High risk sexual behaviours of young psychoactive substance users in Kampala’s informal settlements, Uganda

Abstract

Background The use of psychoactive substances such as marijuana, alcohol, khat and heroin continues to rise globally. The increased use of these substances is coupled with an increase in risky sexual behaviours among its users. To date, Kampala’s informal settlements have been seen as a hub for the trade and usage of these drugs. Never the less, little attention has been given to their influence on young people’s risky sexual behaviours. Yet, an increase in risky sexual behaviours is a gateway for an increase in the spread of HIV/AIDS and other sexually transmitted infections. Objective of the study This study sought to establish the high-risk sexual behaviours of young psychoactive substance users in Kampala’s informal settlements in order to inform appropriate sexual and reproductive health programs. Methodology A cross-sectional study design in which 768 respondents were recruited using respondent driven sampling was used. Structured questionnaires were used to collect the quantitative data from study participants. Data were entered using Kobo Collect mobile application. STATA version 14 was used for statistical analysis. ‘Modified’ Poisson regression was used to establish the factors associated with high risk sexual behaviours. Results About 89.2% (664/744) (90.8% of the females and 88.8% of the males) of the respondents had engaed in high-risk sexual behaviour i.e. were engaged in multiple sexual partnerships in the last 30 days, inconsistently used condoms and had sex under the influence of psychoactive substances. With regard to the specific sexual behaviours, 61.0% of the young psychoactive substance users had ever had sex while the influence of psychoactive substances; 40.6% had engaged in multiple sex relationships in the last one month; and only 62.6% inconsistently used condom. High-risk sexual behaviour was associated with attaining less the primary level of education and below (aPR 0.81, 95% CI: 0.77-0.85, p<0.001), earning an average monthly vii

income of more than 500,000 UGX (aPR 1.07, 95% CI: 1.00-1.16, p=0.050) and using heroin atleast once in the last 30 days (aPR 1.13, 95% CI: 1.04-1.21, p=0.002). Regarding perceptions on the influence of psychoactive substance use on sexual behaviour, 45.6% (339/744) of the respondents believed that psychoactive substances improve sexual performance; 43.3% (322/744) believed that sex is more pleasurable when under the influence of psychoactive substances, and more than half, 53.1% (395/744) believed that using psychoactive substances gives courage/confidence to approach a partner for sex. Conclusion and recommendation This study indicates a high prevalence of high-risk sexual behaviour among young psychoactive substance users in Kampala’s informal settlements. There is need for the ministry of health, and the ministry of Gender Labour and Social Development to reinvigorate sexual and reproductive health programs for young people in Kampala’s informal settlements. There is also a need to implement the sexual education framework in schools in order to tackle the issue of psychoactive substance use and high-risk sexual behaviour.