; p = 0.008). Education level was also independently associated with risky sexual behaviour. Adolescents with primary education (AOR = 0.01; 95% CI: 0.0001–0.042; p = 0.018), secondary education (AOR = 0.01; 95% CI: 0.0001–0.42; p = 0.017), and tertiary education (AOR = 0.002; 95% CI: 0.0001–0.14; p = 0.004) were significantly less likely to engage in risky sexual behaviours compared to those with no formal education. Duration since HIV diagnosis was significantly associated with risky behaviour. Adolescents who had been diagnosed for more than 24 months were more likely to engage in risky sexual behaviours compared to those diagnosed for less than 12 months (AOR = 19.37; 95% CI: 1.03–363.37; p = 0.048). Sexual behaviour variables showed strong associations. Adolescents who had one sexual partner in the past six months were significantly more likely to engage in risky sexual behaviour compared to those with no partner (AOR = 41.16; 95% CI: 23.66–822.74; p < 0.001). Those who did not use a condom during their last sexual intercourse were more likely to engage in risky sexual behaviours compared to those who used a condom (AOR = 10.01; 95% CI: 1.01–20.08; p < 0.001). Similarly, adolescents who never used condoms were significantly more likely to engage in risky sexual behaviours compared to those who always used condoms (AOR = 14.60; 95% CI: 1.34–159.01; p = 0.028). Among environmental factors, adolescents who did not watch sexually explicit media were less likely to engage in risky sexual behaviours compared to those who watched such media (AOR = 0.12; 95% CI: 0.02–0.84; p = 0.032). Similarly, those who had never used alcohol or drugs were less likely to engage in risky sexual behaviours compared to those who had used substances (AOR = 0.07; 95% CI: 0.01–0.61; p = 0.016). Distance to the health facility was also significant; adolescents residing 5–10 km (AOR = 99.99; 95% CI: 5.77–173.51; p = 0.002) and those living more than 10 km away (AOR = 87.53; 95% CI: 5.35–143.06; p = 0.002) were more likely to engage in risky sexual behaviours compared to those living within 5 km. Psychosocial factors were also independently associated with risky sexual behaviour. Adolescents who lacked confidence in expressing sexual boundaries were more likely to engage in risky sexual behaviours compared to those who felt confident (AOR = 6.53; 95% CI: 1.18–36.16; p = 0.032). Those who had not experienced HIV-related stigma were less likely to engage in risky sexual behaviours compared to those who had experienced stigma (AOR = 0.02; 95% CI: 0.002–0.29; p = 0.004). Furthermore, adolescents who had not received sexual health counseling were significantly more likely to engage in risky sexual behaviours compared to those who had received counseling (AOR = 41.30; 95% CI: 2.05–830.88; p = 0.015). Qualitative findings Qualitative findings from in-depth interviews provided contextual insights into factors influencing risky sexual behaviours among adolescents living with HIV/AIDS. Thematic analysis identified several key themes, including cultural norms, HIV-related stigma, limited sexual negotiation skills, and gaps in sexual and reproductive health services. Cultural and religious norms influencing early marriage Cultural practices, particularly the value placed on bride wealth, were reported to influence early and sometimes forced marriages among adolescent girls. Participants explained that families may encourage early marriage in order to obtain bride wealth, which indirectly exposes adolescents to early sexual activity. One participant explained: “In our community family members, especially fathers, like bride wealth so much which leads to early and forced marriages.” HIV-related stigma and emotional reactions HIV-related stigma emerged as an important psychosocial factor shaping adolescents’ attitudes toward sexual relationships. Some participants described experiencing discrimination and labeling within their communities, which created emotional distress and resentment. One adolescent explained: “When most of the people in the community pinpoint me as an HIV carrier who is dangerous to their sons, I feel annoyed… I feel like their boys should also get some HIV from me and we suffer the same.” These experiences of stigma appeared to influence risk-taking attitudes and emotional responses toward sexual relationships. Limited confidence in negotiating safe sex Some adolescents reported difficulties in expressing sexual boundaries or negotiating condom use with partners. Lack of confidence and fear of rejection were described as barriers to insisting on safer sexual practices, increasing vulnerability to risky sexual behaviours. Gaps in sexual and reproductive health services Participants acknowledged that sexual and reproductive health services were available at the hospital; however, they noted that such programs were irregular and poorly communicated to adolescents. One participant stated: “There are sexual and reproductive health programs here at the hospital but they are very irregular and not well communicated to community members and adolescents even if they are registered with the HIV/AIDS clinic.” Discussion Findings from this study revealed high prevalence of risky sexual behaviours at 37% (63;37%). This was attributed to several factors that included; individual, environmental and psychological factors. Most of the adolescents living with HIV/AIDS were females who were vulnerable to sexual activities given the cultural norms of the society where early adolescent marriages were socially accepted. Also given the low levels of education and long duration they took to diagnose the viral load this negatively affected their knowledge on the different adverse sexual behaviours such as irregular condom use and having many sexual partners. The adolescents also were never confident in expressing sexual boundaries which was partially associated with stigma they experienced and lack of counseling to reinstate hope among them. Similar findings were reported in study carried out in Uganda, where Ssebunya et al. (2019) found that 11.4% of adolescents living with HIV/AIDS engaged in high-risk sexual behaviours in a study of 1,439 adolescents. Nuwaha et al., (2019) also reported that adolescents diagnosed with HIV for less than 24 months were significantly more likely to engage in risky sexual practices compared to those diagnosed earlier. More recently, Becker et al . (2024) found that while 72% of perinatally infected adolescents in Kampala had adequate HIV knowledge, nearly 30% still reported inconsistent condom use, highlighting the persistent gap between knowledge and practice. Male adolescents living with HIV/AIDS were less likely to engage in risky sexual behaviours comparedto female adolescents. This implied that females were more vulnerable to risky sexual practices since males of all ages manipulated them for their sexual desires which weren’t the case with male adolescents. Also there were cultural norms that favoured marrying off adolescents which predisposed female adolescents to early marriages and risky sexual behaviours. Similar findings were reported in a study carried out in Uganda where HIV positive female adolescents had higher odds of experiencing risky sexual practices compared to their male counterparts (Omona and Ssuka, 2023). In terms of education status, this study found that;-adolescents living with HIV/AIDS who had primary education, had secondary education and had tertiary education were less likely to engage in risky sexual behaviours compared to adolescents who never had any formal education. This implied that the lower the levels of education one had the higher the odds of engaging in risky sexual behaviours. This could be associated with lack of adequate knowledge about the dangers of risky sexual behaviours since they never had regular chances to experience them. Similar findings were reported in a study carried out in Uganda where respondents who had not attained any level of formal education had nearly twice more odds of engaging in unsafe sexual behaviours compared to those with primary, secondary, and tertiary education levels (Nnakate et al., 2020). In the same line, a study carried out in Nigeria among 41,821 adolescents with data extracted from the 2018 Nigerian Demographic and Health Survey where respondents with secondary or higher levels of education were less likely to engage in risky sexual behaviours than those with lower levels of education (Olusegun and Adebola, 2023) due better sexual and reproductive health knowledge they had. On the contrary, Zhang et al. (2021), in a cross-sectional study carried out in China among 1,602 adolescents living with HIV/AIDS, where attending university had 1.56 times more odds of engaging in risky sexual behaviours than those in lower levels of education. The difference in results could be associated with high permissiveness among university students in developed countries This study also found that adolescents living with HIV/AIDS who last diagnosed for HIV viral status two years ago, were nineteen times more likely to engage in risky sexual behaviours compared to adolescent who were diagnosed for HIV viral status in the last 12 months. This implied taking long without diagnosing for the HIV viral status predisposed them to risky sexual behaviours because they had taken long to get sex related education from well-trained health care workers. Similarly, another study carried out in Uganda among 380 adolescents living with HIV/AIDS observed that respondents who were diagnosed with HIV for less than 24 months had 3.67 times more odds of engaging in unsafe sexual behaviours than those who were diagnosed with HIV for more than 24 months (Nuwaha et al., 2019). Regarding the number of sexual partners in the past 6 months, this study established that adolescents who had more than one partner were fourty one times more likely to engage in risky sexual behavior compared to adolescents who never had any sexual partner. This implied that having many sexual partners meant having different sexual experiences and demands which could not be safely fulfilled. This led to malpractices such as irregular and none condom use, taking long to diagnose HIV viral load and watching sexually explicit media. Similar findings were also reported in another study conducted in Uganda by (Becker et al., 2024). This study also established that adolescents living with HIV/AIDS who never used condoms in the last sexual intercourse were ten times more likely to engage in risky sexual behaviours compared to adolescents who used condoms in the last sexual intercourse. This implied that irregular use of condoms increased the spread of HIV to other people and also led to re-infection of HIV among adolescents living with HIV/AIDS which was a major problem to the society. Similar findings were reported in a cross-sectional study that took place in Accra, Ghana which established that respondents who perceived safe sex as such as regular use of condoms to be important had 1.58 times lesser odds of engaging in unsafe sexual behaviours than those who did not perceive it important (Kenu et al., 2020). Environmental factors that were significantly associated with risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital included; watched sexually explicit media , ever used alcohol or drugs and distance to health facility. Adolescents living with HIV/AIDS who never watched sexually explicit media were less likely to engage in risky sexual behaviours compared to adolescents who watched sexually explicit media. Watching sexually explicit media aroused the adolescents into sexual desires which were associated with risky factor in engaging in risky sexual practices. On the other hand refraining from sexually explicit media limited the odds of adolescents living with HIV/AIDS to engage into sexual experiences that could have attracted them to practice the same behavior. Similar findings were reported in a study carried out in Indonesia among 214 adolescents living with HIV/AIDS selected using a cluster random sampling technique, Ramadani et al. (2024) revealed that exposure to digital media and information was significantly associated with engagement in unsafe sexual behaviours among the respondents. Also a study in Zimbabwe among 341 adolescents living with HIV/AIDS established that respondents who had exposure to erotic digital television programs were nearly 4 times more likely to engage in sexual behaviours than those who did not have the exposure (Sandy et al., 2019). Regarding use of drugs and alcohol, adolescents living with HIV/AIDS who never used alcohol or drugs were less likely to engage in risky sexual behaviours compared to adolescents who used alcohol or drugs. This was associated with the fact that adolescents living with HIV/AIDS and took alcohol and drugs were predisposed to making irrational sexual decisions which led to engaging in risky sexual behaviours. Irrational decisions included; none or irregular condom use and failure to seek advice from healthcare workers. Similar findings were reported by Rus et al. (2024) in a cross-sectional study conducted in Malaysia among 1,082 adolescents who established that respondents who smoked were 10 times more likely to engage in unsafe sexual behaviours than those who did not smoke. Also a study carried out in Ethiopia among 181 adolescents living with HIV/AIDS Worede et al. (2022a) revealed that using substances such as drinking alcohol and chewing khat contributed to engagement in unsafe sexual behaviours among the respondents because it led to loss of senses to make right sexual decisions. Regarding distance from the health facility; adolescents living with HIV/AIDS who stayed 5–10 km were almost one hundred times more likely to engage in risky sexual behaviours and adolescents who stayed in more than 10km from the health facility were eighty eight times more likely to engage in risky sexual behaviours compared to who lived in less than 5 km from the health facility. This implied the long the distance between respondents’ homes and the health facility the higher the odds of engaging in risky sexual behaviours which was associated with inaccessibility to sexual and reproductive health related information. Similar findings were noted by in a cross-sectional study carried out in Lagos, Nigeria, among 117 adolescents living with HIV/AIDS where long distances and lack of money to access the health facility failed 59.8% of the respondents and contributed to engagement in unsafe sexual behaviours (Babatunde et al. (2025). This study established that, attending the ART clinic at Aber Hospital enabled the study participants to feel, confident in expressing sexual boundaries, experienced HIV-related stigma and received sexual health counseling.Adolescents who never felt confident in expressing sexual boundaries were almost seven times more likely to engage in risky sexual behaviours compared to adolescents who felt confident in expressing sexual boundaries. This could be associated with strict cultural norms that highly regarded sexual activities as sacred and discussing them with minors was immoral and obscene. This rendered adolescents living with HIV/AIDS unaware of the life style they had to live to minimize spreading HIV to other people. Similar findings were reported in a systematic review study conducted in Mexico analyzing 5 articles found out that revealed that higher self-esteem among adolescents was significantly associated with unsafe sexual relations among the adolescents as opposed to lower self-esteem (Arodi et al., 2022). Furthermore adolescentsliving with HIV/AIDS who never experienced HIV-related stigma were less likely to engage in risky sexual behaviours compared to adolescents who experienced HIV-related stigma. This implied that lack of stigma was associated with having self-confidence to seek sexual behavior related information from well-trained healthcare providers which increased the odds of prevalence of risky sexual behaviours. Similar findings were reported in aMpango et al. (2022) reported similar findings in a multi-site study involving 1,339 adolescents living with HIV. They found that adolescents with depression were more likely to engage in risky sexual practices such as inconsistent condom use and multiple sexual partnerships compared to those without depressive symptoms. This study also found that adolescents living with HIV/AIDS who never received sexual health counseling were fourty one times more likely to engage in risky sexual behaviours compared to adolescents who received sexual health counseling. This implied that lack of counseling among adolescents living with HIV/AIDS predisposed them to anxiety and stress which lured them to engage into risky sexual behavours due to lowself-hope and esteem. Similar findings were reported in a study carried out in Uganda by Adrawa et al. (2023) which established that the odds of unsafe sexual behaviours were higher among the respondents who had not received any counseling on HIV care from healthcare workers than among those who had received quality counseling. Abbreviations AIDS Acquired Immunodeficiency Syndrome ALHIV Adolescents Living with HIV ART Antiretroviral Therapy CDC Centres for Disease Control and Prevention HIV Human Immunodeficiency Virus MOH Ministry of Health STIs Sexually Transmitted Infections UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund Declarations Acknowledgements My sincere and great gratitude go to my supervisor Dr. John Bosco Alege who gave me courage and professional guidance throughout the time of my study. I further extent my sincere appreciation to the management of St. John XXIII Hospital Aber that permitted my studies and enabled the smooth collection of data together with the respondents for providing me with data during the study. I would also like to acknowledge my dear husband Mr. Otim Johnstone and our children; Obangakene Deogracious, Lamunu Angela and Lagum Mary Immaculate for standing by me and allowing me devote time for my studies. Funding No funding from any institution was received for this study. This was a self-funded study. Availability of data and materials The questionnaire was developed for this particular study (unpublished questionnaire). The dataset for this study is available and shall be provided in a separate file upload. Ethics approval and consent to participate Ethical approval for the study was obtained from the Clarke International University Research Ethics Committee. Permission to conduct the study was also obtained from the administration of Aber Hospital. Written informed consent was obtained from participants aged 18–19 years, while assent and parental or guardian informed consent were obtained for participants 17 years and below. Participation was voluntary, and respondents were informed of their right to withdraw from the study at any time without consequences. Confidentiality was maintained by using unique identification codes instead of names on questionnaires and data files. All data were stored securely and accessed only by the research team.). Consent for publication Not applicable for the above section. Competing interests There are no competing interests in this study, findings and the manuscript. Author details 1 School of Public Health and Management, Clarke International University, Kampala, Uganda. References Adrawa, N., Izudi, J., Nyeko, K., Welikhe, E., Kizito, B. J., & Bajunirwe, F. (2023). High prevalence of risky sexual behaviour among key populations receiving antiretroviral therapy at a large HIV clinic in northern Uganda. African Health Sciences, 23 , 362–372. Anyanwu, M. U., & Tamwesigire, I. (2023). A cross-sectional study of prevalence and predictors of risky sexual behavior among school-going adolescents in Mbarara Municipality, Uganda. African Health Sciences, 23 , 109–116. Arodi, T. M., Moreno-Monsiváis, M. G., Esquivel-Rubio, A., Rivera-Fierro, K., & González-Vázquez, A. (2022). Self-esteem and its relationship with risky sexual behavior for HIV in migrants: A systematic review. Babatunde, A. A., Femi-Adebayo, T., Adebayo, B. I., Somefun, E. O., Haruna, A., Popoola, B. F., Adepoju, F. O., Samuel, M. U., Akinyemi, O. T., Fisher, O., Adeleke, M., Goldson, E., & Mueller, U. (2025). Sexual and reproductive health needs and barriers among youth living with HIV/AIDS in Lagos State, Nigeria. Becker, G., Namanya, P., Kiganda, C., Nabukenya, J., Wendt, L., Rukundo, G., Yoyeta, I., Motevalli, M., Mooberry, M., Voss, N., Jackson, J. B., & Etima, J. (2024). HIV knowledge and sexual behaviors in perinatally infected Ugandan youth: A cross-sectional survey. Journal of the International Association of Providers of AIDS Care, 23 , 23259582241299712. Birdthistle, I., Tanton, C., Tomita, A., De Graaf, K., Schaffnit, S. B., Tanser, F., & Slaymaker, E. (2019). Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: A systematic review and meta-analysis. The Lancet Global Health, 7 , e1521–e1540. Centers for Disease Control and Prevention (CDC). (2018). Youth risk behavior survey: Data summary and trends report 2007–2017 . Atlanta, GA. Ewemooje, O. S., & Adebola, O. G. (2023). Risky sexual behaviour among adolescent girls and young women in Nigeria: Persistent driver of HIV infections. Journal of Interventional Epidemiology and Public Health, 6 . Girmay, A., & Mariye, T. (2019). Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum Town, Northern Ethiopia, 2018. BMC Research Notes, 12 , 698. Kenu, E., Bandoh, D. A., Adu, R., Akwa, A. O., Sam, M., & Lartey, M. (2020). Sexual experiences of adolescents and young adults living with HIV attending a specialized clinic in Accra, Ghana. Ghana Medical Journal, 54 (2 Suppl), 91–97. Keto, T., Tilahun, A., & Mamo, A. (2020). Knowledge, attitude, and practice towards risky sexual behaviors among secondary and preparatory students of Metu Town, southwestern Ethiopia. BMC Public Health, 20 , 1394. Kinoti, J., Kamau, A., & Moloo, P. (2022). Determinants of sexual behaviours among adolescents living with HIV and AIDS in Nairobi, Kenya. Eastern Africa Social Science Research Review, 38 , 1–24. Legislative Council Secretariat. (2018). Sexuality education . Hong Kong. Levin, K. A. (2006). Study design III: Cross-sectional studies. Evidence-Based Dentistry, 7 , 24–25. Mpango, R. S., Ssembajjwe, W., Rukundo, G. Z., Salisbury, T. T., Levin, J., Gadow, K. D., Patel, V., & Kinyanda, E. (2022). Prevalence, risk factors, and negative outcomes of anxiety and depressive disorders among HIV-infected children and adolescents in Uganda: CHAKA Study 2014–2017. Psychiatry Journal, 2022 , 8975704. Nnakate, B. J., Nakafeero, M., Ssekamatte, T., Isabirye, N., Guwatudde, D., & Fawzi, W. W. (2020). Sexual behaviours among adolescents in a rural setting in eastern Uganda: A cross-sectional study. Tropical Medicine & International Health, 25 , 81–88. Nuwaha, F., Ekirapa, E., Kityo, C., Ssali, F., & Mugyenyi, P. (2019). Sexual behaviour among adolescents living with HIV/AIDS in Kampala, Uganda. East African Medical Journal, 87 , 91–99. Odugbesan, J. A., & Rjoub, H. (2019). Relationship among HIV/AIDS prevalence, human capital, good governance, and sustainable development: Empirical evidence from Sub-Saharan Africa. Sustainability, 11 , 1348. Olusegun, S. E., & Adebola, O. G. (2023). Risky sexual behaviour among adolescent girls and young women in Nigeria: Persistent driver of HIV infections. Journal of Interventional Epidemiology and Public Health, 6 , 19. OmonA, K., & Ssuka, J. K. (2023). Early sexual debut and associated factors among adolescents in Kasawo Sub-county, Mukono District, Uganda. Cogent Public Health, 10 , 2183561. Ramadani, R., Ibrahim, K., Mirwanti, R., Maulana, S., Jabareen, R., & Ibrahim. (2024). Social media use, knowledge, attitudes, and risky sexual behavior of HIV transmission: A survey among boarding school adolescent students in Indonesia. Belitung Nursing Journal, 10 . Rus, S. C., Dahlui, M., Al-Sadat, N., & Aziz, N. A. (2024). Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: A cross-sectional study. BMC Public Health, 14 (Suppl 3), S9. Sandy, P. T., Vhembo, T., & Molotsi, T. K. (2019). Sexual behaviour among adolescents living with the human immunodeficiency virus in Zimbabwe: Educational implications. African Journal of AIDS Research, 18 , 130–137. Ssebunya, R. N., Matovu, J. K. B., Makumbi, F. E., Kisitu, G. P., Maganda, A., & Kekitiinwa, A. (2019). Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10–19 years) in a pastoralist post-conflict community, Karamoja sub-region, northeastern Uganda. BMC Public Health, 19 , 1027. Ssewanyana, D., Mwangala, P. N., Van Baar, A., Newton, C. R., & Abubakar, A. (2018). Health risk behaviour among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis. BioMed Research International, 2018 , 7375831. Stover, J., Glaubius, R., Teng, Y., Kelly, S., Brown, T., Hallett, T. B., Revill, P., Bärnighausen, T., Phillips, A. N., & Fontaine, C. (2021). Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030. PLoS Medicine, 18 , e1003831. Tafere, G. W., Hunduma, F., & Yesuf, A. (2023). Viral suppression rate at Operation Triple Zero (OTZ) and regular ART follow-up programs and associated factors among adolescent clients of Addis Ababa, Ethiopia: A comparative cross-sectional study. Virology Journal, 20 , 208. UNAIDS. (2023). Global HIV & AIDS statistics — Fact sheet . Retrieved August 12, 2024, from https://www.unaids.org/en/resources/fact-sheet United Nations Children's Fund (UNICEF). (2024). Global and regional trends . New York: UNICEF. Retrieved May 2, 2024, from https://data.unicef.org/topic/hivaids/global-regional-trends/ Wondmeneh, T. G., & Wondmeneh, R. G. (2023). Risky sexual behaviour among HIV-infected adults in Sub-Saharan Africa: A systematic review and meta-analysis. BioMed Research International, 2023 , 6698384. Worede, J. B., Mekonnen, A. G., Aynalem, S., & Amare, N. S. (2022a). Risky sexual behavior among people living with HIV/AIDS in Andabet District, Ethiopia: Using a model of unsafe sexual behavior. Frontiers in Public Health, 10 . Additional Declarations No competing interests reported. Supplementary Files QuestionaireEnglishversion.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9146467","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627737195,"identity":"46e75f55-bd38-44b3-8600-fb1f0ccaa80d","order_by":0,"name":"Grace Adu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBADHgb2BiBlYEG0DgMeBp4DIFqCeC0MDBIJIAYRWuSjDz/88KHij4zuzOdXN/wokGDgb+9OwKvF8FyaseSMMwY8Zrdzym72AB0mcebsBvxaehjMmHnbwFrSbvAAtRhI5BLSwv6N+S9Iy80zaTf/EKNFnofHjJkRpOUG+7HbRNliwMNTLNlzxpjH7EwO220ZAwkegn6R72Hf+OFHhZy92fHjz26++WMjx9/eS8CWA3AmjwGYxKscbEsDnMn+gKDqUTAKRsEoGJkAAGTXQzpWrYTQAAAAAElFTkSuQmCC","orcid":"","institution":"Clarke International University","correspondingAuthor":true,"prefix":"","firstName":"Grace","middleName":"","lastName":"Adu","suffix":""},{"id":627737196,"identity":"d7537668-4bd8-42c9-b51a-af4c50321fd3","order_by":1,"name":"John Bosco Alege","email":"","orcid":"","institution":"Clarke International University","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"Bosco","lastName":"Alege","suffix":""}],"badges":[],"createdAt":"2026-03-17 08:55:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9146467/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9146467/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107937215,"identity":"2efc240b-b8f5-4e68-a132-cc838385f27e","added_by":"auto","created_at":"2026-04-27 18:25:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":57083,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9146467/v1/8b68d4245c4958c33e9403bc.png"},{"id":108490922,"identity":"ec2a2323-0a6a-4d52-a8cd-6fb7c23602cb","added_by":"auto","created_at":"2026-05-05 09:50:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":371622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9146467/v1/e89811ca-d533-48fd-8aed-ce9da6724759.pdf"},{"id":107937205,"identity":"23ea8512-984b-421c-bb7d-61d8365858e3","added_by":"auto","created_at":"2026-04-27 18:25:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23622,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionaireEnglishversion.docx","url":"https://assets-eu.researchsquare.com/files/rs-9146467/v1/49e2ca19524bb07a184d8f92.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of risky sexual behaviours among adolescents living with HIV and AIDS attending the ART clinic at Aber Hospital, Oyam District","fulltext":[{"header":"Background","content":"\u003cp\u003eRisky sexual behaviours are defined as sexual practices that increase the likelihood of HIV transmission and other adverse sexual and reproductive health outcomes. These behaviours include unprotected sexual intercourse, having multiple sexual partners, early sexual debut, transactional sex, and engaging in sexual activity under the influence of alcohol or other substances (Keto et al., 2020). Among adolescents living with HIV/AIDS (ALHIV), such behaviours not only heighten the risk of secondary HIV transmission but also compromise treatment adherence, mental health, and long-term reproductive health outcomes (Birdthistle et al., 2019).\u003c/p\u003e\n\n\u003cp\u003eGlobally, approximately 38 million people are living with HIV/AIDS, including about 1.7 million adolescents aged 10–19 years (UNAIDS, 2023; Tafere et al., 2023). Adolescence is a critical developmental stage characterized by experimentation, identity formation, and risk-taking behaviours, which may increase vulnerability to unsafe sexual practices (Girmay \u0026amp; Mariye, 2019). The World Health Organization reports that nearly one-third of new HIV infections occur among young people, while rates of teenage pregnancy and sexually transmitted infections (STIs) remain high in many regions. Risky sexual behaviours during adolescence can therefore lead to severe long-term consequences, including unintended pregnancies, STI transmission, and further spread of HIV infection.\u003c/p\u003e\n\n\u003cp\u003eEvidence from different regions indicates that adolescents continue to engage in unsafe sexual practices despite ongoing prevention efforts. For example, the 2017 United States National Youth Risk Behavior Survey reported that 39.5% of high school students had engaged in sexual intercourse, although this represented a decline from 47.8% in 2007 (Centers for Disease Control and Prevention [CDC], 2018). However, condom use during the last sexual encounter also declined from 61.5% in 2007 to 46.2% in 2017, while approximately 70.6% of sexually active adolescents reported not using any form of birth control before intercourse (CDC, 2018). Similar trends have been observed in other settings; in Hong Kong, HIV infections increased from 181 cases in 1997 to 692 cases in 2016, accompanied by a rise in premarital pregnancies (Legislative Council Secretariat, 2018).\u003c/p\u003e\n\n\u003cp\u003eSub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. The region accounts for approximately 75% of global HIV/AIDS prevalence and represents nearly 89% of adolescents living with HIV worldwide (Odugbesan \u0026amp; Rjoub, 2019; UNICEF, 2024). Adolescent girls in the region are particularly vulnerable and are newly infected at rates up to four times higher than adolescent boys. Furthermore, Acquired Immunodeficiency Syndrome (AIDS) remains one of the leading causes of death among adolescents in sub-Saharan Africa (Gabre et al., 2024). Despite ongoing prevention strategies, studies indicate that between 10% and 60% of seropositive individuals continue to engage in unprotected sexual behaviours, thereby increasing the risk of onward HIV transmission (Wondmeneh \u0026amp; Wondmeneh, 2023).\u003c/p\u003e\n\n\u003cp\u003eCultural norms and social dynamics also influence adolescents’ sexual behaviour across different African settings. In some countries such as South Africa, sexual relationships have historically been embedded within broader social structures that regulate sexual expression, while in other contexts such as the Democratic Republic of Congo, premarital relationships among youth have been culturally tolerated in certain forms (Birdthistle et al., 2019; Stover et al., 2021). These socio-cultural factors, combined with limited access to youth-friendly health services, have contributed to persistent HIV transmission rates among adolescents in the region. For example, in Kenya, adolescents living with HIV have reported difficulties disclosing their HIV status to sexual partners, despite their desire to maintain normal intimate relationships (Kinoti et al., 2022).\u003c/p\u003e\n\n\u003cp\u003eIn Uganda, adolescents and young people remain significantly affected by the HIV epidemic. In 2021, approximately 14,000 youths aged 15–24 years were living with HIV/AIDS, accounting for about 37% of the total HIV burden in the country (Uganda AIDS Commission, 2021). Risky sexual behaviours among young people, including unprotected sex, multiple sexual partnerships, and sexual activity under the influence of alcohol or other substances, remain prevalent, with over 22% of youths aged 15–24 reportedly engaging in such practices (Anyanwu \u0026amp; Tamwesigire, 2023). These behaviours not only increase the risk of HIV transmission but also contribute to poor treatment outcomes among adolescents living with HIV.\u003c/p\u003e\n\n\u003cp\u003eAdolescents living with HIV/AIDS remain a particularly vulnerable population. Risky sexual behaviours among this group contribute to secondary HIV transmission, poor adherence to antiretroviral therapy (ART), and adverse reproductive health outcomes (Ssewanyana et al., 2018). In Oyam District, approximately 31% of adolescents living with HIV reportedly engage in risky sexual behaviours such as unprotected sex and having multiple sexual partners (MARPI, 2024). Similar patterns have been reported in other parts of Uganda. For example, a cross-sectional study conducted in Mbarara Municipality found that 18.8% of adolescents engaged in high-risk sexual behaviours, including sex under the influence of alcohol and inconsistent condom use (Anyanwu \u0026amp; Tamwesigire, 2023). In the Karamoja sub-region, 11.4% of adolescents living with HIV were found to engage in high-risk sexual practices despite being aware of their HIV status (Ssebunya et al., 2019).\u003c/p\u003e\n\n\u003cp\u003eThe Ministry of Health recommends that adolescents living with HIV receive comprehensive sexuality education, consistent access to antiretroviral therapy, and routine psychosocial counselling (Ministry of Health, 2022). However, these services remain fragmented or underutilized in many districts. Failure to adequately address the needs of adolescents living with HIV may result in increased HIV transmission, treatment failure, psychological distress, and increased strain on already limited health care resources (Worede et al., 2022; Ewemooje \u0026amp; Adebola, 2023).\u003c/p\u003e\n\n\u003cp\u003eDespite the growing burden of risky sexual behaviours among adolescents living with HIV in Uganda, limited research has specifically examined the determinants of these behaviours at the district level. Understanding these determinants is essential for designing targeted interventions that promote safer sexual practices and improve treatment outcomes among adolescents living with HIV. Therefore, this study aimed to assess the determinants of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital in Oyam District, Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed an analytical cross-sectional design to assess the determinants of risky sexual behaviours among adolescents living with HIV/AIDS attending the antiretroviral therapy (ART) clinic at Aber Hospital in Oyam District, Northern Uganda. Aber Hospital is a private not-for-profit facility under the Uganda Catholic Medical Bureau that provides comprehensive health services, including HIV counselling, testing, and ART care. The hospital serves a large rural and peri-urban catchment population and offers specialized HIV services for adolescents, including routine follow-up visits, ART refills, adherence counselling, and psychosocial support. The cross-sectional design was considered appropriate because it allowed the assessment of the prevalence of risky sexual behaviours and their associated factors among adolescents receiving HIV care at a specific point in time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined using the Leslie Kish formula for cross-sectional studies (n=Z\u003csup\u003e2\u003c/sup\u003epq/d\u003csup\u003e2\u003c/sup\u003e), assuming a 95% confidence level (Z=1.96), a prevalence of risky sexual behaviour among adolescents living with HIV of p=0.114 based on Ssebunya et al. (2019), and a margin of error of d=0.05. The calculated minimum sample size was 155 participants. After adjusting for a 10% non-response rate, the final sample size was 171 adolescents. Participants were selected using systematic random sampling from the ART clinic register, which listed approximately 500 adolescents receiving ART at Aber Hospital. The sampling interval was calculated as k=N/n=500/171=2. A random starting point between 1 and 2 was selected, after which every second adolescent on the register was recruited until the required sample size was achieved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using interviewer-administered structured questionnaires and key informant interviews. The structured questionnaire was used to obtain quantitative data on socio-demographic characteristics, individual factors, psychosocial factors, environmental influences, and sexual behaviours among adolescents living with HIV/AIDS. In addition, semi-structured key informant interviews were conducted with selected health workers to obtain qualitative insights into contextual and health system factors influencing adolescents\u0026rsquo; sexual behaviours. To ensure data quality, research assistants were trained on the study objectives, ethical considerations, and data collection procedures prior to data collection. The questionnaire was translated from English into Langi and back-translated to ensure linguistic accuracy and cultural appropriateness. The tools were pre-tested among adolescents with similar characteristics at a health facility outside the study area, and necessary adjustments were made to improve clarity and reliability before the main data collection.\u003c/p\u003e\n\u003cp id=\"_Toc223691608\"\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eanalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were entered, cleaned, and analyzed using statistical software. Descriptive statistics were used to summarize participants\u0026rsquo; characteristics and were presented using frequencies, percentages, means, and standard deviations. Bivariate analysis using chi-square tests was conducted to assess associations between independent variables and risky sexual behaviour. Variables with p-values less than 0.05 were considered statistically significant. Variables that were significant at bivariate analysis (p \u0026lt; 0.05), together with potential confounders (p \u0026lt; 0.15), were included in a binary logistic regression model to identify independent predictors of risky sexual behaviours. Results from the multivariate analysis were presented as Adjusted Odds Ratios (AORs) with corresponding 95% confidence intervals (CIs). Qualitative data from key informant interviews were transcribed verbatim and analyzed using thematic content analysis. Codes were generated from the transcripts, grouped into categories, and organized into themes that described contextual and psychosocial factors influencing risky sexual behaviours among adolescents living with HIV/AIDS.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePrevalence of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital, Oyam District\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 170 respondents that participated in this study; 63 (37%) had risky sexual behaviours while 107 (63%) never had risky sexual behaviours. The details are shown in figure 2 below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Individual factors of respondents\u003c/p\u003e\n\u003ctable style=\"width: 5.0e+2pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10-13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e14-16 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e17-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003esecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e51.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOther Anglican faiths\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIndigenous religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSingles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWidows\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSource: Primary Data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows that the majority of respondents were aged 17\u0026ndash;19 years, 99 (58.2%), followed by those aged 14\u0026ndash;16 years, 51 (30.0%), while only 20 (11.8%) were aged 10\u0026ndash;13 years. Females constituted 96 (56.5%) of the respondents, compared to 74 (43.5%) males.\u003c/p\u003e\n\u003cp\u003eIn terms of education level, most adolescents had attained primary education, 70 (41.2%), while 42 (24.7%) had secondary education and 36 (21.2%) had tertiary education. However, 22 (12.9%) had no formal education. The majority of respondents were single, 124 (72.9%), although 28 (16.5%) were married. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Factors factors on risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital\u003c/p\u003e\n\u003ctable style=\"width: 5.0e+2pt;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95%) CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemales\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMales\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02 (0.001-0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.008**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01(0.0001-0.042)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.018**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.01 (0.0001-0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.017**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTertiary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002 (0.0001-0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eDuration since HIV Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;12months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;24 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.37 (1.03-363.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.048**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eNumber of sexual partners in the past 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOne partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.16 (23.66-822.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eUsed a condom during last sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.01 (1.01-20.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eFrequency of using condoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.60 (1.34-159.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.028**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eWatched sexually explicit media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12 (0.02-0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.032**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eEver used alcohol or drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eN o\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.07 (0.01-0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003eDistance to health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;5km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u0026ndash;10km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99.99 (5.77-173.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;10km\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87.53 (5.35-143.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychosocial Factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eFelt confident in expressing sexual boundaries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eN o\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.53 (1.18-36.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.032**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eExperienced HIV-related stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eN o\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02 (0.002-0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eReceived sexual health counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eN o\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.30 (2.05-830.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.015**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc222689797\"\u003eTable 2 presents the results of the multivariate logistic regression analysis identifying independent factors associated with risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital.\u003c/p\u003e\n\u003cp\u003eAfter adjusting for potential confounders, sex remained significantly associated with risky sexual behaviour. Male adolescents were significantly less likely to engage in risky sexual behaviours compared to females (AOR = 0.02; 95% CI: 0.001\u0026ndash;0.38; p = 0.008).\u003c/p\u003e\n\u003cp\u003eEducation level was also independently associated with risky sexual behaviour. Adolescents with primary education (AOR = 0.01; 95% CI: 0.0001\u0026ndash;0.042; p = 0.018), secondary education (AOR = 0.01; 95% CI: 0.0001\u0026ndash;0.42; p = 0.017), and tertiary education (AOR = 0.002; 95% CI: 0.0001\u0026ndash;0.14; p = 0.004) were significantly less likely to engage in risky sexual behaviours compared to those with no formal education.\u003c/p\u003e\n\u003cp\u003eDuration since HIV diagnosis was significantly associated with risky behaviour. Adolescents who had been diagnosed for more than 24 months were more likely to engage in risky sexual behaviours compared to those diagnosed for less than 12 months (AOR = 19.37; 95% CI: 1.03\u0026ndash;363.37; p = 0.048).\u003c/p\u003e\n\u003cp\u003eSexual behaviour variables showed strong associations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdolescents who had one sexual partner in the past six months were significantly more likely to engage in risky sexual behaviour compared to those with no partner (AOR = 41.16; 95% CI: 23.66\u0026ndash;822.74; p \u0026lt; 0.001). Those who did not use a condom during their last sexual intercourse were more likely to engage in risky sexual behaviours compared to those who used a condom (AOR = 10.01; 95% CI: 1.01\u0026ndash;20.08; p \u0026lt; 0.001). Similarly, adolescents who never used condoms were significantly more likely to engage in risky sexual behaviours compared to those who always used condoms (AOR = 14.60; 95% CI: 1.34\u0026ndash;159.01; p = 0.028).\u003c/p\u003e\n\u003cp\u003eAmong environmental factors, adolescents who did not watch sexually explicit media were less likely to engage in risky sexual behaviours compared to those who watched such media (AOR = 0.12; 95% CI: 0.02\u0026ndash;0.84; p = 0.032). Similarly, those who had never used alcohol or drugs were less likely to engage in risky sexual behaviours compared to those who had used substances (AOR = 0.07; 95% CI: 0.01\u0026ndash;0.61; p = 0.016). Distance to the health facility was also significant; adolescents residing 5\u0026ndash;10 km (AOR = 99.99; 95% CI: 5.77\u0026ndash;173.51; p = 0.002) and those living more than 10 km away (AOR = 87.53; 95% CI: 5.35\u0026ndash;143.06; p = 0.002) were more likely to engage in risky sexual behaviours compared to those living within 5 km.\u003c/p\u003e\n\u003cp\u003ePsychosocial factors were also independently associated with risky sexual behaviour. Adolescents who lacked confidence in expressing sexual boundaries were more likely to engage in risky sexual behaviours compared to those who felt confident (AOR = 6.53; 95% CI: 1.18\u0026ndash;36.16; p = 0.032). Those who had not experienced HIV-related stigma were less likely to engage in risky sexual behaviours compared to those who had experienced stigma (AOR = 0.02; 95% CI: 0.002\u0026ndash;0.29; p = 0.004). Furthermore, adolescents who had not received sexual health counseling were significantly more likely to engage in risky sexual behaviours compared to those who had received counseling (AOR = 41.30; 95% CI: 2.05\u0026ndash;830.88; p = 0.015).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative findings from in-depth interviews provided contextual insights into factors influencing risky sexual behaviours among adolescents living with HIV/AIDS. Thematic analysis identified several key themes, including cultural norms, HIV-related stigma, limited sexual negotiation skills, and gaps in sexual and reproductive health services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural and religious norms influencing early marriage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCultural practices, particularly the value placed on bride wealth, were reported to influence early and sometimes forced marriages among adolescent girls. Participants explained that families may encourage early marriage in order to obtain bride wealth, which indirectly exposes adolescents to early sexual activity. One participant explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In our community family members, especially fathers, like bride wealth so much which leads to early and forced marriages.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV-related stigma and emotional reactions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHIV-related stigma emerged as an important psychosocial factor shaping adolescents\u0026rsquo; attitudes toward sexual relationships. Some participants described experiencing discrimination and labeling within their communities, which created emotional distress and resentment. One adolescent explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When most of the people in the community pinpoint me as an HIV carrier who is dangerous to their sons, I feel annoyed\u0026hellip; I feel like their boys should also get some HIV from me and we suffer the same.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThese experiences of stigma appeared to influence risk-taking attitudes and emotional responses toward sexual relationships.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimited confidence in negotiating safe sex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome adolescents reported difficulties in expressing sexual boundaries or negotiating condom use with partners. Lack of confidence and fear of rejection were described as barriers to insisting on safer sexual practices, increasing vulnerability to risky sexual behaviours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGaps in sexual and reproductive health services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants acknowledged that sexual and reproductive health services were available at the hospital; however, they noted that such programs were irregular and poorly communicated to adolescents. One participant stated:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There are sexual and reproductive health programs here at the hospital but they are very irregular and not well communicated to community members and adolescents even if they are registered with the HIV/AIDS clinic.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp id=\"_Toc223691624\"\u003eFindings from this study revealed high prevalence of risky sexual behaviours at 37% (63;37%). This was attributed to several factors that included; individual, environmental and psychological factors. Most of the adolescents living with HIV/AIDS were females who were vulnerable to sexual activities given the cultural norms of the society where early adolescent marriages were socially accepted. Also given the low levels of education and long duration they took to diagnose the viral load this negatively affected their knowledge on the different adverse sexual behaviours such as irregular condom use and having many sexual partners. The adolescents also were never confident in expressing sexual boundaries which was partially associated with stigma they experienced and lack of counseling to reinstate hope among them. Similar findings were reported in study carried out in Uganda, where Ssebunya et al. (2019) found that 11.4% of adolescents living with HIV/AIDS engaged in high-risk sexual behaviours in a study of 1,439 adolescents. Nuwaha et al., (2019) also reported that adolescents diagnosed with HIV for less than 24 months were significantly more likely to engage in risky sexual practices compared to those diagnosed earlier. More recently, Becker \u003cem\u003eet al\u003c/em\u003e. (2024) found that while 72% of perinatally infected adolescents in Kampala had adequate HIV knowledge, nearly 30% still reported inconsistent condom use, highlighting the persistent gap between knowledge and practice.\u003c/p\u003e\n\u003cp\u003eMale adolescents living with HIV/AIDS were less likely to engage in risky sexual behaviours comparedto female adolescents. This implied that females were more vulnerable to risky sexual practices since males of all ages manipulated them for their sexual desires which weren\u0026rsquo;t the case with male adolescents. Also there were cultural norms that favoured marrying off adolescents which predisposed female adolescents to early marriages and risky sexual behaviours. Similar findings were reported in a study carried out in Uganda where HIV positive female adolescents had higher odds of experiencing risky sexual practices compared to their male counterparts (Omona and Ssuka, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of education status, this study found that;-adolescents living with HIV/AIDS who had primary education, had secondary education and had tertiary education were less likely to engage in risky sexual behaviours compared to adolescents who never had any formal education. This implied that the lower the levels of education one had the higher the odds of engaging in risky sexual behaviours. This could be associated with lack of adequate knowledge about the dangers of risky sexual behaviours since they never had regular chances to experience them. Similar findings were reported in a study carried out in Uganda where respondents who had not attained any level of formal education had nearly twice more odds of engaging in unsafe sexual behaviours compared to those with primary, secondary, and tertiary education levels (Nnakate et al., 2020). In the same line, a study carried out in Nigeria among 41,821 adolescents with data extracted from the 2018 Nigerian Demographic and Health Survey where respondents with secondary or higher levels of education were less likely to engage in risky sexual behaviours than those with lower levels of education (Olusegun and Adebola, 2023) due better sexual and reproductive health knowledge they had. On the contrary, Zhang et al. (2021), in a cross-sectional study carried out in China among 1,602 adolescents living with HIV/AIDS, where attending university had 1.56 times more odds of engaging in risky sexual behaviours than those in lower levels of education. The difference in results could be associated with high permissiveness among university students in developed countries\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also found that adolescents living with HIV/AIDS who last diagnosed for HIV viral status two years ago, were nineteen times more likely to engage in risky sexual behaviours compared to adolescent who were diagnosed for HIV viral status in the last 12 months. This implied taking long without diagnosing for the HIV viral status predisposed them to risky sexual behaviours because they had taken long to get sex related education from well-trained health care workers. Similarly, another study carried out in Uganda among 380 adolescents living with HIV/AIDS observed that respondents who were diagnosed with HIV for less than 24 months had 3.67 times more odds of engaging in unsafe sexual behaviours than those who were diagnosed with HIV for more than 24 months (Nuwaha et al., 2019).\u003c/p\u003e\n\u003cp\u003eRegarding the number of sexual partners in the past 6 months, this study established that adolescents who had more than one partner were fourty one times more likely to engage in risky sexual behavior compared to adolescents who never had any sexual partner. This implied that having many sexual partners meant having different sexual experiences and demands which could not be safely fulfilled. This led to malpractices such as irregular and none condom use, taking long to diagnose HIV viral load and watching sexually explicit media. Similar findings were also reported in another study conducted in Uganda by (Becker et al., 2024).\u003c/p\u003e\n\u003cp\u003eThis study also established that adolescents living with HIV/AIDS who never used condoms in the last sexual intercourse were ten times more likely to engage in risky sexual behaviours compared to adolescents who used condoms in the last sexual intercourse. This implied that irregular use of condoms increased the spread of HIV to other people and also led to re-infection of HIV among adolescents living with HIV/AIDS which was a major problem to the society. Similar findings were reported in a cross-sectional study that took place in Accra, Ghana which established that respondents who perceived safe sex as such as regular use of condoms to be important had 1.58 times lesser odds of engaging in unsafe sexual behaviours than those who did not perceive it important (Kenu et al., 2020).\u003c/p\u003e\n\u003cp\u003eEnvironmental factors that were significantly associated with risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital included; watched sexually explicit media\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eever used alcohol or drugs and distance to health facility.\u003c/p\u003e\n\u003cp\u003eAdolescents living with HIV/AIDS who never watched sexually explicit media were less likely to engage in risky sexual behaviours compared to adolescents who watched sexually explicit media. Watching sexually explicit media aroused the adolescents into sexual desires which were associated with risky factor in engaging in risky sexual practices. On the other hand refraining from sexually explicit media limited the odds of adolescents living with HIV/AIDS to engage into sexual experiences that could have attracted them to practice the same behavior. Similar findings were reported in a study carried out in Indonesia among 214 adolescents living with HIV/AIDS selected using a cluster random sampling technique, Ramadani et al. (2024) revealed that exposure to digital media and information was significantly associated with engagement in unsafe sexual behaviours among the respondents. Also a study in Zimbabwe among 341 adolescents living with HIV/AIDS established that respondents who had exposure to erotic digital television programs were nearly 4 times more likely to engage in sexual behaviours than those who did not have the exposure (Sandy et al., 2019).\u003c/p\u003e\n\u003cp\u003eRegarding use of drugs and alcohol, adolescents living with HIV/AIDS who never used alcohol or drugs were less likely to engage in risky sexual behaviours compared to adolescents who used alcohol or drugs. This was associated with the fact that adolescents living with HIV/AIDS and took alcohol and drugs were predisposed to making irrational sexual decisions which led to engaging in risky sexual behaviours. Irrational decisions included; none or irregular condom use and failure to seek advice from healthcare workers. Similar findings were reported by Rus et al. (2024) in a cross-sectional study conducted in Malaysia among 1,082 adolescents who established that respondents who smoked were 10 times more likely to engage in unsafe sexual behaviours than those who did not smoke. Also a study carried out in\u0026nbsp;Ethiopia among 181 adolescents living with HIV/AIDS Worede et al. (2022a) revealed that using substances such as drinking alcohol and chewing khat contributed to engagement in unsafe sexual behaviours among the respondents because it led to loss of senses to make right sexual decisions.\u003c/p\u003e\n\u003cp\u003eRegarding distance from the health facility; adolescents living with HIV/AIDS who stayed 5\u0026ndash;10 km were almost one hundred times more likely to engage in risky sexual behaviours and adolescents who stayed in more than 10km from the health facility were eighty eight times more likely to engage in risky sexual behaviours compared to who lived in less than 5 km from the health facility. This implied the long the distance between respondents\u0026rsquo; homes and the health facility the higher the odds of engaging in risky sexual behaviours which was associated with inaccessibility to sexual and reproductive health related information. Similar findings were noted by in a cross-sectional study carried out in Lagos, Nigeria, among 117 adolescents living with HIV/AIDS where long distances and lack of money to access the health facility failed 59.8% of the respondents and contributed to engagement in unsafe sexual behaviours (Babatunde et al. (2025).\u003c/p\u003e\n\u003cp\u003eThis study established that, attending the ART clinic at Aber Hospital enabled the study participants to feel, confident in expressing sexual boundaries, experienced HIV-related stigma and received sexual health counseling.Adolescents who never felt confident in expressing sexual boundaries were almost seven times more likely to engage in risky sexual behaviours compared to adolescents who felt confident in expressing sexual boundaries. This could be associated with strict cultural norms that highly regarded sexual activities as sacred and discussing them with minors was immoral and obscene. This rendered adolescents living with HIV/AIDS unaware of the life style they had to live to minimize spreading HIV to other people. Similar findings were reported in a systematic review study conducted in Mexico analyzing 5 articles found out that revealed that higher self-esteem among adolescents was significantly associated with unsafe sexual relations among the adolescents as opposed to lower self-esteem (Arodi et al., 2022). \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore adolescentsliving with HIV/AIDS who never experienced HIV-related stigma were less likely to engage in risky sexual behaviours compared to adolescents who experienced HIV-related stigma. This implied that lack of stigma was associated with having self-confidence to seek sexual behavior related information from well-trained healthcare providers which increased the odds of prevalence of risky sexual behaviours. Similar findings were reported in aMpango et al. (2022) reported similar findings in a multi-site study involving 1,339 adolescents living with HIV. They found that adolescents with depression were more likely to engage in risky sexual practices such as inconsistent condom use and multiple sexual partnerships compared to those without depressive symptoms.\u003c/p\u003e\n\u003cp\u003eThis study also found that adolescents living with HIV/AIDS who never received sexual health counseling were fourty one times more likely to engage in risky sexual behaviours compared to adolescents who received sexual health counseling. This implied that lack of counseling among adolescents living with HIV/AIDS predisposed them to anxiety and stress which lured them to engage into risky sexual behavours due to lowself-hope and esteem. Similar findings were reported in a study carried out in Uganda by Adrawa et al. (2023) which established that the odds of unsafe sexual behaviours were higher among the respondents who had not received any counseling on HIV care from healthcare workers than among those who had received quality counseling.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAIDS\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eALHIV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eAdolescents Living with HIV\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eART\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eAntiretroviral Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCDC\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eCentres for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eHuman Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMOH\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eMinistry of Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTIs\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eSexually Transmitted Infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNAIDS\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eJoint United Nations Programme on HIV/AIDS\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNICEF\u003c/strong\u003e United Nations Children\u0026rsquo;s Fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMy sincere and great gratitude go to my supervisor Dr. John Bosco Alege who gave me courage and professional guidance throughout the time of my study. I further extent my sincere appreciation to the management of St. John XXIII Hospital Aber that permitted my studies and enabled the smooth collection of data together with the respondents for providing me with data during the study. I would also like to acknowledge my dear husband Mr. Otim Johnstone and our children; Obangakene Deogracious, Lamunu Angela and Lagum Mary Immaculate for standing by me and allowing me devote time for my studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding from any institution was received for this study. This was a self-funded study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire was developed for this particular study (unpublished questionnaire).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The dataset for this study is available and shall be provided in a separate file upload.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Clarke International University Research Ethics Committee. Permission to conduct the study was also obtained from the administration of Aber Hospital. Written informed consent was obtained from participants aged 18\u0026ndash;19 years, while assent and parental or guardian informed consent were obtained for participants 17 years and below. Participation was voluntary, and respondents were informed of their right to withdraw from the study at any time without consequences. Confidentiality was maintained by using unique identification codes instead of names on questionnaires and data files. All data were stored securely and accessed only by the research team.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable for the above section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests in this study, findings and the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 School of Public Health and Management, Clarke International University,\u003c/p\u003e\n\u003cp\u003eKampala, Uganda.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdrawa, N., Izudi, J., Nyeko, K., Welikhe, E., Kizito, B. J., \u0026amp; Bajunirwe, F. (2023). 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Risky sexual behaviour among adolescent girls and young women in Nigeria: Persistent driver of HIV infections. \u003cem\u003eJournal of Interventional Epidemiology and Public Health, 6\u003c/em\u003e, 19.\u003c/li\u003e\n\u003cli\u003eOmonA, K., \u0026amp; Ssuka, J. K. (2023). Early sexual debut and associated factors among adolescents in Kasawo Sub-county, Mukono District, Uganda. \u003cem\u003eCogent Public Health, 10\u003c/em\u003e, 2183561.\u003c/li\u003e\n\u003cli\u003eRamadani, R., Ibrahim, K., Mirwanti, R., Maulana, S., Jabareen, R., \u0026amp; Ibrahim. (2024). Social media use, knowledge, attitudes, and risky sexual behavior of HIV transmission: A survey among boarding school adolescent students in Indonesia. \u003cem\u003eBelitung Nursing Journal, 10\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eRus, S. C., Dahlui, M., Al-Sadat, N., \u0026amp; Aziz, N. A. (2024). 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(2018). Health risk behaviour among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis. \u003cem\u003eBioMed Research International, 2018\u003c/em\u003e, 7375831.\u003c/li\u003e\n\u003cli\u003eStover, J., Glaubius, R., Teng, Y., Kelly, S., Brown, T., Hallett, T. B., Revill, P., B\u0026auml;rnighausen, T., Phillips, A. N., \u0026amp; Fontaine, C. (2021). Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030. \u003cem\u003ePLoS Medicine, 18\u003c/em\u003e, e1003831.\u003c/li\u003e\n\u003cli\u003eTafere, G. W., Hunduma, F., \u0026amp; Yesuf, A. (2023). Viral suppression rate at Operation Triple Zero (OTZ) and regular ART follow-up programs and associated factors among adolescent clients of Addis Ababa, Ethiopia: A comparative cross-sectional study. \u003cem\u003eVirology Journal, 20\u003c/em\u003e, 208.\u003c/li\u003e\n\u003cli\u003eUNAIDS. (2023). \u003cem\u003eGlobal HIV \u0026amp; AIDS statistics \u0026mdash; Fact sheet\u003c/em\u003e. Retrieved August 12, 2024, from https://www.unaids.org/en/resources/fact-sheet\u003c/li\u003e\n\u003cli\u003eUnited Nations Children\u0026apos;s Fund (UNICEF). (2024). \u003cem\u003eGlobal and regional trends\u003c/em\u003e. New York: UNICEF. Retrieved May 2, 2024, from\u003cbr\u003ehttps://data.unicef.org/topic/hivaids/global-regional-trends/\u003c/li\u003e\n\u003cli\u003eWondmeneh, T. G., \u0026amp; Wondmeneh, R. G. (2023). Risky sexual behaviour among HIV-infected adults in Sub-Saharan Africa: A systematic review and meta-analysis. \u003cem\u003eBioMed Research International, 2023\u003c/em\u003e, 6698384.\u003c/li\u003e\n\u003cli\u003eWorede, J. B., Mekonnen, A. G., Aynalem, S., \u0026amp; Amare, N. S. (2022a). Risky sexual behavior among people living with HIV/AIDS in Andabet District, Ethiopia: Using a model of unsafe sexual behavior. \u003cem\u003eFrontiers in Public Health, 10\u003c/em\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Risky sexual behaviours, Adolescents living with HIV/AIDS, Antiretroviral therapy (ART) clinic, Determinants, HIV prevention, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-9146467/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9146467/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eThis study assessed the determinants of risky sexual behaviours among adolescents living with HIV/AIDS attending the ART clinic at Aber Hospital in Oyam District, Uganda. Specifically, it determined the prevalence of risky sexual behaviours and examined individual, environmental, and psychosocial factors associated with these behaviours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA community-based cross-sectional study using quantitative methods was conducted among adolescents aged 10–19 years. A total of 170 respondents were selected using systematic random sampling. Data were collected using researcher-administered questionnaires and analyzed using SPSS version 26. Binary logistic regression was used to determine associated factors, with Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) used to assess statistical significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eOf the 170 respondents, 63 (37%) reported engaging in risky sexual behaviours, while 107 (63%) did not. Individual factors significantly associated with risky sexual behaviours included sex, level of education, delayed HIV testing (AOR=19.37, p=0.048), having more than one sexual partner in the past six months (AOR=41.16, p\u0026lt;0.001), and non-use of condoms during the last sexual intercourse (AOR=10.01, p\u0026lt;0.001). Environmental factors included exposure to sexually explicit media, use of alcohol or drugs (AOR=0.07, p=0.016), and long distance from the health facility (5–10 km: AOR=99.99, p=0.002; \u0026gt;10 km: AOR=87.53, p=0.002). Psychosocial factors included low confidence in expressing sexual boundaries (AOR=6.53, p=0.032), HIV-related stigma (AOR=0.02, p=0.004), and lack of sexual health counseling (AOR=41.30, p=0.015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eRisky sexual behaviours remain prevalent among adolescents living with HIV at Aber Hospital and are influenced by multiple individual, environmental, and psychosocial factors. Strengthening counseling services, improving access to HIV care, and enhancing sexual health education may help reduce these behaviours.\u003c/p\u003e","manuscriptTitle":"Determinants of risky sexual behaviours among adolescents living with HIV and AIDS attending the ART clinic at Aber Hospital, Oyam District","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-27 18:24:40","doi":"10.21203/rs.3.rs-9146467/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0061d44c-32db-482d-9203-45ccabd17fae","owner":[],"postedDate":"April 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T13:25:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-27 18:24:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9146467","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9146467","identity":"rs-9146467","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}