Does the experience of sexual coercion predispose the sufferer to the kind of sexual behaviour likely to render him/her more vulnerable to HIV? Knowing the extent and the mechanisms of such influence could be helpful to those planning public health interventions in high risk populations. How important to HIV prevention is it to modify coercive behaviour? Of course, answers to such questions are likely to differ from one culture to another.
Results of a recent study on 1,200 university students at Mbarara University Uganda, based on a self-administered questionnaire, has established, for this setting at least, a strong association between coercion, measured on a validated scale of six items, and 3 out of 4 “high-risk” sexual behaviours. Significant odds ratios (OR), adjusted for various social and other confounders, are given for: (1.) having previously had sex: OR 1.6; (2.) early sexual debut (≤18 years): OR 2.4; (3.) having had ≥3 sexual partners: OR 1.9. There was no significant association with the fourth type of high-risk behaviour: inconsistent condom use. The results obtained also indicate a significant correlation between coercion and 3 social factors: namely, religious background, mental health scores and capacity to trust. The authors conclude that religion, high trust in others, and good mental health help to buffer the negative effect of sexual coercion.
These results will no doubt be of interest to anyone planning HIV interventions in settings that could be considered culturally comparable to those of a Ugandan university. However, the study seems to fall somewhat short of demonstrating causal mechanisms, even for the setting of the study – something that the authors themselves acknowledge would be hard to achieve.
One particularly interesting aspect of this study – which, according to its authors, marks it out from previous work – is that males report coercion almost at the same levels as females (29% as against 31%), and most of the associations between coercion and high-risk behaviour (as well as the buffering effects of social and religious factors) apply, in varying measure, not just to females but to both sexes. It will be interesting to see how far this is borne out by future studies in this area.
Agardh A, Odberg-Pettersson K, Östergren, “Experience of sexual coercion and risky sexual behavior among Ugandan university students”, BMC Public Health 2011, 11:527 (4 July 2011)