Final AYSRH Survey Report - AHC Team - 10th Feb 2017

REPUBLIC OF UGANDA
UNITED NATIONS POPULATION FUND MINISTRY OF HEALTH
FINAL REPORT
Submitted By
FEBRUARY 2017
ASSESSMENT OF ADOLESCENT AND YOUTH SEXUAL REPRODUCTIVE HEALTH (AYSRH) IN UGANDA
FINAL REPORT
ACKNOWLEDGEMENT
We acknowledge all of those who took part in the survey in the various consultative meetings,
interviews and validation workshops for their efforts in rendering the successful completion of the
study. Particular thanks go to the members of the Knowledge Management Committee (KMC) at
UNFPA and the Adolescent Health (ADH) Steering Committee (Prof. Anthony K. Mbonye,
Miriam Namugeere, Olivia Kiconco, Dr. Irene Mwenyango, Dr. Nampewo Solome, Doreen
Tukamushaba, Judith Amongin and Dr. Lyn Atuyambe, Dr. Sabrina Bakeera – Kitaka, of the
Ministry of Health and Makerere University College of Health sciences , School of Public Health,
for the guidance and oversight role in the implementation of the study.
Special thanks also go to the Assistant Representative (Dr Edson Muhwezi) and Programme
Analyst – AYSRH (Raquel Palomino González) and Laura Medel from UNFPA and Olivia
Kiconco from the Ministry of Health for their tireless efforts in organizing meetings, reviewing
the report and organizing the validation workshop.
We thank the Institutions Review Board (IRB), that is, the Mildmay Uganda Research Ethics
Committee (MUREC) for approving the study. In addition, we appreciate the Uganda National
Council of Science and Technology (UNCST) for the final review and registration of the AYSRH
inception protocol.
We are grateful to the District Health Officers, in-charges and health workers of the various health
facilities visited (HCIIIs, HCIVs, district Hospitals and RRHs) in the 44 districts selected that
dedicated time to respond to the health facility checklist and allowed the consultants to access their
records.
We also acknowledge the collaboration and input provided by the key stakeholders at the district
i.e. department of Health, Education, Community based services and administration at the district,
other partners in provision of AYSRH services such as the NGOs and the local authorities at the
sub-county and village levels. These stakeholders allowed the team of researchers to conduct the
study within the selected enumeration areas and also accepted to be interviewed.
We are grateful to management of AH Consulting and the team of consultants. Special thanks go
to the Principal investigator (Dr. Roy William Mayega), Co-investigators (Dr. John B Sekamatte
Ssebuliba, Dr. Damazo Trevor Kadengye, Caroline Mwebesa Kyosiima, Joseph Oriekot, and
Nathan Tumuhamye), and the supervisors (Kenneth Kinyera, Daniela Nina Burger, Millicent Okwarampe,
Joan Ashabiirwe, Samantha Kasozi, Pamela Eunice Ahairwe, Kathy Faith Magoba, Nancy Katusabe, Denis
Semakula, Rashid Atugonza, Derrick Mbalule, Ambrose Akampurira and Sharron Alwelo,).
We appreciate the parents and guardians for allowing their young people (aged 10-24 years) to
participate in the study. The parents/guardians signed the consent and assent forms and on the
questionnaire to permit the enumerators to interview their young household member below 18
years.
We also extend sincere gratitude to the young people (aged 10-24 years) for accepting to participate
in the study by responding to the questionnaire and engaging in focus group discussion.
Finally, we appreciate the team of enumerators and data entry clerks for the quality of the work
done.
i
FINAL REPORT
ACRONYMS AND ABBREVIATIONS
ADH - Adolescent Health

AYFS - Adolescent and Youth Friendly Services
AYSRH - Adolescent and Youth Sexual Reproductive Health
CPR - Contraceptive Prevalence Rate
CSE - Comprehensive Sexuality Education
DCDO - District Community Development Officer
DDP - District Development Plan
DEO - District Education Officer
DHO - District Health Officer
DHT - District Health Team
DIS - District Inspector of Schools
DLG - District Local Governments
EA. - Enumeration Areas
ECP - Emergency Contraceptive Pill
EMIS - Education Management Information System
EPHS - Essential Package of Hospital Services
FGD - Focus Group Discussion
FP Family Planning
GEM - Girl Education Movement
GoU - Government of Uganda
HC - Health Centre
HH - Household
HMIS - Health Management Information System
ICPD - International Conference on Population and Development
IRB - Institutional Review Board
KAP - Knowledge Attitudes and Practices
KII - Key Informant Interviews
MCH - Maternal and Child Health
MDG - Millennium Development Goals
MoES - Ministry of Education and Sport
MoGLSD Ministry of Gender Labour and Social Development
MoH - Ministry of Health
NGO - Non-Governmental Organizations
PLHIA - People Living with HIV/AIDS
PWDs - People with Disabilities
RA - Research Assistants
SDG - Sustainable Development Goals
SGBV - Sexual and Gender Based Violence
SRH - Sexual Reproductive Health
STI - Sexually Transmitted Infection
TFR - Total Fertility Rate
UAIS - Uganda AIDS Indicator Survey
UBOS - Uganda Bureau of Statistics
UDHS - Uganda Demographic Health Survey
UN - United Nations
UNFPA - United Nations Population Fund
UNHS - Uganda National Household Survey
UNICEF United Nations Children Fund
UNJPP - United Nations Joint Program on Population
VHT - Village Health Team
WHO - World Health Organization
WRA - Women of Reproductive Age
YFC - Youth Friendly Corner
ii
FINAL REPORT
TABLE OF CONTENTS
CONTENT PAGE
ACKNOWLEDGEMENT ................................................................................................... i
ACRONYMS AND ABBREVIATIONS ............................................................................ ii
TABLE OF CONTENTS .................................................................................................. iii
LIST OF TABLES.............................................................................................................. vi
1. BACKGROUND ...........................................................................................................1
1.1 Introduction ....................................................................................................................................................... 1
1.2 Overview of Adolescent and Youth SRH issues in Uganda ...................................................................... 2
1.2.1. Overview of young people’s SRH in Uganda...................................................................................... 2
1.2.2. Sexual debut and sexual behaviors among young people .................................................................. 2
1.2.3. Sexual and Reproductive Health (SRH) among HIV positive young people ................................ 4
1.2.4. Access to Sexual and Reproductive Health (SRH) services among young people ........................ 4
1.2.5. SRH in the Ugandan education system ................................................................................................ 6
1.2.6. Reproductive Health policies in Uganda .............................................................................................. 7
1.2.7. Effective interventions addressing young people’s SRH ................................................................... 7
1.3. Statement of the problem ............................................................................................................................... 8
1.4. Rationale for the study .................................................................................................................................... 9
1.5. Objectives of the Study ................................................................................................................................... 9
2. APPROACH AND METHODOLOGY ..................................................................... 10
2.1 Summary of the approach ............................................................................................................................. 10
2.2 Study area and study population................................................................................................................... 10
2.3. Approval of the study by the Institutional Review Board ....................................................................... 10
2.4. Study design .................................................................................................................................................... 10
2.5. Sample size determination and selection .................................................................................................... 10
2.5.1. Sample size for the Household Survey ............................................................................................... 10
2.5.2. Selection of Key Informants ................................................................................................................ 12
2.5.3 Focus Group Discussions (FGDs) ...................................................................................................... 12
2.6 Team preparations, Training, Pretesting and Refinement of tools ......................................................... 12
2.7 Fieldwork/Data collection ............................................................................................................................ 12
2.8 Data management and analysis ..................................................................................................................... 13
2.9 Ethical Issues ................................................................................................................................................... 13
3. RESULTS ....................................................................................................................... 14
3.1 Background Characteristics of Respondents .............................................................................................. 14
3.1.1 Response rates ......................................................................................................................................... 14
3.1.2 Socio-demographic characteristics of respondents ........................................................................... 14
3.2. SRH/HIV knowledge, attitudes and practices among young people (10-24 years)............................ 16
3.2.1 Knowledge and sources of information on Sexual and Reproductive Health .............................. 16
3.2.2 Knowledge about Family Planning ...................................................................................................... 20
3.2.3 Knowledge of STIs ................................................................................................................................. 22
3.2.4 Knowledge of HIV/AIDS .................................................................................................................... 25
3.2.5 Sources of SRH information among young people .......................................................................... 30
3.2.6 Self-perceived SRH risk ......................................................................................................................... 32
3.2.7 Sexual behavior........................................................................................................................................ 35
3.2.8 Empowerment ......................................................................................................................................... 41
3.2.9 Contraceptive use .................................................................................................................................... 45
3.2.10 Sexually Transmitted Infections (STIs) ............................................................................................. 47
3.2.11 HIV Testing and Counselling ............................................................................................................. 48
iii
FINAL REPORT
3.2.12 Child marriage, pregnancy, childbearing and abortion ................................................................... 48

3.2.13 Alcohol and substance abuse .............................................................................................................. 52
3.2.14 Gender Based Violence (GBV) .......................................................................................................... 55
3.3 Vulnerability Mapping .................................................................................................................................... 59
3.3.1 Constructing Vulnerability Indices for the AYSRH study ............................................................... 59
3.3.2 Actual scores across vulnerability areas ............................................................................................... 63
3.3.3 Prevalence of vulnerability..................................................................................................................... 65
3.3.4 Vulnerability to HIV/AIDS .................................................................................................................. 66
3.3.5 Vulnerability to teenage pregnancy ...................................................................................................... 66
3.3.6 Vulnerability to abortion ........................................................................................................................ 66
3.3.7 Vulnerability to child marriage .............................................................................................................. 67
3.3.8 Vulnerability to Gender Based Violence (GBV) ................................................................................ 67
3.3.9 Correlations among the vulnerability areas ......................................................................................... 67
3.4. Services Availability and Utilization ............................................................................................................ 68
3.4.1 Health facility based youth programming ........................................................................................... 68
3.4.2 Access to SRH services in Health facilities ......................................................................................... 71
3.4.3 School based Youth Programming ...................................................................................................... 77
3.4.4 Community based Youth programming ............................................................................................. 80
3.4.5 Quality of services ................................................................................................................................... 81
3.4.6. Challenges to SRH service delivery among young people .............................................................. 87
3.5. District Level Programming for SRH ......................................................................................................... 91
3.5.1. AYSRH initiatives at the District Local Government ..................................................................... 91
3.5.2 SRH program coordination ................................................................................................................... 92
3.5.3 Service sustainability ............................................................................................................................... 96
3.5.4 AYSRH policies at district level............................................................................................................ 97
3.5.5 Youth participation ................................................................................................................................. 98
3.5.6. Proposed programming interventions by stakeholders ................................................................... 99
4. RECOMMENDATIONS AND IMPLICATIONS FOR PROGRAMMING ............ 103
5. REFERENCES ............................................................................................................ 107
6. APPENDICES .............................................................................................................. 109
Appendix 6.1: List of the forty four districts selected for the study ........................................................... 109
Appendix 6.2: Sample distribution of households and health facilities by region .................................... 111
Appendix 6.2a: Response rates from the interview with young people at household level per region ......................... 111
Appendix 6.2b: Sample distribution of health facilities visited by region and ownership ........................................ 111
Appendix 6.3: Additional result tables ............................................................................................................. 112
Appendix 6.3a: Proportion of young people that have ever heard about SRH....................................................... 112
Appendix 6.3b: Proportion of young people aware of STIs by age, gender, marital and schooling status, and location
........................................................................................................................................................................... 113
Appendix 6.3c: Proportion of sexually active young people aware about STIs....................................................... 113
Appendix 6.3d: Proportion of young people that have ever heard about HIV/AIDS .......................................... 114
Appendix 6.3e: Main sources of information on SRH and modern Family Planning methods for young people aged
10-14 years ......................................................................................................................................................... 115
Appendix 6.3f: Main sources of information on SRH and modern Family Planning methods for young people aged
15-19 years ......................................................................................................................................................... 116
Appendix 6.3g: Main sources of information on SRH and modern Family Planning methods for young people aged
20-24 years ......................................................................................................................................................... 117
Appendix 6.3h: Proportion of young people whose parents/guardians discussed SRH issues with them by age group
and demographic characteristics ............................................................................................................................ 118
Appendix 6.3i: Rating of risk perception to suffer from SRH problems by age group ........................................... 118
iv
FINAL REPORT
Appendix 6.3j Discussion of reproductive choices with partner before pregnancy among young people aged 15-24... 119
Appendix 6.3k: Proportion of young people who believe they can take an HIV test at any time ........................... 119
Appendix 6.3l: Median Age at first marriage among young people ever married................................................... 120
Appendix 6.3m: Percentage of young people who reported taking alcohol .............................................................. 120
Appendix 6.3n: Proportion of young people who experienced Gender based Violence by Age group and Gender ... 121
Appendix 6.3o: Percentage distribution of reasons justifying GBV among young people aged 10-14 years by
background characteristics .................................................................................................................................... 121
Appendix 6.3p: Percentage distribution of reasons justifying GBV among young people aged 15-19 years by
Appendix 6.3q: Percentage distribution of reasons justifying GBV among young people aged 20-24 years by
Appendix 6.3r: Average distance to the nearest facility ........................................................................................ 125
Appendix 6.3s: Ownership of the health facilities accessed by young people ........................................................... 125
Appendix 6.4: References under Vulnerability mapping .............................................................................. 126
v
FINAL REPORT
LIST OF TABLES
Table 1: Allocation of sampled households by region ........................................................................................................ 11

Table 2: Sample allocation of clusters (EAs) in sampled districts by residence per region .................................................. 11
Table 3: Background characteristics of Survey respondents.............................................................................. 15
Table 4: Percentage of respondents aged 10-14 years who have ever heard about selected SRH services 16
Table 5: Percentage of respondents aged 15-19 years who have ever heard about selected SRH services
n=1491 ......................................................................................................................................................................... 18
n=1015......................................................................................................................................................................... 19
Table 7: Awareness of family planning methods among young people aged 10-14 years (n=1553) ........... 20
Table 8: Awareness of family planning methods among young people aged 15-24 years ............................. 20
Table 9: Knowledge of family planning methods by background characteristics ........................................... 21
Table 10: Proportion of young people aged 15 – 24 years having knowledge of STI symptoms ................ 24
Table 11: Percentage of respondents aged 10-14 with knowledge of HIV prevention methods (n=967) . 25
Table 12: Percentage of respondents aged 15-24 with knowledge of the specific ways of preventing HIV
....................................................................................................................................................................................... 26
Table 13: Percentage of respondents with comprehensive knowledge of HIV/AIDS.................................. 27
Table 14: Percentage of young people with knowledge of HIV testing sites by different socio-
demographic characteristics ..................................................................................................................................... 29
Table 15: Main sources of information on SRH components for young people aged 10-24 years ............. 30
Table 16: Percentage of young people who feel they are at risk of SRH problems ........................................ 32
Table 17: Percentage of young people that have been engaged in any sexual activities by age, gender,
marital and schooling status, and location ............................................................................................................. 36
Table 18: Median age at first sexual intercourse by age, gender, marital and schooling status and location
....................................................................................................................................................................................... 37
Table 19: Percent of young people who have consented vs. been coerced / forced to have sex at
first sexual experience ........................................................................................................................................... 38
Table 20: Number of partners with whom sexually-active young people had sex within the last 6 months
....................................................................................................................................................................................... 40
Table 21: Type of partner whom sexually active young people had sex with in the last 12 months ........... 41
Table 22: Ability to negotiate less risky alternatives to sexual intercourse when pressured to have unsafe
sex among young people aged 15-24 ...................................................................................................................... 42
Table 23: Ever discussed family planning/reproductive choices with partner ................................................ 44
Table 24: Modern contraceptive prevalence among sexually active young people ......................................... 45
Table 25: Proportion of sexually active young people who had a health problem from sexual contact in
the last 12 months ...................................................................................................................................................... 47
Table 26: Proportion of sexually active young people who have tested for HIV and accessed results and
counselling................................................................................................................................................................... 48
Table 27: Among females that have ever had sex, proportion who have ever been pregnant and those
currently pregnant ...................................................................................................................................................... 50
Table 28: Percent of young people who have ever used psychoactive drugs and had sex under the
influence of drugs in last 12 months ....................................................................................................................... 52
Table 29: Percent of young people who have ever taken alcohol and those that have had sex under its
influence ...................................................................................................................................................................... 53
Table 30: Prevalence of Gender Based Violence among young people in the last 12 months ..................... 55
Table 31: Proportion of young people that experienced violence in the last 12 months, by type of GBV
experienced ................................................................................................................................................................. 56
Table 32: Percentage of young people with who justify partner violence, by age, gender, marital and
schooling status, and location .................................................................................................................................. 58
Table 33: Overview of indices relevant to the AYSRH survey........................................................................................ 59
Table 34: Steps followed in AYSRH survey to conduct vulnerability analysis ................................................................ 60
Table 35: Overview of indices relevant to the AYSRH survey........................................................................................ 63
Table 36: Actual score ranges and frequencies (n = 4,287) ................................................................................ 64
Table 37: Mean vulnerability indices by background characteristics ................................................................. 65
vi
FINAL REPORT
Table 38: Prevalence of vulnerability by background characteristics ................................................................ 66

Table 39: Range of SRH Services offered in health facilities .............................................................................. 68
Table 40: AYSRH clinic days, hour run per day, number of clients and waiting time ................................... 70
Table 41: Stock-outs of commodities and supplies related to SRH services in the past 3 months .............. 70
Table 42: Percentage distribution of the Type/ level of health facility accessible to Young people by
background characteristic ......................................................................................................................................... 71
Table 43: Sources of HIV testing services ............................................................................................................. 72
Table 44: Source of contraceptives among young people who reported ever using them ............................ 74
Table 45: Source of STI treatment .......................................................................................................................... 75
Table 47: Family planning services preferred by young people ......................................................................... 76
Table 48: Preferred sources of SRH Services ........................................................................................................ 77
Table 46: Extent to which AYSRH standards are met and reasons for shortfall ............................................ 81
Table 49: Listing of key partners in provision of SRH services ......................................................................... 93
LIST OF FIGURES
Figure 1: Age at which parents first talked about AYSRH ................................................................................. 31

Figure 2: Age group at first sexual intercourse – comparison with UDHS 2011 ............................................ 36
Figure 3. Among young people that have ever had sex, proportion of young people that have ever
engaged in transactional sex, by age, gender, marital and schooling status, and location .............................. 39
Figure 4 : Proportion of young people by marital status ..................................................................................... 49
Figure 5 : Histogram of scores of the vulnerability areas .................................................................................... 64
Figure 6: Scatter plot of scores of the vulnerability areas .................................................................................... 67
Figure 7: Proportion of health facilities with staff trained to provide AYSRH services ................................ 82
vii
FINAL REPORT
1. BACKGROUND
1.1 Introduction
The world is home to the largest generation of young people in history, with more than 1.75 billion
people aged between 10 and 24 years (LIVE, 2010). The United Nations defines Youth as those
aged 15–24 years, while adolescents are defined as those aged 10–19 years. The UNFPA, WHO
and UNICEF define the age-group 10-24 years as ‘Young People’. This is a diverse demographic
group whose life circumstances, opportunities and lifestyle related challenges vary considerably
within and between countries. As outlined in The State of the World’s Children report (UNICEF,
2011), adolescence is a critical phase of human development during which the stage is set for later
life. Adolescents (10-19 year olds) experience rapid social, physical, and emotional changes.
Appropriate support structures and skills can lead to increased independence and development of
positive and healthy behaviors with significant implications for society as a whole. However,
without the skills to face these changes, adolescence can be a time of great risk. Global statistics
show that 17 million young women aged 15–19 years give birth every year. Half of all new HIV
infections are among people aged 15–24 years, and over 6,000 contract the HIV virus daily (LIVE,
2010). There are 2.6 million deaths annually among young people, the majority of which are
preventable. At the 64th World Health Assembly, held in Geneva in May 2011, the report by the
Secretariat on Youth and Health Risks led to a resolution calling on Member States to increase
their efforts on the health of young people and consider this important population group in all
policies within and beyond the health sector. This resolution is also consistent with UNFPA’s
mandate of delivering a world where every pregnancy is wanted, every birth is safe, and every
young person's potential is fulfilled. To accomplish this resolution, UNFPA works to ensure that
all people, especially women and young people, are able to access high quality sexual and
reproductive health services, including family planning, so that they can make informed and
voluntary choices about their sexual and reproductive lives (See more at:
http://www.unfpa.org/frequently-asked-questions#mandate).
Uganda’s population continues to grow currently at rate of 3.0 percent and is way higher than the
region’s average population growth of 2.8%. According to the 2014 National Population and
Housing Census, Uganda's total population stood at 34.9 million an increase of 10.7 million from
the 24.2 million in 2002 Census (UBOS, 2014). With every Ugandan woman on average producing
over 6 children throughout her reproductive period, the country presents a scenario of one of the
youngest and most rapidly growing populations of today’s world (World Bank, 2011).
Consequently, close to half (48.7 percent) of Uganda’s population is made up of child dependents
(under 15 years), and 70 per cent less than 25 years of age (UBOS, 2014). This population structure
of high dependency, undermines the social transformation and sustainable development efforts of
the Country. Nevertheless, the large youthful that the country has achieved through years of high
fertility can be turned into an opportunity if appropriate policies and investments are made for
young people (10-24 years), particularly with respect to Adolescent Health and HIV services
among others. Uganda Vision 2040 has pronounced harnessing the “demographic dividend” as
one of the key strategies for realizing the social and economic transformation envisaged by the
year 2040. For the abundant youthful human resource to be converted into appropriate human
capital, it must healthy, educated and properly skilled.
This is also in line with the recently adopted global Sustainable Development Goals (SDG), which
Uganda has largely mainstreamed in her development planning frameworks, particularly goal 3 on
good health and well-being for all and goal 4 on universal access to quality education and live-long
learning.
1
FINAL REPORT
1.2 Overview of Adolescent and Youth SRH issues in Uganda
1.2.1. Overview of young people’s SRH in Uganda

Uganda’s reproductive health indicators manifest a big challenge for the health sector. At
6.2children per woman, Uganda has one of the highest Total Fertility Rates (TFR) in the world
(UBOS, 2011; Haub and Gribble, 2011; PMA, 2015) . The adolescent birth rate stands at 159 per
1,000 births (UDHS, 2011). Teenage pregnancy rate among the 15-19 years olds stands at 24
percent, and the median age of sexual debut is only 16.7 years. Adolescent pregnancy contributes
to 30 per cent to the primary school drop-out ratio (AODI/UNICEF study, 2011).
Although knowledge of modern contraception is high among adolescents aged 15-19 at 92 % for
girls and 96 % for boys, access to appropriate SRH services in usually limited (UBOS, 2011). The
unmet need for Family Planning (FP) stands at 30% (PMA, 2015). The contraceptive prevalence
rate among the married young women 15-24 years of age is only at 11.4 per cent with a high Family
Planning (FP) unmet need: for 15-19 year old girls it is 31.3% and among those aged 20-24 years
it is 35.4% (UDHS, 2011). The health sector plans to lower the unmet FP need to 20%, as
mandated in the Health Sector Strategic Plan (HSSP III), 2010/11-2014/15 while the Uganda’s
Vision 2040 TFR target is 4 children per woman by 2030, eventually coming down to 3 by 2040
as one of the strategies for harnessing the demographic dividend.
At 438 per 100,000 live births, Uganda’s Maternal Mortality Rate (MMR) is one of the highest in
the world.1 Given the vulnerabilities associated with early pregnancy, maternal death among young
women 15-24 years of age makes a large contribution the overall maternal mortality ratio in
Uganda. Unsafe abortion contributes partly to this (Singh et al., 2006). As in all countries where
abortion is illegal, young people are the worst affected by its negative outcomes. Uganda’s abortion
rate stands at 54 per 1,000 Women of Reproductive Age (WRA). Most abortions are unsafe,
although over 50% are believed to be carried out by medical practitioners. A study of women who
were treated for pregnancy-related problems in three Kampala hospitals found that 21% of the
maternal deaths were due to complications of abortion (Mbonye, 2000). Additionally, 7.5 billion
shillings is the estimated annual cost on unsafe abortion to the health system.
1.2.2. Sexual debut and sexual behaviors among young people
While the overall burden of disease may be lower in adolescents compared to children and the
older people, there are specific conditions that are much more common and have more devastating
effect in the adolescent age group. These include Reproductive Health (RH) problems such as
early/unwanted pregnancy, unsafe abortion, harmful traditional practices for example Female
Genital Mutilation (FGM), access to contraception and STI/HIV/AIDS; Psycho-social problems
such as substance abuse, delinquency and sexual abuse among others. According to Uganda
National Adolescents Health Policy (MOH, 2000), the health of adolescents and young people is
affected by both personal and external environmental conditions. The life styles and behaviour
patterns acquired during adolescence are lifelong and therefore efficient and timely intervention
during adolescence may avert the negative consequences. It is therefore indispensable that, young
people be provided with an environment with minimum health risks and that they have access to
health services that are sensitive and relevant to their particular and wide ranging health and
development concerns.
2
FINAL REPORT
There are several factors that influence young people’s Sexual and Reproductive Health (SRH)
behaviors. In particular, young people’s sexual behavior is influenced by their social and economic
context. Aspects of this context that increase or decrease susceptibility of young people to negative
SRH outcomes include gender issues in relationships and families, social norms regarding early
marriage and poverty (Boerma et al., 2002, Wight et al., 2006). For instance, what was understood
as the normalization of teenage sexual activity through mutually reinforcing messages about the
desirability and excitement of teenage sex from multiple media sources, and peers, was a strong
factor in influencing young people into early sexual intercourse (Hoggart and Phillips, 2011). In
particular, the assumption that by a certain age (most often seen as over 16 years) “all their friends
are doing it” has been seen as a central point in deciding whether to have sex. Older girls talk about
feeling pressured not only to maintain their relationship with boys but their own reputation as well:
“that is to say, if you are not doing it something is wrong with you” (Hoggart and Phillips, 2011).
This chimes with recent work that has argued that as a consequence of a greater sexualization of
culture, young women may be under pressure to show sexual autonomy and sexual knowledge
(McRobbie, 2009).
A growing number of young people are becoming sexually active before marriage and as a
consequence the rate of unplanned pregnancies among this age group, particularly among those
with unmet need for contraceptives, increases(D. Alene et al., 2004). The damaging consequences
of child bearing at a young age pose health threats to both the adolescent mother and the infant.
Adolescent sexual activity, within or outside of marriage, can lead to negative reproductive health
outcomes (Dixon‐Mueller, 2008). Research has indicated that a complex web of influences lead to
sexual decision-making being fraught with difficulties for many young people. These influences
may include, for example: difficulties negotiating contraceptive use due to ‘chaotic lifestyles
(Hoggart and Phillips, 2011), the influence of drugs or alcohol (Mason, 2005, Shoveller and
Johnson, 2006) and coercion (Barter et al., 2009). Studies also point to a tension between positing
the need for controlled sexual encounters for ‘safer’ sex; and what Michelle Fine has referred to as
“the missing discourse of desire”(Fine, 1988, Tolman and Tolman, 2009).
In Uganda, girls become sexually active earlier than boys. In 2011, the median age of first sexual
relationship for women aged 25 to 49 years was 16.8 years compared with 18.6 years for men
(UDHS 2011). A study that was conducted in Mbale district Uganda found out that first sexual
experience among female and male respondents occurs at quite an early age, 15 years for males
and 16 years for females (Agyei et al., 1994).
Also, the girl-child is commonly looked at as a source of wealth and society expects or forces girls
to marry at very young ages (Neema et al., 2004). Studies in Tanzania (Nnko et al., 2004, Wamoyi
et al., 2010) have noted that in order to satisfy their material needs, young women from poor
families may engage in transactional sexual activity with multiple partners or casual partners or
agree to have sex without a condom. Desmond et al., (2005) found that in an endeavor to maximize
financial gains from sex, women engaged in high risk sexual practices such as anal sex. Studies
indicate that female sex workers enter the trade as early as 13 years and most are HIV infected
within four years; alcohol and drug abuse predisposes young people to risky sexual behaviors;
many cultures still promote early and sometimes forced marriages often to male partners that are
much older; and there is prevalent sexual abuse among young people including rape, defiled and
coercion. The 2011 Uganda AIDS Indicator survey (AIS) indicated that about 19% of young women
were coerced at their first sexual encounter.
3
FINAL REPORT
1.2.3. Sexual and Reproductive Health (SRH) among HIV positive young people
Uganda’s HIV success story was largely a result of significant reduction of new infections among
young people 15-24 years in the 1990s and early 2000s. There is however a resurgence of the HIV
epidemic with increasing HIV infections among young people especially young women. According
to the 2011 Uganda AIDS Indicator survey (AIS), HIV prevalence among all young people 15-24
years of age was at 3.7% (4.9% females and 2.1% males); among young women 15-17 years, it was
at 1.7% increasing sharply to 5.1% among those aged 18-19 years and to 7.1% among those aged
20-22 years with a peak of 9.6% among young women aged 22 years. HIV prevalence among
young pregnant women is at 6.1% presenting a huge burden for prevention of mother-to-child
transmission of HIV and also contributing to high maternal mortality in the country. Young people
in the highest wealth quintile and those residing in urban areas have a higher HIV prevalence than
those in lower wealth quintiles and rural residents. A similar trend obtains for prevalence of other
Sexually Transmitted Infections (STIs) that in turn predispose young people to HIV infection. For
Young People with HIV, the unadventurous challenges of adolescence are even more complex
considering the intricate relationship between sexual activity and HIV transmission.
Given the dynamics of sexual and reproductive needs and choices of people living with HIV
(PLHIV) (ICW, 2011), addressing sexual and reproductive health needs of young people with
perinatally acquired HIV introduces a complex chapter in the fight against HIV and AIDS. This is
because of the intricate relationship between sexuality and the main modes of HIV transmission.
In Uganda for example, 80% of HIV infections are through heterosexual intercourse while mother
to child transmission accounts for 22-25% of all HIV infections in the country (Baryamutuma and
Baingana, 2012). As many children with perinatally acquired HIV graduate into adolescence and
adulthood, it is imperative that their sexual and reproductive health needs and rights are critically
examined in relation to existing HIV programs, policy environment and health systems, to identify
the gaps and opportunities. These young people desire to love and to be loved and have plans to
have children. Additionally, these young people have the freedom of choice regarding sexual
matters, reproduction, marriage and the fundamental right to access sexual health information and
comprehensive sexual health services. A study commissioned by TASO and the Population
Council titled: ‘Sexual and Reproductive Health needs of adolescents perinatally infected with
HIV’ shows that 52% of them were in relationships and 33% had had sexual intercourse. Forty-
one per cent of those who had never had sexual intercourse reported that they desired to have it
in the near future (Buringi et al; TASO and USAID report 2008).
1.2.4. Access to Sexual and Reproductive Health (SRH) services among young people
The prevalence of unsafe sexual behaviors and practices among young people has been coupled
with limited access to SRH and HIV information and services. The UDHS 2011 reported low
comprehensive HIV knowledge1 among young people at 38% for women and 40% for males. The
AIS 2011 also revealed that young people in Uganda initiate sex at an early age and they are engaged
in multiple sexual partnerships but with low condom use at 24% for women and 30% for men.
Adolescents are frequently reluctant to seek health services for sexual and reproductive health.
Included among the many barriers are judgmental health workers, lack of supplies, equipment,
materials and private workspace, and a lack of training for and in understanding of adolescent
reproductive needs (Bearinger et al., 2007, Tylee et al., 2007).
1
Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful
partner can reduce chances of getting AIDS, knowing a health –looking person can have the AIDS virus and rejecting the two most common
misconceptions(two most common misconceptions about HIV/AIDS (i.e., HIV can be transmitted by mosquitoes or by sharing food with a
person who has AIDS)
4
FINAL REPORT
In 2012, the World Health Organization (WHO) together with UKAID and the Ministry of Health
commissioned a largely qualitative study on ‘Understanding Social Cultural barriers to SRH of
individuals, families and communities in 8 districts in Uganda’. These districts were part of 15
United Nations Joint Population Programme (UNJPP) districts, and included districts that had
faced recent conflict or were hard to reach. The study shows that although there is no legal
restriction for young people to access SRH and HIV services, adolescents below the age of 18
years (legally categorized as minors) sometimes have to seek permission from their guardians when
going to health facilities. In this study two thirds of people aged 15-19 reported to be sexually
active and only 45% of them had ever been pregnant. Forced marriages were reported to be
rampant in these districts, their occurrence attributed to bride price, parents seeking to marry off
their girls into wealthy families, misunderstanding of children’s rights, permissive parenting,
broken families, defilement and the social cultural norms. The study also noted that often times
when a young girl got pregnant, her parents would use it as an opportunity to negotiate for
‘compensation’ from the responsible boy’s parents.
Adolescents face inter-related barriers that prevent them from accessing facility-based RH services.
These include: individual barriers, such as feelings of shame, fear or anxiety about issues related to
sexuality and reproduction, lack of awareness about the services available, poor health, or advice-
seeking behaviors and the perception that services will not be confidential; socio-cultural barriers,
such as social norms which dictate the behavior and sexuality of both young men and women,
stigma surrounding sexually active adolescents, cultural barriers which limit the ability of women,
girls or certain sub-sets of the population from accessing health services, educational limitations,
language differences, the attitudes of health care providers towards adolescents or their
unwillingness to attend to their RH needs; and structural barriers, such as long distances to health
facilities, lack of facilities for clients with disabilities, inconvenient hours of operation, long waiting
times, charging fees for services and lack of privacy.
Adolescents are quite explicit about what they want from health-care providers. They value their
privacy and identity, and want to make decisions for themselves based on correct information.
WHO stipulates a number of elements that stimulate adolescents to seek healthcare. These
elements include: confidentiality, provision of required information and services, accepting
adolescents as they are, considering and respecting adolescents’ opinions, allowing adolescents to
make their own decisions, ensuring that adolescents feel welcome and comfortable, being non-
judgmental, and provision of services at a time that adolescents are able to come (Atuyambe et al.,
2015).
To reach young people, RH programs must take innovative approaches to make services
acceptable, accessible and appropriate for adolescents, taking cultural sensitivity and diversity into
consideration. Adolescents should be involved as much as possible in the design, implementation
and monitoring of program activities, so that programs are more likely to respond to their RH
needs and priorities and so that interventions are acceptable to them. Introducing adolescent
friendly health services and involving adolescents in the both the design and monitoring of these
services will make facility-based RH services more accessible and acceptable to adolescents. In
addition, health providers, adolescents and community members should consider alternative
implementation strategies such as community interventions that will make it easier to reach
adolescents with RH information and services
With JPP support in Uganda, youth-led groups that are a vital link in the Adolescent Friendly
Health Services (AFHS) chain have been established in communities. They include the Male
Action Groups (MAGs) and Alliance for Parents, Adolescents and Community for Adolescent
Health (APADOC).
5
FINAL REPORT
These committees bring parents, adolescents, teachers and religious leaders together to deal with
adolescent health problems as well as social economic activities. One of the highly applauded
achievements of the JPP is the establishment of Youth Friendly Corners (YFCs) in selected health
units where young people meet to play and also learn about health. The YFCs are equipped with
infrastructure that appeals to young people such as video and TV screens, CD players and games
such as ludo, pool tables, volleyball and football. In fact, YFCs are a response to the finding that
young people shy away from seeking certain health services offered in open-to-all clinics for fear
of being seen by parents or people who know them.
1.2.5. SRH in the Ugandan education system

In Uganda, common avenues for sexuality education are parents or caregivers, formal school
programs, and public health campaigns. However, young people are not adequately prepared at
home, in schools, and within the wider social setting with enough SRH information, early enough
for them to use it in preventing, managing and mitigating the SRH disease burden. Formal
education is based on seven years of primary and six years of secondary education. Secondary
education consists of 6 years divided into two levels the first level comprising grades 1–4 (ordinary
level) and the second level, grades 5 and 6 (advanced level). In a survey carried out in secondary
schools, the respondents identified the following as the most commonly offered health services
which varied in secondary schools: guidance and counselling (54%), General medical check-ups
(45%), HIV/AIDS/Sexual and Reproductive Health Counselling (37%), Pregnancy prevention
programmes (29%), Dental treatment (14%) and Immunization (9%)2. However the draft national
school Health policy recognizes the lack of both guidance on which health services to provide and
the system/tool for support supervision of available services in schools. The health system has
generally not fully integrated schools in their programmes.
A draft curriculum on Sexuality Education for lower secondary school and aligned to the
international standards is in place but has not been implemented yet. A teacher training curriculum
on Comprehensive Sexuality Education (CSE) has also not been finalized. In addition, integration
of Comprehensive Sexuality Education (CSE) in the school curriculum still faces resistance from
different stakeholders. Discussions on sexuality in the existing Ugandan primary and secondary
school curriculum mainly include anatomy, changes during adolescence and fertilization, leaving
out important aspects like dealing with gender based violence and prevention of: sexually
transmitted infections other than HIV, abortions and teenage pregnancy thus the need to bridge
the existing gap. Some schools offer no sexuality education, since it remains a controversial issue
especially with regard to the age at which children should start receiving such education and the
amount of detail to be revealed. A study by Ajah et al., (2015) recommended the need to establish
adolescent-friendly clinics and include sexuality education in the curriculum of schools.
Knowledge, perceptions and negotiation skills are most efficiently influenced during secondary
education schooling (Lewin and Caillords, 2001, Nsubuga, 2003). The increased access to
secondary schools is a good opportunity to capture young actors for sexuality and reproductive
health education.
Non-Governmental Organizations (NGOs) such as Straight Talk Foundation has worked on SRH
communication initiatives in Northern Uganda but there are still challenges of sustainability and
coverage of adolescents in remote areas. It is thought that an investigation in this area would shed
light on the perceptions and factors influencing acceptability to a comprehensive adolescent sexual
and reproductive health education amongst secondary schools and in particular knowledge on
prevention of STIs, teenage pregnancies and abortions.
2 Situation analysis on school health programmes and clubs in Uganda, 2011
6
FINAL REPORT
1.2.6. Reproductive Health policies in Uganda

The policies in Uganda are favorable for adolescent health and development. Uganda has a number
of policies in place such as Uganda National Adolescent Health Policy 2004, Adolescent Health
Policy Guidelines and Service Standards (MOH, 2012), the National Minimum Healthcare Package
which includes Sexual Reproductive Health (SRH) and rights for adolescent (MOH, 1999), and
the Health Sector Strategic and Investment Plan (HSSIP), MoH 2010. In addition, the country has
a number of platforms that advocate for young people’s issues including the Uganda National
Youth Parliamentary Forum (UNYPF), the National Youth Council (UYC), and the National
Youth Forum (NYF). Other policy related documents that address young people related issues
include National Youth Action Plan, Uganda National Youth Policy, the Uganda Gender policy
2007, The Education Act 2008, Employment Act 2006, National Orphans and other vulnerable
children policy, National strategic plan for HIV and AIDS 2011/12-2014/15, National Health
policy, National population policy action plan 2011-2015 and HIV and AIDS prevention and
control act 2014. However, their functions but have not been fully exploited to advocate for the
promotion of the rights of SRH among young people. Most of these lack the technical and financial
capacity to adequately advocate for marginalized young people. Further, these platforms are not
well coordinated and their work is not based on a proper assessment and analysis of existing laws
and policies to inform their advocacy activities. In addition, SRH policies in the country have
lacked translation into practice.
There are also initiatives directed at empowering Ugandan adolescent girls and young women to
reduce their vulnerabilities. They include: Girl Education Movement (GEM); Girl Child Initiative
(GCI); Adolescent Girl Initiative (AGI); End Child Marriage (ECM); Girls not Brides (GnB);
Youth Enterprise Model (YEM); and the Campaign to Prevent Teenage Pregnancy. Indeed, such
initiatives provide an opportunity to transform the visibility and status of girls and young women
in their communities and shift social norms and practices to align with the rights of adolescent
girls and young women. However, these initiatives have a limited coverage; and are not fully
integrated into the general health, social and economic programs. In addition, recent studies done
in Central Uganda have shown that there is need for a critical assessment of Adolescent Friendly
Services (AFS) to gain insights on current practice and inform future interventions (Atuyambe et
al., 2015). There are existing gaps as well at policy, program and health systems level as far as
addressing SRH needs of young people who have lived with HIV since infancy is concerned. In a
study to determine SRH needs and rights of young people with perinatally acquired HIV in Uganda
(Baryamutuma and Baingana, 2011), it was found that young people HIV positives are sexually
active and are engaging in risky sexual encounters. Yet, the existing policies, programs and services
are inadequate in responding to their sexual and reproductive health needs and rights. This study
used both qualitative and quantitative assessments to explore the extent to which current programs
and policies are responding to the SRH/HIV needs of the young people at a national level, but
also provided a breakdown by gender, age group, regional and rural-urban estimates among others.
1.2.7. Effective interventions addressing young people’s SRH

The World Health Organization (WHO) commissioned desk review on ‘Reducing inequality
through universal access to SRH in Uganda’ undertook an assessment of key policies regarding
SRH including adolescent health in the country. It notes that Uganda’s has a National adolescent
health policy and guidelines in which young people are described as a ‘best buy’ in improving SRH.
The desk review study notes that from a policy angle, ‘There exists no restriction for adolescents
or unmarried women to access and utilize FP services and methods. All sexually active males and
females in need of contraception are eligible for FP services provided that they have been educated
and counseled on all available methods and choices, and attention has been paid to their current
medical, obstetric contra-indications and personal preferences (MOH, 2006).
7
FINAL REPORT
In the effort to ensure no restrictions, the Uganda National Policy Guidelines and Service
Standards for Reproductive Health Services recommend that no verbal or written consent is
required from parent, guardian or spouse before a client can be given family planning services’.
Several approaches have been employed to address the situation of SRH/HIV in young people.
These comprise individual (biomedical and behavioral) approaches as well as those that go beyond
the individual. Published literature on sexual health interventions has emphasized the importance
of changing young people’s risk profiles (especially their knowledge level and attitudes), but have
consistently failed to produce long-term behavior change or improved sexual health outcomes at
the population level (Kaaya et al., 2002, Ross et al., 2007). For example, their emphasis has been
on assessing individual level risk factors such as contraception and condom use knowledge. As
much as unwanted pregnancy and STIs pose serious problems to young people, an exclusive
reliance on “risk factor” explanation enhances the likelihood that our understanding of these
problems is denuded of social meaning (Frohlich et al., 2001) and that interventions to address
such issues remain focused exclusively on reducing adolescent risk behavior rather than
understanding the social environment facilitating risk. This study explored both individual and
environmental factors that influence young people’s sexual behaviors.
1.3. Statement of the problem
As Uganda transitions from the Millennium Development Goals (MDGs) to SDGs, a key area of
sub-optimal performance was Sexual Reproductive Health (SRH). Despite a range of program
activities targeted to SRH in the country, indicators for SRH in Uganda still show substantial
inadequacy. According to the 2011 Uganda AIDS Indicator survey (AIS), HIV prevalence among
all young people 15-24 years of age was at 3.7%; among young women 15-17 years, it was at 1.7%
increasing sharply to 5.1% among those aged 18-19 years and to 7.1% among those aged 20-22
years with a peak of 9.6% among young women aged 22 years. The contraceptive prevalence rate
among the married young women 15-24 years of age is only at 11.4 per cent with a high Family
Planning (FP) unmet need: for 15-19 year old girls it is 31.3% and among those aged 20-24 years
it is 35.4% (UDHS, 2011). Teenage pregnancy rate among the 15-19 years olds stands at 24 percent,
and the median age of sexual debut is only 16.7 years. Adolescent pregnancy contributes to 30 per
cent to the primary school drop-out ratio (AODI/UNICEF study, 2011). Uganda’s abortion rate
stands at 54 per 1,000 WRA. Most abortions are unsafe, although over 50% are believed to be
carried out by medical practitioners. Within the continuum of SRH challenges, young people still
face substantial barriers to quality SRH services at individual, community and health system levels.
However, despite various SRH assessments conducted by different stakeholders, evidence on the
SRH needs of young people in Uganda is fragmented, and not adequately informative for planning.
Many assessments do not provide adequate disaggregation of issues of SRH issues of young people
vis-à-vis the entire population of reproductive age. Moreover, available assessments have not used
a comprehensive needs-based approach which is necessary to foster a better understanding of what
young people think are their priority SRH needs.
UNFPA through its strategic plan is supporting Government of Uganda (GoU) to address the key
gaps in SRH using a 5 pronged approach: 1) Evidence-based advocacy for policy and
programming; 2) Promoting comprehensive sexuality education; 3) Building capacity for SRH
service delivery; 4) Bold initiatives to reach the most vulnerable; and 5) Youth leadership and
participation. In line with its strategic focus, UNFPA is working closely with the Ministry of Health
to undertake a comprehensive situational analysis on SRH issues affecting young people.
8
FINAL REPORT
This was a nation-wide study under the auspices of the Ministry of Health, targeted to informing
efforts at developing a comprehensive program that is responsive to the needs of young people,
in line with the anticipated benefit that this demographic important group will contribute to the
Demographic Dividend. As part of achieving Uganda’s aspirations for socioeconomic
transformation and transition into an upper-middle income country by 2040, policy actions in areas
such as Health and family planning are being considered for adoption in-order to harness a sizable
demographic dividend (National Planning Authority, 2014).
1.4. Rationale for the study

There is generally insufficient evidence to facilitate understanding of the needs of young people
and the driving factors leading to their current SRH and HIV status. The UDHS and Health
Management Information System (HMIS) provide statistics on some of these indicators however
do not provide for a needs based analysis and disaggregation by age group. Very often, available
SRH assessments mix the issues of young people into the continuum of the reproductive age
population. Whereas relevant policies and strategies are in place including: the National Adolescent
Health Policy and Strategy, Health Sector Strategic and Investment Plan (HSSIP), Uganda National
Youth Parliamentary Forum (UNYPF), the National Youth Council (NYC), and the National
Youth Forum (NYF), National Youth Action Plan, Uganda National Youth Policy, the Uganda
Gender policy 2007, The Education Act 2008, Employment Act 2006, National Orphans and
other vulnerable children policy, National strategic plan for HIV &AIDS 2011/12-2014/15,
National Health policy, National population policy action plan 2011-2015, National adolescent
health policy for Uganda and HIV &AIDS prevention and control act 2014, their implementation
is still weak. Other relevant policies such as the National Youth Policy and the School Health
Policy have been in draft form for long pending cabinet approval.
Efforts have been made to increase access to the Youth-Friendly Services (YFS) with support from
development partners. However, data on partners’ interventions, current coverage of supported
services and extent of their alignment to national guidelines and standards is not known. Further,
there are still some cultural, religious and social barriers that hinder young people, particularly girls
and young women from accessing correct and timely SRH and HIV information and services.
Therefore there is need for a comprehensive evidence generation exercise to fill identified evidence
gaps so as to inform policy implementation and effective programming. There is also a need to
understand issues affecting vulnerable, marginalized and hard to reach young people and those in
special categories such as very young adolescents (10-14 years), adolescents with disabilities and
adolescents infected with HIV so as to program appropriately for them.
1.5. Objectives of the Study
The main objective of this study was to map out SRH/HIV knowledge, attitudes, practices and
vulnerability among young people aged 10-24 years in and out of school; and to assess Adolescents
and Youth Sexual Reproductive Health (AYSRH) service availability, user perceptions and service
gaps in Uganda. The study will generate information that will be utilized for improving national
AYSRH advocacy and programming. The specific objectives were:
a) To establish SRH/HIV knowledge, attitudes, and practices among young people (10-24 years).
b) To map out vulnerable groups with regard to HIV/STIs and SRH ill-health among young people.
c) To determine AYSRH/HIV needs and access to information and services.
d) To establish existing AYSRH/HIV services and coordination mechanisms.
e) To determine young people’s perceptions towards available AYSRH/HIV services.
f) To determine the utilization, effectiveness efficiency and sustainability of AYSRH/HIV services.
9
FINAL REPORT
2. APPROACH AND METHODOLOGY
2.1 Summary of the approach

A mixed methods approach involving quantitative and qualitative (participatory and consultative
techniques) was used to assess AYSRH in Uganda. Quantitatively, a young people’s questionnaire
was used to collect data on knowledge, attitudes, practices and experiences of young people
regarding SRH information, education and services. Qualitatively, participatory techniques
including Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) were used to
gain deeper insights into SRH related vulnerability, services and current programmes among
others.
2.2 Study area and study population

The study was conducted country-wide in all the ten (10) statistical regions of Uganda as defined
by Uganda Bureau of Statistics (UBOS) and the primary target population was aged young people
aged 10-24 years. A total of 31.4% of the Uganda’s population (10,984,300) are young people aged
10-24 years (UBOS, 2014). The household survey and the Focus Group Discussions were
conducted among the young people. In addition, stakeholders/partners supporting and / or
providing ASRH/HIV services in Uganda were also targeted as key informants to provide
additional information concerning SRH/AIDS issues affecting young people. The health facility
survey was conducted in the 44 districts located in the 10 statistical regions of Uganda. Health
facilities at the level of HCIII and above, and nearest to the enumeration area were eligible for the
study. The EAs were randomly selected by UBOS for the AYSRH survey of young people aged
10-24 years within the households.
2.3. Approval of the study by the Institutional Review Board

The AYSRH inception protocol study obtained ethical approval from the Institutional Review Board
(IRB), that is, the Mildmay Uganda Research Ethics Committee (MUREC), and was registered with
the Uganda National Council of Science and Technology (UNCST).
2.4. Study design

A cross-sectional descriptive and analytical design was used because it is a valuable tool for
assessing health aspects relating to factors such as knowledge, attitudes and practices of individuals
in a population. Descriptive aspects involved an analysis of the prevalence of different
characteristics of interest regarding knowledge, attitudes, practices and experiences related to SRH
and SRH services. This was supplemented with qualitative data from the key informants and
FGDs. Analytical aspects involved assessing the quantitative data for determinants of desirable
and un-desirable SRH practices and experiences of young people.
2.5. Sample size determination and selection
2.5.1. Sample size for the Household Survey

The sample design targeted a national sample of households selected to produce representative
estimates for the country as a whole, for the urban and rural areas separately, and for each of ten
statistical regions. Using a standard formula3 and pertinent assumptions, a total of 2,976
households were targeted, for a total of 4,404 young people. This sample was drawn from 149
Enumeration Areas from 44 districts distributed to the 10 statistical regions of Uganda. From each
enumeration area, a total of 20 households were selected. Table 1 below shows the sample size
allocation per region:
3
UN (2008). Designing Household Survey Samples: Practical Guidelines. Studies in Methods. Series F. No. 98
10
FINAL REPORT
Table 1: Allocation of sampled households by region

# Region No, of Proportion of Sampled Estimated Number
Households Households per number of Number of EAs
(UBOS 2014) Region Households per of Young per region
(HH/Overall region people
Total)
1 Central 1 1,048,559 0.14 424 628 21
2 Central 2 848,604 0.12 344 508 17
3 East Central 779,065 0.11 315 467 16
4 Eastern 974,641 0.13 395 584 20
5 Kampala 418,787 0.06 170 251 8
6 Karamoja 167,110 0.02 68 100 3
7 North 714,334 0.10 289 428 15
8 South West 945,281 0.13 383 566 19
9 Western 982,281 0.13 398 589 20
10 West Nile 472,344 0.06 191 283 10
TOTAL 7,351,006 1 2977 4404 149
The first stage involved selecting districts from the district sampling frame. Out of the 112 districts
in the country, a total of 44 districts were sampled. Kampala district was sampled purposively
because of its unique socioeconomic and demographic characteristics both as a region and a
district. The remaining 43 districts were selected using random numbers generated in MS-Excel
2007. Appendix 6.1 indicates the listing of the 44 districts which were selected for the study and
the total number of households sampled for each of the districts. The second stage involved
selecting EAs from the census sampling frame. The 149 clusters (20 households per EAs in each
region) were selected with probability proportional to size of sampled districts. UBOS randomly
selected the EAs from the list frame generated during mapping for the 2014 National Population
and Housing Census (NPHC). A total of 20 households were selected as the ultimate sampling
units per EA. Table 2 below shows the distribution of the number of districts and EAs sampled
per region.
Table 2: Sample allocation of clusters (EAs) in sampled districts by residence per region
Proportion Proportion of Total Total
No. of Sampled Total Rural
Statistical of districts Urban EAs number of Urban
# Districts Number of EAs per
Region per region (based on AIS EAs per EAs per
(N) districts (n) region
(N/112) 2011) region region
1 Central 1 12 0.107 5 0.09 21 3 18
2 Central 2 11 0.098 4 0.06 17 2 15
3 East Central 11 0.098 4 0.11 16 3 13
4 Eastern 21 0.188 8 0.06 20 2 18
5 Kampala 1 0.009 1 1.00 8 8 0
6 Karamoja 7 0.063 3 0.06 3 1 2
7 North 15 0.134 6 0.06 15 2 13
8 South West 14 0.125 5 0.09 19 2 17
9 Western 12 0.107 5 0.09 20 3 17
10 West Nile 8 0.071 3 0.09 10 2 8
TOTAL 112 1 44 0.17 149 28 121
11
FINAL REPORT
2.5.2. Selection of Key Informants

Key informants were targeted from four levels: Representatives from development partners and
NGOs, representatives from government sectors that have a stake in AYSRH and representatives
from district Local Governments and community leaders. At the district level, the study targeted
District Health Officers (DHOs), District Community Development Officers (DCDOs), District
Education Officers (DEOs), and Women and youth representatives at the district council.
Community leaders targeted included Sub-county Chiefs, Religious Leader, Cultural Leaders, head-
teachers, youth leaders, program and health facility managers, health workers and peer educators,
and VHTs. A total of 172 Key Informant Interviews were conducted. These included 88
community leaders, 74 district level resource persons and 10 development partners/NGOs.
2.5.3 Focus Group Discussions (FGDs)

A total of 98 FGDs were conducted. The FGDs captured additional information on SRH and
consisted of young people aged 10-24 years who have not been administered questionnaires within
the selected EAs. The FGDs were conducted separately for boys and girls and for those in-school
and those out of school within their respective age groups of very young adolescents (10-14 years),
older adolescents (aged 15-19) and young adults (aged 20-24). A total of 84 FGDS for young
people were conducted (12 in Kampala, 12 for other urban4 areas as defined by UBOS and 12 in
rural settings from each of the 5 selected regions – Northern, Western, Eastern, Central and
Karamoja). Additionally, 16 FGDs for parents were conducted (2 in Kampala area, 2 in other
urban areas, and 2 in rural settings for each of the 5 selected regions)
2.6 Team preparations, Training, Pretesting and Refinement of tools

During the planning and inception phase of the study, a questionnaire for young people was
developed to capture data for answering the study objectives, benchmarking on previous studies
relating to SRH/HIV among young people (UNJPP baseline 2012 and UNJPP midterm reviews;
UDHS 2011; and UAIS 2011). The desk-based review of documents, provided by UNFPA and
MoH, at the inception phase of the assignment also helped to inform the development of data
collection tools in order to ensure all the necessary variables are included in the tools. The final
refined data collection tools/instruments were reviewed and approved by technical teams both
from the Ministry of Health and UNFPA and the IRB at MUREC. The tools were also pretested
in Kampala and Wakiso districts.
A total of 10 supervisors and 54 research assistants were recruited and trained by the principal
investigator and the co-investigators. The training was also attended by a representative from
UNFPA and MoH. The research team was then clustered into regional sub-teams that went out
to the respective regions. Each regional team was led by a supervisor. The teams also received
monitoring visits by the study investigators and representatives of UNFPA and MoH as part of
quality assurance.
2.7 Fieldwork/Data collection

Data was collected using a combination of both qualitative and quantitative techniques in order to
capture data and information necessary to address the objectives of the assessment. All cognitively
competent adolescents and young people aged 10-24 years in the selected households were
interviewed upon seeking their full informed consent. For the young people under 18 years verbal
consent was sought first from their parent/guardian. Completed questionnaires were cross-
checked by the district supervisors to ensure accuracy, completeness and uniformity of the data
collected.
4
* Wakiso, Mbarara, Gulu, Fort Portal, Hoima and Mbale district. These are the main urban centres where UNFPA
is planning to establish HIV service Hubs)
12
FINAL REPORT
Key Informant Interviews (KIIs) were conducted with the help of KII guides, while the FGDs
were conducted with the help of FGD guides. A desk-based review of relevant documents was
also conducted in order to generate background information and additional secondary data about
the Young People’s Sexual and Reproductive Health needs, Services and implementing partners
in Uganda.
2.8 Data management and analysis

Quantitative data from the questionnaires was checked for completeness in the field, and
mitigation measures taken to ensure quality. Data from the young people’s questionnaire was
entered in Epi-Info 7 owing to its advantage of simplicity in use, ability to use auto checks and
skips for quality assurance/control. The entered data was then exported to SPSS v17 and STATA
12 for analysis. At univariate analysis level, basic descriptive statistics in form of frequencies, means
and percentages of the different variables were computed. The generated analyses were
disaggregated by region, gender, location (rural/urban), age group (10-14 years, 15-19 years, 20-24
years), schooling-status and education levels among others with respect to the study objectives.
The vulnerability analysis involved cross-tabulation of key vulnerability indicators to determine
population sub-groups that were most vulnerable to key SRH outcomes.
Qualitative data collected especially from literature, Key Informant Interviews (KIIs) and FGDs
was analyzed using thematic content and discourse analysis. Qualitative findings were triangulated
with the quantitative findings so as to provide context to the key findings. The qualitative findings
were used to strengthen the interpretation of the quantitative findings and provided additional
information. In some instances direct quotes from respondents were used.
2.9 Ethical Issues
Ethical clearance was obtained from Mildmay Research and Ethics Committee (REF 0312-2015)
and Uganda National Council for Science and Technology (SS 4018). The objectives, benefits and
risks of the study were explained to the study participants and informed consent was obtained. All
data obtained during the study was treated with confidentiality and anonymity. Access to raw data
was restricted to only the study investigators and the research assistants.
13
FINAL REPORT
3. RESULTS
3.1 Background Characteristics of Respondents
3.1.1 Response rates
Response rates to the survey: The survey was conducted in 10 statistical regions across the
country. A total of 2,927 households participated in the study out of 2,977 sampled, representing
a response rate of 98%. The overall response rate for the survey was therefore high, and this was
observed across all statistical regions. The lowest response rates were recorded in the East Central
region, at 94%. All response rates were way higher than the response rate that was anticipated for
the study (80%). Within the participating households, a total of 4,287 young people aged 10-24
years were interviewed (Refer to appendix 6.2a).
Focus Group Discussions and Key Informant Interviews: All the planned Focus Group
Discussion (FGDs) were conducted, making a total of 98 FGDs with 84 FGDS among young
people and 14 FGDs among parents/guardians. A total of 172 Key Informants were interviewed,
higher than the targeted 129 respondents. These included 88 community leaders (cultural leaders,
religious leaders, teachers, peer educators and health facility managers) and 74 district level
resource persons (district officials, women representatives and youth representatives) and 10
Development partners/NGOs.
Health facility checklist: Out of the 132 health facilities initially targeted (3 per district), a total
of 127 health facilities (i.e. 10 Regional Referral Hospitals, 23 District/General Hospitals, 41
HCIVs, and 53 HCIIIs) participated in the study. The health facilities were represented by the
heath facility in-charges, in close consultation with other health workers at the health facility in
departments such as maternity, family planning, Out-Patients (OPD), pharmacy, ART clinic, and
stores and records. Out of the 127 Health Facilities (HFs), majority were owned by government
(91.3%), while others were Private Not For Profit (8.7%). 42% of health facilities assessed were
HCIII, 32% were HCIVs, 18% were district/general hospitals, while 8% were Regional Referral
Hospitals (Refer to Appendix 6.2b for a detailed table on health facilities visited).
3.1.2 Socio-demographic characteristics of respondents

Characteristics of survey respondents: The percent distributions of the socio-demographic
characteristics of survey respondents are presented in Table 3 below. The majority of survey
respondents were female (54%). As expected, the majority of respondents were residing in the
rural areas (83%). The proportion of young people that were in school (68%) varied substantially
across age category. Over 95% of the participants aged 10-14 years were in school as compared to
72% among those aged 15-19 years. Only about one quarter (24%) of those aged 20-24 were in
school. The proportion of those ever married i.e. married/ cohabiting, widowed Separated/ divorced/
Widowed increased with age from only 5 young people (0.4%) among those aged 10-14 to 162
(9%) and 501 (46%) young people among those aged 15-19 and 20-24 years respectively. In terms
of orphanhood, about 8% of the participants were single orphans while close to one fifth (19.5%)
were double orphans. Majority of the participants were sons/daughters to the household head
(44%) and students (59%).
14
FINAL REPORT
Table 3: Background characteristics of Survey respondents

BACKGROUND CHARACTERISTICS AGE GROUP OVERALL
10-14 years 15-19 years 20-24 years 10-24 years
% No. % No. % No. % No.
Gender Male 46.4 725 45.0 741 48.2 520 46.3 1,986
Female 53.6 837 55.0 906 51.8 558 53.7 2,301
Residence Urban 14.2 222 15.8 261 21.9 236 16.8 719
Rural 85.8 1,340 84.2 1,386 78.1 842 83.2 3,568
Schooling In school 95.2 1,483 72.0 1,184 24.1 258 68.4 2,925
status Out of school 4.8 74 28.0 461 75.9 814 31.6 1,349
Education No formal Education 1.5 24 1.1 18 2.0 21 1.5 63
level Some Primary 91.9 1,433 50.6 833 39.2 422 62.8 2,688
Some Secondary 6.0 93 48.0 790 52.8 568 33.9 1,451
More than secondary 0.6 9 0.2 4 6.0 65 1.8 78
Religion Catholic 35.2 549 38.7 636 34.8 374 36.4 1,559
Protestant 36.5 570 559 37.3 401 35.8 1,530
Other Christian 12.6 197 11.0 181 13.1 141 12.1 519
Moslem 14.7 230 15.4 253 14.4 155 14.9 638
Others 0.9 14 0.9 15 0.4 4 0.8 33
Marital Status Single/Never married 99.7 1,557 90.2 1,484 53.5 576 84.4 3,617
Married/ Cohabiting 0.3 4 8.8 145 41.6 448 13.9 597
Separated/ divorced/ Widowed 0.1 1 1.0 17 4.9 53 1.7 71
Parents alive Both parents alive 81.3 1,269 71.7 1,181 60.4 650 72.4 3,100
Both Parents NOT alive 4.6 71 7.9 130 11.6 125 7.6 326
Single parent alive 14.0 219 20.0 330 27.0 291 19.6 840
Don't know 0.1 1 0.4 6 0.9 10 0.4 17
Relationship Head of Household 3.7 57 6.1 101 21.7 234 9.1 392
to Household Spouse 0.4 7 4.7 78 20.8 224 7.2 309
Head Son/Daughter 55.1 860 46.8 771 25.2 271 44.4 1,902
Brother/Sister 4.4 68 4.9 80 5.5 59 4.8 207
Mother/Father 24.2 377 23.9 394 15.8 170 22.0 941
In-Law 1.0 15 1.9 32 1.9 20 1.6 67
Grand child 5.4 84 5.1 84 2.8 30 4.6 198
Other Relatives/Non relatives 6.0 93 6.5 107 6.4 69 6.3 222
Occupation/I Unemployed 4.1 64 5.5 91 8.5 91 5.8 246
ncome Source Student 85.2 1,329 61.0 1,003 18.9 203 59.3 2,535
Peasant/ farming 3.6 56 15.0 247 32.5 349 15.2 652
Brick making 0.8 12 2.7 44 2.7 29 2.0 85
Casual labor 0.8 13 2.2 36 4.5 48 2.3 97
Market vendor 0.7 11 0.9 15 4.3 46 1.7 72
Others 4.7 74 12.6 207 28.7 308 13.8 589
OVERALL 100 1,561 100 1,647 100 1,077 100 4,287
15
FINAL REPORT
3.2. SRH/HIV knowledge, attitudes and practices among young people (10-24 years)
3.2.1 Knowledge and sources of information on Sexual and Reproductive Health

a) Awareness about SRH
Overall, 83% of young people have ever heard about Sexual and Reproductive Health. Young
people who are out of school were more likely to have heard of SRH (91%) as compared to those
in school (79%). However, although those who were out of school were more likely to have heard
of SRH, young people with no formal education were much less likely to have heard of SRH (67%)
as compared to those educated i.e primary (76%) & Secondary plus (94%). As expected, young
people who are married or have ever been married were more likely to have heard of SRH (95%)
compared to those who had never been married (80%). Karamoja region recorded the lowest
percentage of respondents aware of SRH (65%). Refer to appendix 6.3a for the detailed table.
b) Awareness about specific SRH components among young people aged 10-14 years
Awareness about specific components of the SRH package is important for young people as it
contributes to their empowerment to seek care when needed. However, assessment of knowledge
about the SRH package ought to be age appropriate. Table 4 below shows awareness about
selected components of SRH services among young people aged 10-14 years. Awareness was sub-
optimal. Overall, the SRH service that adolescents in the age-group 10-14 were most aware of was
HCT (54%) followed by safe male circumcision (53%). Only 37% of adolescents in the age group
10-14 years had heard about services for STI diagnosis and treatment and only 27% were aware
about tetanus toxoid vaccination for women of reproductive age.
Background Percentage who are aware about the service n=1030
characteristics STI prevention and HIV counseling Tetanus Toxoid (TT) Safe male
services (%) testing and care (%) vaccination (%) circumcision (%)
Gender
Male 36.1 53.3 20.8 57.8
Female 38.2 54.5 32.1 47.8
Residence
Urban 50.4 73.9 35.1 70.3
Rural 34.9 50.5 24.4 49.3
Region
Kampala 57.1 83.7 22.4 73.5
Central 1 58.8 62.6 31.5 64.7
Central 2 43.2 51.7 31.8 45.4
East Central 22.9 45.7 25.0 36.7
Eastern 19.2 39.1 25.0 42.9
Karamoja 35.7 10.7 35.7 39.3
Northern 27.3 21.7 13.3 46.1
West Nile 44.9 67.3 45.5 59.0
Western 32.5 52.1 23.1 58.6
South Western 39.3 60.2 20.9 59.0
Schooling status
In school 38.0 55.1 27.7 53.0
Out of school 22.2 34.7 12.5 43.1
Education
No formal 21.7 30.4 17.4 34.8
Primary 34.9 52.5 25.9 50.9
Secondary+ 71.3 79.2 41.6 75.2
Marital Status
Never married 37.1 54.0 26.8 52.4
Ever married 60.0 40.0 40.0 60.0
OVERALL 36.7 54.2 26.5 52.4
16
FINAL REPORT
Awareness about specific SRH components among young people aged 15-24 years
Tables 5 and 6 below show the percentage of young people aged 15-19 and 20-24 years who are
aware of each of the different components of the SRH package.
Respondents in the age-group 20-24 years were more aware of the different SRH services than
those aged 15-19 years. The most known SRH services were HCT (92% among those aged 20-24
& 86% among those aged 15-19), safe male circumcision (81% for those aged 20-24; and 74% for
15-19), pregnancy services (82% for those aged 20-24; and 69% for 15-19 years), STI diagnosis
and treatment (79% for those aged 20-24 years; and 67% for 15-19 years), ) and counselling on
sexual and gender based violence (71% for those aged 20-24 years; and 62% for 15-19 years).
Certain SRH services were little known across both age groups, particularly HPV vaccination (37%
for those aged 20-24; and 30% for 15-19), post-abortion care (41% for those aged 20-24; and 31%
for 15-19), breast cancer screening (54% for those aged 20-24; and 42% for 15-19), and cervical
cancer screening (57% for those aged 20-24; and 74% for 15-19). Males across all age groups (30%
of males and 43% of females 20-24; 25% of Males and 34% of females aware 15-19), post-abortion
care (36% of males and 46% of females 20-24; 27% of males and 36% of females 15-19), breast
cancer screening (47% of males and 61% of females aware) and cervical cancer screening (50% of
males and 63% of females 20-24; 35% of males and 49% of females 15-19). Males were generally
less aware about the different SRH services except for male circumcision as compared to females
across the different age groups. Likewise, young people who had never married were less aware of
the different SRH services compared to those who had ever married.
The focus group discussions showed varied awareness about existing SRH services among young
people. Almost all discussants aged 15-19 were aware about condoms as a measure for self-
protection from STIs. Young girls aged 15-19 and in school were aware of the availability of HPV
and TT vaccination at health facilities, but those out of school were less aware about such
programs. Young people aged 10-14 years (both boys and girls) were aware of the availability of
HIV/AIDS Counselling and Testing (HCT) services. On the other hand, discussants in the age-
group 10-14 years didn’t express sufficient knowledge about safe male circumcision as compared
to the older adolescents (15 years and above).. The discussions also showed that awareness about
MCH services (i.e. pregnancy, antenatal, postnatal, EMTCT and malaria in pregnancy prevention)
was relatively good among those in and out of school among young girls aged 15 and above.
However, the FGDs showed that young people of all ages were not adequately aware of some
SRH services such as cervical and breast cancer screening, mental health, drugs and alcohol abuse
rehabilitation and psycho-social support and post-abortion counselling. Some of them considered
these services not easily accessible due to long distances while others were not even aware of what
the services involved or where they could obtain them when needed.
17
FINAL REPORT
Table 5: Percentage of respondents aged 15-19 years who have ever heard about selected SRH services n=1491
SRH Service (%), n=1491.

Background characteristic
abortion care
management
circumcision
Toxoid (TT)
drugs rehab.
Counseling,
ANC/PNC
vaccination
vaccination
Counseling
(HCT) and
diagnosis/
Pregnancy
screening
screening
on SGBV
Planning
health &
Tetanus
Cervical
Testing
testing,
Mental
Family
cancer
cancer
Breast
(boys)
Post-
HPV
Male
HIV
care
STI
Aged 15-19 years
Gender Male 56.2 67.8 83.8 62.4 43.4 43.6 24.9 26.5 42.7 82.2 35.1 33.8
Female 66.4 70.0 87.1 75.0 54.1 63.8 34.1 35.8 42.5 68.0 49.4 48.7
Residence Urban 69.7 75.5 92.7 78.9 61.3 62.1 27.6 31.4 53.3 84.7 51.3 55.2
Rural 60.2 67.7 84.2 67.4 46.9 53.2 30.4 31.7 40.5 72.5 41.2 39.4
Region Kampala 60.3 78.1 91.8 76.7 74.0 47.9 23.3 32.9 58.9 93.1 57.5 61.6
Central 1 77.2 82.9 91.2 82.9 67.9 65.8 34.7 38.9 54.4 86.5 58.0 59.1
Central 2 90.0 91.1 93.5 89.4 76.5 76.5 67.1 73.5 77.6 88.8 77.6 76.5
East Central 54.6 46.3 75.5 54.6 22.7 45.4 15.7 18.5 27.3 44.4 20.4 24.1
Eastern 47.5 57.1 77.0 544 34.1 52.5 19.8 18.0 25.3 63.6 25.3 23.5
Karamoja 53.5 69.8 72.1 62.8 44.2 48.8 25.6 25.6 34.9 62.8 34.9 30.2
Northern 44.1 67.8 88.2 64.5 44.1 40.8 21.7 21.0 25.7 72.4 33.5 23.7
West Nile 62.7 69.4 87.3 70.1 49.2 62.7 20.9 32.1 58.2 78.4 40.3 43.3
Western 67.4 64.6 85.4 72.9 41.0 53.5 29.2 31.9 41.0 84.7 38.2 40.3
South Western 58.4 73.3 90.2 70.2 53.7 49.0 34.9 27.4 37.2 80.4 49.0 44.3
Schooling status In school 63.7 70.0 86.4 67.9 49.4 56.1 30.6 32.3 45.6 74.8 42.9 43.0
Out of sch. 56.9 66.7 83.4 73.2 49.0 50.8 28.1 29.7 34.7 73.5 43.1 39.5
Formal education None 50.0 44.4 61.1 50.0 33.3 38.9 11.1 27.8 16.7 66.7 22.2 33.3
Primary 51.6 62.0 81.8 63.0 41.1 46.8 25.5 25.8 33.3 69.6 34.9 31.5
Secondary+ 72.6 76.7 90.1 76.4 57.8 63.2 35.0 37.7 52.8 79.6 51.7 52.9
Marital Status Never married 61.8 68.9 85.2 67.3 48.7 53.9 29.5 31.4 43.2 74.8 42.4 41.8
Ever married 62.3 70.8 89.6 88.3 53.9 61.0 33.8 33.8 37.0 71.4 46.7 42.9
Overall 61.6 68.7 85.7 68.8 48.9 54.4 29.7 31.4 42.2 74.3 43.0 42.1
18
FINAL REPORT
Table 6: Percentage of respondents aged 20-24 years who have ever heard about selected SRH services n=1015
SRH Service (%), n=1015.

Background characteristic
abortion care
management
circumcision
Toxoid (TT)
drugs rehab.
Counseling,
ANC/PNC
vaccination
vaccination
Counseling
(HCT) and
diagnosis/
Pregnancy
screening
screening
on SGBV
Planning
health &
Tetanus
Cervical
Testing
testing,
Mental
Family
cancer
cancer
Breast
(boys)
Post-
HPV
Male
HIV
care
STI
Aged 20-24 years
Gender Male 69.0 78.6 90.6 77.4 62.4 55.4 29.6 35.7 53.4 87.9 49.9 47.4
Female 71.8 78.8 92.7 86.6 67.3 75.3 42.8 45.9 47.9 74.9 62.7 60.9
Residence Urban 77.5 83.9 95.3 89.8 74.1 66.1 41.5 47.5 59.7 87.3 64.4 68.6
Rural 68.4 77.2 90.7 80.0 62.3 65.5 34.9 39.1 47.9 79.5 54.3 50.2
Region Kampala 70.9 87.3 96.2 91.1 82.3 54.4 31.6 44.3 73.4 91.1 59.5 67.1
Central 1 75.0 85.9 93.0 83.6 75.0 66.4 40.6 53.1 60.2 88.3 65.6 66.4
Central 2 91.3 90.3 95.1 92.2 87.4 88.3 76.7 76.7 79.6 88.3 78.6 82.5
East Central 68.3 67.3 84.6 66.3 29.8 59.6 26.0 14.4 26.9 72.1 28.8 34.6
Eastern 57.2 78.7 89.0 74.8 54.2 73.5 31.0 30.3 45.8 84.5 44.5 43.2
Karamoja 61.5 71.8 87.2 82.0 64.1 71.8 41.0 41.0 38.5 76.9 46.1 46.1
Northern 48.8 79.1 98.8 77.9 70.9 58.1 20.9 27.9 26.7 66.3 66.3 39.5
West Nile 74.5 70.9 92.7 87.3 80.0 69.1 25.4 47.3 52.7 83.6 38.2 43.6
Western 77.8 73.0 96.0 91.3 52.4 61.9 32.5 40.5 46.8 77.8 61.9 57.9
South Western 73.5 77.3 87.6 81.1 68.1 57.8 35.7 39.5 50.8 80.0 61.6 54.6
Schooling status In school 74.2 84.3 91.4 80.9 67.6 69.9 41.0 44.9 62.5 88.7 60.5 60.9
Out of school 69.3 76.8 91.7 82.5 63.9 64.2 34.8 39.6 46.6 78.9 55.3 52.1
Education None 75.0 75.0 85.0 75.0 75.0 50.0 55.0 55.0 70.0 70.0 55.0 60.0
Primary 61.2 71.1 88.1 78.2 57.0 60.2 27.7 34.7 39.6 73.3 48.8 42.0
Secondary+ 76.5 83.7 94.2 85.1 69.8 69.8 41.5 44.6 57.2 86.9 61.7 62.3
Marital Status Never married 71.6 81.2 90.3 78.9 65.8 63.0 36.5 41.6 57.0 85.8 56.8 56.7
Ever married 69.1 75.9 93.5 85.9 64.0 68.9 36.4 40.1 43.1 75.9 56.2 51.5
OVERALL 70.7 78.7 91.8 82.3 64.8 65.8 36.8 41.3 50.7 81.2 56.9 54.4
19
FINAL REPORT
3.2.2 Knowledge about Family Planning

Awareness about family planning methods among young people aged 10-14
Due to their age and given that the majority are not sexually active, younger adolescents aged 10-
14 are not expected to have in-depth knowledge about Family Planning (FP). However, age-
appropriate knowledge of some core FP methods would empower these young adolescents to
protect themselves in case they are faced with an un-expected situation. Awareness about selected
FP methods among those aged 10-14 is presented in table 7 below. In this group, only 61% of
respondents (63% males and 59% females) were aware of any modern method of family planning.
The male condom (60% of males and 55% of females), followed by oral contraceptive pills (23%
of males and 28% of females) were the contraceptive methods that young adolescents were most
aware of.
Table 7: Awareness of family planning methods among young people aged 10-14 years (n=1553)
Modern method of Family planning Gender Overall
Males (%) Female (%) % Number of YP
Any modern method 63.1 59.4 61.1 949
Oral Contraceptive Pill 23.1 28.2 25.8 402
Emergency Contraceptive pill 7.6 13 10.5 163
Male condom 60.3 55.1 57.5 898
Female condom 18.2 20.2 19.3 301
Awareness about family planning methods among young people aged 15-24 years
General awareness about any modern method of FP was higher among the age group 20-24 (98%)
compared to those aged 15-19 (91.3%) as shown in table 8 below. Male condoms were the most
widely known method (85.5% among 15-19 years-olds and 93.6 among those aged 20-24 years).
Awareness of female condoms was at 50% and 67% respectively. Condoms were followed by oral
contraceptive pills (66% among 15-19 and 81% among 20-24 year olds) and injectables (60%
among 15-19 and 77% among 20-24 year olds).
Table 8: Awareness of family planning methods among young people aged 15-24 years
Family Planning Method 15 -19 years (n=1641) 20 - 24 years (n=1078)
Female Male Total Female Male Total
% % % Number % % % Number
Any modern method 91.4 91.3 91.3 1499 97.8 98.1 98.0 1056
Male condom 83.8 87.5 85.5 1402 92.5 94.8 93.6 1008
Female condom 53.3 45.0 49.5 813 68.2 65.9 67.1 721
Contraceptive pill 71.0 59.2 65.8 1079 85.5 75.5 80.7 869
Injectables 66.8 51.2 59.8 981 82.7 70.7 76.9 826
Implants 49.3 35.2 43 705 64.7 52.3 58.7 632
Diaphragm 12.5 12.9 12.7 208 19.5 16.8 18.2 195
Emergency contraceptive pill 39.7 34.7 37.4 614 51.4 50.4 50.9 548
Intra-uterine device (IUD) 30.5 19.5 25.6 419 46.1 34.5 40.5 436
Lactational amenorrhea (LAM) 17.4 11.2 14.6 239 30.9 17.1 24.2 260
Female sterilization 46.2 38.0 42.5 698 59.1 58.2 58.7 632
Male sterilization 32.0 33.9 32.8 538 48.4 58.1 53.1 572
Rhythm 25.9 15.3 21.2 345 40.4 25.4 33.2 355
Cream/foam or jelly 10.8 8.8 9.9 162 16.6 13.2 14.9 160
Withdrawal 29.5 35.5 32.2 523 49.6 55.6 52.5 560
Awareness about family planning methods by demographic characteristics

Table 9 below shows knowledge about the different FP methods by background characteristics.
In general, females were slightly more knowledgeable about any modern method of FP (83%)
compared to males (81%). Respondents who were residing in the urban areas (91%), out of school
(75%) and respondents who were never married (98%) were more likely to be aware about any of
the modern FP methods than their counterparts. In terms of region, Eastern (94%) followed by
20
FINAL REPORT
Kampala (86%) and central 1(84%) had a higher proportion of young people aware of any modern
FP method.
Table 9: Knowledge of family planning methods by background characteristics

Background
Female sterilization (%)

Characteristic
Contraceptive Pill (%)

Male sterilization (%)
contraceptive pill (%)

Any modern method
Female condom (%)

Male condom (%)
cream/Foam (%)
Diaphragm (%)
Injectables (%)
Contraceptive
Implants (%)
Emergency
LAM (%)
IUD (%)
(%)
Gender
Male 81.4 33.4 31.1 50.1 28.7 17.9 44.5 29.9 79.2 40.5 10.1 7.2 9.6
Female 82.8 37.6 27.6 58.9 32.8 26.5 55.2 40.7 75.4 44.8 11.0 9.1 16.1
Age group
10-14 61.1 12.6 9.0 25.7 10.4 7.1 22.2 12.4 57.5 19.3 3.3 1.9 4.0
15-19 91.3 42.4 32.7 65.5 37.3 25.4 59.6 42.8 85.1 49.4 12.6 9.8 14.5
20-24 98.0 58.6 53.0 80.5 50.8 40.4 76.6 58.6 93.4 66.8 18.1 14.8 24.1
Region
Kampala 85.4 43.8 38.8 72.1 46.3 48.8 58.2 41.3 91.0 58.2 9.0 8.0 19.4
Central 1 84.4 42.9 32.5 62.4 35.8 24.6 55.5 37.8 81.3 52.2 11.4 6.5 17.5
Central 2 72.7 51.3 38.7 69.8 50.7 45.1 63.7 48.7 82.9 62.0 42.9 31.6 40.0
East Central 79.1 20.3 14.8 40.1 10.4 8.0 45.5 27.2 65.3 39.9 4.6 3.9 3.0
Eastern 94 31.0 22.7 46.1 22.0 13.7 50.0 31.6 76.1 38.0 3.6 4.3 11.1
Karamoja 78.2 21.8 11.8 42.7 33.6 16.4 25.5 21.8 75.5 30.0 6.4 5.5 5.5
Northern 81.4 33.4 23.4 50.4 30.6 17.5 50.6 45.0 77.9 38.6 2.6 3.3 8.5
West Nile 87.0 21.2 17.4 47.0 24.4 18.0 35.1 25.5 75.1 31.9 10.4 9.6 8.1
Western 79.4 34.7 29.6 58.0 31.3 22.0 53.9 35.8 75.4 37.7 5.6 6.6 9.4
South Western 81.2 44.6 45.8 58.6 35.6 23.7 47.7 36.0 78.7 38.6 8.5 4.4 9.0
Residence
Urban 90.9 39.8 35.5 66.8 44.8 33.2 56.8 43.7 86.7 56.1 12.5 11.3 15.4
Rural 80.2 34.8 27.9 52.4 28.1 20.4 48.9 34.1 75.2 40.1 10.2 7.6 12.6
Schooling status
In school 68.3 29.1 23.2 46.8 26.4 17.4 41.2 28.9 72.6 37.7 9.2 7.0 10.4
Out of school 74.6 49.6 42.2 72.1 40.7 33.7 69.7 50.4 87.2 53.8 13.5 10.7 18.9
Education level
No formal education 95.5 38.1 31.8 38.1 17.5 23.8 42.9 34.9 61.9 36.5 15.9 11.1 12.7
Primary 77.1 25.5 18.7 42.5 20.1 14.4 40.0 25.5 70.0 29.8 5.5 4.1 8.0
Secondary+ 92.7 53.4 47.5 77.2 50.5 36.8 68.8 53.7 90.3 66.0 19.4 15.2 22.1
Marital status
Never married 98.4 32.1 26.0 50.1 28.3 38.8 44.6 31.3 74.4 39.7 9.8 7.4 11.3
Ever married 79.0 54.5 46.6 80.1 44.8 61.2 80.7 59.7 91.9 59.6 15.1 12.6 22.9
Overall 81.7 35.6 29.2 54.8 30.9 22.5 50.2 35.7 77.2 42.8 10.6 8.2 13.1
Focus group discussions with the young people (aged 10-24 years) further revealed a majority of
young people being aware of condoms and injectables as contraceptive methods, and noting that
those are the ones they have available at the health centers. Young people expressed however that
they were not aware of long term methods like implants and IUDs, mainly because they were not
regularly talked about nor available at health centers. They also expressed low awareness about the
emergency contraceptive pill. Young people reported that their level of awareness of family
planning was influenced by information from peers, eavesdropping on adult discussions, and
beliefs, biases and misconceptions both among young people and the community at large.
21
FINAL REPORT
The most commonly cited reason for not using contraception among young girls (aged 10-24
years) both in school and out of school was the fear of side effects and the view that natural
methods are more effective. Contraceptives were associated with irregular periods and heavy
bleeding, which creates discomfort and leads to insecurity among young girls. Young girls also
reported that these side effects are not easily managed at health facilities as most of them eventually
have to meet the costs of treating these side effects at private health facilities which they often
times cannot afford. Among the many misconceptions about family planning, some young people
believe that family planning ‘spoils the female reproductive eggs’ leading to delivery of deformed
children. There is also a belief that it can cause cancer of the cervix, as well as pregnancy
complications which result into caesarian section deliveries rather than normally delivery.
In all regions, young people (aged 10-24 years) both in and out of school expressed mixed reactions
on the influence of religion on use of FP. They highlighted that religions like SDAs, Catholics, and
Moslems prohibit contraception as a moral issue. They argued that religious beliefs have to be
systematically streamlined to align their teachings to information that promotes SRH because
without this, they will continue to receive confusing, contradictory or downright erroneous
messages which could expose them to SRH problems. For example, they expressed that among
Catholics modern family planning is not permitted, yet there some methods that are promoted by
the Catholic Church itself i.e. the natural family planning methods.
Overall, there were few incidences where young people indicated a degree of reliance on traditional
family planning practices used by women to prevent pregnancy. For instance, in an FGD with the
out-of-school girls aged 20-24 years in Wakiso district, it was stated: “If you get the umbilical cord of the
baby you have delivered and you tie it around your waist or put it under your mattress then you can’t get pregnant
again unless you want in which case you will have to remove it.” Quoting a VHT in Kotido District; “When
a woman has given birth, the spouse leaves the home and goes to another Kraal to graze for some time as a means
to avoid impregnating her too soon.”
FGDs with parents revealed their opposition against allowing their children to access and use
family planning services. Quoting some parents in Moroto: “It is hard to tell your own children to use
condoms even if you are aware they are messing around with girls. That is like encouraging them to get spoilt,” said
a mother. “If I found my son with condoms, I would chase him. That means he is old enough to have his own
family,” a father of five boys expressed. “The distribution of condoms has increased sexual activity. Girls are
losing their virginity. Back in time girls used to guard their virginity because it is the only thing that determines her
value at marriage. These days they get married and you find ‘nothing’!” said also a father in the group.
3.2.3 Knowledge of STIs
a) Awareness about STIs;

Nearly 72% of the males and 75% of the female respondents had ever heard of STIs. Awareness
about STIs increased with age group from 52.6% among those aged 10-14 years to 80.5% and
89.4% respectively among those aged 15-19 and 20-24 years respectively (Refer to Appendix 6.3b for
details ). Awareness about STIs was highest in the South Western region (84%), followed by the
Northern (77.4%) and lowest in the East Central region (60%). Awareness about STIs was slightly
higher in the urban areas (77% compared to 72% in the rural areas). STI awareness was also
substantially higher among those out-of-school participants (82%) and the ever married
participants (86%). Majority of the sexually active young people (89% of n=1,301) had heard of
STIs (Appendix 6.3c for details).
22
FINAL REPORT
b) Knowledge about specific symptoms of STIs among young people 15-24 years;
Knowledge of specific symptoms of STIs was assessed among those young people aged 15-24
years who indicated having ever heard about STIs. Younger people aged 10-14 years were excluded
from this analysis owing to the fact that the median age at first sexual intercourse was 16 years.
Key findings are presented in the table 10 below. In general, the young adults (aged 20-24 years)
were more knowledgeable about the different symptoms than the older adolescents (aged 15-19
years). The most frequently identified symptoms were itching of the genital area (46%), followed
by pain on urination (35%) and genital discharge (34%). Only 11% did not know any STI
symptoms. Females seemed to be more knowledgeable than males across all symptoms.
The focus group discussions showed that young people, especially those older than 15 years were
generally aware of STI prevention methods. These included use of condoms, safe male
circumcision and abstinence. Probably in reference to candidiasis and other discharge related
genital diseases, some young people associated the spread of STIs to non-sexual contact and
recommended to avoid sharing personal belongings such as reusable sanitary pads, towels, basins,
etc. and to use of clean washrooms as methods of preventing STIs.
23
FINAL REPORT
Table 10: Proportion of young people aged 15 – 24 years having knowledge of STI symptoms
Background
wounds on private
Warts, growths on
Burning/ pain on
Lower abdominal
Genital discharge
Itching in private
tenderness /pain
Characteristics
No symptoms
Ulcers, sores,
Do not know
private parts
urination
Others
parts
parts
No. % No. % No. % No. % No. % No. % No. % No. % No. %
Gender
Female 465 31.8 517 35.3 680 46.4 346 23.6 190 13.0 466 31.8 46 3.1 171 11.7 38 2.6
Male 412 32.7 407 32.3 574 45.5 234 18.6 183 14.5 476 37.7 51 4.0 134 10.6 31 2.5
Residence
Urban 183 36.8 170 34.2 271 54.5 130 26.2 79 15.9 201 40.4 24 4.8 35 7.0 16 3.2
Rural 694 31.1 754 33.8 983 44.1 450 20.2 294 13.2 741 33.3 73 3.3 270 12.1 53 2.4
Age group
15 -19 years 473 28.7 488 29.6 694 42.1 306 18.6 189 11.5 498 30.2 52 3.2 205 12.4 47 2.9
20 – 24 years 404 37.5 436 40.4 560 51.9 274 25.4 184 17.1 444 41.2 45 4.2 100 9.3 22 2.0
Region
Central 1 105 32.7 135 42.1 187 58.3 75 23.4 41 12.8 99 30.8 13 4.0 22 6.9 4 1.2
Central 2 117 42.9 97 35.5 148 54.2 53 19.4 45 16.5 100 36.6 3 1.1 10 3.7 5 1.8
East Central 107 32 102 30.5 156 46.7 75 22.5 57 17.1 99 29.6 17 5.1 22 6.6 1 0.3
Eastern 96 25.7 108 28.9 138 36.9 66 17.6 24 6.4 122 32.6 7 1.9 57 15.2 27 7.2
Kampala 58 38.2 61 40.1 89 58.6 46 30.3 33 21.7 67 44.1 9 5.9 9 5.9 9 5.9
Karamoja 16 19.5 16 19.5 32 39 9 11.0 13 15.9 23 28.0 1 1.2 15 18.3 0 0.0
North 51 21.2 41 17.1 69 28.8 32 13.3 9 3.8 93 38.8 10 4.2 70 29.2 5 2.1
South West 140 31.8 217 49.3 212 48.2 113 25.7 83 18.9 128 29.1 11 2.5 51 11.6 13 3.0
West Nile 52 27.5 45 23.8 76 40.2 37 19.6 24 12.7 68 36 12 6.3 20 10.6 1 0.5
Western 135 42.2 102 31.9 147 45.9 74 23.1 44 13.8 143 44.7 14 4.4 29 9.1 4 1.2
Schooling status
In school 455 31.6 475 32.9 676 46.9 278 19.3 199 13.8 486 33.7 52 3.6 167 11.6 48 3.3
Out of school 418 32.8 448 35.1 574 45.0 299 23.5 174 13.6 455 35.7 45 3.5 138 10.8 21 1.6
Education level
No formal education 8 20.5 8 20.5 19 48.7 5 12.8 8 20.5 7 17.9 0 0.0 3 7.7 1 2.6
Primary 335 26.7 355 28.3 478 38.1 224 17.8 132 10.5 359 28.6 34 2.7 188 15.0 30 2.4
Secondary 532 37.3 559 39.2 755 52.9 349 24.5 232 16.3 575 40.3 63 4.4 114 8.0 38 2.7
Marital Status
Ever married 232 35.0 244 36.8 309 46.6 165 24.9 104 15.7 236 35.6 21 3.2 77 11.6 10 1.5
Never married 644 31.3 678 32.9 943 45.8 414 20.1 269 13.1 706 34.3 76 3.7 228 11.1 59 2.9
Overall (n=2725) 877 32.2 924 33.9 1254 46.0 580 21.3 373 13.7 942 34.6 97 3.6 305 11.2 69 2.5
24
FINAL REPORT
3.2.4 Knowledge of HIV/AIDS
a) Awareness about HIV;

Uganda’s Health Surveys show that there is almost universal awareness about HIV/AIDS. Young
people who are not aware of HIV/AIDS therefore represent a very vulnerable group with regard
to access to basic reproductive health information. Findings from the AYSRH survey confirm that
the vast majority of the young people are aware about HIV/AIDS (refer to apppendix6.3d). Only 6%
of surveyed young people expressed never having heard of HIV/AIDS. The majority of those
who were not aware about HIV were aged 10-14 years (11.5%). Lack of awareness about
HIV/AIDS was also higher among young people from the West Nile region (13.3%), and those
with no formal education (14.8%).
b) Knowledge about HIV prevention methods among young adolescents (10-14 years);
Table 11 below shows the percentage of respondents aged 10-14 years with knowledge of HIV
prevention methods. Among adolescents aged 10-14 years, awareness about any main method of
HIV prevention was higher in females (64%) than males (59%). Young adolescents residing in the
urban areas (69%) and those in school were more likely to know at least one method of HIV
prevention. West Nile region (34%) followed by Central 2 region (50%) had the lowest proportion
of young adolescents aware of any HIV prevention method.
Table 11: Percentage of respondents aged 10-14 with knowledge of HIV prevention methods (n=967)
Background HIV prevention method among young people 10-14 years (n=967)
Characteristic Using condoms every Abstinence Being faithful to Not sharing sharp Any HIV
time of sexual activity (%) one’s partner objects (%) prevention method
(%) (%) (%)
Gender
Female 40.7 59.0 84.7 3.6 59.0
Male 36.4 64.4 15.4 4.7 64.4
Residence
Urban 42.3 68.9 22.1 10.4 68.9
Rural 37.8 60.8 14.3 3.1 60.8
Region
Kampala 55.1 81.6 32.7 28.6 81.6
Central 1 43.8 71.7 19.8 4.3 71.7
Central 2 35.6 49.7 8.5 2.3 49.7
East Central 44.4 57.5 17.9 2.4 57.5
Eastern 29.1 58.9 10.1 1.3 58.9
Karamoja 53.6 64.3 42.9 17.9 64.3
Northern 30.2 68.5 8.1 1.3 68.5
West Nile 42.3 34.0 6.4 3.9 34.0
Western 36.3 66.1 17.0 5.7 66.0
South Western 36.4 75.3 20.5 2.9 75.3
Schooling status
In School 38.6 62.3 15.4 4.2 62.3
Out of School 32.4 52.7 16.2 4.1 52.7
Education
No formal 20.8 45.8 20.8 0.0 12.5
Primary 37.3 61.7 14.2 4.1 6.1
Secondary+ 57.8 68.6 31.4 5.9 5.9
Marital Status
Never married 38.4 62.0 15.4 4.2 6.2
Ever Married 40.0 40.0 0.0 0.0 0.0
Overall 38.4 61.9 15.4 4.2 61.9
25
FINAL REPORT
c) Knowledge about HIV prevention among young people aged 15-24 years;
Table 12 below shows knowledge of the different HIV prevention methods by demographic characteristics among young people aged 15-19
and 20-24 years. Knowledge of all the main methods of HIV prevention increase with age. While in the age group 15-19 females were more
knowledgeable about all prevention methods compared to males(66% compared to 59%), the reverse was found in the age-group 20-24,
where females were found to be less knowledgeable than males (51% compared to 62%). Out-of-school adolescents in both age groups were
less knowledgeable of the different methods of HIV prevention compared to in-school adolescents (50% compared to 67% among 15-19
age group; 51% compared to 73% among 20-24 age group).
Table 12: Percentage of respondents aged 15-24 with knowledge of the specific ways of preventing HIV
Background HIV prevention method (%)
Characteristic Aged 15-19 (n=1035) Aged 20-24 (n=605)
Using condoms Abstinence Being faithful Not sharing Any Using condoms Abstinence Being faithful to Not sharing Any
every time of to one’s sharp objects prevention every time of one’s partner sharp objects prevention
sexual partner methods sexual methods
Gender Male 73.4 59.0 70.6 4.1 59.0 81.9 62.1 51.1 4.6 62.1
Female 65.9 66.0 35.4 3.0 66.0 77.2 50.5 49.5 5.6 50.5
Residence Urban 77.4 65.9 40.6 8.4 65.9 83.0 63.1 56.8 10.2 63.1
Rural 67.8 62.3 31.2 2.5 62.3 78.5 54.2 47.0 3.7 54.2
Region Kampala 72.6 72.6 37.0 20.6 72.6 89.9 62.0 57.0 16.5 62.0
Central 1 78.8 67.4 43.5 1.6 67.4 77.3 60.2 43.0 3.1 60.2
Central 2 57.7 46.5 24.1 1.2 46.5 69.9 43.7 33.0 1.0 43.7
East Central 74.1 67.5 35.1 3.1 67.5 85.9 60.4 50.0 7.6 60.4
Eastern 73.9 66.1 26.1 1.8 66.1 81.4 54.5 55.1 5.1 54.5
Karamoja 79.1 62.8 53.5 11.6 62.8 92.3 76.9 71.8 20.5 76.9
Northern 74.5 42.5 28.8 5.9 42.5 85.1 23.0 42.5 8.1 23.0
West Nile 57.5 47.8 16.4 1.5 47.8 65.5 38.2 27.3 0.0 38.2
Western 68.9 66.1 38.9 2.2 66.1 82.1 55.0 55.7 2.9 55.0
South Western 62.3 78.4 35.7 2.4 78.4 73.5 74.1 53.5 1.1 74.1
Schooling In school 68.6 67.7 31.3 3.5 67.7 84.1 72.5 54.7 7.8 72.5
status Out of school 70.9 50.3 36.0 3.5 50.3 78.1 51.0 47.5 4.3 51.0
Education No formal 72.2 55.6 16.7 5.6 5.7 81.0 61.9 47.6 14.3 0.0
Primary 65.8 58.2 26.4 2.5 1.6 74.6 44.3 41.0 3.8 1.9
Secondary+ 72.9 67.9 39.8 4.4 1.8 82.6 64.0 54.8 5.7 1.4
Marital Status Never married 68.7 65.0 31.0 3.4 1.8 82.1 63.7 44.4 5.4 1.7
Ever married 74.1 43.2 49.4 4.3 1.2 76.5 47.3 54.7 4.8 1.4
OVERALL 69.3 62.8 32.7 3.5 63.0 79.5 56.1 49.2 5.1 56.0
26
FINAL REPORT
d) Comprehensive knowledge about HIV;

Comprehensive knowledge about HIV/AIDS is defined as awareness about HIV, knowledge of its
transmission and correctly rejecting three out of five common misconceptions about HIV/AIDS. The
percentage of young people with comprehensive knowledge on AIDS/HIV, by demographic
characteristics, is shown in table 13 below. The level of comprehensive knowledge about HIV/AIDS
was generally low with only 36% of the young people (10-24 years) found to have comprehensive
knowledge. Comprehensive knowledge about HIV was highest in the Karamoja region (51%) and
central 1 region (49%). South Western region (23%) had the lowest proportion. Comprehensive
knowledge about HIV was higher in the urban areas (48%) compared to the rural areas (32%). It was
also higher among youth who have ever married (42%) and those educated secondary and beyond
(51%).
Table 13: Percentage of respondents with comprehensive knowledge of HIV/AIDS

Background Aged 10-14 years Aged 15-19 years Aged 20-24 years OVERALL
Characteristic (Aged 10-24 years)
No. % No. % No. % No. %
Gender
Female 171 20.4 382 42.2 257 46.1 810 35.2
Male 149 20.6 286 38.6 256 49.2 691 34.8
Region
Central 1 71 38.0 105 54.4 73 57.0 249 49.0
Central 2 33 18.6 90 52.9 73 70.9 196 43.6
East Central 33 15.9 103 45.2 46 43.4 182 33.6
Eastern 27 17.1 61 28.0 57 36.5 145 27.3
Kampala 9 18.4 24 32.9 34 43.0 67 33.3
Karamoja 8 28.6 20 46.5 28 71.8 56 50.9
North 36 24.2 78 51.0 40 46.0 154 39.6
South West 23 9.6 62 24.3 69 37.3 154 22.7
West Nile 36 23.1 56 41.8 24 43.6 116 33.6
Western 44 20.8 69 38.3 69 49.3 182 34.2
Residence
Urban 68 30.6 146 55.9 133 56.4 347 48.3
Rural 252 18.8 522 37.7 380 45.1 1154 32.3
Schooling Status
In School 310 20.9 512 43.2 139 53.9 961 32.9
Out of School 10 13.5 156 33.8 372 45.7 538 39.9
Education
No formal education 3 12.5 5 27.8 9 42.9 17 27.0
Primary 278 19.4 273 32.8 145 34.4 696 25.9
Secondary + 39 38.2 389 49.0 357 56.4 785 51.3
Marital Status
Ever married 1 20.0 61 37.7 219 43.7 281 42.1
Never married 319 20.5 606 40.8 293 50.9 1218 33.7
Discussions with the young people showed that they had misconceptions about HIV transmission:
These misconceptions were mainly prevalent in younger adolescents 10-14 years of age. The
Misconceptions cited included transmission of HIV through mosquito bite, dirty bathing facilities, pit
latrines, by witchcraft and sharing of under-clothes.
“One who is engaged in activities such as stealing a man’s wife for instance can be sent HIV/AIDS through
witchcraft as punishment. People also believe in traditional healers having the power to cure someone from
27
FINAL REPORT
HIV/AIDS. Some people fear that these healers have the power to infect you with the disease should you fail
to meet their demands.” (Budaka district boys aged 15-19yrs out of school).
“A doctor in Masaka can give HIV-infected people a drug that can collect and contain the HIV virus in one
place in the body which can then be sucked out and the person becomes HIV negative.” Girls aged 15-19
years in Kalungu.
Young people seem to have hints of the dangers of multiple sex partners, they do not seem to
understand what actually constitutes the danger i.e. linking the risky behaviour to heightened risk. For
example, they mentioned views like: ‘If you have ten women, you will get infected with HIV’; ‘If you have a
woman in every district e.g. in Soroti, Mbale, Tororo, and Busia, you get HIV’. Similarly, they said: ‘If a man does
not use a condom, he gets infected’. Such beliefs are incomplete without linking them to ‘having sex with an
infected person’. Young people should also know the gender implications – that the affected women
are also put at risk if the man is infected. Young people also mentioned some dangerous
misconceptions about self-protection e.g. “If you take lemon before sex you do not get infected with HIV”.
Regarding HIV narratives and treatment practices derived from religious beliefs, Young people
mentioned two main themes: among the Christmas the belief in healing due to prayer and among the
Muslims inability to acquire the virus once one is circumcised. For example. “They say that if you have
HIV and you get ‘born again’ you can be prayed for and if you believe and have faith you can be healed Another
discussant in the same FGD said: “Catholics have holy water that can heal HIV” [FGD Boys 15-19 years,
Kampala].
Some young people’s beliefs about acquiring HIV/AIDS involve stigma in the way they perceive
people who are infected. The stigma was mainly about mode of transmission and how to tell one is
HIV positive. For example, they mentioned that if one gets married to a woman who was “used”
before, they may acquire HIV. [FGD boys aged 15-19 years out of school – Kalangala], Some young
people said that they heard that “if you touch someone infected with HIV you can acquire HIV”, and that “if
your parent had HIV, you will always be born with it”; [FGD Boys 10-14 years, out of school Moroto].
Perpetrating such beliefs can cause young people to stigmatize people living with HIV/AIDS.
Asked how they can recognize an HIV-infected person, many of them mentioned classical symptoms
such as: “the infected person becomes thin; has sores and wounds on their body”. Some young people also
mentioned symptoms like: “The infected person is always unhappy,” and “When you see them at ARV clinics in
hospitals or at TASO [you know they are HIV positive]” [Mubende out of school boys aged 20-24 years;
Bundibugyo out of school girls aged 10–14 years; Karamoja in school boys aged 15-19 years].
However, they also identified certain symptoms that promote unnecessary stigma and bias. Some of
the symptoms they mentioned include red lips and mouth; body scars and scratches on the skin; very
black eyes; pimples and boils all over the body and sunken eye. Symptoms of being HIV-positive were
also confused with those associated with the progression of the HIV infection to AIDS such as loss
of weight i.e. becoming very thin but with a protruding stomach; being physically weak all the time;
being sickly all the time; having wounds and sores on the skin or having skin rashes. Given that many
of these symptoms may not be apparent in the vast majority of people living with HIV, young people
might expose themselves to risk based on a sense of false security given that their sexual partner does
not show those symptoms. Only a few of the young people during FGDs mentioned that one can
only know a person’s HIV status by undergoing HIV testing. [Moroto 15- 19 years Girls out of school
28
FINAL REPORT
and boys 15-19 years in school, Soroti Girls 15 – 19 years in school, Bundibugyo Girls 15-19 years out
of school]
e) Knowledge of where to test for HIV;

Knowing where to get an HIV test is one of the important steps in the process of knowing one’s HIV
status and taking proper follow up action based on the HIV results. Overall, 77% of the young people
were knowledgeable of where to go for a HIV test. Awareness of where to go for a HIV test was
highest in Kampala (91%) and lowest in the East Central region (62%). Awareness of where to go for
HIV testing was higher in urban areas (87%) compared to the rural areas (75%). Respondents who
are out of school (91%), ever married (95%) and educated secondary or more (91%) were also more
likely to know where to go for HIV testing as shown in Table 14 below.
“..In Busia town here, for example, there are many small clinics and even the health facility is near. In most cases we
see people under tents set up by NGOs to do take blood and test for slim (HIV) and usually they display posters
along busy roads in town. But when you go the grandparent for holiday in the village, the health centres are very far so
when you are sick, it is hard to get transport to hospital yet even those people who set up tents are not common in
village…….” FGD with young boys aged 10-14 years still in school.
Table 14: Percentage of young people with knowledge of HIV testing sites by different socio-demographic
characteristics
Background Knows where to go for an HIV Test (%) Overall (%) No. of Young people
Characteristic Aged 10-14 years (%) Aged 15-19 years (%) Aged 20-24 years Aged 10-24 years (%)
Gender
Male 59.6 81.7 95.2 77.0 1,533
Female 52.2 87.2 94.4 76.2 1,754
Region
Kampala 73.5 94.5 97.5 90.6 182
Central 1 60.0 87.1 96.9 79.5 404
Central 2 50.9 84.1 98.1 74.2 334
East Central 42.0 68.9 87.7 62.3 337
Eastern 42.4 81.7 96.8 74.4 396
Karamoja 53.6 83.7 87.2 77.3 85
Northern 53.0 90.2 98.9 77.9 303
West Nile 62.8 78.4 90.9 73.3 253
Western 65.6 93.9 94.3 82.7 441
South Western 61.1 91.0 94.1 81.3 552
Residence
Urban 66.7 92.7 98.3 86.5 622
Rural 53.8 83.2 93.8 74.7 2665
Schooling status
In school 55.6 84.3 92.6 70.5 2062
Out of school 56.8 85.9 95.5 90.7 1216
Education
No formal education 45.8 77.8 95.2 71.4 45
Primary 54.1 80.6 92.9 68.4 1839
Secondary+ 78.4 89.2 96.1 91.3 1396
Marital status
Never married 55.6 83.7 93.9 73.2 2649
Ever Married 80.0 93.8 95.8 95.2 636
Overall 55.6 84.7 94.8 76.7 3287
29
FINAL REPORT
3.2.5 Sources of SRH information among young people

The survey included an assessment of the main channels through which young people accessed SRH
information. Overall, the main sources of information for young people regarding the different SRH
services included radio (14.1%), school/academic institution (16.3%) and health facilities/workers
(12.4%) as seen in table 15 below:
Table 15: Main sources of information on SRH components for young people aged 10-24 years
Health Worker (%)

School/ Academic
Parent /Guardian
Health Facility/
institution (%)
Radio e.g. FM
Sexual Reproductive Health (SRH) services
Others (%)
Radios (%)
(%)
Counselling on sexual violence and abuse (n=2,276) 21.2 18.8 1.5 5.5 5.9
STI diagnosis and management (n=2,553) 16.7 23.9 1.8 11.2 5.4
HIV counselling (n=3,247) 18.4 26.1 2.6 18.9 8.6
Pregnancy testing and antenatal and postnatal care (n=2613) 13.7 17.8 2.4 19.1 7.5
Contraception with an emphasis on dual protection (n=1,801) 9.3 12.6 1.1 11.2 15.7
Tetanus Toxoid (TT) vaccination (n=2017) 8.4 17.1 1.3 14.5 5.2
HPV vaccination (n=1,063) 7.1 8.0 0.6 6.2 3.3
Post-abortion care (n=1,145) 6.1 8.0 1.0 6.3 5.2
Mental health, drugs and alcohol abuse, rehabilitation (n=1,612) 9.0 12.1 1.4 7.0 7.5
Male circumcision boys) (n=2,917) 18.4 15.2 2.6 15.9 13.8
Cervical cancer screening (n=1,649) 13.5 8.0 0.6 9.9 6.4
Breast cancer screening (n=1,584 ) 13 7.7 0.6 8.6 6.6
Overall 14.1 16.3 1.7 12.4 8.0
The three main sources of information on the basic package of RH issues for adolescents were schools
followed by radio (refer to Appendix 6.3e and 6.3f). Taking as an example STIs, the most common source
of STI messages among age group 10-14 years was schools (20.1%) followed by radio (8.7%) and
health workers (2.6%). Regarding information on pregnancy and HIV in younger adolescents, the
main sources of information were mainly schools followed by radio and health workers. Parents were
clearly not a common source of SRH messages given only 2.6% and 2.4% of the young adolescents
identified them as main informants on HIV and pregnancy. Other sources of messages were much
less cited by the respondents. The young adults aged 20-24 had more access to information on various
aspects of SRH as compared to the younger age-groups. Health workers were also a main source of
information for this age group (Refer to appendix 6.3g for detailed table).
All FGDs conducted among girls and boys aged 10-24 years both in and out of school mentioned
either School, Radio or health workers as their main sources of SRH information.
“….. on radios they usually talk about avoiding very many partners as well as using condoms to prevent STIs
and HIV…” [FGD in Bundibugyo district with girls aged 10-14 years out of school]
“…Teachers during assembly speak to the pupils and encourage them to be safe…” [FGD with boys aged 20–
24 years in school in Kalungu district]
“…A health worker at the health center III and the peer educator give us SRH information….” [FGD with
boys aged 20-24 years in School in Wakiso]
30
FINAL REPORT
Parental involvement in young people’s SRH: Slightly more than half (51%) of the young people
surveyed mentioned that their parents/ guardians talked to them about body and body changes e.g.
menstruation, puberty, functions of the body parts and pregnancy. Young females (60%) were more
likely to have discussed this than males (40%). Young people in rural areas (31%) and those in regions
such as Eastern (44%) and South Western (44%) were least likely to have their parents discuss SRH
issues with them (refer to appendix 6.3h). The age at which parents start talking to young people about
body changes has declined in the last few years (as shown in figure 1 below) from 14 years among the
young adults (aged 20-24 years) to 10 years among the young adolescents (aged 10-14 years).
Figure 1: Age at which parents first talked about AYSRH Parents seem to have realized that there is
need to increase awareness of AYSRH among
16
14.04 their children from an early age. This might be
14 12.81 12.58
attributed to the increase in risk factors to
Mean age (Years)
12 10.38
10 which young people are exposed e.g. drugs
8 abuse, alcoholism, pornography, discipline
6 problems, peer pressure, sex trade, etc.
4 However, it is likely that increasing levels of
2
sensitization by civil society organizations
0
10-14 YEARS 15-19 YEARS 20-24 YEARS OVERALL (CSOs), religious institutions, and government
(10-24
YEARS)
have also contributed toward increasing
attention to this topic by parents.
The question about whether young people discuss SRH and HIV issues/ concerns with their parents
generated a lot of discussion among young people. FGD participants said that parents/guardians
usually discuss only hygiene and discipline or conduct, which are considered by the young people
themselves as soft topics, with both boys and girls. They further report that the mothers usually discuss
menstrual hygiene with girls only, while the father/ male guardians typically do not talk about SRH
except discipline and income generating activities with boys. Young people cited very low levels of
parental involvement in providing SRH information to them mainly due to parents finding it
inappropriate to discuss issues on sexuality with children who are not married as they feel this only
exposes them to early sexual behavior. Young people indicated that parents would rather talk to them
about social behavioral issues like alcohol, hygiene, work and academics.
Discussions with parents also revealed that they were not conformable about giving SRH related
information to their children mainly because Parents viewed their children as ‘too young to discuss
those issues’, school going children spend most of their time engaged with school work and they also
expect teachers, health workers and elders to carry on the responsibility of giving SRH related
information to their children. Citing some parents:
“Sexuality education has spoilt some of our kids and exposed them to things they did not know before,
such as using contraceptives at a young age. So you cannot expect us as parents to encourage this behavior
by exposing our kids in the home.” Parents in an FGD in Soroti district.
“Young people are always busy with school, even in the holidays. Children are never home and they claim
that they go for coaching or holiday studies especially those who are 15 years and above. So they seem to be
too busy for us as parents to get time to talk to them.” Parent in an FGD in Kasese district.
31
FINAL REPORT
“It is hard to tell your own children to use condoms even if you are aware that they were messing around
with girls, that is like encouraging then to get spoilt., If I found my son with condoms I would chase him
that means he is old enough to have his own family.” Parent in an FGD in Moroto
“Parents have left the responsivity of speaking to their children to the teachers at school and they try to
discipline children when the situation is already out of hand. They have been passing on the blame to the
teachers. The children end up getting used to being yelled and shouted at become none responsive in the long
run after all their parents negative reactions is expected.” Parent in an FGD in Kampala.
3.2.6 Self-perceived SRH risk

Young people were asked their self-perceived risk of being exposed to sexual reproductive health
problems such as HIV, STIs, pregnancy and GBV. Perceptions among young people by sex, age
group, marital status, and schooling status are presented in Table 16 below:
Table 16: Percentage of young people who feel they are at risk of SRH problems
Background Characteristic Females at risk Males at risk Overall No. of
YP
10-14 15-19 20-24 10-14 15-19 20-24 years (%) 10-24
years years years years years years
(%) (%) (%) (%) (%) (%)
Region
Kampala 13.2 42.2 52.9 45.4 28.6 64.4 41.8 201
Central 1 34.6 52.6 55.7 15.1 50.6 48.3 42.3 508
Central 2 27.4 59.8 84.5 30.0 61.4 82.2 53.2 449
East Central 21.4 52.0 71.4 30.6 44.9 70.8 44.9 508
Eastern 20.2 42.6 65.1 23.4 48.4 70.8 44.9 528
Karamoja 18.8 43.5 42.1 8.3 60.0 55.0 40.9 110
Northern 9.3 33.8 44.0 5.9 41.7 72.2 30.7 381
West Nile 20.9 41.3 50.0 20.0 44.1 51.9 33.9 345
Western 17.1 45.3 76.3 23.0 44.9 58.0 42.4 439
South Western 20.5 48.9 60.3 18.0 54.2 61.6 42.7 679
Residence
Urban 20.9 46.7 65.3 18.2 41.4 60.9 43.0 719
Rural 21.7 47.6 62.7 21.3 50.1 64.8 42.3 3429
Schooling status
In school 20.9 43.5 58.4 20.9 49.1 63.2 34.8 2824
Out of school 35.1 56.8 64.2 22.9 47.3 64.0 58.4 1311
Education
No formal education 25.0 72.7 40.0 13.3 42.9 70.0 42.6 61
Primary 20.7 45.8 61.7 21.0 47.8 62.2 35.4 2573
Secondary+ 32.2 48.2 65.5 23.8 50.3 64.6 54.3 1507
Marital status
Never married 21.2 44.6 59.1 21.0 48.0 62.3 38.0 3498
Ever Married 100.0 63.8 66.0 0.0 66.7 67.3 65.9 648
Overall 21.5 47.4 63.2 20.9 48.8 63.9 42.4 4148
About 42% of the young people surveyed feel they are at risk of suffering SRH related problems. The
level of self-perceived risk is lowest among people aged 10-14 (22% in females and 21% in males),
and highest among those aged 20-24 (63% in females and 64% in males). Personal risk perception was
highest among those in the Central 2 region (53%), out of school young people (58%) and have ever
been married (66%).
32
FINAL REPORT
Regarding perceived severity of risk, 6.5% of adolescent females aged 10-14 felt they were at high risk
for HIV compared to 16% of those aged 15-19 and 24% of those aged 20-24 years. A similar pattern
was observed for males. (Refer to Appendix 6.3i for details).
Regarding risk of suffering from specific SRH ailments, 4% of females aged 10-14 felt at risk for STIs
compared to 14% of females aged 15-19 and 19% for those aged 20-24, with similar trends among
the males. Among adolescents aged 15-19, 4% of the female respondents felt they were at high risk
of GBV compared to 2.5% of the males perceiving so. GBV risk was higher in the age group 20-24
years in which 10% of female respondents felt at great risk of GBV as compared to 5.6% of male
respondents.
FGDs with young people revealed several factors that make them vulnerable to SRH problems and
HIV/AIDS which include drug abuse, engaging in early sexual behaviours, peer influence into sexual
behaviors, unprotected sex, and high desire for material goods which forces them into cross
generational sex. Other identified risky factors included school dropout, poor access to SRH services,
lack of information on SRH, early marriage, and fear to discuss sexuality issues with parents. Below is
a discussions of the some of these risk factors most especially faced among the older adolescents and
young adults:
 Unemployment and casual work: Most of the young people (aged 10–24 years) mentioned
that unemployment drives them to look for jobs in economically active areas such as the
fishing communities, agricultural communities, market centres, transit trade areas with
truckers, main transportation sites with boda-boda cyclists where they end up into risky jobs
like, working in bars, cinemas, restaurants as a means to survive. As a result behaviors such
as prostitution, joining bad peer groups, drugs and alcohol abuse are adopted given their
social characteristics. This makes them vulnerable to SRH problems.
Engaging in casual work by adolescents where they receive intermitted payment was
associated by FGD participants with increased risk of ‘binge drinking and partying’. They
indicated that income from casual work is often used to purchase prostitutes, engage in
alcohol and drug abuse, engage in multiple sexual relations, as well as to buy gifts and
‘luxurious’ items to lure young girls into sex.
“We often do casual work such as brick laying and growing cocoa and when we get money some of us instead
use this money to buy alcohol and drugs and pay for sex.” FGD with boys aged 15-19 years in Kasese
district.
 Unwanted pregnancies: Young people aged 10–24 years across all regions are faced with
unwanted and unplanned pregnancies are led to seek unsafe abortions conducted outside
health facilities with support from traditional birth attendants, parents or peers; or they drop
out of school.
“…..Boys and girls engage in sex at an early age and end up making their girlfriends pregnant. These girls
then face problems with their families, drop out of school or even get shunned by community members…..”
FGD with girls out-of-school aged 15-19 years in Mbale district.
33
FINAL REPORT
 Poverty: Poverty was identified as the underlying cause for parents/guardians’ failure to meet
the scholastic costs and other economic necessities of their children. FGDs and KIIs across
all regions linked parental economic difficulties with transactional sex, cross generation sex
and child marriage among young people. In particular, young girls are driven into offering sex
in exchange for money (enticement for material rewards) and agreeing to marriage so as to
provide for themselves a better life. For example, primary and secondary school girls get
derailed by ‘boda boda’ riders and older men to get their school needs:
“Luwero being on the highway has many truck drivers with money who pass and park there especially at night
and in the evening and these lure young girls with simple gifts like food, clothes, which makes the girls give into
cross-generational sex with these men.” Key Informant in Luwero district.
 Rape and defilement: Young people aged 10– 24 years across all regions reported cases of
rape and defilement as some of the key SRH issues affecting their wellbeing. The main
perpetrators were reported to be teachers, relatives and parents responsible to protect the
young people. KIIs and FGD across all regions indicated that these cases are most times
settled at a family level leading to forced marriages. This puts girls at risk of SRH problems
such as early pregnancy, STIs and HIV infection.
“A pupil of primary three aged 13 was defiled by a teacher and the case is with the police. It should be noted
that most of these cases have been reported but they usually disappear and culprits go free. They are often handled
at the local level by local leaders who are given some tokens and they close the cases.” Key Informant in
Ntungamo district.
 Orphanhood: During KIIs and FGDs across all regions, informants indicated that Orphans
tend to lack parental guidance and easily give in to peer influence to engage in risky behaviours
which exposes them to early pregnancy, STIs and HIV infection.
“High rate of orphanage and abandoned children, this leaves then with no choice but to get married, for girls,
so that a man can look after them which makes them vulnerable and boys resort to drug abuse, alcohol which
increases their risk of getting involved in sexual immorality and thus AIDS…” KII in Arua district.
“Orphans due to HIV and child headed households are a common occurrence in our community and these
homes often lack income to enable them cater for their needs. Usually the older sibling may turn to prostitution
or something else risky so as to take care of the family” Parents in FGD in Lyantonde district
 Parental neglect: During FGDs and KIIs across all regions, cases of parental neglect were
mentioned in the form of not providing basic needs, not providing guidance and counselling
and child endangerment. Parents tend to give too much freedom to their children and at times
make them move late night to run errands, thus exposing them to SRH risks
… “In some homes parents leave children with house maids who are careless and they are left vulnerable to
situations of rape defilements and assault from maids” KII Kampala .
“… In some cases parental or guardian neglect lead young people to run the street where they beg for money and
end up doing things like drugs” KII in Arua.
34
FINAL REPORT
 Distant schools: FGDs and KIIs indicated that young people in school are expose to SRH
risks due to the long distances from home to school and vice versa. The risks they are exposed
to range from rape and defilement along their routes, enticement into behaviours from bad
character and structures from surrounding area.
“These young people as they move they find trading centers and town councils with local videos halls referred to
as ‘Kibanda’ that expose them to blue movies and pornography and they end up practicing what they see
exposing them to HIV/AIDS Risks. There is also a likelihood of meeting new people whom they are not sure
of their history and can be exposed to moral decadence” KII in Nebbi district.
“Girls end up going to discos and get drunk where they can be raped or defiled exposing them to HIV. They
also show these blue movies in the cinema that these young people like which are not good and make them bad
people in society KII in Kotido district.
 Hot spot areas: The young people 10 – 24 years across all regions particularly point out three
trouble spots, namely, fishing communities, border points and transit routes. They report that
these “red spots” are associated with problems like early sexual debut and early marriages;
subsistence abuse including marijuana and jet fuel sniffing; prostitution, and enticement into
sex of young males by widows.
Coping mechanisms reported by young people: Young people aged 10-24 years across all regions
revealed several coping mechanisms they use in order to protect themselves from SRH problems. The
most commonly identified mechanism was staying in school so as to secure their future, building on
their knowledge in handling SRH issues, and avoiding all the risks they could encounter out of school
such as early pregnancies, early marriages, and other bad or risky behavior.
These risks are avoided by keeping away from bad peer groups, abstaining from sex until marriage,
engaging in protected sex, safe male circumcision, among others. “Avoiding lonely places and walking in
groups to prevent cases of being raped alone and coming back home by 7pm at night keeps us safe.” Girls aged 20-
24years in school in Kapchorwa district.
3.2.7 Sexual behavior

Sexual behavior can predispose young people to SRH problems/risks. This section explores key
findings on the sexual behavior of adolescents and young adults.
a) Exposure to sexual activity;

Survey participants were asked if they had ever engaged in any form of sexual activity. Key findings
are summarized in the table 17 below by type of sexual activity and by age, gender, marital and
schooling status, and location. Overall 40% (n=1,694) of adolescents and young adults reported
having ever had penetrative vaginal sex. The proportion of young people that have ever had
penetrative sex did not differ significantly by gender and residence. Those who have had vaginal sex
included 4% of surveyed young adolescents (10-14years), 43% of the surveyed old adolescents (15-
19) and 86% of the surveyed20-24 year olds. However, adolescents and young people who were out
of school were much more likely to have ever engaged in vaginal sexual intercourse (80%) than those
in school (21%). The Western region (45%) followed by Kampala (42%) had the highest proportions
of young people having ever had sexual intercourse.
35
FINAL REPORT
Table 17: Percentage of young people that have been engaged in any sexual activities by age, gender, marital
and schooling status, and location
Background Vaginal Kissing Breast Oral sex Masturbation No. of Young
Characteristic sex (%) (%) fondling (%) (%) (%) people
Age group
10-14 years 4.2 2.8 2.0 0.3 0.4 1562
15-19 years 42.7 26.5 15.3 3.0 2.0 1647
20-24 years 85.8 55.6 33.2 8.9 5.5 1078
Gender
Male 39.3 25.0 14.0 3.2 3.2 1986
Female 39.7 25.3 15.8 3.7 1.6 2301
Residence
Urban 42.1 32.3 20.0 7.6 3.3 719
Rural 39.0 23.8 14.0 2.6 2.1 3568
Region
Central 1 35.9 25.4 13.0 6.4 5.2 515
Central 2 40.1 32.0 13.2 5.7 0.9 441
East Central 36.6 17.9 10.3 1.3 1.1 543
Eastern 40.6 26.5 16.9 0.8 1.1 532
Kampala 42.3 44.8 36.8 21.9 7.5 201
Karamoja 40.4 21.1 19.3 0.9 1.8 109
North 39.2 15.1 9.5 0.5 1.3 398
South West 41.2 20.2 10.8 0.6 1.2 677
Western 44.9 33.8 20.3 2.5 1.5 526
West Nile 33.9 23.8 16.8 4.6 5.2 345
Schooling status
In school 20.8 15.2 8.4 2.0 1.7 2925
Out of school 80.0 46.8 29.3 6.7 3.7 1349
Education
No formal education 41.3 20.6 22.2 4.8 1.6 70
Primary 29.7 16.3 10.5 1.6 1.6 2688
Secondary+ 56.8 41.1 22.6 6.7 3.6 1529
Marital status
Ever married 98.4 56.0 36.2 8.5 4.5 670
Never Married 28.6 19.5 11.0 2.5 1.9 3617
Overall 39.5 25.2 15.0 3.5 2.3 4287
Figure 2: Age group at first sexual intercourse – comparison with UDHS 2011
Comparison with the 2011 UDHS 2011
100 92 89 findings indicates a slight decline in the
%AGE THAT EVER HAD SEXUAL
86 83
80
proportion of young people that ever had
sex across all age categories, with exception
INTERCOURSE
60
45 43
of males aged 15-19 years for whom sexual
40 43 initiation increased by 3% (see figure 2).
40
This indicates a small proportion of the
20 older adolescents and young adults
especially are beginning to delay having sex.
0
15-19 20-24 15-19 20-24
Males Females
UDHS 2011 AYSRH Survey 2015
b) Age at first sexual intercourse;

Table 18 below shows the median age at first sexual intercourse by background characteristics. The
median age at first sexual intercourse was 16 years, without much variation across regions, residence,
schooling status and marital status. The median age at first sexual intercourse among young adults
36
FINAL REPORT
aged 20-24 years (17 years for females & Males) was slightly lower than those reported in the UDHS
2011, which found the median age for young adults aged 20-24 years to be 17.5 years for females and
18.4 for males. This suggests young people are not waiting longer before having sex which can be
attributed to the influence by their social and economic context today.
Table 18: Median age at first sexual intercourse by age, gender, marital and schooling status and location
Background Characteristic Females Males Overall

No. of
Young
20-24 years
20-24 years
10-24 years
10-24 years
10-24 years
10-14 years
15-19 years
10-14 years
15-19 years
people
who ever
Overall
Overall
had
vaginal sex
Region
Kampala - 16 17 17 - 15 18 18 17 85
Central 1 12 16 18 16 - 16 17 17 16 185
Central 2 11 16 17 16 12 15 17 16 16 177
East Central 12 14 15 15 12 14 17 15 15 199
Eastern 13 16 17 16 11 15 18 16 16 216
Karamoja 13 15 16 16 - 16 18 16 16 44
Northern 14 15 16 16 - 16 18 16 16 156
West Nile 10 16 18 15 12 16 18 15 16 117
Western 13 15 16 16 12 15 17 17 15 236
South Western 14 16 17 16 13 16 18 16 16 279
Residence
Urban 14 16 17 16 - 16 17 17 16 303
Rural 12 15 17 16 12 15 17 16 16 1391
Schooling status
In school 12 15 18 15 12 15 18 15 15 609
Out of school 13 16 17 16 12 16 17 17 17 1079
Education
No formal education 10 14 15 15 - 16 19 18 16 28
Primary 13 15 17 16 12 15 17 16 16 798
Secondary+ 13 16 17 16 13 16 17 17 16 868
Marital status
Never married 12 15 17 16 12 15 17 16 16 1026
Ever Married 14 16 17 16 - 16 17 17 17 658
Overall 13 15 17 16 12 15 17 16 16 1694
c) Pressured to have sex;

The survey assessed, among those who have ever had sex, the proportion of young people who
reported to have been pressured or forced to have sexual intercourse. These findings are summarized
in the table 19 below. Overall, 10% (n=173) of participants that ever had sex reported to have been
forced/coerced to have sex at their first sexual intercourse. The proportion that reported having been
forced to have sexual intercourse was highest among females (16%, n=149) and those aged 10-19
years. By region, Karamoja had the highest proportion of young people coerced (27.9%) at their first
sexual encounter.
37
FINAL REPORT
Table 19: Percent of young people who have consented vs. been coerced / forced to have sex at first sexual
experience
FEMALE MALE TOTAL

Background
Consensual Coerced Consensual Coerced Consensual Coerced
characteristics
No. % No. % No. % No. % No. % No. %
Residence
Urban 145 84.8 26 15.2 127 96.9 3 2.3 272 90.1 29 9.6
Rural 615 83.3 123 16.7 626 96.3 21 3.2 1241 89.4 144 10.4
Age group
10 - 14 20 62.5 12 37.5 32 94.1 2 5.9 52 78.8 14 21.2
15 - 19 314 82.0 69 18.0 302 95.6 11 3.5 616 88.1 80 11.4
20 - 24 426 86.2 68 13.8 419 97.2 11 2.6 845 91.4 79 8.5
Region
Central 1 103 89.6 12 10.4 65 95.6 3 4.4 168 91.8 15 8.2
Central 2 90 96.8 3 3.2 84 98.8 1 1.2 174 97.8 4 2.2
East Central 87 77.7 25 22.3 81 95.3 4 4.7 168 85.3 29 14.7
Eastern 103 85.8 17 14.2 91 94.8 5 5.2 194 89.8 22 10.2
Kampala 34 87.2 5 12.8 44 95.7 1 2.2 78 91.8 6 7.1
Karamoja 12 54.5 10 45.5 19 90.5 2 9.5 31 72.1 12 27.9
North 67 83.8 13 16.2 74 97.4 2 2.6 141 90.4 15 9.6
South West 94 77.0 28 23.0 153 98.7 2 1.3 247 89.2 30 10.8
West Nile 41 67.2 20 32.8 50 87.7 4 7.0 91 77.1 24 20.3
Western 129 89.0 16 11.0 92 100 0 0.0 221 93.2 16 6.8
Schooling status
In school 216 80.0 54 20.0 323 95.6 14 4.1 539 88.7 68 11.2
Out of school 540 85.0 95 15.0 429 97.3 9 2.0 969 90.1 104 9.7
Education level
No formal education 9 64.3 5 35.7 12 100 0 0.0 21 80.8 5 19.2
Primary 372 80.7 89 19.3 319 95.8 11 3.3 691 87.0 100 12.6
Secondary 378 87.5 54 12.5 422 96.8 13 3.0 800 92.2 67 7.7
Marital status
Ever married 388 85.3 67 14.7 194 96.5 6 3.0 582 88.7 73 11.1
Never married 372 81.9 82 18.1 558 96.4 18 3.1 930 90.0 100 9.7
Overall 760 83.2 149 16.3 752 96.3 24 3.1 1512 89.3 173 10.2
d) Transactional sex;
Transactional sex refers to sex for gifts or monetary rewards. Engagement in transactional sex among
young people is a key indicator of sexual vulnerability, especially in communities with high levels of
poverty. Key findings on the prevalence of transactional sex among young people of different age
groups are presented in the figure 3 below. Overall, 13% (n=536) of the young people surveyed had
ever engaged in transactional sex. This represents about a third (31%) of the young people that have
ever had sexual intercourse (n=1,694). Transactional sex was reported to be higher among females
(40%, 365) as compared to males (22%, 171) among those who had ever had sex.
Interviews with SRH stakeholders and discussions with young people also revealed that poverty;
orphanhood and child-headed families are major drivers of early sex initiation, whether that is done
consensually, forcefully, commercially or through early marriages. “We get born into poor homes. If you are
born in a poor home and you don’t have patience, you can you can land into many problems. Because your parent can be
poor, without money, you want a good dress but you can’t have it. You end up playing sex and doing all other bad things
to sustain yourself and your family.” said by a female respondent 15-19 years in Kalangala District.
38
FINAL REPORT
Figure 3. Among young people that have ever had sex, proportion of young people that have ever engaged in
transactional sex, by age, gender, marital and schooling status, and location
70%
Females Males
58%
60%
43%
43%
50%
41%
41%
41%
41%
41%
41%
40%
40%
40%
39%
39%
38%
37%
37%
33%
32%
40%
28%
28%
25%
25%
23%
22%
30%
22%
21%
21%
21%
20%
20%
20%
19%
18%
17%
16%
13%
13%
20%
8%
5%
10%
0%
Western
Central 1
Central 2
Karamoja
Secondary+
East Central
Kampala
South West
West Nile
In school
No formal education
Out of school
Eastern
Primary
Never married
Rural
North
Urban
Ever married
Overall
Region Residence Schooling Education Marital status
Some cultural practices are also encouraging young people to engage in early sex. One example is the
cultural practice of ‘imbalu’ (male circumcision) in Eastern Uganda. “Among the Bagisu, the imbalu
ceremonies encourage risky sexual behavior due to the practice of ‘Akadodi’ where young boys are encouraged to engage
in sex under the guise that it leads to fast healing of the wound after the foreskin has been cut. Also the drinking
festivities and dancing provide an environment for bad behavior.” Key Informant in Mbale.
Parents noted that technological advancement and the changing social norms expose young people to
risky sexual behavior. The emergence of social media (e.g. WhatsApp, Facebook, Twitter), mass media,
print media, as well as entertainment options such as video halls, bars, night clubs, and some social
gatherings, expose young people to vices that trigger them to engage in risky behavior such as early
sex.
“Young people are exposed to information from sources that have no limitations on their young people like certain radio
stations and watching television shows. Nowadays with using the internet and social media platforms like Facebook,
these young people watch what they wish to. They go to say internet cafes and surf anything they’d like to look up and
because the person at the café is not going to look into what these young people are surfing, they are exposed to a lot where
information may be beyond this young person’s age of understanding or exposure. From this, they have received all kinds
of information and with the technology these days, they create copies on CDs of this information and share it with their
friends.” Parents during the FGD in Kampala.
“The wave of technology where children have access to blue movies online and from libraries which they often claim a
parent has sent them for; exposes them to sex so early with no prior knowledge of the subject which makes them curious
and eager to try it out” Parents in FGD in Lyantonde
“Here we have a video hall which shows pornography at night. Entrance is only sh.1000, and everyone is free to enter
as long as we have paid” said by a boy in an FGD of 20-24 years in Katakwi.
39
FINAL REPORT
Changing social norms such as the emergence of sexual freedom, evolving dress codes including those
perceived as ‘indecent dressing’ and the increasing social acceptability of sex before marriage are also
viewed by discussants as playing a key role in influencing young people to engage in risky sexual
behavior such as early sex, sex with multiple partners and commercial sex. “Girls wear leggings and very
short skirts which are very tempting and are meant to entice us to look at them in a sexual way. Usually these girls dress
like this to suggest sex especially in the night clubs and bars.” Boys aged 20-24 years in Kampala.
e) Multiple sexual partnerships

Sex with more than one concurrent sexual partner is one of the highest behavioral risk markers for
STIs and HIV/AIDS. Table 20 shows the number of partners with whom sexually active young people
had sex within the last 6 months preceding the survey. The term “sexually active” refers to young
people that had sex within the last 12 months preceding the survey (30%, n=1,301).
Table 20: Number of partners with whom sexually-active young people had sex within the last 6 months
Female Male Overall

Background
1 Partner ≥1 partner 1 Partner ≥1 partner 1 Partner ≥1 partner
Characteristics
No. % No. % No. % No. % No. % No. %
Residence
Rural 102 75.6 33 24.4 61 59.2 42 40.8 163 68.5 75 31.5
Urban 463 81.5 105 18.5 287 58.1 207 41.9 750 70.6 312 29.4
Age group
10-14 14 77.8 4 22.2 13 65.0 7 35.0 27 71.1 11 28.9
15-19 215 78.8 58 21.2 140 60.6 91 39.4 355 70.4 149 29.6
20-24 336 81.6 76 18.4 195 56.4 151 43.6 531 70.1 227 29.9
Region
Central 1 72 79.1 19 20.9 31 54.4 26 45.6 103 69.6 45 30.4
Central 2 56 71.8 22 28.2 39 63.9 22 36.1 95 68.3 44 31.7
East Central 80 79.2 21 20.8 47 65.3 25 34.7 127 73.4 46 26.6
Eastern 84 84.8 15 15.2 46 62.2 28 37.8 130 75.1 43 24.9
Kampala 28 93.3 2 6.7 22 68.8 10 31.2 50 80.6 12 19.4
Karamoja 9 64.3 5 35.7 14 73.7 5 26.3 23 69.7 10 30.3
North 63 90.0 7 10.0 40 63.5 23 36.5 103 77.4 30 22.6
South West 61 81.3 14 18.7 46 46.0 54 54.0 107 61.1 68 38.9
West Nile 27 73.0 10 27.0 23 54.8 19 45.2 50 63.3 29 36.7
Western 85 78.7 23 21.3 40 51.9 37 48.1 125 67.6 60 32.4
Schooling status
In school 131 74.0 46 26.0 132 57.4 98 42.6 263 64.6 144 35.4
Out of school 431 82.4 92 17.6 215 58.7 151 41.3 646 72.7 243 27.3
Education level
No formal education 6 66.7 3 33.3 5 55.6 4 44.4 11 61.1 7 38.9
Primary 295 81.9 65 18.1 151 58.3 108 41.7 446 72.1 173 27.9
Secondary 263 79.0 70 21.0 192 58.4 137 41.6 455 68.7 207 31.3
Marital status
Ever married 343 86.8 52 13.2 116 63.4 67 36.6 459 79.4 119 20.6
Never married 222 72.1 86 27.9 232 56.0 182 44.0 454 62.9 268 37.1
Overall 565 80.4 138 19.6 348 58.3 249 41.7 913 70.2 387 29.8
Overall, 29.8% of sexually active adolescents and young adults surveyed reported to have had more
than one sexual partner in the 6 months preceding the survey. By gender, more males (42%) than
females (20%) had more than one sexual partner. No significant differences were identified in
proportions between residence as well as age groups in regards to having multiple sexual partners.
However, sexually active young people who are not yet married (37%) and those in school (35%) had
a higher prevalence of multiple sexual partners.
40
FINAL REPORT
f) Type of sexual partner

The type of partner with whom a young persons has sex is important as it influences their level of
vulnerability to SRH ill-health. Key findings on the distribution of the different types of partner by
age group and other characteristics are presented in the table 21 below. Among young people who
had sexual intercourse in the last 12 months, the majority (57%) had their last sexual intercourse with
a boyfriend/girl-friend (anticipated given that the majority of respondents are not married). This was followed
by husband/wife (33%) and friend/colleague (8.8%).
Table 21: Type of partner whom sexually active young people had sex with in the last 12 months
Relationship to the sexual partner (%) Young people that had

Background sex in the last 12 months
Characteristics Boyfriend / Husband Friend / Employer Teacher Unknown/ Others % Number
Girlfriend / Wife Colleague Stranger
Gender
Female 48.4 44.4 4.8 0.0 0.4 0.7 1.3 100 703
Male 66.2 19.1 11.0 0.3 0.2 2.0 1.2 100 598
Age group
10-14 years 70.3 2.7 18.9 0.0 0.0 2.7 5.4 100 37
15-19 years 71.4 19.3 8.2 0.0 0.2 0.8 0.2 100 503
20-24 years 46.1 43.1 6.8 0.3 0.4 1.6 1.7 100 761
Residence
Urban 65.7 21.3 9.2 0.4 0.4 1.3 1.7 100 239
Rural 54.5 35.3 7.3 0.1 0.3 1.3 1.1 100 1062
Region
Central 1 60.7 27.3 8.7 0.0 0.7 1.3 1.3 150
Central 2 67.4 25.2 2.2 0.0 0.0 0.7 4.4 100 135
East Central 57.2 32.4 8.7 0.6 0.0 1.2 0.0 100 173
Eastern 54.3 38.3 6.3 0.0 0.0 1.1 0.0 100 175
Kampala 75.4 16.9 3.1 0.0 0.0 1.5 3.1 100 65
Karamoja 30.3 66.7 3.0 0.0 0.0 0.0 0.0 100 33
North 48.9 50.4 0.8 0.0 0.0 0.0 0.0 100 131
South West 41.7 38.3 14.3 0.6 0.6 2.3 2.3 100 175
West Nile 62.8 23.1 10.3 0.0 1.3 2.6 0.0 100 78
Western 61.8 23.7 11.3 0.0 0.5 1.6 1.1 100 186
Schooling status
In school 83.0 4.0 11.4 0.2 0.0 1.0 0.5 100 405
Out of school 44.7 45.7 6.1 0.1 0.4 1.5 1.6 100 891
Education
No formal education 33.3 50.0 5.6 0.0 5.6 0.0 5.6 100 18
Primary 48.6 41.3 7.5 0.2 0.2 1.1 1.1 100 617
Secondary+ 64.5 24.4 8.0 0.2 0.3 1.5 1.2 100 665
Marital status
Ever married 28.0 67.0 2.6 0.2 0.3 1.0 0.9 100 582
Never married 79.7 5.0 11.8 0.1 0.3 1.5 1.5 100 719
Overall 56.6 32.7 7.7 0.2 0.3 1.3 1.2 100 1301
3.2.8 Empowerment
a) Ability to negotiate less risky alternatives to sexual intercourse;
An assessment of young people’s perceived ability to negotiate out of risky relationships was
conducted, focusing only on those who were sexually active and aged 15 years and above. Overall
59% of the young people (15-24 years) that had engaged in vaginal sex felt that they could negotiate
for less risky alternatives to sexual intercourse even when pressured to have unsafe sex (Refer to table
22 below for details). Males (65% aged 15-19 and 60% aged 20-24) were more likely to negotiate for
safe sex than females (52% for both age groups 15-19 and 20-24 years). Almost one out of two females
41
FINAL REPORT
aged 15-19 years and 20-24 years that have ever had sex feel that they cannot negotiate their way out
of unsafe sex.
Table 22: Ability to negotiate less risky alternatives to sexual intercourse when pressured to have unsafe sex
among young people aged 15-24
OVERALL - YP Total number
Proportion of FEMALES that can Proportion of MALES that can that can negotiate of YP aged 15-
negotiate safe sex negotiate safe sex for safe sex 24 that have
Background 15-19 years 20-24years 15-19 years 20-24years 15-24 years ever had
Characteristics No. No. No. No. of No. of vaginal sex
of YP % of YP % of YP % YP % YP %
Region
Central 1 25 61.0 20 37.7 12 92.3 31 86.1 88 61.5 180
Central 2 22 57.9 23 45.1 15 51.7 23 71.9 83 55.3 170
East Central 18 35.3 19 40.4 12 41.4 15 40.5 64 39.0 189
Eastern 23 53.5 44 62.0 19 52.8 39 78.0 125 62.5 210
Kampala 3 42.9 23 100 3 75.0 19 65.5 48 76.2 83
Karamoja 1 33.3 4 33.3 3 60.0 6 54.5 14 45.2 42
North 15 71.4 38 80.9 22 73.3 28 87.5 103 79.2 155
South West 27 60.0 32 65.3 29 76.3 48 65.8 136 66.3 263
Western 23 45.1 43 55.1 13 44.8 21 60.0 100 51.8 228
West Nile 13 50.0 6 33.3 20 83.3 9 60.0 48 57.8 108
Educational Level
No formal education 0 0.0 6 75.0 3 75.0 3 42.9 12 57.1 26
Primary 88 53.3 131 57.2 71 59.7 80 67.2 370 58.5 745
Secondary + 82 51.6 114 54.3 74 64.9 156 69.6 426 60.3 857
Location
Urban 25 54.3 66 71.0 18 85.7 49 67.1 158 67.8 297
Rural 145 51.8 186 52.2 130 60.2 190 68.6 651 57.7 1331
Schooling
In-school 75 50.7 30 63.8 99 66.0 56 70.0 260 61.2 555
Out of school 95 53.4 220 55.1 49 56.3 182 67.7 546 58.5 1067
Marital status
Ever married 111 52.6 85 61.6 136 63.8 136 70.8 468 62.1 656
Never married 59 51.3 167 53.7 12 50.0 103 65.2 341 56.1 972
OVERALL 170 52.1 252 56.0 148 62.4 239 68.0 809 59.4 1628
b) Discussion of sexual and reproductive health choices with partner before pregnancy
Participants aged 15-24 years who have ever been pregnant were asked if they had discussed
reproductive health choices with their partner before they got pregnant (for females) or before they
got their partner pregnant (for males). Only 40% percent of female respondents aged 15-19 years and
those 20-24 years reported that they discussed with their partner issues of SRH before getting
pregnant. Likewise, 31% of males aged 15-19 years and 43% of those aged 20-24 years reported having
discussed SRH issues before the pregnancy (Refer to Appendix 6.3j). The findings imply therefore that
discussion of SRH among sexually active young people is low, even among those intending to get
pregnant.
From the discussions with young people and parents, it was noted that most young people (especially
females in the 20-24 year age group) do not discuss reproductive choices with their partners. This was
mainly attributed to culture. They noted that children are viewed as payment for the dowry the man
pays when acquiring a wife. They are also seen as a source of cheap labour to enhance the family’s
wealth. It was noted therefore that it is the role of the woman to give birth to as many children as the
husband desires without discussing the issue. “When a man marries a wife, he is more respected in society if he
has many children and is expanding the clan. The number does not depend on anything, they just have as many as they
can.” Soroti, boys 20-24 years in school.
42
FINAL REPORT
c) Discussion of family planning options with partner

Young people who reported as being sexually active were asked if they had ever discussed family
planning choices with their partners. Table 23 below shows the proportion of sexually active young
people aged 15 years and older who have ever discussed family planning/ reproductive choices with
their partner. Among sexually active youth aged 15-24 years, 55% reported to have discussed family
planning choices with their partners with females more likely to have done so than males. Discussion
of FP choices was lower among the older adolescents (51% of females and 41% of males) as compared
to the young adults with 69% of females and 60% of males aged 20-24 years having ever discussed
family planning issues with their partner. Young people in school (48%) and never married (47%)
were least likely to discuss family planning options with their partners.
Although the quantitative results indicate that married people are the subgroup that discusses FP
choices the most, FGDs revealed that this is not prevalent or generally accepted as a common practice.
This is attributed mainly to cultural and religious beliefs. Culturally, men tend to order their wives not
to use family planning under the notion that it is ‘their duty is to reproduce and expand the clan’.
Those who use it do so secretly, usually opting for long term or undetectable methods such as the
IUD or injectables. “These days our husbands have been taught about the implants and they know how to feel for
them in the arm and if he finds you with it you can be in serious trouble, so we end up opting for injectables which cannot
be felt by them.” Girls aged 20-24 in Budaka district.
From the religious stand point, young people pointed out that some religious communities such as
Catholics consider use of modern contraceptives as a form of abortion, especially for methods like
IUDs which prevent implantation of an already fertilized egg. Islam is also perceived to encourage
polygamy and bearing ‘as many children as one can handle’: “God said go and multiply and therefore family
planning goes against this command from God since it is not even natural.” Girls 20-24 years in school,
Kapchorwa.
43
FINAL REPORT
Table 23: Ever discussed family planning/reproductive choices with partner
Female Male Overall (Males & Females) Overall Total

Background Overall Overall
15-19 years 20-24 years 15-19 years 20-24 years 15-19 years 20-24 years
Characteristics Females Males
No. % No. % No. % No. % No. % No. % No. % No. % No. %
Residence
Urban 33 55.9 64 69.6 97 64.2 17 40.5 48 55.2 65 50.4 50 49.5 112 62.6 162 57.9
Rural 155 51.2 242 68.8 397 60.6 110 41.2 185 60.1 295 51.3 265 46.5 427 64.7 692 56.3
Region
Central 1 20 51.3 39 69.6 59 62.1 11 47.8 19 51.4 30 50.0 31 50.0 58 62.4 89 57.4
Central 2 13 40.6 28 62.2 41 53.2 7 20.6 16 43.2 23 32.4 20 30.3 44 53.7 64 43.2
East Central 38 62.3 41 82.0 79 71.2 18 52.9 30 71.4 48 63.2 56 58.9 71 77.2 127 67.9
Eastern 19 55.9 46 67.6 65 63.7 12 37.5 28 54.9 40 48.2 31 47.0 74 62.2 105 56.8
Kampala 5 55.6 17 70.8 22 66.7 5 50.0 24 70.6 29 65.9 10 52.6 41 70.7 51 66.2
Karamoja 4 57.1 8 72.7 12 66.7 5 83.3 5 71.4 10 76.9 9 69.2 13 72.2 22 71.0
North 17 42.5 38 77.6 55 61.8 15 26.3 26 72.2 41 44.1 32 33.0 64 75.3 96 52.7
South West 18 36.0 29 58.0 47 47.0 24 51.1 44 51.8 68 51.5 42 43.3 73 54.1 115 49.6
West Nile 22 57.9 14 60.9 36 59.0 13 38.2 12 57.1 25 45.5 35 48.6 26 59.1 61 52.6
Western 32 61.5 46 67.6 78 65.0 17 53.1 29 64.4 46 59.7 49 58.3 75 66.4 124 62.9
Schooling status
In school 98 52.4 38 65.5 136 55.5 74 36.6 54 51.4 128 41.7 172 44.2 92 56.4 264 47.8
Out of school 90 51.4 266 69.5 356 63.8 53 50.0 179 62.2 232 58.9 143 50.9 445 66.3 588 61.8
Education level
No formal education 1 33.3 6 60.0 7 53.8 1 50.0 5 83.3 6 75.0 2 40.0 11 68.8 13 61.9
Primary 84 46.4 150 69.1 234 58.8 65 40.6 76 59.8 141 49.1 149 43.7 226 65.7 375 54.7
Secondary 103 57.9 150 69.4 253 64.2 61 41.8 152 58.0 213 52.2 164 50.6 302 63.2 466 58.1
Marital status
Ever married 65 54.2 220 74.1 285 68.3 19 70.4 119 76.3 138 75.4 84 57.1 339 74.8 423 70.5
Never married 123 50.8 86 58.5 209 53.7 107 38.1 114 47.7 222 42.5 230 44.0 200 51.8 430 47.3
OVERALL 188 51.9 306 68.9 494 61.3 127 41.1 233 59.0 360 51.1 315 46.9 539 64.2 854 56.5
44
FINAL REPORT
d) Empowerment attributed to SRH services made available and information received
In the discussions and key informant interviews with health workers, they observed that due to
increased access to information and knowledge on SRH, young people’s habits have changed.
According to them, young people now seek and use these SRH services more than in the past.
Health workers indicate that young people go to the health facilities and seek out for safe male
circumcision services and ask for condoms with confidence. In the discussions with young people,
they too acknowledged that they had seen some behavioral changes among their peers as a result
of increased SRH information available to young people. Examples they quoted included reduction
in alcohol intake and abstinence from sex. School-going adolescents also acknowledged their
exposure to programs such as PIASCY and school clubs like Straight Talk Club, Youth Alive, Red
Cross Clubs etc. They said these had greatly increased their awareness and empowered them on
SRH issues, specifically those in the 10-19 year age group. Cited quotes below
“…I learnt how to correctly use the condom which was illustrated on the ‘Obulamu charts’ displayed on the walls
of the ‘Kibanda (local video hall) in town” FGD young people with aged 15– 19 years out of school in
Moroto.
“I have been going to a community organization called HEYFU where they carry out counselling on SRH and life
skills for free. I go there with my friends who are older and have people who we can talk to and encourage us to be
responsible for our lives” FGD young people aged 15 – 19 years in school in Kampala
“We get SRH information from School through PIASCY and teachers” FGD with 15-19 year old Girls in
school in Lyantonde.
3.2.9 Contraceptive use
The prevalence of contraceptive use among sexually active young people was assessed by asking
them whether a modern contraceptive method was used the last time they had sexual intercourse.
Table 24 below shows the prevalence of contraceptive use among young people who had sex
within the last 12 months preceding the survey, by background characteristics. Overall, about half
(52%) of the sexually active young people used a modern contraceptive method the last time they
had sexual intercourse. The distribution of contraceptive use at last sexual intercourse was higher
among males (60%) than females (46%). Sexually active young people in the age group 15-19 years
were more likely to use a modern contraceptive method as compared to other age groups.
Contraceptive use was lowest in the Eastern (35%) and Karamoja regions (30%). A very high
proportion of the urban dwellers (70%) used a modern contraceptive method as compared to their
rural counterparts at 48%. Young people ever married (33%) and those out of school (44%) were
least likely to have used a modern contraceptive method the last time they had sexual intercourse.
Table 24: Modern contraceptive prevalence among sexually active young people
Female Male OVERALL No. of young

Background
Characteristics Total Sexually Total Sexually people sexually
No. % active (#) No. % active (#) No. % active*
Age group
10-14 years 8 44.4 18 7 36.8 19 15 40.5 37
15-19 years 143 52.2 274 150 65.5 229 293 58.3 503
20-24 years 170 41.4 411 202 57.7 350 372 48.9 761
Residence
Urban 83 62.4 133 84 79.2 106 167 69.9 239
Rural 238 41.8 570 275 55.9 492 513 48.3 1062
45
FINAL REPORT
Region
Central 1 44 47.8 92 39 67.2 58 83 55.3 150
Central 2 43 56.6 76 48 81.4 59 91 67.4 135
East Central 56 54.4 103 48 68.6 70 104 60.1 173
Eastern 31 31.3 99 30 39.5 76 61 34.9 175
Kampala 16 53.3 30 29 82.9 35 45 69.2 65
Karamoja 4 28.6 14 6 31.6 19 10 30.3 33
North 28 40.6 69 35 56.5 62 63 48.1 131
South West 24 32.0 75 55 55.0 100 79 45.1 175
West Nile 18 50.0 36 25 59.5 42 43 55.1 78
Western 57 52.3 109 44 57.1 77 101 54.3 186
Schooling status
In school 129 73.7 175 153 66.5 230 282 69.6 405
Out of school 191 36.5 524 205 55.9 367 396 44.4 891
Education level
No formal education 4 44.4 9 7 77.8 9 11 61.1 18
Primary 126 35.0 360 122 47.5 257 248 40.2 617
Secondary + 191 57.4 333 230 69.3 332 421 63.3 665
Marital status
Ever married 126 31.7 398 68 37.0 184 194 33.3 582
Never married 195 63.9 305 291 70.3 414 486 67.6 719
OVERALL 321 45.7 703 359 60.0 598 680 52.3 1301
*Young people that had sex in the last 12 months preceding the survey
a) Access and preferred contraceptives;

Out of the 1,301 young people that reported having sex in the last 12 months, only 53% (n=687)
had used protection during sexual intercourse. The main protection/prevention method used
among those that protected themselves was the Male condoms (81%) followed by injectables with
only 8%. In the discussions with young people, out of school young people aged 20-24 years said
that they were able to access condoms easily unlike the adolescents in and out of school who
mentioned not easily accessing condoms in the community. As part of the national policy,
condoms are prohibited for young people in schools and this was reflected in most discussions
with in-school younger people. In general, young people 10 -24 years in all regions both in and out
of school showed preference towards using modern contraceptive methods. “I prefer using injectables
since I can get it before I go into school and it lasts the entire duration of the term and it cannot be detected.” Girls
aged 15-19 years in Soroti district. “We prefer to use condoms since they are easily accessible and readily
available in health facilities and in some places like bars and nightclubs. VHTs also hand them out in community
outreaches.” Boys aged 15-19 years out of school in Kayunga.
b) Cultural and religious beliefs and practices relating to family planning;

The discussions with young people showed that young people had some cultural beliefs and biases
towards family planning that in turn affect their use of FP services. Misconceptions included fear
of side effects and fear of birth defects that some young people associate with FP methods. Boys
aged 15-19 years in Kawempe division explained:
“Family planning methods react with your body systems; you get body swellings; some of these methods are even
considered as an abortion because the eggs in the ovaries are like babies. When contraceptive pills are swallowed for
long, they accumulate and sit in the body and don’t dissolve.” FGD with Fears of side effects were also
highlighted by females 20-24 years in Nakawa, who indicated that “The copper coating of the IUD rust
and cause body reactions like swellings and rushes.” Similar concerns regarding side effects were
expressed by boys 20-24 years out of school in Katakwi district: “Family planning can cause cancer of
the cervix as a side effect, as well as lead women to caesarian section deliveries due to complications that make them
fail to deliver normally”
KIIs and FGDs also revealed that some cultures believe that having many children provides a
sense of continuity and security. For example, clans in Kasese and Hoima districts which are facing
46
FINAL REPORT
a growing influx of refugees are discouraged from using family planning methods because they are
told their land will be grabbed by intruders if they don’t expand the clan.
“Children are gift to a family and a reward for paying bride price and therefore couples are supposed to give birth to
as many children as possible to expand the clan. Children are a source of casual labour and dowry in the case of the
girls” FGD with aged boys 20-24 years in school in Soroti.
“… Men are against family planning especially since they paid bride price for the wife they expect her to give birth
to as many children as possible” FGD with girls aged 20-24 years in school in Kapchorwa.
“Men also prevent their wives from accessing family planning, because according to their tradition they are supposed
to produce as many children as they can. They went ahead to tell me that the king of Rwenzururu ‘Mumbere’ told
them to produce as many children as they can.” FGD with girls aged 15-19 years in school in Kasese.
3.2.10 Sexually Transmitted Infections (STIs)
a) STI prevalence among sexually active young people

Sexually active young people aged 10-24 years were asked if they had experienced problems with
their reproductive health over the 12 months preceding the survey which they suspected or
confirmed to be a sexually transmitted disease. Table 25 below shows that overall, nearly 18 in
every 100 young people aged 10-24 years (18%) had health problems thought to have been
contracted from sexual contact in the last 12 months preceding the study. Occurrence of the
suspected STIs among the sexually active young people increased with age, from a prevalence of
3% among those aged 10-14 years, to 16% in the age group 15-19 years, and highest in age group
20-24 years (22%). This was because the age group 15-24 years falls within the child bearing age
(15-49 years for women) whereby people become more sexually active and use less duo protection
methods or have unprotected sex without testing for STIs including HIV. Females (22%) and
those residing in urban areas (25%) were more likely to report have acquired an STI. Out the 251
young people who reported experiencing problems relating to an STI, approximately 77% (n=192)
of them sought treatment. Young people mainly sought STI treatment/advice from the Health
center (48%, n=115) followed Private clinic (23%, n=56) and Hospital (20%, n=49).
Table 25: Proportion of sexually active young people who had a health problem from sexual contact in the
last 12 months
Background No. of sexually

Characteristic Sexually active young people who had a health problem from active young
Overall (%)
sexual contact in the last 12 months (%) people who had
an STI
10-14 years (%) 15-19 years (%) 20-24 years (%) 10-24 years Number
Gender
Female 3.03 18.63 25.91 21.73 161
Male 3.13 11.74 17.31 14.26 90
Residence
Urban 0.0 18.39 31.13 25.2 63
Rural 3.77 15.03 19.47 16.76 188
Schooling status
In school 1.82 14.97 16.08 13.91 74
Out of school 10 16.27 23.17 20.93 175
Overall 3.08 15.53 21.91 18.29 251
47
FINAL REPORT
3.2.11 HIV Testing and Counselling
Lack of knowledge about one’s HIV sero-status, as established through HIV Counseling and
Testing (HCT) is one of the key drivers of HIV incidence in Uganda. Awareness of one’s HIV
status can motivate young people to further protect themselves against infection or to protect their
partners from acquiring the disease. Overall, 72% of the young people surveyed believe they can
get an HIV test at any time (refer to appendix 6.3k). Slightly more than half (52%, n=2218) of the
young people involved in the survey had ever tested for HIV as seen in table 26 below. The
proportion that had ever tested increased with age from 83% among young adults (20-24 years) to
61% and 21 % among those aged 15-19 and 10-14 respectively. More females (54%) than males
(50%) had ever tested. Young people in urban areas (64%), out of school (75%) and ever married
(85%) were much more likely to have ever tested for HIV as compared those in the rural areas, in-
school and never married.
Table 26: Proportion of sexually active young people who have tested for HIV and accessed results and counselling
Background Ever tested for HIV Tested for HIV in Received results if Received counselling
Characteristic last 12 months tested for HIV in last during the HIV test in
12 months last 12 months
Yes (%) No. of Yes (%) No. Yes (%) No. of Yes (%) No. of YP
YP of YP YP
Gender
Male 49.7 984 36.3 710 97.6 931 90.2 853
Female 53.7 1234 42.4 960 97.2 685 90 633
Age group
10-14 years 20.7 322 11.9 181 96.6 170 84.6 148
15-19 years 60.7 995 46.3 755 96.5 724 89.8 670
20-24 years 83.6 901 68.2 734 98.5 722 91.8 668
Residence
Urban 63.5 454 51.7 366 98.4 358 90.5 325
Rural 49.6 1764 37.1 1304 97.1 1258 90.0 1161
Schooling status
In school 41.2 1201 30.0 859 96.6 819 89.2 750
Out of school 74.9 1009 60.0 807 98.3 793 91.2 733
Marital status
Never married 54.7 1647 33.7 1196 97 1151 89.4 1052
Ever Married 85.2 569 70.9 98.3 463 91.9 432
Overall 51.9 2218 39.6 1670 97.4 1616 90.1 1486
In the last 12 months, only 2 in every 5 young people (39.6%, n=1670) had tested for HIV. Among
those that tested for HIV in the last 12 months, 97.4% received results of the HIV test and 90.1%
received counselling on HIV/AIDS (see table 26 above).
3.2.12 Child marriage, pregnancy, childbearing and abortion
a) Child marriage
According to the UN Convention on the Elimination of All Forms of Discrimination against
Women, formal marriage or informal union before the age of 18 years is considered child marriage.
Child marriage is a key cause of poor reproductive health outcomes, given its association with early
pregnancy, a major cause of complications during child birth. Figure 4 below shows the proportion
of participants in the survey by marital status. Child marriage disproportionately affects girls as
compared to boys. Only 5 of the 1,562 young people in the age-group 10-14 years had ever been
married. Although this this represents a very small percentage (0.3%), these young people still
represent a very vulnerable group. In the age-group 15-19, about 9.8% had ever been married. This
category as well represents a vulnerable group, having got married when they were still teenagers.
There is a wide disparity in the likelihood of ever being married between the sexes. In the
48
FINAL REPORT
vulnerable age-bracket (10-19 years), 15% of females have ever been/are currently married as
compared to only 4.4% of males.
Figure 4 : Proportion of young people by marital status

Never married Ever married
99.6
99.7
99.7
95.9
90.2
89.6
100.0
85.4
84.4
79.9
66.5
80.0
58.7
53.5
46.5
60.0
%
41.3
33.5
40.0
19.1
15.6
14.6
10.4
9.8
20.0 4.1
0.4
0.3
0.3
0.0
FEMALE MALE TOTAL FEMALE MALE TOTAL FEMALE MALE TOTAL FEMALE MALE TOTAL
10-14YRS 15-19YRS 20-24YRS OVERALL
Poverty has driven young girls into marriage so as to provide for themselves and parents a better
life. “When I dropped out of school because my parents could not afford school fees anymore, my parents forced me
to get married and I was only 13 years at that time and I ended up getting pregnant just one month after the
marriage.” Said a girl in an FGD for Girls 15-19 years Out of School in Gulu. Child marriage is also
still treasured with many cultures marrying off young girls and boys as long as they have reached
puberty and are showing signs such as development of breasts, menstrual periods, development
of beards for males, etc. “In some sections of the society here, a girl of 15 years is considered ready for marriage,
as long as she has started having her menstrual periods. This also means that she is ready for child bearing roles as
a wife.” Said a Women Leader in Arua.
 Age at first Marriage-The median age at first marriage for young people was 18 years. Males
(19 years) marry a year later than females (18 years). The median age at first marriage increased
with the level of education (refer to appendix 6.3l for detailed information by background characteristics)
b) Females who have ever been pregnant and those currently pregnant
Table 27 below shows among females that have ever had sex (n=913), the proportion of young
females aged 10-24 years that have ever been pregnant and those currently pregnant by the
different background characteristics. Overall 56% of the females that ever had sexual intercourse
were found to have ever been pregnant. The age group with the highest percentage of females
who have ever been pregnant was those aged 20-24 years (73.7%) as compared to the other age
groups. The highest prevalence of females who have ever been pregnant were in the rural areas
(59.9%), out of school (75.1%) and those who had ever been married (84.2%). The Northern
region (72.5%) followed by Karamoja region (65.2%) had the highest proportions of females ever
pregnant among those who ever had sexual intercourse.
Similar observations were noted among those currently pregnant (9.7%) by the different
background characteristics as seen in table 27 below. Discussions with young people and SRH
stakeholders revealed that pregnancy was common among adolescents due reasons such as the
recurrence of child marriages in the communities.
49
FINAL REPORT
Table 27: Among females that have ever had sex, proportion who have ever been pregnant and those
currently pregnant
Background characteristics
Ever pregnant Currently pregnant Total number of Young females that have
ever had sexual intercourse
No. % No. %
Age Group
10-14 years 3 9.4 0 0.0 32
15-19 years 145 37.5 31 8.0 387
20-24 years 364 73.7 58 11.7 494
Residence
Urban 68 39.5 12 7.0 172
Rural 444 59.9 77 10.4 741
Region
Central 1 68 58.6 16 13.8 116
Central 2 49 52.1 5 5.3 94
East Central 61 53.5 10 8.8 114
Eastern 70 58.3 15 12.5 120
Kampala 17 43.6 2 5.1 39
Karamoja 15 65.2 8 34.8 23
North 58 72.5 7 8.8 80
South West 71 58.2 12 9.8 122
West Nile 21 35.0 5 8.3 60
Western 82 56.6 9 6.2 145
Schooling status
In school 30 11.1 3 1.1 271
Out of school 479 75.1 85 13.3 638
Education level
No formal education 12 78.6 4 28.6 14
Primary 305 65.7 56 12.1 464
Secondary + 195 45.0 29 6.7 433
Marital status
Ever married 384 84.2 71 15.6 456
Never married 128 28.0 18 3.9 457
OVERALL 512 56.1 89.0 9.7 913
Parents of adolescents noted that some communities reinforce child marriage by marrying off
young girls and boys as soon as they have reached puberty and are showing signs such as
development of breasts, menstrual periods, and development of beards for males. Families do so
for monetary gain, especially if the child has dropped out of school. Quoting some discussants:
“In some sections of the Muslim society here, a girl of 15 years is considered ready for marriage as long as
she has started having her menstrual periods. This also means that she is ready for child bearing roles as a
wife.” Said a Women Leader in Arua.
“When I dropped out of school because my parents could not afford school fees anymore, my parents forced
me to get married and I was only 13 years at that time and I ended up getting pregnant just one month
after the marriage.” Said a girl in an FGD for young people aged 15-19 years in Gulu.
It was noted that cases of early or teenage pregnancy are often handled by the parents of both
parties agreeing to have their children married off. Cases of defilement or rape are also handled in
the same manner, resulting in propagation of child marriages. Parents of the affected female child
often use such opportunities to extort financial gain from the boy’s family. Quoting one discussant:
“I was raped at the age of 10 years by a shamba boy as I was working in the garden one time. 2 month after my
parents wondered what was wrong with me and later found out I was pregnant. My father sent me away for a while
50
FINAL REPORT
to stay with the boy and his parents and afterwards, they all agreed that we should get married.” Said a girl in an
FGD of girls aged 10-14 years in Lyantonde.
c) Child bearing
Overall (19.3%, n=444) of the females aged 10-24 years (n=2301) reported to have had a live birth.
About one in ten females aged 15-19 and two in five females aged 20-24 had a live birth. In
comparison with the UDHS 2011, there is a 10% and 15% reduction in the proportion of females
giving birth in age group 15-19 and 20-24 respectively. The mean age at the first birth for young
people was 18.2 years which is attributed to the fact that the majority of the females reporting to
ever having been pregnant fell within the age group of 20-24 years. The mean age at first birth
among females was 16.9 years among older adolescents (aged 15-19 years) and 18.64 years among
young adults (aged 20-24 years). The mean number of children ever born was 1.3 among the 15-
19 year olds and 1.74 among those aged 20-24 years. The findings are similar to the UDHS, which
indicated mean number of children ever born being 0.24 among 15-19 year olds and 1.6 among
those aged 20-24 years. This continues to signify early start in child bearing.
d) Females who have ever had an abortion

Out of the total number of females aged 10-24 years that have ever been pregnant (n=512), only
6% (n=33) have ever had an abortion. The likelihood of an abortion among females was higher
among those in urban areas and young people with schooling. On the other hand, 14% (n=30) of
the males that had ever made a woman pregnant (n=209) reported being aware of their partner
having carried out an abortion.
Discussions with young people aged 10-24 year across all regions revealed various factors that lead
them to seek abortion services. These factors included, fathers denying responsibly for the
pregnancy, some cases of conception as a result of rape and defilement community stigmatization
especially in cases of teenage pregnancy and conceiving out of wedlock, bringing shame to the
family, poverty for instance, some parents encourage their children to carry out abortions once
they discover the family of the boy/man’s family who impregnated their daughter is too poor to
support their daughter: However, young people’s demands for abortion services is not only driven
by the parents but also sexual partners, peers, members from the community, health workers and
also the young people themselves. The circumstances under which the young people are
encouraged to seek abortion services differ based on the factors mentioned.
“If a boy impregnates a girl and his family cannot afford to pay cows to the family of the girl, the girl is
usually made to abort the kid so the family does not make a loss.” FGD with Girls aged 15-19 years
in Moroto district.
Discussions with young people further revealed that the young people were aware of various
means and methods of carrying out abortions in their communities. For example; some
mentioned the use of herbs to induce an abortion such as leaves of “Muhoko shrub” in Mbarara
district, leaves of “Ennanda” in central Uganda, leaves of the Magadi tree and pawpaw roots in
Moroto district, taking aspirin, and taking anti-malarial drugs. Quoting some discussants:
“When a girl takes Enanda when they are below 3 months pregnant and then hide from everyone, the
pregnancy then disappears,” said Girls aged 20-25 years in Wakiso district, etc. “
Others cited very dangerous methods like the use of sharp sticks or metals:
Use of sharp hooked sticks to poke the uterus and pull the foetus out of the womb,” was a method
cited by girls aged 15-19 years in Moroto district.
51
FINAL REPORT
3.2.13 Alcohol and substance abuse
a) Prevalence of substance abuse

Substance abuse is a significant challenge faced by young people. Harmful use of narcotics,
nicotine and other psychoactive drugs can affect an individual’s risk for unwanted SRH outcomes.
An analysis of the prevalence of harmful substance use is presented in table 28 below. Overall, a
total of 243 (5.7%) out of the 4,287 young people participating in the survey reported to have ever
taken psychoactive drugs in their life. Prevalence of drug use was higher among males (8.3%) as
compared to females (5%). Young people in urban areas (10.3%), those out of school (8.9%) and
young people ever married (8.4%) were more likely to ever having used drugs. By region, drug use
was highest in Kampala (16.4%, n=33) and west Nile (15.9%, n=55) as compared to other regions.
Table 28: Percent of young people who have ever used psychoactive drugs and had sex under the influence
of drugs in last 12 months
Background Young people that have Among those that have ever used drugs, young Total number of
characteristics ever used drugs people who had sex under influence of drugs young people
No. % (Out of Total No. % (Out of those that ever
YP) used drugs )
Gender
Female 79 3.4 31 39.2 2301
Male 164 8.3 62 37.8 1986
Age group
10-14 24 1.5 3 12.5 1562
15-19 108 6.6 39 36.1 1647
20-24 111 10.3 51 45.9 1078
Residence
Urban 74 10.3 28 37.8 719
Rural 169 4.7 65 38.5 3568
Region
Central 1 17 3.3 6 35.3 508
Central 2 4 0.9 3 75.0 450
East Central 29 5.4 16 55.2 541
Eastern 16 3.0 4 25.0 532
Kampala 33 16.4 14 42.4 201
Karamoja 9 8.2 5 55.6 110
North 8 2.1 5 62.5 389
South West 31 4.6 8 25.8 679
West Nile 55 15.9 19 34.5 345
Western 41 7.7 13 31.7 532
Schooling status
In school 123 4.2 36 29.3 2925
Out of school 120 8.9 57 47.5 1349
Education level
Primary 121 4.5 43 35.5 2688
Secondary 115 7.5 47 40.9 1529
Marital status
Ever married 56 8.4 30 53.6 670
Never married 187 5.2 63 33.7 3617
Overall 243 5.7 93 38.3 4287
Young people pointed out that substance abuse was rampant, especially among boys aged 20-24
years. Common substances abused and mentioned included: marijuana or ‘weed’, ‘kuba’, cocaine,
cannabis, ‘crystal meth’, heroine, and sniffing of petroleum (especially jet fuel). In some cases,
prescription drugs such as pain killers are also abused. For example:
“……Young people these days take drugs like ‘kuba’ as a pass time which they get from shops in small
quantities like tot-packs and in hangout joints. Some of them are even folded like cigarettes” Said a
parent in Makindye division Kampala.
52
FINAL REPORT
“In Busia municipality here, we see many young people sniffing jet fuel at the border point. The jet fuel
comes from airstrips in Busia (Kenya) and is sold amongst the young boys in Sofia market. As young
people sometimes we feel we want to try out and see what the experience is like so we end up tasting and
using the jet fuel as well.” Boys aged 10-14 years in schools in Busia.
b) Sexual intercourse under the influence of drugs

Young people that had ever used drugs were asked if they had ever had sexual intercourse under
the influence of drugs. The findings revealed that 38.3% (n=93) of the young people who have
ever used drugs reported to have had sexual intercourse under their influence in the last 12 months
preceding the survey (see table 28 above). This points at the increased risk of contracting STIs and
HIV/AIDs as well as unwanted pregnancy among young people engaged in risky behavior. There
was no significant difference in gender and residence in the proportion that had sex under
influence of drugs.
c) Alcohol intake among adolescents and young people

Table 29 below shows the percentage of young people who reported to have ever taken alcohol
by background characteristics. The data indicates that 13% (n=558) of adolescents and young
adults had ever taken alcohol. Refer to Appendix 6.3m for detailed table on Alcohol intake among young
people by age group.
Table 29: Percent of young people who have ever taken alcohol and those that have had sex under its
influence
Background Young people that have ever Among those that have taken alcohol, young Total number of
characteristics taken alcohol people that had sex under influence of alcohol young people.
No. % (Out of Total No. % (Out of those that have ever
YP) taken alcohol)
Gender
Female 211 9.2 72 34.1 2301
Male 347 17.5 105 30.3 1986
Age group
10-14 62 4.0 8 12.9 1562
15-19 204 12.4 49 24.0 1647
20-24 292 27.1 120 41.1 1078
Residence
Urban 147 20.4 44 29.9 719
Rural 411 11.5 133 32.4 3568
Region
Central 1 61 12 21 34.4 508
Central 2 23 5.1 11 47.8 450
East Central 56 10.4 22 39.3 541
Eastern 42 7.9 17 40.5 532
Kampala 44 21.9 16 36.4 201
Karamoja 51 46.4 17 33.3 110
North 31 8.0 12 38.7 389
South West 110 16.2 22 20.0 679
West Nile 47 13.6 9 19.1 345
Western 93 17.5 30 32.3 532
Schooling status
In school 230 7.9 47 20.4 2925
Out of school 326 24.2 129 39.6 1349
Education level
Primary 270 10.0 82 30.4 2688
Secondary 265 17.3 85 32.1 1529
Marital status
Ever married 171 25.6 86 50.3 670
Never married 387 10.7 91 23.5 3617
Overall 558 13.0 177 31.7 4287
53
FINAL REPORT
Young people residing in the urban areas (20%) and those with no formal education (24.2%) were
more likely to take alcohol. Karamoja region had the highest proportion of young people taking
alcohol (46%) followed by Kampala (21.9%). In Karamoja region, the high levels of food insecurity
were reported to drive young people to taking alcohol as a meal:
“In Karamoja here, we do not have enough food, so during breakfast time and lunch parents give us alcohol
(local brew known as Kwete) as a meal.” Young boys aged 15-19 year out of school in Moroto district
in Karamoja.
Young people identified socio-cultural influences as contributing their own alcohol intake:
“In my culture, I was given alcohol right from when I was a child as part of initiating me into the clan. It is a
cultural norm. My parents and relatives also told me that alcohol is nutritious because it is made from millet
and yeast, so I also take it” said boys aged 10-14 years in school and boys 20-24 years out of
school in Katakwi district, Eastern region.
Young people also attributed alcohol abuse to academic stress, as well as peer pressure:
“During my PLE examinations, I did the first paper in the morning without drinking alcohol and it was
hard for me to write answers, but when I went home with my friend, we took three jags full of Kwete. When I
came back to sit for another paper in the afternoon, we found it easy and past it.” Young girls aged 15-19
years out of school in Moroto district, Karamoja sub region.
Others noted that urban day schooling was associated with exposure of children to bars, video
halls and other distractions as they walked to and from school. Some parents also noted that
some boarding schools do not adequately enforce rules against alcohol intake, resulting in
children escaping from school to engage in binge drinking. In Luwero, it was noted that some
young people start drinking as early as 15years. This is attributed to low cost spirits that are sold
in sachets. These sachets are very common, available in almost in all shops and are sold at 500shs
only. Quoting one young person:
“I personally use kitoko to clean my throat as I do voice training since I am a musician. Other age mates
of mine take it with an aim of treating flu and cough.” FGD of boys aged 15-19 years out of
school in Luwero district.
In some regions, parents also expressed concern over the rate at which young people (children)
are accessing and using alcohol due to the laxity in restrictions regarding sale of alcohol to
children by the law enforcers. For example:
“The young boys as early as 10 years drink alcohol, they do casual work on cocoa farms and coffee farms;
they use the wages they earn to buy alcohol at cheap prices in the evening from alcohol joints.” FGD with
Parents of young people in Kasese district.
d) Sex under the influence of alcohol

The study explored the proportion of young people having sex under the influence of alcohol in
the last 12 months preceding the survey (see table 29 above). 31.7% (n=177) of the young people
who had ever taken alcohol reported to have ever had sex under its influence. Sex under the
influence of alcohol was more prevalent among females (34.1%), those residing in the rural areas
(32.4%) and young people out of school (39.6%). By region, among the young people that had
ever taken alcohol, Central 2 (47.8%) followed by Eastern (40.5%) and East central region (39.3%)
had the highest proportions of young people who had sex under the influence of alcohol in the
last 12 months.
54
FINAL REPORT
3.2.14 Gender Based Violence (GBV)

a) Prevalence of Gender- Based Violence
Gender-Based Violence (GBV) is defined as any act that results in, or is likely to result in, physical,
sexual, or psychological harm or suffering among women, including threats of such acts and
coercion or arbitrary deprivations of liberty, whether occurring in public or in private life (United
Nations, 1993; United Nations 1995). Young people were asked if they had experienced any form
of GBV i.e. physical violence, sexual violence, emotional violence, forced/child marriage and FGM
among others in the 12 months preceding the survey. Table 30 below shows the prevalence of
GBV with close to half (46%) of the young people reporting having experienced any form of
violence. Young people aged 20-24 years reported the highest incidence of GBV at 56%. In
comparison with UDHS 2011, GBV among those aged 20-24 years and 15-19 years had reduced
by 8% and 5% respectively. This slight reduction in incidences of GBV can be attributed to the
various interventions made by Government and Human right activists.
Females (50%), those residing in the urban areas (50%), young people out of school (62%) and
those ever-married (74%) were more likely to have experienced any form of gender based violence
in the last 12 months. West Nile (59.6%), South western (59.3%) and East central region (59.4%)
had the highest proportions of young people reporting to have experienced any form of GBV.
Table 30: Prevalence of Gender Based Violence among young people in the last 12 months
Background Age Group in Years Overall proportion of young people who
characteristics experienced any form of GBV
10-14 years (%) 15-19 years (%) 20-24 years (%) 10-24 years (%) No. of Young People
Gender
Female 33.8 56.5 63.7 50.0 1,146
Male 31.8 47.5 48.3 42.0 831
Residence
Urban 39.1 49.4 61.9 50.3 361
Rural 31.8 53.0 54.6 45.5 1,616
Region
Central 1 25.9 32.8 45.3 33.4 172
Central 2 20.1 29.3 24.3 24.5 188
East Central 40.9 71.4 70.1 59.4 322
Eastern 45.6 51.8 69.9 55.3 294
Kampala 39.1 43.8 58.2 48.5 96
Karamoja 59.3 60.5 51.3 56.9 62
North 38.9 43.8 39.1 40.8 162
South West 36.9 72.9 69.0 59.3 396
Western 11.1 41.7 44.6 30.4 160
West Nile 42.3 67.2 90.7 59.6 205
Schooling Status
In School 31.9 45.3 46.3 38.6 1,124
Out Of School 53.4 70.9 58.4 62.4 840
Marital Status
Never Married 33.0 48.0 45.7 41.2 1,483
Ever Married 0.0 93.2 68.4 73.9 493
Overall 32.9 52.5 56.2 46.3 1,977
b) Forms of Gender- Based Violence experienced

The study findings revealed that GBV was rampant among the young people especially in the
form of physical abuse (35%), emotional abuse (24%), economic abuse (8%) and sexual abuse
(4.9%) as shown in table 31 below. Refer to Appendix 6.3nfor detailed table showing Violence experienced
by young people in the different forms by age group and gender.
55
FINAL REPORT
Table 31: Proportion of young people that experienced violence in the last 12 months, by type of GBV
experienced
Young people that experienced
Gender Based Violence (GBV) practices Violence by GBV form
Proportion (%) No. of YPs
a) Physical abuse (i.e. hitting, slapping, punching, choking, pushing, burning, 35.0 1501
attacked with a weapon e.g. knife, stick, panga, and other types of contact that result
in physical injury to the victim)
b) Emotional abuse (includes verbal abuse, humiliating the victim privately or 24.3 1040
publicly, controlling what the victim can and cannot do, withholding information from
the victim, deliberately doing something to make the victim feel diminished or
embarrassed, isolating the victim from friends and family, blackmailing,
degradation).
c) Economic abuse (involves preventing a spouse from resource acquisition, limiting 7.7 329
the amount of resources to use by the victim, or exploiting economic resources of the
victim).
d) Sexual abuse (Defilement or rape including marital rape) 4.9 210
e) Discrimination or denial of opportunities/services (e.g. education, 4.1 175
health, employment, property rights)
f) Forced marriage 2.8 120
g) Child marriage 2.8 119
h) Trafficking in persons (for Domestic work, baby-sitting, etc.) 3.6 154
i) Female Genital Mutilation (FGM) 0.5 23
j) Dowry violence 0.7 30
k) Denial of access to exercise and enjoy civil and political rights (e.g. 1.6 69
elections, voting, etc.)
Physical abuse was identified to occur mainly among young people who have ever been married.
Discussions with the young people unraveled several factors that were identified as being
responsible for the high occurrence of physical abuse among these young people: In some cultures,
domestic violence is considered as an acceptable way to express love for one’s spouse. In other
cultures, physical abuse is tolerated by the community and in-laws as a sign of dominance and
control by a husband of his home. Citing some discussants:
“A husband who beats you loves you. One who doesn’t beat you does not love you enough - in fact the wife
would wonder why you’re not being bothered enough in the marriage”. FGD Girls aged 20-24 years
out of school, Budaka district.
Some cases of physical abuse are attributed to alcoholism, with men as the main perpetrators:
“Men drink ajono ‘local brew’ all day long as the women work in the gardens and in the markets and
when the men return home drunk they beat their wives.” FGD with Boys aged 20-24 years out of
school in Katakwi district.
Other cases of physical abuse were identified to be resulting from early/child marriages in which
the young wife is not expected to confront the husband and is supposed to be submissive to him.
Given the circumstances under which under-age girls are forced to get married, either due to early
pregnancy, rape or defilement, the environment in the home becomes one of a timid young wife
who has no choice but to accept whatever the husband does to her.
Young people are also taken advantage of, due to prevailing socio-cultural practices. These
practices are very rampant in the Karamoja region:
56
FINAL REPORT
“My eventual husband came with his friends and grabbed me from the well and later took me to his home.
I lost my virginity and that is how my parents got cows from his family and we got married.. If you are not
got in this way, then you are not beautiful enough.” Said a girl in the FGD of girls aged 15-19 in
Kotido district.
Cases of marital rape were also identified to be resulting from the fact that men feel entitled to
their wives’ bodies since they paid sufficient amounts of dowry:
“The day I was discharged from hospital I went home and had to return to the health facility the next day
because I had removed my stitches….. my husband paid a lot of dowry for me so there is no way I could
say no to him.” Said a girl in an FGD aged 20-24 years out of school, Budaka district.
Economic abuse occurred mainly to families where the women were the bread winners. On
harvesting, the men take advantage of the income acquired through the sale of yields from the
farms and gardens. The men then retain the money acquired from the sale and leave the women
with little or no money to keep the household activities running between seasons of harvest.
“….we go through the entire rainy season planting our crops, while our husbands go out to the trading
centres to drink. Come harvest time, we sell our crops on the market days and once you reach home with
the money, you have to give your husband the money because he is already aware that you went to sell the
produce.” Said in an FGD of girls aged 20-24 years in Kapchorwa district.
Young people who justify Gender Based Violence for any reason
The survey explored key attitudes regarding GBV among young people. Respondents were asked
if they thought that there are any reasons when violence towards a partner is justified. Table 32
below summarizes key findings from the analysis.
Overall, 30% of respondents believed that there are some circumstances when violence towards a
partner is justified. This belief was slightly higher among those aged 15-19 years (34.3%) as
compared to other age-groups. The most frequently cited reasons/circumstances among those
aged 10-14years were delay to return home, failure to do household chores and arguing with the
partner (see appendix 6.3o) while those aged 15-19 cited arguing with the partner, going out without
informing the partner and delay to return home as circumstances that justify partner violence (see
appendix 6.3p). The oldest age group (20-24 years) also cited extra-marital affairs as a justifying
circumstance for gender-based violence ((see appendix 6.3q).
Young people also expressed various beliefs about GBV; beliefs centered around GBV being
acceptable as a sign of love by ones spouse or parent, superiority/authority of a man in a family,
necessary to keep girls and wives in line with societal values.
“… A woman may doubt how much her husband loves her if h never beats her. It is believed that a husband who
beats you loves you, one who never beats you never loves you enough” FGD boys 15-19 years out of school
in Budaka.
“Women are often beaten and economically abused, it men who are suppose o sell off produce even if it belongs to a
woman” FGD girls 15-19 years in school, Kasese
“Normally women provoke their husbands to beat them they tend to over demand form husbands and failure to
provide the woman begins to abuse the husband which results into beating and fighting to make her behave” FGD
with Boys 15-19 years out of school in Kayunga.
57
FINAL REPORT
Table 32: Percentage of young people with who justify partner violence, by age, gender, marital and
schooling status, and location
Proportion of young people that think SGBV is justified for any reason (%)
Background Characteristic Aged 10-14 years Aged 15-19 years Aged 20-24 years Aged 10-24 years
Number of Number of Number of Number of
% % % %
YP YP YP YP
Gender
Female 25.1 210 35.3 320 29.7 166 30.2 696
Male 20.4 148 31.4 233 39.2 204 29.5 585
Region
Kampala 14.3 7 21.9 16 27.8 22 22.4 45
Central 1 21.2 40 34.8 69 33.6 43 29.5 152
Central 2 36.8 64 36.6 60 42.7 44 38.1 168
East Central 29.8 62 43.9 100 54.2 58 40.5 220
Eastern 12.0 19 25.2 55 28.8 45 22.4 119
Karamoja 22.2 6 41.9 18 33.3 13 33.9 37
Northern 17.8 28 29.4 45 20.5 18 22.9 91
West Nile 36.5 57 44.4 60 42.6 23 40.6 140
Western 20.8 43 34.4 62 31.7 44 28.3 149
South Western 13.5 32 26.7 68 32.4 60 23.6 160
Residence
Urban 24.3 54 33.3 87 39.0 92 32.4 233
Rural 22.7 304 33.6 466 33.0 278 29.4 1048
Schooling status
In school 22.9 339 32.9 389 34.9 90 28.0 818
Out of school 23.0 17 35.4 163 34.2 278 34.0 458
Education
No formal education 16.7 4 22.2 4 38.1 8 25.4 16
Primary 22.5 323 33.0 276 32.4 137 27.3 736
Secondary+ 30.5 102 34.3 273 35.3 224 34.5 528
Marital status
Ever Married 20.0 1 38.3 62 33.9 170 34.9 233
Never married 22.9 357 33.1 491 34.7 200 29.0 1048
Overall 22.9 358 33.6 553 34.3 370 29.9 1281
58
FINAL REPORT
3.3 Vulnerability Mapping

3.3.1 Constructing Vulnerability Indices for the AYSRH study
The age range 10 to 24 years is a critical stage of human development during which young people
experience rapid social, physical, psychological, and emotional changes on the path from
childhood to adulthood. In this period of puberty, adolescence and experimentation, young people
are confronted with a need to make decisions that may make them face disproportionate risks and
distinctive vulnerabilities, most specifically with respect to their sexual and reproductive health
needs. Consequences from the vulnerabilities experienced (e.g. sexual and gender based violence,
teen pregnancy, child marriage, abortion, HIV/AIDS) play a crucial role and affect not only the
self-well-being of the individual, but also the well-being of the entire society in the immediate and
long term.
3.3.1.1 Review of relevant literature
A survey of composite indices on various development-related topics was funded by UNDP in
2008. In addition, additional indices of relevance to this research were published after the
completion of the 2008 UNDP survey. Table 33 shows an overview of the indices identified to be
of relevance to the AYSRH survey.
Table 33: Overview of indices relevant to the AYSRH survey

Index Author and Methodology
Relevance
Focus area
Early Save the Data are gathered for three indicators of risks associated with early
Motherhood Children: motherhood. Z-scores were created for each of the indicators and divided
Risk Prevalence and by the range of Z scores for each variable in order to control for
Ranking risk of early differences in the range of possible scores. These percentage scores were Medium
marriage / early then averaged to create the index scores. The indexed risk score was
childbearing calculated as a weighted average of early marriage (30 %), early
motherhood (40 %) and risk to children (30 %).
Mother’s Save the The index is based on a composite of separate indices for women’s and
Index Children: children’s well-being. The six indicators of women’s well-being are: 1.
Maternal health Lifetime risk of maternal mortality, 2. Percent of women using modern
and well-being contraception, 3. Percent of births attended by trained personnel, 4.
Percent of pregnant women with anemia, 5. Adult female literacy rate 6.
Low
Participation of women in national government. The four indicators of
children’s well-being are: 1. Infant mortality rate, 2. Gross primary
enrollment ratio, 3. Percent of population with access to safe water, 4.
Percent of children under age 5 suffering from moderate or severe
nutritional wasting.
Reproductive Population The index is composed of 10 indicators of reproductive health. The
Risk Index Action observed range for the indicators is transformed into a range of 0 to 100.
International: For 8 of the indicators, each country is located in the new range, giving
Reproductive the country at the top of the range for each indicator a score of 100 and
Medium
health the country at the bottom of the range a score of zero. Life time risk is
given a weight of two to reflect the importance of the two indicators from
which it is derived. The final composite index score is derived by dividing
the sum of the eight-scaled values and the two assigned scores by 10.
Vulnerable USAID: Girls’ Research identified a range of family, socia,- and structural-level factors
Girls’ Indices vulnerability to (over which adolescent girls have no control) that are statistically
Guide HIV associated with HIV infection. The Vulnerable Girls Index (VGI) is an
unweighted sum of the 12 component items, with a potential range of 0- High
14 and an actual range of 0-7. The index was created by assigning
respondents one point for each of the indicators mentioned above. Thus,
the higher the score, the more vulnerable the girl.
The UNICEF: Girls The first step was the development of a theoretical framework that could
Adolescent general serve as a basis for selecting and combining indicators into a composite
Girls vulnerability score. The framework was matched with the available data sources and
Vulnerability indicators and data prepared for index construction. Index construction High
Index involved decisions about the structure of the index (e.g., number of
dimensions and number and type of indicators per dimension), method of
normalization, and weighting scheme (e.g., equal or unequal).
59
FINAL REPORT
3.3.1.2 Methodology
A combination of several risk factors for young people (ages 10-24 years) are normally used to
form a composite index for specific vulnerabilities. To construct the composite indicators for
vulnerability areas of HIV/AIDS, teenage pregnancy, abortion, child marriage and sexual gender
based violence the vulnerability indices for the AYSRH survey, the following steps described in
table 34 below were followed1:
Table 34: Steps followed in AYSRH survey to conduct vulnerability analysis

Step Purpose
A. Theoretical framework  To get a clear understanding and definition of the
This provided the basis for the selection and combination of vulnerability area to be measured.
variables into meaningful composite vulnerability indicators under a  To structure the various sub-groups.
fitness-for-purpose principle. This involved search of related  To compile a list of selection criteria for the
literature and involvement of experts. Theory and data were used to underlying risk factors of different vulnerability
construct different composite indices. areas.
B. Data selection  To check the quality of the available indicators.
This was based on the analytical soundness, data availability, and  To understand the strengths and weaknesses of
relevance of the indicators to the vulnerability area being measured each selected indicator.
and relationship to each other. Use of proxy variables were  To create a summary table on data characteristics
considered when data are scarce (based on literature) of the different indicators
C. Normalization  To select and assign suitable indices through
This was carried out to render the variables comparable. Indicators procedure(s) that respect both the theoretical
with different measurement units were normalized to have the same framework and the data properties.
scale. For all the indices in the AYSRH study, the indicators/risk  To make scale adjustments, if necessary.
factors were dichotomized and coded as 0 for “no” and 1 for “yes.” 
Variables were standardized so that each contributed equally to the
overall summary statistic.
D. Aggregation  To select appropriate aggregation procedure(s) that
Once the structure of each vulnerability index was identified and respects both the theoretical framework and the
relevant risk factors selected, the scores per person were aggregated data properties.
(through summation method) to create a composite indicator.  To format data such that, if necessary, correlation
This was done taking into account the underlying theoretical issues among indicators can be accounted for.
framework, based on the reviewed literature, appropriateness and
relevancy to study objectives.
E. Statistical analysis  To profile performance of the indicator level so as
The actual data analysis takes place here. This was done to reveal the to reveal what is driving the composite indicator
prevalence of vulnerability across selected background results.
characteristics of respondents. This involved tabular and visual  To check for correlation and causality (if possible).
presentation of results. Proper attention was given to visualization of  To identify if the composite indicator results are
results as this can influence (or help to enhance) interpretability overly dominated by few indicators and to explain
the relative importance of the sub-components of
the composite indicator.
 To select the visualization technique which
communicates the most information.
 To present the composite indicator results in a
clear and accurate manner
Based on the steps discussed in Table 34 above, a survey of similar studies as presented in Table
33 and their adopted methodologies provided a benchmark for development of the composite
indices for the AYSRH survey. Specifically, we adopted the methodology used in the Vulnerable
Girls’ Indices’ Guide based on data from Botswana, Malawi and Mozambique2 whose relevance is
ranked as ‘high’ to this AYSRH study.
In the AYSRH survey, data was collected on a range of individual-, and family/peer network-level
factors over which young people aged 10-24 years may or may not have control (intended or
unintended) and which influence their opportunities, decisions and options. Based on literature,
factors that are hypothesized to be associated with selected vulnerability areas were identified and
these are discussed in Section 3.3.1.3. Therefore, for each of the vulnerability areas relevant to the
AYSRH study, a different composite vulnerability index was developed as an unweighted sum of
the identified risk factors. An index was created by assigning respondents a point (0 or 1) for each
of the corresponding risk factors, where 0 indicates that the risk factor is not associated with the
60
FINAL REPORT
vulnerability area and 1 indicates that the risk factor is associated. Thus, the higher the score, the
more vulnerable a respondent (young person) is to the identified vulnerability area. Table 35 shows
the different risk factors associated with the different vulnerability areas as identified by search of
the literature.
3.3.1.3 Drivers of AYSRH vulnerability

Drivers of vulnerability to HIV/AIDS: Adolescent girls and young women in Southern Africa
are uniquely vulnerable to HIV and have up to eight times more infection than their male peers.3
Factors influencing vulnerability to HIV in the Sub-Saharan African region include but are not
limited to: young women’s engagement in transactional relationships,4 high prevalence of inter-
generational relationships,5 few years of schooling, experience of food insecurity, and limited ability
to negotiate condom use given the gender-power dynamics.6 Gender inequality plays a role in
shaping the vulnerability of women.7 Strong evidence has also emerged on the relationship
between intimate partner violence and HIV.8 Other risk factors for HIV infection in young women
include early sexual debut (before 15 years of age) which provides more opportunities over time
for adolescents to be exposed to HIV, 9 and loss of a family member.10 Although the link between
wealth status and sexual behavior is not consistent, there is evidence that poor females are
vulnerable to infection because of earlier sexual debut and non-use of condoms.11 Basic
understanding of HIV and how it spreads is low among young people in the region. Although this
is a necessary component of prevention, it is not sufficient to change behavior and reduce risk.12
Drivers of vulnerability to teenage pregnancy: Teenage pregnancy is defined as a teenage girl,

usually within the ages of 13-19, becoming pregnant.13 Research has identified education and socio-
economic status as consistent determinants of teenage pregnancy in sub-Saharan African
countries. 14 Age is positively related to teenage pregnancies, with older adolescents being more
predisposed to pregnancies. In addition, lack of access to education opportunities (with non-
schooling and primary school level education increasing vulnerability), lack of access to sexuality
education and to information regarding contraceptives, as well as widespread poverty (particularly
low family income) predispose girls to teenage pregnancies. Studies have also show parents’ marital
status and parental instability (including parental separation / divorce in early childhood, father
absence and maternal role models of young single motherhood), exposure to family violence in
early childhood and to sexual abuse during adolescence, illicit drug use (ever or in pregnancy) and
idealization of the pregnancy as significant predictors of teenage pregnancy. 15,16,17,18,19,20 Additional
key factors as outlined by the adolescents themselves include peer pressure and social
environment-related factors like inappropriate forms of recreation, as well as lack of parental
guidance and counselling.21
Drivers of unsafe abortion: The World Health Organization defines unsafe abortion as a
procedure for terminating an unintended pregnancy carried out either by persons lacking the
necessary skills or in an environment that does not conform to minimal medical standards, or
both.22 The limited quantitative and qualitative evidence available for Sub-Saharan Africa suggests
that the most important reason why women have abortions in this region are socioeconomic
concerns, specifically, that young unmarried women perceive pregnancy as disrupting education
and employment. Other socioeconomic reasons from worldwide data include poverty,
unemployment, desire to provide schooling for existing children, and inability to afford to educate
any additional children.23 24 For adolescents who engage in a sexual relationship with an older man
because of financial need, this same need will most likely be their main reason for seeking an
abortion if an unintended pregnancy results.25 A second reason for abortion reported by women
in the region is to postpone or limit births (this might be due to their or their children’s health, or
to the desire of postponing first birth in societies where young unmarried mothers are ostracized).
Relationship problems with the husband or partner are also a cause of abortion in the region.
61
FINAL REPORT
Underlying this general reason are such specific ones as that the partner threatened to abandon
the woman if she gives birth, that the partner or the woman herself refuses to marry to legitimate
the birth, that a break-up is imminent for reasons other than the pregnancy, that the pregnancy
resulted from an extramarital relationship, that the husband or partner mistreated the woman
because of her pregnancy, or that the husband or partner simply does not want the child.26 A
woman's age is only moderately associated with why she seeks an abortion.27 28 However, a
woman's perception that she is too young or fearing that parents or others would object to the
pregnancy is a fairly common reason for having an abortion.29 More proximate causes of abortion
include poor access to, and utilization of, contraceptives as well as contraceptive failure.30 31 32
Drivers of vulnerability to child marriage: The term “child marriage” is used to describe a legal
or customary union between two people, of whom one or both spouses is below the age of
18.33Several factors affect the likelihood of occurrence of child marriage. These include the child
or adolescent’s gender, level of education (especially the post-primary and secondary level), the
wealth and location of the household in which he/she lives, as well as religion.34 Research indicates
a causal link between early marriage and domestic work, as household poverty often necessitates
children being overworked at home, which can encourage young girls to marry early to escape
harsh conditions.35 Child marriage is directly related to social norms that undervalue girls36 and to
the level of empowerment of girls themselves.37 In many male-dominated or patriarchal societies,
the marriage of girls is perceived as a necessary way of reinforcing existing norms.38 In several
societies in Africa, child marriage is also intimately connected with FGM, because the practice is a
requirement for marriage.39
Drivers of vulnerability to Gender Based Violence (GBV): GBV is a combination of several

factors that increase the risk of a woman experiencing violence. The ecological framework
developed by Heise40 distinguishes risk factors at four levels.41.Individual-level factors are
biological and personal history risk factors such as a low level of education, young age (early
marriage) and low-economic status/income. Exposure to sexual abuse and intra-parental violence
during childhood as well as a history of experiencing violence in previous intimate relationships
increases the likelihood of violence in future relationships. Pregnant women are also at high risk
of experiencing violence by an intimate partner. There is also a strong correlation between women
perceiving violence as acceptable behaviour and their exposure to intimate partner and sexual
violence. Relationship-level factors associated with an increased risk of intimate partner violence
include men having multiple partners, partnerships with low marital satisfaction and continuous
disagreements, as well as disparities in education status between the partners. Community-level
factors refer to the extent of tolerance towards GBV in contexts where social relationships are
embedded. The existence of community sanctions against violence, and access for women to
shelter or family support result in the lowest levels of GBV. Women living in poverty are
disproportionately affected by GBV. Society-level factors include the cultural and social norms
that shape gender roles and the unequal distribution of power between women and men. Social
breakdown due to conflicts or disasters further increase the risk of rape in conflict and post-
conflict situations.
4.3.1.4 Selection of indicators

The selection of indicators for the five vulnerability areas of interest was based on their analytical
soundness, measurability and data availability. Proxy variables were selected when relevant data
was scarce. In table 35 below is an overview of the indices relevant to the AYSRH survey.
62
FINAL REPORT
Table 35: Overview of indices relevant to the AYSRH survey

Indicator Proxy indicator
HIV/AIDS
availability
Pregnancy
Marriage
Abortion
Teenage
SGBV
Child
Data
Self-reported poverty ● ● ● ● ● - Self-reported
poverty
Unemployment ● ✓
Self-reported food insecurity ● - Self-reported
food insecurity
Never attended school ● ● ● ● ✓
Not currently in school ● ● ● ✓
Sexually active and currently in school ● ✓
Orphan (Maternal, paternal or dual) ● - ✓
Sexually active and unmarried ● ✓
Marriage before 18 years ● ● ✓
Pregnancy (ever/currently) ● ✓
Sexual debut before 15 years ● ● ● ● ● ✓
Transactional sex relationships ● ● ✓
Intergenerational sex relationships (age ● ● ● ● ● ✓
difference is 10 years/ above)
Sex with non-regular partners ● ● ✓
Sex with multiple partners other than the ● ● ● ✓
spouse/regular partner
Inability to negotiate safe sex ● ● ✓
Lack of parental guidance about body and ● ✓
body changes
No access to sexuality education ● - Self-reported lack
of SRH
knowledge
Lack of knowledge of FP information ● ● - Self-reported
knowledge of FP
methods
No utilization of contraception (<20yrs) ● ● ✓
No basic understanding of HIV (i.e never ● ✓
heard of HIV)
No comprehensive HIV knowledge ● ✓
Sex under drugs ● ● ✓
Sex under alcohol influence ● ● ✓
GBV by partner or in childhood ● ● ● - Self-reported
SGBV
Acceptance of GBV ● ● ✓
Female Genital Mutilation (FGM) ● ✓
Potential Score Range 0 - 16 0 - 14 0 - 12 0-7 0-8
3.3.2 Actual scores across vulnerability areas

Table 36 below shows actual scores by background characteristics for the different vulnerability
areas assessed in the AYSRH study5. The actual score ranges were 0 – 12 of 16, 0 – 10 of 14, 0 –
10 of 12, 0 – 5 of 7 and 0 – 7 of 8 respectively for HIV, teen pregnancy, abortion, child marriage
and SGBV. Generally the distribution of aggregated scores was skewed to the right for all
vulnerability areas. This can also be observed from the histograms in Figure 5. This implies that
across all the assessed vulnerability areas, most respondents tended to have scores on 1 – 3 risk
factors6. As such, and although open for discussion, the fact that most respondents (>55%) scored
on at least one risk factors for each vulnerability indicator, implication is that most respondents
5 Potential would be the highest that should have been scored if an individual scored a “YES” on all risk factors that
define each indicator. Actual, is what was actually scored (sum of all the YES).
6 The fact that almost each respondent scored on 1-3 risk factors for each vulnerability indicator simply implies that
most respondents were vulnerable to the identified indicators.
63
FINAL REPORT
were vulnerable to the identified indicators because one does not have to score on all risk factors
to be considered vulnerable.
Table 36: Actual score ranges and frequencies (n = 4,287)

Actual HIV Teen Pregnancy Abortion Child Marriage GBV
Scores Freq % Freq % Freq % Freq % Freq %
0 666 15.54 419 9.77 877 20.46 1,657 38.65 1,916 44.69
1 1,120 26.13 1,005 23.44 1,410 32.89 1,518 35.41 1,372 32.00
2 891 20.78 1,112 25.94 889 20.74 778 18.15 642 14.98
3 673 15.7 920 21.46 453 10.57 274 6.39 244 5.69
4 435 10.15 528 12.32 348 8.12 54 1.26 80 1.87
5 268 6.25 203 4.74 178 4.15 6 0.14 28 0.65
6 124 2.89 69 1.61 90 2.10 4 0.09
7 69 1.61 22 0.51 37 0.86 1 0.02
8 29 0.68 6 0.14 3 0.07
9 9 0.21 1 0.02 1 0.02
10 2 0.05 2 0.05 1 0.02
11 0 0.00
12 1 0.02
Figure 5 : Histogram of scores of the vulnerability areas
40
25
25
HIV/AIDS Teen Pregnancy

Abortion
20
20
30
Percent
Percent
Percent
15
15
20
10
10
10
5
5
0
0 5 10 15 0 2 4 6 8 10 0 2 4 6 8 10
Scores Scores Scores
40
50
Child Marriage SGBV

40
30
30
Percent
Percent
20
20
10
10
0
0 2 4 6 0 2 4 6 8
Scores Scores
Mean vulnerability scores: The skewed distribution of the aggregated scores in Figure 5 ideally
indicates that the most reasonable summary statistic for these data should be the median. However,
we are interested in making inference about the population mean, for which the sample mean is at
least an unbiased estimator. Use of the median value, which is not an estimator for the population
mean, would lead to biased inferences, in this situation. Therefore, mean scores were computed
by background characteristics as given in Table 37 below.
64
FINAL REPORT
Table 37: Mean vulnerability indices by background characteristics

Back ground Vulnerabilities
characteristic Number
HIV Teen Pregnancy Abortion Child Marriage GBV
Gender
Female 2.29 2.30 1.76 1.01 1.03 2301
Male 2.17 2.25 1.82 0.91 0.76 1986
Residence
Urban 3.08 1.92 1.86 0.93 0.85 719
Rural 2.06 2.35 1.78 0.97 0.92 3568
Age group
10 - 14 1.33 2.10 1.20 0.45 0.41 1562
15 - 19 2.28 2.17 2.11 1.04 0.99 1647
20 - 24 3.48 2.68 2.16 1.60 1.49 1078
Region
Central 1 2.05 2.00 1.64 0.88 0.84 508
Central 2 2.15 2.37 1.77 1.04 1.00 450
East Central 2.57 2.67 2.09 1.24 1.20 541
Eastern 1.92 2.35 1.74 0.82 0.78 532
Kampala 3.00 1.73 1.58 0.85 0.71 201
Karamoja 2.88 2.94 1.55 1.36 1.19 110
North 1.78 2.12 1.52 0.79 0.72 389
South West 2.31 2.28 1.86 0.95 0.83 679
West Nile 2.50 2.39 2.30 1.00 0.95 345
Western 2.09 2.10 1.60 0.94 0.93 532
Religion
Catholic 2.19 2.29 1.79 0.96 0.90 1559
Protestant 2.22 2.26 1.76 0.94 0.87 1530
Pentecostal 2.32 2.27 1.72 1.02 0.96 416
SDA 2.24 2.26 1.68 1.00 0.93 103
Moslem 2.35 2.29 1.93 1.03 0.99 638
Other 1.82 2.15 1.73 0.76 0.64 33
Overall 2.23 2.28 1.79 0.97 0.90 4287
Overall, the mean vulnerability score to HIV was 2.23 (min=0, max=12), teen pregnancy (𝑥̅ =
2.28, min=0, max=10), abortion (𝑥̅ = 1.79, min=0, max=10), child marriage (𝑥̅ = 0.97, min=0,
max=5), and sexual gender based violence, GBV, (𝑥̅ = 0.90, min=0, max=7). Generally, higher
mean vulnerability scores across all the assessed vulnerability areas were found to be among
females, those residing in rural areas, respondents aged 20 -24 years, those from Karamoja and
East central regions. On the other hand, mean scores across religions were generally similar for
the assessed vulnerability areas.
3.3.3 Prevalence of vulnerability

Prevalence was defined as having at least one score on all risk factors identified as being negatively
associated with the respective vulnerability area. The overall prevalence of vulnerability to teen
pregnancy was about 90% followed by HIV/AIDS with 85%, abortion 80%, child marriage 61%
and the least GBV with 55% as shown in table 38 below.
65
FINAL REPORT
Table 38: Prevalence of vulnerability by background characteristics

Background characteristic Vulnerabilities (%)
Number
HIV Teen Pregnancy Abortion Child Marriage GBV
Gender
Female 84.5 89.0 80.3 62.9 58.4 2301
Male 84.4 91.6 78.7 59.6 51.7 1986
Residence
Urban 100 84.6 77.6 61.6 55.2 719
Rural 81.3 91.4 79.9 61.3 55.3 3568
Age group
10 - 14 74.8 90.3 73.5 36.0 34.1 1562
15 - 19 85.3 87.1 79.4 66.7 60.6 1647
20 - 24 97.2 94.9 88.5 90.0 78.0 1078
Region
Central 1 80.3 88.0 75.0 56.5 51.2 508
Central 2 89.3 94.2 84.0 68.2 66.4 450
East Central 88.0 93.0 85.0 70.2 66.4 541
Eastern 81.4 91.9 83.8 53.6 47.7 532
Kampala 100 78.6 71.6 58.2 48.8 201
Karamoja 89.1 92.7 80.9 71.8 62.7 110
North 80.5 90.5 76.3 56.8 47.8 389
South West 83.5 91.0 77.5 60.4 50.5 679
West Nile 89.6 91.3 86.1 63.5 60.9 345
Western 77.8 86.5 73.7 61.1 55.1 532
Religion
Catholic 83.2 90.2 79.9 61.5 55.2 1559
Protestant 83.7 90.7 78.2 59.8 53.3 1530
Pentecostal 89.4 90.4 80.5 64.9 58.4 416
SDA 80.6 87.4 77.7 57.3 55.3 103
Moslem 87.5 89.0 81.3 63.5 59.1 638
Other 75.8 97.0 78.8 57.6 48.5 33
Overall 84.5 90.2 79.5 61.3 55.3 4287
3.3.4 Vulnerability to HIV/AIDS

From Table 38 above, it can be noted that there is no difference in the prevalence of vulnerability
to HIV/AIDS between males and females. However, young people residing in urban areas had
the highest prevalence (100%) as well as those aged 20 – 24 years old (97%). For regional
comparisons, Central 2, East Central, Kampala, Karamoja, West Nile had higher prevalence
(≥88%) when compared to other regions such as Western region (78%). Furthermore,
vulnerability to HIV/AIDS was highest among Muslims (88%) and Pentecostals (89%) as
compared to all other religions.
3.3.5 Vulnerability to teenage pregnancy

Male teenagers had a slightly higher prevalence of vulnerability to impregnating a female (92%)
when compared to the prevalence of vulnerability to pregnancy by females (89%). In terms of
residence, young people living in rural areas had a higher prevalence to teen pregnancy (91%) when
compared to their counterparts in urban areas (85%) as shown in table 36 above. Based on the
evaluated risk factors/indicators, about 95% of young people aged 20-24 years had been vulnerable
to teen pregnancy, perhaps during their teenage years. Interestingly, young people aged 10-14
years had a higher prevalence of vulnerability to teen pregnancy (90%) when compared to that of
counterparts aged 15-19 years (87%). With the exception of Kampala (79%), all other regions had
prevalence of vulnerability area above 85% with Central 2 being the highest region at 94%. There
seem to be no major disparities in the teen pregnancy prevalence for the different religions.
3.3.6 Vulnerability to abortion

As seen from table 38 above, there are relatively small differences in prevalence of vulnerability to
participate, encourage or engage in abortion by gender and residence. Among age groups,
prevalence was highest among young people aged 20-24 years (88%), followed by 79% for those
66
FINAL REPORT
15-19 years and 74% for 10-14 year olds. Regional prevalence was high especially in Central 2, East
Central, Eastern, Karamoja and West Nile (≥80%) while this was least in Kampala at 72%.
3.3.7 Vulnerability to child marriage

Overall (see Table 38), the prevalence of vulnerability to child marriage was generally moderate at
61%. However, it was highest among girls (63%) when compared to males (60%) and highest
among those aged 20 – 24 years (90%) but this is not unexpected. There were no significant
differences in prevalence by residence. Karamoja, East Central and Central 2 regions clearly stood
out as having a higher prevalence of vulnerability to child marriage at about 70%. Although not
much disparity across the different religions, the prevalence of vulnerability to child marriage
among Moslems and Pentecostals was higher (about 60% versus about 65%).
3.3.8 Vulnerability to Gender Based Violence (GBV)

Results in Table 38 show that as expected, the prevalence of vulnerability to GBV was highest
among females (58%) as compared to males (52%). It was also more than double among those
aged 20 – 24 years (78%) when compared to those aged 10 – 14 years. This could perhaps be
attributed to the fact older people may be better placed to identify a GBV behavior and perhaps
because they are/have been involved in intimate relations more than the young people. There seem
to be no differences between rural and urban prevalence as well that of the different religious
groupings. Among regions, Karamoja (63%), East Central (66%), Central 2 (66%) and West Nile
(61%) had a higher prevalence of vulnerability to GBV when compared to other regions where
prevalence is about 50%.
3.3.9 Correlations among the vulnerability areas

As observed in the scatter matrix (Figure 6 below), there is a strong positive correlation between
vulnerability to HIV and teen pregnancy (𝑟 = 0.65), abortion (𝑟 = 0.65), child marriage (𝑟 =
0.70) and SGBV (𝑟 = 0.68). This implies that young people who are vulnerable to HIV/AIDS
are equally strongly likely to be exposed to the other four vulnerability areas. Teen pregnancy is
moderately positively correlated with abortion (𝑟 = 0.54), child marriage (𝑟 = 0.56) and GBV
(𝑟 = 0.51). Similarly, abortion is moderately positively correlated with child marriage (𝑟 = 0.50)
and GBV (𝑟 = 0.56). However, there is a very strong positive correlation between child marriage
and GBV (𝑟 = 0.88) as expected.
Figure 6: Scatter plot of scores of the vulnerability areas
67
FINAL REPORT
3.4. Services Availability and Utilization

3.4.1 Health facility based youth programming
3.4.1.1 Range of services offered in health facilities
Table 39 below shows the availability of the different components of SRH services in the sampled
facilities assessed, by level of facility (i.e. Regional Referral Hospital (RRH), General Hospital, Health
Center IV and Health Center III). Only half of the 12 components of the SRH package were nearly
available in all of the health facilities assessed. Over 95% of the Health facilities offered HIV
counselling, Pregnancy testing & antenatal, Tetanus Toxoid (TT) and Family Planning services.
“TT vaccination is done during child days (in October) as well as at the beginning of the financial year” key
informant Kabarole district. Less than 50 percent of HCIIIs provided safe male circumcision
(30.2%), cervical cancer screening (30.8%), and breast cancer screening (41.5%). SMC was done
by clinical officers specifically trained to provide SMC and with support from partners. The HCIIIs
and HCIVs only did physical examination for cancer of the breast and cervix because they did not
have the equipment and expertise to screen for cancers. At HCIIIs, mental health services,
counselling on drugs and alcohol abuse, rehabilitation and psycho-social support, and education
(for young people) were provided. At some HCIIs, there was inadequate staffing and skills to
provide psycho-social support and metal health specifically to young people. Only 60.4% of HCIIs
provided mental health services to young people (Table 39 below).
Table 39: Range of SRH Services offered in health facilities

Range of SRH Services RRH General Hospital HCIV HCIII Overall
(%) (%) (%) (%) (%)
Counselling on sexual violence and abuse (and referral for 100 78.3 92.7 96.2 99.1
needed services)
STI diagnosis and management. 100 100 100 98.1 99.2
HIV counselling (and referral for testing and care). 100 100 100 100 100
Pregnancy testing and antenatal and postnatal care 100 100 100 100 100
including EMTCT, and malaria in pregnancy prevention.
Family Planning with an emphasis on dual protection. 80 91.3 100 94.3 94.5
Tetanus Toxoid (TT) vaccination (for female young people). 100 100 95.1 100 98.4
Human Papilloma Virus (HPV vaccination). 80 60.9 56.1 47.1 55.2
Post-abortion counselling and contraception (with referral for 100 91.3 95.1 92.3 93.7
management of emergency complications when necessary).
Mental health, drugs and alcohol abuse, rehabilitation and 100 95.7 85.4 60.4 78
psycho-social support, counselling, and education
Safe Male Circumcision (SMC) 100 90 75.6 30.2 61.1
Cervical cancer screening 100 87 58.5 30.8 55.6
Breast cancer screening 100 72.7 68.3 41.5 60.3
In November 2015, the Ministry of Health introduced the Human Papilloma Virus (HPV) vaccine
into the routine immunization programme which is slowly being integrated into various district
programs with preliminary activities such as training health workers and sensitization of the
community being done.
“Training of health workers to provide HPV was integrated with the mass measles and polio immunization
campaign.” Key informant (DHT) in Busia district.
“HPV vaccination was done in schools amongst eligible girls aged 10 years most of whom were in primary four.
Girls below and above 10 years benefited from the health talks by the district health team.” Key informant in
Rakai district.
Provision of the above range of SRH services was complemented/supported by several partners
(refer to section 3.5.1 for details on partners) working closely with the district health office and
other district departments (education, community based/gender development, district
administration, etc.). Refer to section 3.2.5 in this report.
68
FINAL REPORT
3.4.1.2 Availability of AYSRH clinics in health facilities

About 71% of the surveyed health facilities did not have an AYSRH corner/clinic7 (see table 40
below). This is an indication that many of the young people who seek AYSRH services are attended
to in the same environment as the adult clients in health facilities. Regional hospitals (50%) and
district hospitals (44%) were more likely to have AYSRH clinics followed by HCIVs with one third
of the facilities surveyed having an AYSRH clinic. HCIII were the least likely to have an AYSRH
clinic (17%). Examples of districts that have established to establish Youth Friendly corners/
clinics providing AYSRH services with support from SRH partners .include Katakwi district
(Katakwi hospital, Toroma HC IV and two other youth corners in schools), in Kanungu district
(Kambuga Hospital & Kanungu HCIV), Kabale (Kabale referral hospital), Mukono district
(Mukono HC IV), Luwero district (Luwero HC IV), Mubende (CMRC HC IV), Wakiso district
(Nsangi HC III), Kampala district (Mengo hospital, Kisenyi HC IV and Komamboga HC III),
Rakai district (Kalisizo Hospital) among others. These youth corners conduct health talks, peer to
peer counselling as well as HIV testing and counselling among others.
Some of the surveyed facilities in the urban centers provided SRH services only to HIV positive
adolescents for example Kilembe Mines hospital in Kasese district and Hoima Regional Referral
hospital had an ART clinic specifically for HIV positive young people, supported mainly Baylor
Uganda. The ART clinic run once every month.
Clinic days, duration and waiting time: Table 40 below also shows the structural and process
related characteristics of the surveyed clinics that impacted on perceived quality: Among the 37
facilities with AYSRH clinics surveyed, the median AYSRH clinic days per week was 3 days. Health
centers at level III tended to operate fewer clinic days per week (median of 1 clinic day) than higher
level clinics.
“At health Centre IV, these clinics are normally operated in the evening starting from 5pm during school days to
ensure that students can easily get services after coming back from schools, and also even in the holidays we assume
learners first do some domestic work and then come for the different services at the health Centre” Key Informant
Luwero district
“We have an adolescent clinic every last Thursday of month whereby we only attend to adolescents;” Key informant
Kabarole district.
The median duration of AYSRH clinics was 8 hours per day, but ranged from 1 to 10 hours. The
AYSRH clinics received a median of 20 clients per day, but with a wide range (1 to 150 clients).
Overall, the median waiting time was 30 minutes at the AYSRH clinic. Turn up of young people
in some of these centers was noted to be low due to the lack of edutainment which usually attracts
them:
“Turn up has become low due to lack of activities and incentives to motivate youths to come to the Youth Corner,
for example debates and football games.” Peer educator in Katakwi.
7
AYSRH corner/ Clinic implied the health facility had a space/room for privacy to meet young people, separate
clinic days for young people, provided the wide range of SRH services and had a trained AYSRH health worker.
69
FINAL REPORT
Table 40: AYSRH clinic days, hour run per day, number of clients and waiting time
Background AYSRH Clinic days per Hours AYSRH Clients per day Waiting time in
characteristic clinic week clinic run per day Median (Range) minutes Median
available (%) Median (Range) Median (Range) (Range)
Facility level
RRH 50.0 5 (5-7) 8 (8-9) 39 (20-100) 35 (10-60)
District/General 43.5 1(1-5) 8 (4-9) 35 (5-80) 30 (18-90)
Hospital
HCIV 31.7 2.5(1-6) 9 (1-10) 15 (1-150) 30 (5-90)
HCIII 17.0 1(1-7) 8 (4-10) 10 (4-50) 15 (3-30)
Overall 29.1 2.5(1-7) 8 (1-10) 20 (1-150) 30 (3-90)
Ownership of HF
Government 28.4 3(1-7) 8 (1-10) 19 (1-150) 30 (3-90)
PNFP 36.4 1(1-5) 9 (8-10) 50 (30-90) 47.5 (5-90)
Overall 29.1 2.5 (1-7) 8 (1-10) 20 (1-150) 30 (3-90)
3.4.1.3 Availability of modern contraceptives and supplies related to SRH services

Table 41 below shows that at the time of the survey, most health facilities had availability of male
condoms (87.1%), injectables (89.4%), oral contraception pills (58.9%), implants (58.1%), and
IUD (52.9%), ARVs (89.6%), and PEP (81.6%). Most health facilities (53.2%) experienced
stockouts of Emergency Contraception Pill in the last three months preceding this study. About
30% of health facilities had a stockout of male condoms in the last 3 months whereas about 10%
experienced stockouts of injectable contraceptives. Oral contraceptive pills went out of stock in
45% of the health facilities. Overall, majority (85.8%) mentioned that one or more of the
contraceptive methods offered by the health facility was out-of- stock at least once in the last three
months preceding the survey.
Table 41: Stock-outs of commodities and supplies related to SRH services in the past 3 months
ITEM/Commodities and supplies related to Yes, Available Yes HF had Yes Expired
SRH services in the past 3 months Now/at the time Stock-Outs in last in last 3
of the survey (%) 3 months (%) months (%)
Male condoms 87.1 29.75 5.45
Female Condoms 40.32 24.64 10.17
Oral Contraception pills 58.87 45.25 11.83
Emergency contraception. 40.32 53.19 9.59
Injectables. 89.43 9.82 3.09
Implants. 58.06 27.78 2.82
Intra Uterine Device (IUD) 52.85 19.75 6.56
Diaphragm 8.06 23.81 14.29
Contraceptive Jelly/Foam/Cream 4.84 31.58 9.09
Supplies for female sterilization (Tubaligation). 21.95 12.9 4.55
Supplies for male sterilization (Vasectomy). 20.33 14.29 4.76
ARVs. 89.6 16.07 16
Post Exposure Prophylaxis (PEP). 81.6 11.76 4.6
Provision of IEC materials in health facilities. Although some districts and NGO partners
have produced their own IEC materials, most of the materials found in health facilities came from
the Ministry of Health. The availability and range of IEC materials in English and the local
languages varied from district to district.
“IEC materials and use of models are the main mode of teaching because the youth understand
information better with pictorials.” In-charge of the youth corner at HC IV in Mubende.
“IEC materials are provided by Raising Voices and we also get PIASCY handbooks to use for giving
sexuality education.” Key Informant in Butaleja.
70
FINAL REPORT
3.4.2 Access to SRH services in Health facilities

3.4.2.1 Distance to the nearest health facility
The overall average distance to the nearest health facility was about 2 km from the respondents’
places of residence. The average distance to facilities was longest in Central 1 region (an average
of 5 km) and shortest in the Eastern region (1 km). It was also shorter in the urban areas (an
average of 1 km) compared to the rural areas (an average of 3 km). (refer to appendix 6.3r for details).
3.4.2.2 Ownership and distance to the nearest health facility

Ownership of the most accessed facilities: Facility ownership is one of the factors likely to
influence availability and access to services for young people. Public facilities do not routinely
charge user fees while private facilities (including private not for profit) will charge a user fee for
both prevention and treatment services. Overall, government health facilities were the most
frequently accessed facilities by young people at 82%. Private health facilities followed (12%) while
Private-Not-For-Profit (PNFP) health facilities were the least accessed (5%). In Karamoja region,
100% of facilities accessed by young people surveyed are public facilities, followed by the South
Western region (97%), West Nile (94%), East Central (93%), Eastern (91%) and Northern (90%).
On the other hand, access to public facilities was lowest in Central I (47.9%) and Kampala (45.6%).
Conversely, access to private facilities was highest in Central I (41%) and Kampala (38%) (refer to
appendix 6.3s for details).
Types and level of facilities: Table 42 below presents key findings on the distribution of the
levels of facilities that are most accessed by young people.
Table 42: Percentage distribution of the Type/ level of health facility accessible to Young people by background
characteristic
Background characteristics Referral General Health Health Health Others i.e. private
Hospital Hospital Centre IV Centre III Centre II clinics, traditional
(RRH) % (%) (HCIV) % (HC III) % (HC II) % healers (%)
Gender Male 6.3 5.8 10.5 44.8 29 3.7
Female 6.1 5.2 10.7 44.4 30.4 3.2
Age group 10-14 6.7 4.9 11 45 28.1 4.4
15-19 5.4 5.7 10.4 45 30.3 3.2
20-24 6.7 6 10.3 43.5 31 2.4
Region Central 1 4.2 3 26.1 32.7 25.5 8.5
Central 2 5.7 2.9 8.8 67.3 12.6 2.7
East Central 1.1 9.6 8.1 30.4 48.4 2.4
Eastern 3.6 5.3 24.2 52.3 12.4 2.3
Kampala 5.1 15.3 11.7 22.4 41.8 3.6
Karamoja 11.8 0.9 0.9 43.6 42.7 0
North 8.3 1.8 7.2 32.6 47.8 2.3
South West 5 0.7 2.4 51.3 38.7 1.9
Western 22.4 6.7 6.7 38.7 18.3 7.3
West Nile 5.1 11.5 3.2 56.2 21.6 2.4
Residence Urban 26.1 17 11.2 18.2 19.6 7.9
Rural 2.2 3.2 10.5 49.9 31.7 2.6
Schooling In school 6.7 5.7 10.9 44 28.7 4.1
status Out of school 5.1 5.1 9.9 45.8 32 2.2
Education
No formal 0 1.6 4.8 65.1 23.8 4.8
Primary 5.5 4.5 10.6 46.3 29.7 3.5
Secondary+ 7.8 7.5 10.9 40.8 29.8 3.3
Marital Ever married 4.1 4.7 9.9 46.2 32.9 2.3
Status Never married 6.6 5.7 10.7 44.3 29 3.7
Overall 6.2 5.5 10.6 44.6 29.7 3.5
71
FINAL REPORT
The most accessible health centers were the HCIIIs (named by 45% of respondents) followed by
HCIIs (30% of respondents) and HCIVs (11%). Central 2 had the highest proportion of young
people indicating HCIII as being closest to their place of residence (67%). Other levels of health
centers were not as accessible to participants in terms of distance.
3.4.2.3 Sources of SRH services

HIV testing services: The distribution of the types of health facility where young people obtain
HIV testing services is summarized in table 43 below. Health centers were the most frequent
source of HIV testing services (53%) followed by hospitals (24%). In Karamoja region however,
hospitals are responsible for the bulk of HIV testing services (55%). Young people with no formal
education were much more likely to use health centers for HIV testing (79%) than those with
some formal education. In terms of accessing HIV testing services, about 72% of young people
believe that they can access HIV testing with ease. The perceived ease of accessing HIV testing
services was equal among males and females. It was highest in Kampala region (89%) and lowest
in East Central region (63%). It was also higher in the urban areas (84%) than in the rural areas
(70.2%), higher among out of school youth (84%) than among in-school youth (67%). A
significantly larger proportion of young people aged 20-24 and 15-19 years said they could access
HIV testing services (89% and 80% respectively), compared to the younger adolescents aged 10-
14 years (51%).
Table 43: Sources of HIV testing services

Characteristic Hospital Health Private Community School Others No. of
(%) Centre (%) clinic (%) outreach (%) outreach (%) (%) YPs
Gender
Male 26.3 51.4 8.0 5.6 8.2 0.4 957
Female 21.2 54 8.9 9.0 6.6 0.3 711
Age groups
10-14 24.5 47.8 2.2 9.8 15.8 0 184
15-19 22.6 53.8 7.2 5.9 10.3 0.3 751
20-24 25.6 52.4 11.2 7.6 2.6 0.5 733
Region
Central 1 35 33 14.8 9.9 7.4 0.0 203
Central 2 14.9 55.4 14.9 3.0 11.9 0.0 168
East Central 38.8 37.6 3.0 11.5 9.1 0.0 165
Eastern 16.3 64.9 3.0 7.9 7.4 0.5 202
Kampala 33 35.7 14.8 11.3 3.5 1.7 115
Karamoja 55.3 42.1 0.0 2.6 0.0 0.0 38
North 7.6 73.7 5.3 9.4 2.9 1.2 171
South West 10.9 65.8 6.4 6.4 10.5 0.0 266
Western 31.4 49.2 7.6 3.4 8.5 0.0 118
West Nile 32.4 48.2 9.9 3.2 5.9 0.5 222
Residence
Urban 43.6 31.3 12.8 5.7 5.7 0.8 367
Rural 18.7 58.5 7.1 7.5 8.0 0.2 1301
Schooling status
In school 24.7 48.2 6.9 6.7 13.1 0.3 861
Out of school 23.5 57.2 10 7.5 1.5 0.4 803
Education
No formal education 15.8 78.9 5.3 0.0 0.0 0.0 19
Primary 23.4 58.1 4.5 7.2 6.5 0.3 764
Secondary+ 25.1 47.2 11.8 7.0 8.4 0.5 881
Marital Status
Never married 24.8 60.2 8.5 5.5 0.6 0.4 472
Ever married 24.0 49.5 8.4 7.7 10.1 0.3 1194
Overall 24.2 52.5 8.4 7.1 7.5 0.4 1668
Source of contraceptives: Table 44 below shows the distribution of facilities from which
respondents obtained contraceptives, stratified by different categories of respondents:
Government health centers were the most common source of contraceptives for adolescents and
72
FINAL REPORT
young adults (32%), followed by government hospitals (14%) and pharmacies and drug-shops
(11%). It’s important to note that drug shops are becoming a substantial source of contraceptives
for young people. Contraceptives were also obtained from private entity outreaches by 8% of
young people. In Karamoja region, government hospitals provided 44% of all contraceptives.
73
FINAL REPORT
Table 44: Source of contraceptives among young people who reported ever using them
Friend/ Relative
Family Planning
Private hospital
Drug Shop (%)
distributor (%)
Gov't Hospital
Private Health
Village Health
Private mobile
Outreach (%)
Mobile clinic
Gov't Health
supermarket
Community
Pharmacy/
Teams (%)
Centre (%)
Outreach/
centre (%)
Clinic (%)
Other (%)
Characteristic
clinic/
Shop/
based
NGO
(%)
(%)
(%)
(%)
(%)
Gender
Male 16.0 33.7 6.2 3.5 0.8 2.1 8.5 3.5 9.8 2.1 3.1 2.5 1.7
Female 11.8 29.1 4.2 2.2 2.7 5.9 7.4 2.0 11.6 3.7 6.7 4.9 2
Age groups
10-14 16.7 27.8 0.0 11.1 0.0 5.6 11.1 5.6 11.1 0.0 0.0 0.0 0.0
15-19 12.5 27.8 4.2 3.7 2.5 2.3 9.3 2.3 11.0 4.0 8.2 4.0 1.4
20-24 15.1 34.3 6.2 2.1 1.2 4.8 7.0 3.1 10.3 2.1 2.5 3.5 2.1
Region
Central 1 17.3 24.0 3.8 1.0 1.0 6.7 8.7 6.7 14.4 2.9 3.8 1.9 1.9
Central 2 6.0 20.0 4.0 9.0 0.0 3 11 2.0 20.0 3.0 8.0 1.0 1.0
East Central 24.1 23.4 2.1 2.1 2.1 1.4 6.4 1.4 7.8 9.2 12.1 0.7 0.7
Eastern 6.9 55.2 5.7 0.0 1.1 1.1 3.4 4.6 10.3 0.0 1.1 3.4 4.6
Kampala 18.2 18.2 3.6 0.0 0.0 5.5 14.5 5.5 10.9 0.0 5.5 1.8 0.0
Karamoja 43.8 18.8 12.5 6.2 0.0 0.0 0.0 6.2 0.0 0.0 0.0 0.0 0.0
North 6.7 56.0 8.0 2.7 6.7 1.3 5.3 0.0 6.7 1.3 1.3 2.7 1.3
South West 10.5 48.2 3.5 1.8 0.0 7 6.1 1.8 1.8 0.9 2.6 8.8 0.9
Western 10.9 25.0 15.6 6.2 1.6 6.2 6.2 3.1 15.6 3.1 3.1 3.1 0.0
West Nile 15.3 21.4 5.3 3.1 3.1 3.8 12.2 1.5 12.2 1.5 2.3 7.6 4.6
Residence
Urban 22.1 17.4 8.4 3.2 0.0 6.3 7.9 2.1 15.8 0.5 4.2 2.1 1.1
Rural 11.9 35.4 4.4 2.9 2.2 3.2 8.0 3.0 9.2 3.4 4.9 4.0 2.0
Schooling status
In school 9.7 27.0 4.1 4.1 1.5 3.8 7.9 1.8 15.0 5.0 7.3 3.5 1.5
Out of school 16.9 34.6 5.9 2.2 1.8 3.9 8.1 3.5 7.7 1.5 3.1 3.7 2.0
Education
No formal education 12.5 37.5 12.5 0.0 0.0 12.5 0.0 0.0 0.0 0.0 12.5 0.0 0.0
Primary 15.6 36.8 7.0 2.8 2.5 3.3 5.8 3.1 6.1 2.5 3.6 3.6 2.2
Secondary+ 13.1 27.7 4.0 3.1 1.2 4.0 9.6 2.7 13.9 3.1 5.4 3.7 1.5
Marital Status
Ever married 19.5 39.2 7.1 1.8 1.5 2.4 5.6 2.9 6.2 0.9 1.2 3.5 2.1
Never married 10.8 26.9 4.2 3.7 1.8 4.8 9.3 2.7 13.3 4.0 6.9 3.7 1.6
Overall % 14.1 31.6 5.3 2.9 1.7 3.8 8.0 2.8 10.6 2.8 4.7 3.6 1.8
No. of young people 125 280 47 26 15 34 71 25 94 25 42 32 16
74
FINAL REPORT
Source of STI treatment: Table 45 below summarizes the key sources of STI treatment most
frequently cited by the young people who sought treatment for an STI they acquired in the last 12
months. The most frequent source of STI treatment was the Health Centers (48%), followed by
private clinics (24%), and hospitals (20%). Karamoja is the region where health centres were most
frequented for STI treatment among young people.
Table 45: Source of STI treatment

Background Sources of STI Treatment
characteristics Number of young
people that sought
Traditional herbalist
Others sources (%)

Health Centre (%)
Private clinic (%).

treatment for STI
Pharmacy (%).
Hospital (%)
(%).
Gender
Female 19.1 47.4 24.3 5.3 3.3 0.7 152
Male 22.5 48.3 22.5 1.1 5.6 0.0 89
Age groups
10-14 30.0 20.0 40.0 10.0 0.0 0.0 10
15-19 16.1 54.0 21.8 3.4 3.4 1.1 87
20-24 22.2 45.8 23.6 3.5 4.9 0.0 144
Region
Central 1 31.8 27.3 36.4 4.5 0.0 0.0 22
Central 2 3.1 56.2 25.0 3.1 9.4 3.1 32
East Central 25.0 50.0 7.5 10.0 7.5 0.0 40
Eastern 11.4 62.9 17.1 0.0 8.6 0.0 35
Kampala 30.3 33.3 33.3 3.0 0.0 0.0 33
Karamoja 28.6 71.4 0.0 0.0 0.0 0.0 7
North 0.0 57.1 28.6 14.3 0.0 0.0 7
South West 21.1 26.3 47.4 5.3 0.0 0.0 19
Western 20 50.0 30.0 0.0 0.0 0.0 20
West Nile 26.9 53.8 15.4 0.0 3.8 0.0 26
Residence
Urban 32.3 32.3 32.3 3.2 0.0 0.0 62
Rural 16.2 53.1 20.7 3.9 5.6 0.6 179
Schooling status
In school 25.3 40.7 26.4 3.3 3.3 1.1 91
Out of school 17.6 52.7 21.6 4.1 4.1 0.0 148
Education
No formal education 16.7 66.7 16.7 0.0 0.0 0.0 7
Primary 22.7 47.4 20.6 4.1 5.2 0.0 97
Secondary+ 19.0 46.7 26.3 3.6 3.6 0.7 137
Marital Status
Ever married 15.4 54.8 20.2 4.8 4.8 0 105
Never married 23.5 42.6 26.5 2.9 3.7 0.7 136
Overall 20.3 47.7 23.7 3.7 4.1 0.4 241
3.4.2.4 Preferred Family planning services by young people

Health workers were asked the most sought FP services by the young people from the heath
facilities. Table 47 below shows that overall, young people aged 10-24 years mostly sought for male
condoms (88.9%) and injectables (82.1%). More than 50 percent of young people preferred male
condoms and injectables at all levels of the health facility. The least sought FP method was IUD
which is not usually made available at the HC IIIs.
75
FINAL REPORT
Table 46: Family planning services preferred by young people

RRH District/General HCIV HCIII Overall
Family planning services
(%) Hospital (%) (%) (%) (%)
Emergency Pill 25.0 20.0 25.0 18.4 21.4
IntraUterine Device (IUD) 12.5 15.0 15.0 8.2 12.0
Injectables 62.5 90.0 85.0 79.6 82.1
Implants 50.0 35.0 40.0 24.5 33.3
Male Condom 87.5 95.0 85.0 89.8 88.9
Counselling on LAM 12.5 15.0 20.0 8.2 13.7
Counselling on Rhythm method 12.5 10.0 12.5 14.3 12.8
Contraceptive Pill 25.0 25.0 17.5 14.3 17.9
3.4.2.5 Preferred sources of SRH services

Participants were asked about their preferred sources of SRH services. Table 48 below summarizes
the results. Government health centers were the most preferred source of SRH services (41% of
respondents) followed by government hospitals (36%) and then private hospitals or clinics
including the PNFP facilities (11%). Most young people preferred health facilities especially those
with youth friendly corners because of easy accessibility and services being offered being free of
charge.
Young people preferred radios as well as a source of SRH information because many people listen
to radios and own FM radio receivers. This provides a source of learning for those with no time
to go to the health facilities to attend health education sessions. Also, they highlighted the fact that
anonymity can be maintained when calling with SRH issues into a radio station, as well as the
availability of radio talk shows and radio dramas which are usually conducted in the local languages.
“We love listening to a programme called Ebyamagala on Radio West which airs at 8pm, and Shwenkazi which
airs at 11pm on Sunday.” Girls aged 15-19 years in school in Ntungamo district.
Discussions with school-going young people revealed that their preferred source of information
on SRH/HIV was schools. They said this was because teachers and senior women/men are more
open to discussing issues relating to sexuality with students than parents, who tend to shy away.
“I like the school better because I can ask anything related to sex and the teachers won’t laugh, ignore or question
me like it would be at home or in the health facility where I feel judged or I could get into trouble with my parents,”
said a young girl aged 10-14 years in Kalangala.
Young people however emphasized the need to use sports as well as Music Dance and Drama in
schools and communities to mobilize peers and to convey appropriate SRH information so as to
increase access to, and utilization of, SRH and HIV/AIDS services among young people. In
addition, young people called for establishment of youth friendly services in their schools and
health facilities. They also advocated for strengthening the facilitation of VHTs to provide SRH
services in the community.
“I prefer to get services like condoms from a VHT because they are always available and they keep it confidential.”
FGD of boys 20-24 years out of school in Lira.
76
FINAL REPORT
Table 47: Preferred sources of SRH Services
Where do you MOST prefer to seek Sexual Reproductive Health (SRH) services?
Background
characteristics
Village Health
Gov't Health
community
Institution.
Traditional
institution.
Attendant
Academic
educators
Religious
hospital/
Hospital.
School/
Relative
Relative
Friend/
Teams.
(TBA).
Private
Centre
based.
NGO
clinic.
Gov't
Birth
Peer
people
No. of
young
Gender
Male 36.3 40.8 1.8 2.5 11.7 0.7 3.6 0.2 0.9 1.4 0.1 2182
Female 35.1 40.2 2.7 2.3 10.7 1.5 3.8 0.5 1.3 1.6 0.3 1899
Region
Central 1 42 18.1 1.4 1.2 30.3 1 3 1 0.2 1.4 0.4 502
Central 2 14.4 58.1 1.6 0.5 17.7 0.2 4.4 0.2 1.6 0.9 0.2 430
East Central 45.6 38.8 2.8 2.4 3.6 1.2 4 0.6 0.4 0.4 0.2 502
Eastern 20.6 65.5 1.4 2.6 4.4 0.4 2.8 0 1.4 1 0 504
Kampala 42.4 18.3 4.2 2.6 20.9 5.8 1 0.5 2.1 2.1 0 191
Karamoja 75.9 23 0 1.1 0 0 0 0 0 0 0 87
North 18.2 64.9 0.8 3.6 6.2 1.6 1.8 0 0 2.9 0 385
South West 43.1 34.7 3.6 1.9 11.5 1.1 2.1 0.2 0.9 0.8 0.2 634
Western 40.7 28.8 3 5.9 5 1.5 6.5 0.6 3.9 3.9 0.3 337
West Nile 44.4 32.8 2.2 2.8 7.1 0.2 7.7 0.2 0.6 2 0.2 509
Residence
Urban 49.1 18.4 3.9 1.9 17.5 3 2.6 0.4 1 1.9 0.1 690
Rural 33 45.1 1.9 2.5 9.9 0.7 3.9 0.3 1.1 1.4 0.2 3391
Schooling
status
In school 35.5 39.4 2.3 2.1 11.1 1 5.2 0.4 1.2 1.7 0.2 2775
Out of school 36.2 43.1 2.1 3.2 11.4 1.3 0.5 0.3 0.8 1 0.2 1293
Education
No formal 37.3 42.4 1.7 1.7 11.9 1.7 0 1.7 1.7 0 0 65
education
Primary 35.8 43 1.5 2.8 8.4 0.7 4.4 0.4 1.3 1.6 0.2 2534
Secondary+ 35.6 36.3 3.4 1.9 15.9 1.8 2.7 0.2 0.5 1.4 0.2 1482
Marital
Status
Ever married 37.6 45.8 1.9 2.5 9.3 1.6 0.5 0.2 0 0.5 0.2 637
Never married 35.4 39.6 2.3 2.4 11.6 1 4.3 0.4 1.2 1.7 0.2 3444
Age groups
10-14 35.5 40.2 1.5 2.4 9 0.7 6.6 0.3 1.6 1.8 0.2 1472
15-19 35 40.8 2.7 2.5 11.9 1.1 2.8 0.5 1.1 1.4 0.2 1573
20-24 37.2 40.7 2.5 2.2 13.3 1.5 1 0.1 0.2 1.2 0.1 1036
Overall 35.8 40.6 2.2 2.4 11.2 1.1 3.7 0.3 1.1 1.5 0.2 4081
3.4.3 School based Youth Programming

Education has the highest numbers of young people at the various stages of studies (Primary,
secondary, vocational & university). Schools are therefore vital in promotion and provision of
SRH/HIV services among in-school young people aged 10-24 years. National Adolescent Health
Policy 2000 states that it’s the responsibility for Ministry Education to integrate adolescent health
concerns in the school education system and planning processes. Discussed below are key
SRH/HIV strategies being done in schools among the surveyed districts;
 Existence of senior women and men teachers in school: District education officials in
the surveyed districts have made efforts to ensure that in every school there is a senior woman
and male teacher to provide guidance and counselling services to the boys and girls in regards
to adolescent SRH. This is in accordance with the Education Act 2008 and part of the reforms
in the Education Sector Strategic Plan 2007-2015 (ESSP). Training by the government and
NGOs of senior women and men was done in schools among the surveyed districts. Some
77
FINAL REPORT
schools however, especially in the hard to reach areas8, still lack senior women teachers to
cater for the welfare of girl-child:
“There was a boy who was disturbing me in class and I went to the senior woman and she helped me talk to
the boy so he would stop.” Said a girl in an FGD of 10-14 years in Ntungamo.
We follow-up and remind senior women/men in schools to discuss SRH issues schools” KII Hoima
“The Ministry of Gender Labor and social development around October 2015 trained senior men and women
on SRH including menstrual management” KII Kasese district.
“We have conducted workshops and seminars to train SRH focal points at school on how to deal with young
people” KII in Soroti.
 The Presidential Initiative on AIDS Strategy to Youth (PIASCY): In 2002, Uganda

launched the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY)
which was designed to prevent the spread of HIV/ AIDS and to mitigate its impact on
primary and post-primary education institutions in Uganda. This was done through child-
centric interactive activities such as assemblies; Music, Dance, and Drama (MDD); clubs, use
of PIASCY readers and posters, and building the capacity of teachers to offer better guidance
and counselling services basing on the procedures under PIASCY. The researchers found that
PIASCY is still running in some schools despite funding for the program being at a standstill
in the districts.
 Integration of sexuality education in school curriculum: In 2013, Uganda endorsed and

affirmed the ESA Commitment which was led by UNAIDS with the support from UNESCO.
It represented a joint commitment to deliver good quality, comprehensive sexuality education9
as well as sexual and reproductive health services for young people in the Eastern and
Southern Africa region. According to the draft National School Health Policy, sexuality
education will be part of curricular for health education and life skills education, and will
include contents on gender, sexual health, HIV, sexuality, relationships, communication and
negotiation skills, self-respect, non-discrimination, intimate partner violence, puberty,
reproduction, contraception and prevention of teenage pregnancy, unsafe abortion and rights.
There have been attempts by the district education departments to integrate sexuality
education into the school curricula under the directive of the Ministry of Education whereby
the pupils and students are taught the different SRH issues and body changes within the
science curriculum. However follow-up by the district education departments has been poor.
“Teachers in Soroti have been encouraged to go beyond the curriculum and introduce counselling on health
issues and life skills within their lessons with support from the Ministry of Education.” Said a Key
Informant in the education department in Soroti district.
 Use of role models: Roles models like selected teachers, peer educators, DEOs, Health
workers with expertise in AYSRH are used to sensitize the students on the benefits of staying
in school, offer guidance and counselling on SRH not only to the students but also the
teachers.
8
The term 'hard to reach' is commonly used to describe individuals or groups that are difficult to contact or engage
for a particular purpose. Identification of groups regarded as 'hard to reach' vary with the community, issue, and
context but typically includes: Those who are disadvantaged socially and economically, Those facing barriers to
participation, and Those restricted by lifestyle and occupation.
9
Sexuality Education is defined as an age-appropriate, culturally relevant approach to teaching about sex and
relationships by providing scientifically accurate, realistic, non-judgmental information.
78
FINAL REPORT
“There have been initiatives in Katakwi district by secondary school teachers initiating the DEO to talk to
the students in schools, offer career guidance, counselling even on health related issues, etc. as a recognized role
model”. KII Katakwi District
 Formation of SRH clubs: These clubs generally mobilize the young people together and
offer guidance and counselling services in addition to sensitizing students on SRH/HIV.
Adolescents are also sensitized on how to deal with body changes such as menstruation and
puberty.
“At least 10 schools are now on board with school clubs. This helps us to better inform young people on how
to protect themselves.” Key informant in Kanungu district.
Kabarole district for example implements the School Family Initiatives club where by primary
school children are divided into informal ‘family’ groups of about 25people in each school,
with a mother and a father (who are elderly pupils in the school) and teachers serving as
grandparents. In these ‘families’, challenges are shared with peers in an upper class and peer
to peer counselling is done in every school. Each ‘family’ has a register where minutes of
‘family meetings’ are taken.. For example:
“At Kagumu Primary School we are organised into families of 24 children. Each family is handled by a
specific teacher so we always discuss on a weekly basis on issues regarding HIV/AIDS, STIs, abstinence,
love, etc.” Said by a boy in an FGD of 10-14 years in school in Kabarole district.
The Girls Education Movement (GEM) is another initiative that promotes programs aimed
at keeping the girl-child in school through activities such as “go back to school” campaigns,
equipping the girl-child with skills to make sanitary pads and initiatives to prevent child abuse
and violence. The Girls Education Movement (GEM) started as an initiative of UNICEF,
Ministry of Education and Sports (MoES) and FAWE Uganda and is currently registered as
an autonomous organization. Their initiatives create awareness among the communities about
the benefits of educating and protecting the girl-child.
“GEM clubs are functioning in 40 primary schools. GEM committees comprised of youth across the 37 sub-
counties carry out advocacy for girl child education and SRH.” KII Kasese district
Other clubs found existing in schools include AIDS clubs; guidance and counselling clubs,
WASH clubs Youth Alive clubs and drama clubs.
 Establishment of Youth Corners: At secondary level, schools in districts such as Katakwi

and Mukono district were found to have set up youth corners where SRH services are offered
to students including HIV testing.
 Use of PTA meetings to advocate AYSRH: PTA meetings have also been used as a
platform to engage and sensitize parents on AYSRH issues in some schools. Parents and
teachers are encouraged to offer support to adolescents throughout their developmental
stages. In Mukono, Kampala and Moroto districts these PTA meetings were also used to
engage parents in boosting and funding school programmes relating to SRH issues.
 Provision of washroom and menstrual kits: The Education Sector Strategic Plan 2007-
2015 (ESSP) works to advocate supplying sanitary towels to girls in Universal Primary
Education(UPE) schools and providing girls with washrooms in all schools as part of gender
79
FINAL REPORT
mainstreaming. Separate washrooms for girls have been set up in schools across all districts.
Such initiatives are being supported by various partners; a full list of these partners are in table
49.
“…the education department has allocated some money for senior women to buy sanitary pads and other
necessities in all schools.” KII Bundibugyo district
“Each school is required to include in their budget separate sanitary facilities for the girl child, provide
emergency pads and extra uniforms for girls who accidentally soil themselves. They must also have soap,
basins, and ‘cloth’ for girls to get clean in case of any accidents. Follow up mechanisms have been planned for
implementation purposes.” Key informant in Mbale district.
3.4.4 Community based Youth programming

Community support increases the likelihood of better access and utilization of SRH services
among young people today. Discussed below are a variety of available programs for SRH
information and services for young people in the community;
 Use of media and drama groups: Districts have been using radio talk shows and dramas to
spread the SRH messages. Some of the programmes cited in FGDs and KIIs included
“Shwenkazzi” radio programme on Radio West, Straight Talk programme on KFM, Voice of
Kigezi, Raising Voices on TV (which airs skits on violence against children), and Obulamu
adverts on family planning, reproductive health and HIV/AIDS. Districts also use of public
address systems to raise awareness on several SRH issues in the communities and pass on
important information.
“Since young people had started getting attracted to these vehicles that move around playing loud music with
speakers, we decided to start use these vehicles with speakers on them to call out to the people in the communities
and sensitize them to go for testing at the health centres or to access some other services.” Said a key informant
in Pallisa district.
 Community Outreach services: These are usually supported by SRH partners and are
offered to all age groups in schools and communities. The key activities conducted during
outreaches include health education talks, HIV counselling and testing, STI screening, condom
distribution and safe male circumcision. A full list of partners supporting these activities are in
table 49 below
“I attended an outreach of Marie Stopes at the health centre IV to get my implant because I did not
have to pay any money.” Said by a young person 15-19 years in Rakai.
Youth centres: Youth centres in the urban communities gather youth aged 15-24 together
to engage in activities such as playing football and board games. Young people are also able
to access key SRH information and services such as HIV testing and counselling. Youth
centres identified during the survey included Naguru teenage Centre, Mukono Youth Centre,
Reproductive Health Uganda centres (Mbarara, Kapchorwa, Mukono, Hoima & Moroto)
and Red Cross (Wakiso and Kalangala). Condom dispensers or ‘condom banks’ were also
placed at hot spots such as discos, lodges, bars and boda boda stages by different partners
with consultation from the district health officer.
Use of peer educators and VHTs: Peer educators and Village Health Teams (VHTs) were
trained by different partners to sensitize peers on issues of SRH and provide SRH services such
as condoms as well as counselling on issues related to SRH. Cited quotes;
80
FINAL REPORT
“In Kanungu district, peer educators were trained in how to influence HIV/AIDS positive living
patients to come out and declare their status”key informant in Kanungu district.
“Peer to peer counselling is done by an HIV positive patient who after being trained by the health worker
goes on to sensitize his or her fellow HIV positive patients and offer counselling. VHTs are also used
and engaged in sensitization SRH programmes in the communities.” Key informant in Katakwi.
“VHTs visit us in our homes after we have been discharged from the hospital after giving birth. They
encourage us to go back to the hospital for immunization and postnatal visits.” FGD of girls aged
20-24 years in Abim.
3.4.5 Quality of services

3.4.5.1 AYSRH standards met by health facilities
Table 46 below shows the extent to which AYSRH standards were met by the surveyed facilities
offering AYSRH services and the reasons for not meeting the standards. Over 70% of the 37
clinics that offered SRH services met the AYSRH minimum standards. For example, 92%
provided privacy and confidentiality during provision of AYSRH service to young people. Lower
coverage was noted with regard to: Provision of preferential access to persons with disabilities,
public display of available SRH services, availability of SRH information and educational materials
and availability of a follow-up mechanism for clients, where 20-30% of the facilities did not meet
the required criteria.
Table 48: Extent to which AYSRH standards are met and reasons for shortfall
AYSRH Standards Overall Reasons why are the respective

yes (%) AYSRH standards not being
met/challenges
A. AYSRH provides privacy and confidentiality for 91.9 • Small rooms;
young people (10-24 years) attending the AYSRH • Lack of ceiling allows sound to escape to
clinic (i.e. there special rooms/corners available for other rooms.
private issues)
B. AYSRH consultation is never shared with people 81.1 • Information is shared during referrals to
other than the healthcare provider team and the duty bearers e.g. police, probation office
young person (Excluding HIV testing for young and linking young people to NGOs that
adolescents 10-12 years old) support victims of SGBV.
C. Health facility/AYSRH clinic in an easily 90.3 • Remoteness of some rural area.
accessible/convenient location and clearly • Poor road surface and network.
signposted.
D. Persons Living with Disabilities (PWDs) have 72.2 • Language barriers/lack of SNE skills
preferential access to AYSRH services amongst health workers.
• Few staff
E. There is public display of SRH services available 75.7 • Signage has somewhat faded..
for young people (10-24 years) and opening hours • Most IEC materials are in English.
for the AYSRH clinic.
F. SRH information and educational materials (IEC) 75.7 • Some IEC materials are faded and torn.
for young people (10-24 years) are available in the • Most IEC materials are in English
local language or in pictorial form. rather than the local language.
G. Health facility/AYSRH clinic has a follow-up 70.3 • Remoteness of some areas.
mechanism in place for clients (10-24 years) with • Lack of reliable contacts.
SRH issues. • Erratic communication networks.
• Not prioritized.
• Lack of capacity to follow up.
81
FINAL REPORT
AYSRH Standards Overall Reasons why are the respective

yes (%) AYSRH standards not being
met/challenges
• Handle many clients on a daily basis.
H. Overall, the access/contact hours of the AYSRH 91.7 • Depends on the turn up per clinic day.
clinic are convenient for young people (10-24 • Few health workers.
years).
I. Average length of a consultation in the AYSRH 25.3 • Varies depending on the turn up and
clinic (Minutes) complexity of the case.
J. Facility provides contraceptive or other SRH 81.1 • Inadequate number of health workers at
supplies over weekends and public holidays. the health facility
• Attends to abortion emergencies only.
• Clinic new/Just started.
3.4.5.2 Health workers trained to provide AYRSH services

More than half (55.9%) of the 127 facilities surveyed had health workers specifically trained to
provide AYSRH services as seen in figure 7 below. However, most of the HCIIIs (56.6%) did not
Figure 7: Proportion of health facilities with staff trained to provide have any health workers specifically
AYSRH services trained to provide AYSRH
80 services. Therefore, programs
70 73.9
aimed at strengthening the capacity
60 70
63.6 of health workers to provide
50 58.5 55.9 55.2 55.9 AYSRH services should target
40
%
30
43.4 HCIIIs. Nearly 45 in every 100
20 government owned health facilities
10 (44.8%) did not have health
0 workers specifically trained to
HCIII
RRH
HCIV
Overall
PNFP
Overall
provide AYSRH services. Over

Government
General Hospital
41% of health facilities had health

workers who received in-service
training in provision of AYSRH
Level of health facility Ownership of HF
services between 2-6 months ago
(i.e. Aug 2015- Jan 2016). Overall,
all the health facilities had more female (average 7) than male (average 5) health workers trained to
specifically provide AYSRH services. HCIIIs had the least number of health workers specifically
trained to provide AYSRH services (i.e 3 males and 4 females on average). The average number
of male health workers specifically trained to provide AYSRH services was higher in the
government owned facilities than in the PNFP.
3.4.5.3 Use of SRH guidelines and support supervision done
Supervision: According to the HSSP III (2010/11-2014/15) some of the core functions of the
MoH are (i) capacity development and technical support supervision, and (ii) monitoring and
evaluation of the overall health sector performance. The 1995 Constitution and the 1997 Local
Government Act mandates the District Local Government to plan, budget and implement health
policies and health sector plans. These Local Governments manage public general hospitals and
health centers and also provide supervision and monitoring of all health activities (including those
in the private sector) in their respective areas of responsibility. During the health facility survey,
health facilities were asked when was the last time the facility was visited by a direct supervisory
authority in the past 12 months with respect to RH including family planning. Overall slightly over
50% of the health facilities (51.2%) were supervised less than one month ago from a direct
supervisory authority such as the technical teams from the DHOs office, and MoH. However,
nearly 5 in every 100 government owned HFs (4.7%) were not supervised in the past 12 months
82
FINAL REPORT
by a direct supervisory authority. Monthly supervisory visits at the health centers were most often
conducted by NGOs and implementing partners in AYSRH services.
SRH guidelines and job-aids: Overall, over 50% of the health facilities had family planning
guidelines (52%) and family planning check-lists and/or job-aids (59%) which were displayed at
their workstations. Slightly over 1 in every 5 health facilities (22%) were not in possession of the
family planning check-lists and/or job-aids.
3.4.5.4 Aspects young people liked about existing SRH services

Young people cited the following as the aspects they liked about existing SRH services:
a) Affordable/ free of charge SRH services: Young people liked the fact that SRH services
in government health facilities are free of charge. This enables them to access services despite
the fact that they do not often have money to pay for them.
“I got circumcised at the health centre III near home and they did not ask me for any money.” Said a
young 10-14 years in an FGD of boys aged 10-14 years.
.
b) Convenient health facility contact hours: Young people expressed satisfaction with the
contact hours provided by most health facilities in most of the districts. Several clinics and
departments dealing with SRH issues are open 24 hours a day while others cover at least 8-12
hours a day depending on the turn up for maternity, ANC, ART, and family planning among
others.
“In Kalungu, the district health office declared every day an ANC clinic day for all health facilities
regardless of the level,” key informant in Kalungu district.
c) Informative outreaches conducted: They also noted that the outreaches conducted by the
different SRH service providers were informative and engaging. The outreaches also reduced
the costs of travelling to the HC to seek information.
d) Privacy and confidentiality: Young people cited that privacy and confidentiality was
ensured at the health facilities for those who had ever sought out SRH services at the hospitals
and HCIV. They mentioned that young people seeking services such as antenatal, HIV
counselling and testing, are generally seen in the privacy of a consultation room away from
other clients.
“At the hospital when you have a problem, you are taken to a secret room and the health
worker talks to you in private.” FGD of girls 15-19 years in Kotido district.
“At the hospital when you need condoms, sister puts them in your book when people are not
seeing you.” FGD of boys aged 15-19 years in Kotido
a) IEC materials displayed: The young people reported that IEC materials in Health
centres were in the local language educating on Family planning, HIV testing and
awareness. However this information was displayed in a few health facilities and schools.
“The IEC materials are in pictorial form and they are attractive and easy to understand even for people
who can’t read” said a key informant in Mubende district.
“We have seen poster in the hospital talking ‘okwekuma obulwade bwa mukenenya’- meaning ‘protecting
yourself against HIV/AIDS’ ” FGD Boys 15-19 Kalangala
83
FINAL REPORT
3.4.5.5 Aspects young people disliked about existing SRH services

Young people disliked the following aspects of existing SRH services:
a) Lack of trained personnel in provision of AYSRH services: Young people and health
workers mentioned in the discussions that few medical staff were trained on delivery of
specific AYSRH services like STIs, SMC, HPV vaccination, TT vaccination, psycho-social
support and post abortion counselling. This discourages the young people from going to the
health facilities to seek these services because sometimes their questions are not answered and
they are instead referred to higher levels. Some young people had negative experiences with
some surgical procedures like safe male circumcision, which influenced others not to seek the
service:
“We no longer want to go for circumcision because of a boy got circumcised and the wound failed to
heal,” said a young boy in an FGD of young people aged 10-14 years in Luweero
district.
b) Unconducive environment at health facilities: Young people pointed out some of the
health facilities do not have enough space, separate clinic days or hours and consultation
rooms to ensure complete privacy for the young people during consultation and counseling
sessions.
“The waiting area at the ART clinic at the health facility is in an open area and if you are
referred there friends talk about you because they think you are HIV positive.” FGD of
Boys 15-19 years in Moroto District.
“The youth corner is located near the entrance to the health facility. The moment your seen
lingering around the entrance elders come and ask what you’re doing there especially since the
condom bank is near there and you can’t get the condom if you needed it” FGD Boy 20-24
out of school in Katakwi district.
“I felt uncomfortable when attending ANC health education with older mothers because they
kept asking me why I got pregnant when I was still young” Girls 20-24 years Abim
c) Inadequate IEC materials: It was mentioned that IECs materials in some of the district
were inadequate in number, mainly in English, old and warn out, and some SRH issues were
not displayed. This creates a gap in the SRH information available for young people.
“In this youth corner, we were given very few posters with only words and no pictures and we
had to draw our own which are not as attractive. Also the educational videos we have for the
young people to watch are all in Luganda and yet majority of the people here speak Ateso and
don’t understand Luganda.” Peer Educator in Katakwi district.
d) Inconvenient opening and closing hours. Some of the health facilities visited had few
contact hours with some clinics such as ANC, family planning, mental health etc. only open
on specific days only and entirely closed on the weekend.
“Us here in Budaka most people don’t work on Sunday and some department like family planning, ANC,
and ART are entirely closed on this day.” Health manager Budaka.
e) Unaffordable charges for SRH services: Young people mentioned that some health
facilities especially PNFPs and PFPs charge specific fees they cannot afford for specific SRH
services such as pregnancy testing, STI diagnosis and treatment, psycho-social support and
SGBV and safe male circumcision.
84
FINAL REPORT
“I went to the hospital to get treatment because of itching in my private parts and when I reached they were
telling me to pay 30,000 shillings so I left and went home and used herbs from my aunt.” Said a young
person in an FGD of girls aged 20-24 years out of school in Yumbe district.
f) Long waiting time: Young people complained about the long queues and long waiting time
involved in accessing SRH services at the health centres.
“When I go to the health centre for antenatal, even if I get there very early in order to beat the long lines,
there’s only one doctor to attend to all of us.” said by a female in an FGD 20-24 years in Budaka.
3.4.5.6 Barriers to accessing SRH services

 Stigma by the community: Another key barrier to SRH services is the stigma that parents
and communities attach to SRH issues among young people, especially among adolescents. It
was reported that parents and community members are not supportive of young people
seeking SRH services, particularly family planning services. Parents do not seem to see
benefits in allowing their children to go to youth centres /corners and health facilities to seek
these services.
“We are not comfortable with our children going to the youth centres since they have pool tables and
these are usually for bars.” FGD with parents in Kanungu district.
“We fear being rejected and talked about as sick after visiting the hospital because most people who
visit the hospital regularly are thought to have HIV/AIDS.” Said by boys aged 15-19 years
in an FGD in Nebbi.
 Long distances and lack of transport: Some of the young people mentioned that the health
facilities were quite distant (over 4km). They prefer to stay home or use herbs rather than walk
long distances or spending a lot of money on transportation to receive free medication when
it does not cost much to buy it oneself.
“Here in Kalangala, we don’t have any commercial means of transport. When I hire a special boda boda
person, he takes me for thirty thousand shillings yet the drugs I needed cost ten thousand shillings.” said by
a male 20-24 years in Kalangala.
“Our health centre is far away from here and at the moment, I walk 5km to reach there. This discourages
me from going there often.” said by an out of school female 20-24 years in Yumbe district.
b) Lack of specialized adolescent youth friendly clinics/corners: There is a general lack of

specialized adolescent youth friendly clinics in the health facilities in the regions. In this regard,
SRH services are integrated for all ages and the young people are not given any special
attention when they come to the health facilities. This discourages these young people from
seeking SRH services whenever they are required.
“We don’t like going to the health facility because the line can be very long and sometimes you find the parent
of your friend who can then go back and tell your parent that they saw you at the health centre and you can
get into trouble.” Said in an FGD of girls aged 15-19 years in Kalungu district.
The services offered by some of these youth corners are not tailored to the needs of girls
and often deters them from utilizing them. They tend to be frequented by boys instead.
85
FINAL REPORT
One the key causes of this is the type of games that are provided in their recreational areas,
and the fact that boys tend to dominate the games.
“Games availed and played are boy oriented. The centre used to have indoor games like pool,
‘omweso’, ‘ludo’ and chess which used to attract girls to the corner but the games kept getting lost
and haven’t been replaced. Even for some games that girls can play, the boys are already in big
numbers so it is difficult for girls to be given a chance to play.” Peer educator in Katakwi.
 Stock-out of SRH commodities and other consumables: Many young people pointed
out during the focus group discussions that there is a general problem of stock outs of SRH
commodities particularly family planning commodities such as emergency contraceptives, oral
contraceptives, male condoms and other consumables especially at HC IIIs in rural areas. The
healthy facility survey as well indicated 86% of the health facilities had experienced a stock-
out of one or more contraceptive methods in the last 3 months preceding the survey. This
generally discourages the young people from accessing SRH services because they end up
being referred to private pharmacies to purchase medication and commodities which they
cannot afford.
“I went to the health centre when I suspected that I had got a bad UTI and when I reached the health
worker told me the only antibiotic they had left was Amoxyl and yet it was not strong enough to treat the
level of the infection. I couldn’t tell my parents so I just took the medicine but after finishing the dose I was
still not fine.” Said a young girl from Kamuli district.
 Inadequate youth friendly skills among health workers: Young people raised concerns
about the level of friendliness and ethics of health workers in provision of adolescent and
youth friendly services in the health facilities. The young people reported that a times
health workers leaked information to their parents/guardians and were not friendly. For
example,
“These health workers sometimes are not so friendly and some of them even go ahead and ask you so many
questions when you go to the health centre to get some services. Sometimes when the health worker is too old
and rude, it makes it even harder to go and ask for help at the health facility. It would make us more
comfortable if the people who distributed condoms for example were young and easy for us to relate with”
Said in an FGD of girls 15-19 years in Luweero.
“When I was 14 years old, I remember waiting in the queue at the health centre when a health worker
came and shouted at me asking if I was also pregnant.” said by an out of school female in an FGD
in Gulu
 No legal frameworks supportive of special interest groups accessing SRH services:

There are no specific strategies/legal frame works supporting the minority groups/special
interest groups, the mentally ill and persons with disabilities in accessing SRH services. In
some border districts, some ethnic minorities like the Batwa who are considered as
uncivilized thus stigmatizing them therefore not confident to access the available SRH
services and are therefore widely excluding themselves due to psychosocial barriers related
to their livelihoods.
“The Batwa are shy and as such don’t come to the health facilities and demand for the SRH
services…” Key informant in Kanungu District.
“Some people here are suffering from mental illness and no one minds about them.” Girls 15-19
years in Arua District.
86
FINAL REPORT
 Lack of information on existing SRH services among young people: Young people
lack information on the SRH services provided in their communities, especially HPV
vaccination, cancer screening, STI testing and treatment, post-abortion care, psycho-social
support, and mental health. This is mainly attributed to the inadequate IEC materials on
SRH made available to Young people in some of the health facilities. Some health facilities
have no IEC materials and those that have them they are few, in poor condition and mostly
in English. This creates a gap in provision of information to young people especially those
out of school. For example most IEC materials found in Health centres were on Family
planning, HIV testing and awareness yet there were none on mental health, psychosocial
support, SGBV ,dangers of abortion, drug and alcohol abuse among others. This lack of
information also creates a community of young people who are too timid to go out and
seek SRH services from service points. Some examples include:
“HPV vaccination has just started out in the district and most of these young people are
not yet even aware that the service is being offered. Therefore, so far the turn up has been
so little at the hospital.” Said a key informant in Budaka.
“We hear about these services, like of people who go for some kind of treatment or testing
for cervical cancer, but we really do not know what it is about because no one tells us
about them here deep in the village.” An FGD of females 15-19 out of school in
Hoima.
“Despite condom banks being available, youth are afraid of being seen getting some of
these SRH services like condoms and as such some of them stay away regardless of the
fact they know they need them. They want them available in hidden areas.” District
Official- Kalangala
3.4.6. Challenges to SRH service delivery among young people

This section describes challenges to SRH service delivery, access and utilization faced in schools
and health facilities in all the 10 regions surveyed. The recurrent challenges identified were majorly
in regards to service delivery in schools and at the health facilities.
3.4.6.1 Challenges to delivery of SRH services at the health facilities and by partner
agencies
A number of challenges were observed regarding SRH services in health facilities. These included:
c) Failure to manage complications of unsafe abortions: Young people conduct unsafe

abortions with help of untrained people (i.e. herbalists, traditional birth attendants and
private health workers) leading to complications. Young people that have conducted
unsafe abortions often delay to seek treatment from the health centers and SRH partners
d) Limitations regarding STI management: Young people tend to rely more on family
planning methods that prevent pregnancy such as injectables, implants, emergency
contraceptive pills, and ignore the importance of dual protection through use of condoms.
This is coupled with their sexual behavior in which these young people tend to engage in
sex with multiple partners making them highly vulnerable to STIs. This poses a challenge
to health workers in management of STIs whereby, not only do the young people fear to
seek treatment, but also the existence of multiple partners makes it hard to trace the origin
of the infection and manage the spread to other partners.
87
FINAL REPORT
e) Training gaps among health workers affecting delivery of SRH services : Health
workers have limited or no skills to provide/deliver adolescent and youth friendly SRH
services especially in the lower level health facilities. Major skills found lacking include
skills in delivery of mental health, alcoholism and substance abuse, Special Needs skills e.g.
sign language, SGBV, psychosocial support, post abortion care, Cervical and breast cancer
screening among others. In some cases, staff who have been trained in AYSRH end up
being transferred and this leaves a gap in the available skills, and leads to non-functionality
of the available youth corners. This was noted in districts such as Kyenjojo and
Bundibugyo.
f) Training gaps among peer educators: There is a general training gap among peer
educators in some specific SRH services such as: mental health, post abortion counselling,
counselling on abuse and SGBV, life skills and knowledge on use of other family planning
commodities such as implants and contraceptives. Peer educators are also not given
refresher trainings.
g) Stock out of reproductive health commodities and SRH supplies: Most health
facilities experienced a stock out of SRH commodities and supplies like ARVs, emergency
contraceptive pills, male condoms, anti-bacterial drugs, and sterilization supplies among
others due to the limited credit line that government facilities have with NMS. In addition
the lower health facilities receive drugs through the PUSH system which does not
effectively cater to the high demand for some specific commodities such as injectables and
male condoms. These stock outs force health workers to refer the young people to buy
some of these supplies elsewhere such as pharmacies and private clinics yet these young
people cannot afford to pay for these commodities hence discouraged from seeking SRH
services at these health facilities.
h) Inadequate staffing at health facilities: The health worker to patient ratio remains low
in most health facilities. This leaves most of the health workers overwhelmed with tasks
which in turn hinders service provision and establishment of an AYSRH clinic in a given
facility since there is no adequate staff to provide AYSRH services. Young people end up
mixed up with adults during service delivery thus discouraging them from seeking SRH
services from these facilities.
i) Staff absenteeism: The survey findings revealed that there were recurrent occurrences of
absenteeism among the health workers. This was especially common at the Health Centre
IIIs owing to reasons such as sickness, family emergency, lack of motivation workshops
and meetings. This greatly affects the effectiveness and efficiency at the service delivery
points in the health facilities as it increases the waiting/ consultation time for the patients.
Some people especially the young people who have a tendency to be impatient usually walk
way and are therefore not attended to. Some departments of the health facility end up
closing down for some time during the day because of health worker fatigue:
j) Inadequate infrastructure: Most health facilities are faced with infrastructural challenges
like limited space which hinders them from providing a wider range of SRH services within
the expected standards of service provision. Most health facilities noted a challenge in
providing separate rooms for adolescent clients, as well as a general challenge of space to
set up youth friendly corners in the health facilities.
k) Difficulties in handling of PWDs: Most health facilities had no specialized facilities in

place to cater for young people with disabilities who come to seek SRH services such as
88
FINAL REPORT
ramps, wheel chairs, handicapped- accessible toilet facilities for PWDs, etc. It was also
noted that the health workers were not trained in handling clients with special needs and
some unique disabilities; such as the use of sign language.
l) Limited funding for AYSRH programs: Majority of the district plans and budgets do
not specifically cater to AYSRH programs which was attributed to mainly the lack of
funding. Districts therefore mainly rely on partners and NGOs to implement specific
programs targeting the young people, but these are not adequate given their activities,
coverage and funding is limited.
3.4.6.2 Challenges to delivery of SRH services in schools:

a) Failure to disclose young people living with HIV/AIDS: There is often failure of
parents to disclose their children infected with HIV and on ARV medication which limits
the ability of the school administration to closely support ad counsel them. This can lead
to unintended infections among young people of school going age in situations where
children become sexually active at such a tender age. District Education officials in pointed
out great concerns over this issue.
“Lack of data on children living with HIV/AIDs in schools makes it hard for administration to give
them necessary support. Parents deny information on such children.” Key informant, Moroto district.
b) Lack of ethics amongst teachers. There have been reported cases of teachers defiling
and raping their students and yet they are expected to protect and counsel them. This is
against the teachers’ professional code of conduct Notice, 2012. For example, in
Ntungamo district:
“’In June 2015, KJ’ a pupil in primary three aged 13years was defiled by ‘BL’, a teacher of that very school.” Key
informant Ntungamo district
c) Lack of skills in provision of adolescent and youth friendly services amongst the
teachers. In some districts, teachers including senior men and women lacked the necessary
skills (i.e. SGBV counselling, mental health and psycho-social support, HIV counselling
and counselling on drug and alcohol abuse) to handle SRH problems faced by young
people in school. Other district leaders were concerned that teachers do not consider
sexuality education as an important issue.
“Teachers do not take sexuality education seriously and they don’t even have skills to avail knowledge on
such issues to young people” Key informant, Kotido district
d) Lack of a common understanding amongst stakeholders: In most cases

disagreements arose amongst stakeholders (parents, education officials, school
administration, service providers like the Ministry of Health and partners) on what should
constitute SRH in schools and what age should benefit from these services. Provision of
some SRH services such as family planning services in schools is frowned upon by parents
in the communities as a move to expose young people to early sex. Schools that are under
the management of religious bureaus such as Catholic and Moslem schools are not
accepting of some these services. This creates a gap in effective and comprehensive
implementation of SRH services to young people who need to access these services in the
schools.
89
FINAL REPORT
e) Few senior women teachers: There is a limited number of female teachers in hard to
reach areas and as a result some schools are still lacking senior women in the schools
especially the government aided schools in rural areas
f) Gaps in WASH services affect sanitation for girl children: There is a general gap in
provision of WASH facilities in schools. Most schools lack separate washrooms and
changing rooms for young girls to be able to access sanitary facilities during their menstrual
periods and this leads to these girls missing school for the entire duration of their period.
Important information passed on at school regarding SRH is missed in their absence and
for some, being left behind in the school timetable as well as embarrassment faced in
school due to accidents in their periods leads to dropping out entirely.
g) Duplication of services: District officials noted the challenge of duplication of services

in some areas versus low coverage of services in other areas. Districts rely on partners to
implement SRH services in school and yet these partners are either focusing on specific
sub-counties in a specific district or focusing on delivery of a specific service only for
example safe male circumcision and HIV counseling etc. this leaves a gap in delivery of
other key SRH services such as mental health, SGBV among others.
h) Low supervision: Inspections carried out in schools tend to leave out the aspect of SRH
and this creates a gap in the follow up system and mechanisms The inspection form does
not incorporate monitoring sexuality education activities in schools. District officials also
noted that information about SRH is most of the time misunderstood by the young
people/adolescents hence them being at risk for example messages delivered on safe male
circumcision are often misrepresented leading to young people believing that circumcision
makes you “immune” to being infected with HIV rather than the fact it just reduces your
chances of infection. Teachers capabilities ought to be enhanced through supportive
supervision yet the districts do not have sufficient resources to do that regularly.
i) Inadequate IEC materials in schools. IEC materials in schools are either few or non-
existent in some schools and at times the senior teachers are overwhelmed with school
work to ably conduct sexuality education. Parents and teachers rely on the senior women
and men to educate the children on SRH issues and yet they atimes don’t due to the
overwhelming school work and lack supervision. The available IEC materials are not in
the local languages and pictorial form making it difficult for some young people especially
those out of school to easily understand the SRH message being delivered. A peer educator
in Katakwi district mentioned that: “Videos that are shown in schools during health education talks
are in Luganda yet very few students that understand and speak the language.”
j) Inadequate funding: District officials noted that there is inadequate funding at the
district level and in schools to implement SRH programmes in schools. SRH programmes
running in schools rely on partners for funding and once the programme ends or partners
pull out, they are no longer sustainable and eventually die out.
k) Poor feeding in schools: School feeding programs are poor (no midday meals in most
schools) and parents are not able to provide meals for their children either so children are
left to attend school hungry and this leads them to dropping out of school and missing out
on key information given out in schools regarding the several SRH issues, as well as leaving
them vulnerable to SRH related risks and problems.
90
FINAL REPORT
3.5. District Level Programming for SRH

3.5.1. AYSRH initiatives at the District Local Government
Integration of AYSRH in district planning and programmes: According to the district key
informants, all district integrated SRH services in their DDPs but there was no mention of AYSRH
specifically targeting young people aged 10-14 years, 15-19 years and 20-24 years.
“No implementing partner provide AYRSH services specifically targets young people aged 10-14 years, 15-19
years and 20-24 years in Kamuli district. For example, Family Help Program of Busoga Diocese provide family
planning services to the entire community not specific to young people aged 10-24 years.” Key informant (DHT)
in Kamuli district.
“There is no special implementing partners implementing services that target young people aged 10-24 years only.
Most of the services are integrated and focus on all age groups” Key informant (DHT) in Mayuge district.
However, efforts were being made by all the 44 surveyed districts in the departments of health,
education and community based services to integrate and strengthen specifically AYSRH targeting
young people aged 10-14 years, 15-19 years and 20-24 years in their current programmes/ activities
in the subsequent financial year. This was especially the case in regards to their budgeting and
planning, routine inspections of school and health facilities, capacity building and training of staff,
and establishment of youth corners. Integration of AYSRH activities into their work plans was
however constrained by inadequate funding from the government and SRH partners.
“We are developing our District Strategic Plan for HIV/AIDS (2015-2020) to address the SRH ill health
problems faced by young people through training peers, establishment of youth friendly services and setting up dialogue
meetings to continue identifying key issues exposing young people to HIV.” Key Informant (DHT) in Hoima
District.
“The district work plan (2015/16 -2017/18) plans to start youth friendly corners in all HC IVs and HC IIIs
providing ART- with funding from SOS.” Key Informant (DHT) in Kabarole district.
“School health outreach and training of health workers in long term family planning methods have been planned for
in the district health department work plan (2015/2016-2016/17).” Key Informant in Bundibugyo
district.
The district conducts Lot quality assurance sampling (LQAS) is conducted annually in June/July to inform the
departments of the current situation prevailing in the community on key issues of health, WASH, and education”
Key Informant (DHT) in Kamuli district.
Community based services departments in the districts have made effort to integrate AYSRH into
the various government programs at community level. They mainly focus on combating poverty
among youth (which is a driving vulnerability factor to SRH problems) as well as mobilization and
sensitization of youth on issues relating to SRH/HIV. The probation office under the community
based services department at the district also works hand in hand with the police, especially on
cases of rape and defilement, GBV and family conflicts among others.
Youth Livelihood Programme: In a bid to economically empower the youth, the Youth
livelihood programme has provided soft loans to the youth groups across the country and also
trained them on life skills.
91
FINAL REPORT
“A package of life skills has been integrated in the training component for youth under the Youth
Livelihood Programme …” said a key informant in Kyenjojo district.
“In Abim district, about 23 youth groups have been supported under the Youth Livelihoods Programme
with soft loans which they pay back with small interests….” said a key informant in Abim district.
“We have implemented several government programmes which include a special grant for women to
improve on women’s income; there is also a PWD grant and the Youth Livelihood programme where by
at least 320 million has been distributed to 31 youth groups.” Said a key informant in Mbarara.
AYSRH focal persons: Each district has a Maternal and Child Health (MCH) Focal Person who
is part of the formal health establishment to handle reproductive health and is supported by other
members of the District Health Team. However, some districts like Mbale and Kampala districts
specifically have an adolescent focal person appointed at the district. Other districts like Mbale
have an HIV focal person in the DCDOs office.
District Youth structures in place: The youth have administrative structures in the form of
youth councils with elected youth representatives in place at the district and sub-county levels
which is in accordance with the National Youth Council Act Cap 319. They hold quarterly
meetings to review and discuss youth issues in the district. The office of the youth has a budget
for youth activities although funding is limited.
3.5.2 SRH program coordination

Several partners were found to be providing AYSRH services in all regions in Uganda. However,
these services were found to be targeting beneficiaries across all age groups and not specifically
young people aged 10-24 years. The different partners identified were found to vary in coverage
by region, specific districts within a region and specific sub-counties within a district. At the
district, monthly stakeholder meetings are usually held with the various partners and NGOs to
discuss ongoing activities and unmet needs regarding SRH among young people.
Key partners10 identified across the regions dealing in AYSRH included Marie Stopes,
Reproductive Health Uganda, STAR-EC, Action Aid and Baylor Uganda which are operating
under the health departments in health facilities and communities in the different districts. The
DHTs (DHOs, MCH & Health Facility In-charges) mentioned the key partners operating in the
districts during the consultative discussion with survey team conducting the AYRSH survey.
Key partners operating in schools under the guidance of the district education department included
World Vision, Child Fund, Save the Children and UNICEF. The main SRH services provided by
these partners in schools include: family planning, Safe Male Circumcision, HIV testing and
counselling, antenatal and postnatal services, and STI diagnosis and management. Table 49 below
shows the key partners identified in the different regions and the different SRH services they are
providing for young people:
10Key partners considered were the organizations operating at a regional and or national level. At district level, it included
development partners and CSOs/NGOs and CBOs registered with the district Community Based Services (CBS) department
to operate in the districts within their project arears and work closely with the district official in the line department e.g
Health, education, Water, etc.
92
FINAL REPORT
Table 49: Listing of key partners in provision of SRH services
Key Partners SRH Programs and Services Provided

UNFPA  Support advocacy for increased government financial and human resources for
maternal health and family planning;
 Build a national accountability mechanism, including by scaling up maternal death
surveillance and response, and establish a performance monitoring scorecard
mechanism to ensure access to high-quality care according to human rights
principles;
 Support national and local governments in establishing strong partnerships and
effectively coordinate integrated sexual reproductive health and rights interventions,
including preparedness and response in humanitarian settings;
 Strengthen the midwifery programme and provide equipment to health facilities for
provision of emergency obstetric care, post abortion care, obstetric fistula
management and the Minimum Initial Service Package for Reproductive Health in
humanitarian settings.
 Policy advocacy for task shifting and sharing among service providers, improving
availability of integrated maternal health and family planning services;
 Advocacy for progressive increment of resources to implement family planning
scale up plans;
 Technical and financial support to improve commodity forecasting, procurement
and supply chain management system at national and district levels;
 Establishment of effective coordination mechanisms for family planning
programmes;
 Training of health professionals to provide a high-quality method mix in family
planning, according to the new family planning human rights protocol; and
 Support of community health extension workers strategy to increase demand for
family planning services.
 Support ministries of health, education and social development to deliver integrated
and coordinated HIV and sexual and reproductive health programmes for young
people;
 Mobilize religious and cultural institutions to scale up social and behavioural change
interventions;
 Generate evidence to improve HIV and Sexually-Transmitted Infections
programming for young people;
 Support implementation of the 10-step strategic approach to comprehensive
condom programming, including for most-at-risk populations
 Advocate for the integration of comprehensive sexuality education in curricula for
secondary schooling, teacher training (primary and secondary), vocational training
and in developing a minimum package for out-of school youth;
 Support ministries of health, gender and education to coordinate adolescent sexual
reproductive health initiatives and to provide youth-friendly services, especially for
vulnerable adolescent girls, including in humanitarian settings;
 Support youth networks to facilitate participation of young people in development
processes, particularly in matters of sexual reproductive health and rights;
 Promote evidence-based social and behavioural change communication to address
social norm barriers to adolescent sexual and reproductive health.
Marie Stopes  Family planning services (Permanent and Temporary FP)
 Post abortion care
 Cervical cancer screening, treatment and HPV vaccination
 HIV counselling and testing
 Safe Male Circumcision
93
FINAL REPORT

 Antenatal and Postnatal services
 Infertility Management
 Outreaches in communities regarding SRH issues
STAR-E/ STAR-  Promotion of HIV prevention through sexual risk reduction;
EC  Voluntary medical male circumcision (VMMC)
 HIV testing and counseling (HTC);
 Prevention of mother-to-child transmission (PMTCT) of HIV;
 Antiretroviral therapy (ART);
 Tuberculosis testing and treatment;
 Collaborative treatment of TB/HIV co-infected patients;
 Psychosocial support
 STAR-EC supports a network of village health teams (VHTs) that extends services,
including PMTCT of HIV; HTC; VMMC; condom promotion; HIV prevention
messaging; and care referrals, to communities
 STAR-EC also facilitates district-led performance reviews to help identify coverage
and service gaps.
 Facilitate in-service clinical training and mentoring of health workers in the delivery
of quality HIV & AIDS and TB services.
 behavior change communication activities to increase public awareness and demand
for HIV & AIDS and TB prevention and treatment services e.g. distribution of
information, education, and communication materials and job aides to clients and
health workers
USAID  Recruitment of a female doctor to work in the Buinja HC IV in Namayingo
 Support youth centres under Strides for Family Health in Mayuge HC III
Child Fund  Offer life and entrepreneurship skills to young people.
 Training peer educators in some districts like Luwero
 Psycho-social support for people living with HIV/AIDS and re-inforce the
importance of adhering to drug treatment regimens.
 In some districts such as Mbale, they operate in Bumasikya and Busuwo sub
counties giving guidance and counselling to children as well as training teachers
 Encourage child protection clubs in communities to empower people to protect
children’s rights.
Reproductive  Health Education and Counselling
Health Uganda  Family Planning Services
(RHU)  Treatment of STDs, STIs, HIV/AIDS
 Voluntary Counselling and Testing (VCT)
 Post Abortion Care
 Laboratory services
 Screening of Cervical cancer
 Pregnancy tests
 Infertility Management
 Antenatal, postnatal, immunization and child growth
 Recreational activities for the youth (10-26yrs) &Library services and educative film
Action Aid  SGBV counselling and treatment.
 Offer rehabilitation centres and women shelters for women and victims of SGBV.
 Conduct community outreaches.
 Conduct radio talk shows targeting parents and children in the communities;
 Facilitate child days plus;
 Teach all age groups on how to make sanitary pads, e.g. in Palisa.
 Constructed boreholes for example in Gogonyo sub-county Palisa.
94
FINAL REPORT

 They train student leaders in schools, facilitate MDD activities and other SRH
activities.
 Train teachers, senior women and senior men; for example in (Katakwi district).
Baylor Uganda  Family centered pediatric HIV/AIDS prevention, care and treatment services.
 Supporting OVCs infected with HIV and their caregivers
 Sensitizing on nutrition and feeding in children
 Offer safe male circumcision (SMC)
 Community sensitization of young people on health related issues including SRH.
 Training of health officials in pediatric HIV treatment
 Training of OVCs in vocational skills; tailoring and garment cutting, carpentry and
joinery, hair dressing and cosmetology, and motor vehicle mechanics
World Vision  HIV/AIDS counselling and SRH
 Distribution of condoms and other family planning methods.
 Sponsoring of children in schools.
 Classroom construction activities in some districts such as Soroti district.
 In some districts like Mbale district, World Vision operates in Namanyonyi sub-
county: It is involved in sensitizing young people and teaching them how to make
sanitary pads.
 Sensitization of youths on SRH issues, HIV/AIDS, etc.
Save the Children  Teaching young people on how to make sanitary pads
 Training senior men and women in schools for example in Moroto;
 Training peer educators in districts such as Kabale
 During ANC– identify adolescents and do follow ups
 Promoting Go-back to school for young mothers,
 Youth empowerment in schools for example in Kasese district
UNICEF  Child protection services for victims of rape, defilement and physical abuse.
 Mental health rehabilitation services
 Go to School, Back to School, Stay in School' advocacy campaigns
 Community dialogues to encourage young people and their parents on the
importance of education.
 Training teachers and school administration on child rights and child protection
 Building of sanitation facilities and separate washrooms in schools
 Village Health Teams and Integrated Community Case Management
 Maternal health and antenatal care
 HIV Prevention
 Prevention of mother-to-child transmission intervention (PMTCT)
 Preventing and Responding to Violence (national ZERO tolerance to violence
against children campaign)
 Girls’ Education Movement (GEM)

Doctors without  Adolescent Health clinic offering a broad range of the adolescent friendly services
Borders to ages10-19
FHI-360 Uganda  Provision of injectable contraceptives to the communities
 Women empowerment through availing advanced agricultural technologies
 Improve care for people living with the virus and strengthen nutritional services.
LINKUP  Training School Management Committees (SMCs) to give them skills/ empower
them in conducting their roles and responsibilities of administration of the schools.
 Supporting provision of free youth friendly services such as family planning/
contraception, HIV counselling and testing and ART services, testing and treatment
of sexually transmitted infections
95
FINAL REPORT

 Health education services
Uganda Red  Training peer educators and health workers to handle SRH issues and provide youth
Cross friendly services
 HIV Counselling, Testing
 Set up of youth friendly corners e.g. in Wakiso
 Provision of family planning services e.g. distribution of condoms.
Uganda Cares  Establishment of adolescent ART clinics in health facilities for example in Wakiso,
Rakai, Kalungu, Kalangala
 Provide scholarships for young people in schools for example in Rakai
 Distribute family planning commodities such as condoms.
 HIV/AIDS counselling
SNV  Training women empowerment with skills to make sanitary pads for sell and
Netherlands economic sustenance.
Development  Youth entrepreneurship and skills development
Organization  Sensitization of girls, boys and their parents about menstrual hygiene management
 Boys and girls making reusable menstrual pads at school as part of their
extracurricular activities
FAWE-Focus  Sexuality education through educational activities like skits, poems, role plays,
for Africa discussions, debates, songs etc. Sexuality education for the youth addresses
Woman adolescence, sexuality, gender, rights and the prevention of health risks such as HIV
Educationalist & AIDS, other sexually transmitted infections (STIs) and unintended pregnancies.
 Training of senior men and women in schools
 Offers sponsorships to students in schools
FIDA Uganda.  Legal aid services to women, men and children e.g in Kamuli, Kapchorwa, Kampala,
Gulu, etc
 Human rights protection i.e raising awareness of rights and the mechanisms to
enforce them, including reproductive health rights.
 Advocacy on prevention of GBV
3.5.3 Service sustainability

Several measures have been put in place by the districts, with support from the relevant ministries
and Community Based Organisations (CBOs), to ensure sustainability of SRH services and
programmes being implemented in the district. Measures identified ranged from quarterly support
supervision, trainings, school health clubs and district planning among others. It was however
noted that the districts were faced with the challenge of limited resources and inadequate staff
capacity to support the sustainability strategies. Below are some of key identified measures in place
at the district health and education departments to ensure sustainability of SRH services and
programmes for young people in the regions.
3.5.2.1 Sustainability measures under the District Health department:

a) Monitoring: Some districts have set up reporting channels for the youth corners in the
communities in order to be able to monitor all the activities and services offered in the youth
corners.
b) Capacity building: Health workers in some districts have been trained in delivery of
adolescent and youth friendly services specifically for the young people in order to empower
them to handle them effectively. Peer educators have also been trained in several districts.
c) Participation: Involvement of the district technical team and health workers from planning
to implementation of SRH programmes has ensured ownership and continuity of the
programmes. Majority of the programmes brought in by donors and partners are integrated
within the existing health facility systems.
96
FINAL REPORT
d) Inspection: Some districts conduct quarterly integrated support supervision, mentorship and
inspection of SRH services at the health facilities. Sometimes spot checks/ spot inspections
are done to ensure services are sustained throughout the year; for example in Kampala, KCCA
performs spot inspections of health facilities in Kampala district.
3.5.2.1 Sustainability measures under the District Education department:

a) Supervision: Support supervision of schools is done through the inspectorate of schools.
There is a supervision tool specifically catering to classroom instruction, out of class
instruction, sanitation and hygiene, as well as internal support supervision by head teachers.
b) Presence of trained senior men and women: Senior men and women teachers provide
sexuality education and counseling in schools. In some districts, senior women and men
teachers have been trained in making sanitary pads and these skills are then passed on to the
young people to ensure that they can provide these for themselves. For example, the
MoGLSD trained senior men and women of Kasese district in Oct 2015. Clubs have been set
up in schools to support AYSRH issues in the form of different activities, including drama
clubs. Controls have been put in place to monitor the schools clubs to ensure that the clubs
are functional. This is done by reviewing their reports and meeting minutes regularly.
c) Continuous sensitization: Parents, school administration, and students in schools are being
continuously sensitized on SRH issues. For example, ‘talking compounds’ in schools and
school health clubs are used in schools to discuss SRH issues among students. In some
districts as well, ‘Community Barraza’s’ are held where all stakeholders in a community are
gathered and sensitized about SRH issues affecting young people.
d) Integration of SRH in school activities: Districts make efforts to insure SRH issues are
budgeted for and incorporated in the school programme. In some districts like Yumbe, the
education department encourages that activities to do with SRH be part of the school budget.
In other districts such as Mbarara, Kampala and Rakai, Headteachers are encouraged by the
DEOs office to integrate SRH education talks in their daily school assemblies to enable
effective communication of SRH information to the young people on a daily basis. In schools,
the senior male and women teachers provide talks about SRH to male and women learners
respectively.
3.5.4 AYSRH policies at district level

Overall, all the 44 survey districts had no ordinance or by-laws directly linked to AYSRH.
Consultative discussions with partners and the district officials revealed that majority were not
familiar with the current National Adolescent Health Policy 2004. Despite the fact that most of
the health facilities provided a wide range of SRH services, they lacked a specific AYSRH clinic
and trained personnel to deal with young people. However these policies such as Adolescent
Health policy, FP policy and SGBV protocol among others were being used to inform planning
but not fully disseminated to health centers in some districts. The by-laws and ordinances in place
focused on addressing the driving factors to SRH and HIV/AIDS problems faced by the young
people in- and out-of-school in their communities. They mainly aimed at increasing enrollment,
reducing the dropout rates especially in primary schools, discouraging underage drinking and
promoting child protection (banning child labor, abuse and neglect) among others. Some examples
include;
 In Katakwi, sub counties such as Magoro, Kapijan and Usuk have by-laws whereby no child
should be found in a market on a school day. There is even a taskforce in place to enforce
these by-laws.
97
FINAL REPORT
 In Mbale, the SCDO mentioned that Nakaloke sub-county and town council has a children
and youth by-law whereby issues of sexual harassment, parents not taking children to school,
child neglect are catered for. In Bufumbo sub-county there are regulations of video halls in
terms of opening time and age limit restrictions.
 Mbarara district has an ordinance passed by the district council; in this ordinance, “a bar
business owner shall not allow a child entry into his or her premises, and it is a duty of every
parent or guardian taking care of a girl child to ensure that she attends and remains in school
until she completes primary school education”.
 In Rakai district- there is a Child protection ordinance and child labor ordinance.
 Kalungu the district has an ordinance that stipulates that all health centres in the district should
have a condom bank and that all busy major towns in the district should also have condom
banks.
 Arua district setup a by-law that prohibits bars from operating beyond 10pm. This is aimed at
combating the night behavior that put youth at a risk of SGBV and contracting HIV/AIDS.
 In Mukono district there’s a by law on each school building washrooms to help menstruating
girls.
 In Kayunga district, a by- law was made on child labour whereby if children are found working
on farms, fields and dams, the employer is fined heavily. Violators of this law, for example
employers are given warnings before any legal action is taken.
 Truckers in Soroti district are being re-located out of town councils in order to keep them
away from young people who are easily attracted to these stops and end up vulnerable to SRH
problems like HIV/STIs and pregnancy.
“Truck stops have been set up along Amuria road far away from the town and especially away from the young
girls in the towns,” said a Key Informant in Soroti.
3.5.5 Youth participation

In general, there was hardly any fora for young people to freely air out SRH issues and address
their SRH needs. And the few available fora was provided by religious institutions and government
structures. Some of the available fora identified included:
Youth councils: The National Youth Council Act Cap 319 established the Youth Council
structures from village to national level to provide channels through which the voices and view of
the youth are heard and integrated in development. At sub-county level, the youth councils held
quarterly meetings and at the district level youth councils held meetings every six months. Some
of the members who sit on the youth council include leaders such as the secretary for female affairs
and representatives of PWDs. The councils sit and discuss issues that affect the youth including
SGBV, drug and alcohol abuse, and youth unemployment. Youth councils however lacked funding
to enable them mobilize and meet more regularly to discuss SRH issues facing the youth.
Religious institutions: Religious institutions also organize platforms for young people to air out
their SRH issues. For example, in Bushenyi district, the Church of Uganda organizes annual
conferences whereby they collect students and gather them at Bweranyangi Secondary School
where they discuss SRH like prevention of STIs and HIV/AIDS, prevention of SGBV, livelihood
issues and income generating activities, youth empowerment and staying in school.
Youth groups: Youth groups have been set up in some districts by partners such as Save the
Children International, Uganda Red Cross, Uganda Cares, to discuss various issues including those
relating to SRH. Issues raised and discussed among these groups are passed on to the local
authorities for further action. For example, in Kampala district, Central Division, there are several
98
FINAL REPORT
youth groups such as “Muvubuka Agunjusse”, “Jamal Group”, “Yonja Youth Mengo group” which
mobilize youths as members to advance and discuss SRH issues, provide mentorship to peers,
provide support during outreaches in the communities and carry out several activities meant to
empower these youths in the communities.
International and national Youth Day celebrations: The Youth Day celebrations held at
national and district levels are used as advocacy platforms to air out youth SRH needs and
problems. This include health facility related gaps that affect access to SRH by these youths,
employment and skills related gaps and barriers to their livelihoods as young people in society
among others. On such days, young people through their representatives state their grievances to
the government officials and other stakeholders present at the celebration ceremonies.
3.5.6. Proposed programming interventions by stakeholders

The programming interventions are sited out by the different stakeholders at district, community
and health facility level as service delivery improvement areas meant to strengthen, increase access,
utilization and delivery of SRH services among young people today. The proposed interventions
generally focus on service improvement at district, health facility, school and community levels.
3.5.6.1 District level interventions

a) Strengthening information sharing and dissemination among stakeholders: Strengthen
sharing of information (i.e knowledge, experiences and lessons) among all stakeholders i.e. district,
Ministry of Health, line ministries, political leaders, cultural leaders, religious leaders and
implementing partners.
b) The District management Committee (DMCs), include all departments and all partners should
hold meeting quarterly. For example, in Mayuge district, all departments and all partners under
Health department submit their reports to DHO to make a joint presentation to the DMC,
as a best practice. Therefore strengthening such For a/platforms a at national and districts
levels will ensure better identification of ongoing activities and unmet needs in SRH services
so as to better inform future interventions in SRH, boost stakeholder involvement and avoid
duplication of services.
c) Revise SRH strategies to be more effective: The impatience of the young people and their
reluctance to respond to health issues, for example STIs in their initial stages, SGBV (rape
and defilement) and even getting vaccinations (TT and HPV) is a recurrent barrier to access
and utilization of SRH services in the health facilities. The government and implementing
partners should therefore design strategies that best reach out to the young people in areas of
their convenience such as churches, clubs, villages, schools etc. Additionally, government
institutions and implementing partners should design programs that address the actual root
causes of Sexual and Gender Based Violence (SGBV) against young people e.g. alcoholism,
poverty, and other cultural practices such as FGM. Current interventions are more of a
response to SGBV cases. FGM is done in highly secluded and hard-to-reach locations
sometimes on the other side of the Kenya borer with Uganda. The GoU, development
partners and CSOs should strengthen approaches that lead to changes in the attitudes and
behaviours that have led FGM, e.g obtaining timely, comparable and reliable information on
FGM. In addition, awareness creation is the key to implementation and enforcement of the
Laws.
a) In-service training and capacity building: District officials recommended comprehensive

in-service training and capacity building of health workers and duty bearers in provision of
AYSRH services. Service providers with no prior training on handling adolescents and young
adults SRH issues make an already hard situation impossible; there is therefore need to scale
99
FINAL REPORT
up specific trainings for health workers, teachers, senior women and men, VHTs, and peer
educators on providing SRH services to the young people.
b) Scaling up health facilities that support SRH services for adolescents and young
people: The lack of health facilities in remote and hard-to reach areas such as the small islands
in Kalangala and Mayuge districts and other fishing villages/landing sites where most at risk
populations (MARPs) live around the country makes it impossible for the young adults and
adolescents to have information, knowledge and access to the AYSRH services that are
provided at the available health facilities. Therefore there is need for the government to
establish more health facilities at community level providing SRH services to young people.
There is also further need to scale up youth corners at lower levels of health facilities (HCIIIs)
to increase service delivery of AYSRH services to the young people.
c) Creating, disseminating and enforcement of policies: There is need to strengthen the

enforcement of the existing policies on SRH issues for the young people in the community.
This will ensure that duty bearers at district and community level are more responsive to cases
of child abuse, defilement, rape, child marriages, FGM, and SGBV among others.
Additionally, there is need for the central government to disseminate policies at national level
and create awareness at lower levels i.e. district and community levels so that young people in
the community are empowered to stand up for their rights. The government needs to support
the districts and sub counties in the creation and ensuring the operationalizing of ordinances
and by-laws that are geared towards prevention of the practices and actions that escalate SRH
risks and vulnerabilities such as organized sex workers, discos, and alcohol and drug abuse.
d) Incorporating sustainability as a core aspect of project interventions: There is need for

the implementing partners to have specific sustainability strategies for the ongoing projects/
programmes so that even when they are phasing out, the existing structures at district and
community level can still ably provide these services. These strategies include involvement of
duty bearers such as the probation officers, police, district officials etc. right from project
planning and throughout implementation of the programmes or projects and by engaging
people at the community level like peer educators and VHTs so that there’s project ownership
right from grass root level.
3.5.6.2 Interventions focused on strengthening health facility services

a) Provision of IEC materials in appropriate local languages: Strengthen the provision of
IEC materials in the local languages especially to cater for young people out of school. This
will increase access to information and knowledge on AYSRH issues and services.
b) Training and capacity building of health workers: Strengthen in-service training for
health workers at the health facilities especially at HCIIIs and HCIVs. The main training needs
identified were psychosocial support, mental health, STI management, FP (side effects and
long term methods), SMC, counselling on SGBV and HCT among others with specific
emphasis on provision of AYRSH to young people aged 10-24 years. VHT and peer educators
who engage in provision of SRH in the communities should be trained as well. For example,
in Kamuli district, a total of 141 new workers who are frontline health workers had not yet
received in-service training by the time this AYSRH survey was conducted.
c) Strengthen supply of reproductive health commodities and SRH supplies: Government

should strengthen supply of reproductive health commodities and SRH supplies in adequate
quantities especially male condoms, emergency pills, ARVs (for children mainly), antibiotic
drugs, sterilization materials, etc. mainly across the Health centers to ensure they are made
100
FINAL REPORT
available to the young people that come seeking these services. NMS should increase on the
quantification of drugs that are used for STI management as compared to the anti-malaria
drugs. In addition, the MoH together with MFPED should establish a specific budget line for
AYSRH at health facilities in the districts.
d) Health worker incentives: Motivation packages in form of allowances should also be

introduced for health workers, VHTs, and peer educators and in order to encourage them to
carry out their work effectively. Though VHTs are volunteers, they should be motivated.
e) Establish specific AYSRH clinics: This can best be done through MoH integrating
Adolescent youth friendly services within the structure of health facilities to ensure adequate
time, space and manpower. Adolescent sexual reproductive health clinics should be set up in
the health facilities with special days and space specifically to cater for the SRH needs of young
people. These clinics should be clearly sign posted in the communities and at the health
facilities in order to attract young people in the communities to seek these services.
f) Youth corners: Youth corners should also be set up at the health facilities and be well
equipped with recreational activities, television sets, and other edutainment facilities to attract
young people to the health facilities, as well as avail family planning commodities like female
condoms, male condoms, contraceptive pills etc. These youth corners should also be equipped
with separate skilled staff in the different SRH services to deal with the young people’s needs
separately from other health facility clients.
g) Increase health worker staffing levels especially in delivery of AYSRH: Government

should increase the number of health workers with requisite expertise and skills to provide a
range of AYSRH services. This will increase the efficiency and improve service delivery at the
health facilities.
h) Establish special services catering to PWDs: Special services as well as facilities should be
set up to handle PWDs who come to access SRH services in the health facilities such as ramps,
wheel chairs, handicapped- accessible toilet facilities etc. Strengthen in-service training of
health workers in special skills such as sign language to enable them communication effectively
with the PWDs especially those with audio impairment.
3.5.6.3 Interventions focused on strengthening AYSRH service provision in schools

a) Comprehensive training and capacity building of teachers: Since adolescents spend
more time in schools and interact with their teachers easily, there is need for comprehensive
training of senior women and men on SRH aspects encompassing sensitization on SRH/HIV
as well as providing guidance and counselling services and psycho-social support e.g to victims
of GBV, illegal drugs & alcoholism. Follow up should then be made to ensure that the
acquired skills are actually being put into practice.
b) Support and strengthen school health programmes, initiatives and clubs: There is need
for the Ministry of Health and Ministry of Education to come up with a strategy to support
and strengthen school SRH related interventions such as school clubs and health programmes
like PIASCY. These strategies are a sustainable way of ensuring continuous knowledge
sharing of SRH issues as the children interact and share experiences amongst themselves.
Government and partners should also support initiatives in the schools for provision of
sanitary pads, teaching girls how to make reusable pads and feeding programme as well as
strengthen the PIASCY programme.
101
FINAL REPORT
c) Sensitize young people and parents on the importance of education: This can be
through supporting school initiatives like ‘Go-Back-to-School’ campaigns, ‘Stay-in-School’
campaigns among others and community out reaches on value of education. This will reduce
AYSRH risks of child marriages and pregnancies, alcoholism and drug abuse, prostitution. In
addition, staying in school will increase access to information and knowledge of SRH.
d) Provide fully functional counselling department: The government needs to come up with
a functional and guiding counselling department to listen to and handle the concerns of the
young people in school. The counselling departments in the schools should be fully equipped
and facilitated with counsellors to readily and effectively attend to the needs of the young
people in the schools.
3.5.6.4 Interventions focused on strengthening AYSRH service provision in communities

a) Create more platforms for youth to advance their SRH issues: There is need to come up
with more platforms like outreaches and empower youth groups in SRH to enable young
people freely discuss SRH issues thus increasing awareness of young people at community
level both in school and out of school.
b) Train more peer educators: There’s need to strengthen the peer education approach across
all districts especially those found to lack peer educators. The VHTs and para-social workers
tend to focus more on primary health care and child protection respectively and yet young
people have continued to show a tendency to consult fellow peers when seeking SRH advice.
c) Strengthen sensitization programmes targeting young people: Sensitization

programmes involving use of radio talk shows, outreaches as well as video and drama shows
attract the young people and have been a much more effective means of disseminating SRH
information to the young people today. There is need for young people to clearly understand
HIV, STI, contraception, pregnancy and circumcision aspects.
d) Increase funding for youths income generating activities: The government should
increase on the dedicated funds set aside to support income generating activities for young
people as this will improve their livelihoods and consequently will empower them to prevent
sexual reproductive ill-health and/ or manage SRH issues. Most income generating activities
for the youth are funded by NGOs hence when these NGOs leave the projects barely survive
thus government intervention on funding needed.
e) Sensitization of parents: Parents should be sensitized on the need to sensitize their children
on SRH issues relating to sexuality, pregnancy, family planning, relationships and personal
hygiene among others. This will make parents more receptive to the adolescents and young
adults accessing these services. In addition, this will also change their attitudes and perceptions
towards some of the SRH services like family planning.
102
FINAL REPORT
4. RECOMMENDATIONS AND IMPLICATIONS FOR PROGRAMMING
The following recommendations and implications for programming arise out of the key findings
of this AYSRH assessment:
Given that sexual behavior is central to SRH, the percentage of young people who have had sexual
intercourse is an important indicator of those that need to access services. The finding that 40%
of adolescents (aged 10-19 years) and young adults (aged 20-24 years) have had penetrative sexual
intercourse shows that AYSRH services should be a priority at all levels of intervention. In
line with WHO recommendation, there should be a link in the provision of contraceptive services to
the provision of wider sexual and reproductive health service for adolescents, notably information and
clinical services related to sexually transmitted infections (STIs) and HIV, as an integral component of a
comprehensive response to sexual violence. Since only 4% of those aged 10-14 have had sexual
intercourse, the main target groups for STI prevention should be those aged 15-19 years (where
43% have had sexual intercourse) and those aged 20-24 years (where 86% are sexually active). SRH
packages at all levels should be tailored to identifying young people in these age-groups and
offering appropriate knowledge and support even when not demanded.
 There is need to promote knowledge about specific components of SRH that are age-
appropriate. National Policy Guidelines and Service Standards for Reproductive Health Services
2006 and 2004 Adolescent Health Policy of Uganda address the need to provide direction and focus in
the provision of adolescent health services. These guidelines describe the recommended package of
ASRH which include both services and information. In line with these guidelines, young people aged
10-14 years should be made aware of HCT services, as well as the people whom they can
contact in case they have specific questions related to SRH. Young people aged 15-19 years
should all be made aware of the different types of STI symptoms as well as the availability of
STI diagnosis and treatment services in health facilities, while older young people (20-24)
should be sensitized on existing support mechanisms for SGBV, pregnancy prevention and
post-abortion care. Age appropriate knowledge on pregnancy prevention should also be
promoted among young people, to fill the gaps in awareness about modern methods of
contraception. This should mainly target young people aged 15-24 years because these are the
sub-groups where more young people are sexually active. Those aged 20-24 years should
receive more information about longer term methods for family planning (especially IUDs and
implants), to broaden their choices. Where such services are available, support mechanisms
need to be put in place to address young people’s concerns about side effects of family
planning, with mechanisms for counselling on side effects and switching methods.
 To increase uptake of SRH services, sexually active adolescents and young adults need
information to address the misconceptions they have about certain SRH services. In
particular, they need to be empowered to de-bank the myths they have about family planning,
including cultural and religious beliefs that prevent use of FP as well as the beliefs regarding
side effects. Health workers need to emphasize that side effects following FP can be managed
at the health facilities. They should provide such support to young people who come with
complaints related to side effects.
 The finding that up to 38% of younger adolescents (10-14 years) are not aware of any method
of HIV transmission and that many people in this age-group have misconceptions about how
HIV is prevented, transmitted or mitigated, calls for urgent need for scaled structured HIV
education targeting young adolescents. HIV knowledge should be universal among all
adolescents and young people, without restriction on age-appropriateness. West Nile and
103
FINAL REPORT
Central 2 regions recorded unacceptably low levels of awareness on HIV prevention among
the younger adolescents and interventions ought to be even more emphasized in these regions.
The finding that only 36% of adolescents and young people had comprehensive knowledge
about HIV/AIDS further supports the recommendation that older adolescents and young
people (15-24 years) too need scaled structured HIV education. There is also need for
universal awareness creation among young people on where they can obtain HIV tests
when they need them, more so in the East-Central region where 36% of them did not know
where to obtain HIV testing.
 Currently, the most frequent sources of SRH information for young people are schools, radio
and health workers. These channels need to be optimized by making the SRH information
delivered on these platforms more targeted to address specific knowledge about SRH. There
is need to increase access to the less frequent sources of information, especially health
workers. Findings show that parents are rarely involved in SRH messaging, with only 3% of
adolescents and young people citing them as a source of SRH information. There is a need
to empower parents with guidance on how to give age-appropriate information on
SRH to adolescents. There is also need for SRH messages that target parents’ knowledge and
attitudes to SRH education, so as to break their misconceptions about talking to their children
about SRH issues. The influence of radio on young people messaging should not be under-
estimated. Most young people regularly listen to their local FM stations. FM stations should
therefore be targeted as a platform for wider outreach to young people. Deliberate messages
and programs that empower young people should be designed and made widely available to
FM stations. Government should create partnerships with private FM stations to increase
adolescents (aged 10-19 years) and young adults (aged 20-24 years) centered programming.
 The finding that about 10% of sexually active young people were forced into their first sexual
encounter demonstrates the need for adolescents to be empowered with assertiveness
skills to opt out of forced sexual encounters. Young people are also increasingly exposed
to social media platforms that spread a broad range of negative messages and cues on SRH for
which they need to be empowered to filter and make correct decisions. Mainstreaming of life
skills training is therefore necessary at all levels of young people’s formation to enable them
understand how to deal with the many emerging sources of RH information that are
increasingly accessible to them.
 About 30% of sexually active young people reported to have had multiple concurrent sexual
partnerships in the six months preceding the survey. This bracket of young people represents
the most vulnerable group to SRH problems. There was also a gender difference, males being
more likely to engage in multiple sexual partnerships compared to females. SRH messages
should emphasize the dangers of multiple sexual partnerships as a higher risk behaviour
for STI problems.
 Only 52% of sexually active young people used a modern contraceptive method the last time
they had sexual intercourse. This coupled with the findings that only 40% of young people
discussed pregnancy plans, and only 55% discussed family planning with their partner points
to a gap in partner communication regarding key choices in SRH. SRH messages to young
people should emphasize that SRH choices concern both partners and the need for
partners to discuss these important choices.
104
FINAL REPORT
 The finding that 6% of young people have ever hand an abortion has important implications
for SRH programming. In a context where abortions are illegal, sufficient preparedness to
handle the consequences of these incidents, especially as young people are unlikely to come
out openly.
 The moderate prevalence of alcohol taking among young people (13%) calls for measures to
educate young on the dangers of alcohol use. Such programs should mainly target young
people in urban areas and those with low education level because these were found to have a
higher prevalence of alcohol taking. In the urban areas young people were reportedly exposed
as they walked back from school.
 The prevalence of Gender-Based Violence (GBV) was high and calls for measures to address
this widespread problem in the communities. The prevalence of GBV was higher among young
people who were married. There is need to strengthen local mechanisms for supporting
victims of GBV, with clear structures and protection systems that are safe for the people
undergoing physical abuse. Measures to address this problem should also include approaches
to mitigating the perpetrating factors including alcoholism, child-marriage, financial
disagreements and negative socio-cultural norms that encourage GBV.
 The majority of SRH clinics assessed did not have separate SRH clinics for adolescents, and
reported that adolescents are attended to using the same service provision arrangements as the
adult. It was observed therefore that despite the widespread drives to establish adolescent and
youth-friendly centres, the majority of primary care level facilities that are the first line level
for delivery of SRH services were not equipped with such centres. Many health facilities do
not have the logistics needed to establish attractive youth corners and where these have been
established, the turn-up is low anyway, due to lack of incentivizing activities. It is
recommended therefore that instead of emphasizing separate clinics for youth and ‘youth
corners’ for which the logistics for their setting up may not be accessible to health facilities,
capacity building programs should instead focus on training all the health workers to be
youth friendly in delivery of AYSRH services, and in providing health education for
young people. Health workers will also need integrated job-aids to assist communicating with
adolescents (aged 10-19 years) and young adults (aged 20-24 years).
 The widespread repeated stockouts of modern methods of contraception calls for special
efforts to increase availability of contraceptives in health facilities. About 86% of health
facilities had experienced at least one stockout in the three months preceding the survey, of a
contraceptive method that they usually offer. One quarter of the health facilities experienced
stockouts of condoms. These key gaps need to be addressed in order to ensure continuity of
such services. Young people preferred the shorter acting forms of family planning methods
(e.g. condoms) which should be made widely available.
 While different efforts that have been on-going to provide SRH education in schools, current
SRH education available to adolescents is fragmented and patchy. There is a need to
strengthen school health services, and to empower school supervision systems with the
capacity to improve AYSRH in schools. Schools need to be supported with integrated
training materials to enable comprehensive structured education on SRH, covering key aspects
of life skills, high risk SRH and SRH services components that are available for adolescents
and young people. Available education materials for adolescent and young people education
need to be reviewed to be made more comprehensive and widely available, with graded
information so that they are also relevant to older adolescents and young people in secondary
105
FINAL REPORT
schools. While manuals like PIASCY have emphasized group health education, there is also
need for job-aids on individual counselling. Available manuals need to be updated and graded
to different levels of schools. The nomenclature ‘sexuality education’ has also been associated
with controversy from parents and religious leaders and should instead be in tandem with the
comprehensive nature of the AYSRH messages given.
 The role of one-stop youth centres in mobilizing youth cannot be understated. Where possible,
such resource centres need to be made available at least at the district level to support
a broad range of youth outreach activities. They should also support the more challenging
aspects of SRH services e.g. as one-stop centers for receiving and supporting GBV victims.
District Probation Offices and Family Health units of the district police offices which have
played a key role in mitigating need to be supported to strengthen the package of services they
offer to young people, especially targeting SRH rights. In addition to immediate family support,
District Probation Offices and Family Health units are currently the main source of support
for people whose SRH rights have been abused. Districts also need to be empowered to make
ordinances related to AYSRH as none of the surveyed districts had such instruments in place.
 The most accessible level of health facility to young people is the HC III. However, findings
show that 57% of HCIIIs did not have health workers specifically trained in provision of
AYSRH services. Efforts at strengthening facility-based SRH services should therefore
target improving the SRH package at this level. All health workers at this level need to be
knowledgeable on how to deal with SRH issues of adolescents and young people, while
integrated adolescent and young people health education should be mainstreamed into the
service package of all HCIII. Referral linkages for GBV should be clarified, so that health
centers are appropriately linked to the relevant support organizations and the police. Technical
supportive supervision of SRH services in health facilities by the districts teams should be
strengthened, so that health workers get regular reinforcement on how to improve service
delivery. National policies and guidelines regarding adolescent and young people health need
to be disseminated to the operational levels and health workers guided on how to make their
provisions operational.
106
FINAL REPORT
5. REFERENCES
AJAH, L. O., ONUBOGU, E. S., ANOZIE, O. B., LAWANI, L. O., IYOKE, C. A., ONWE, E. O., & AJAH, M. I.
(2015). Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge
of menstrual pattern and contraceptive adherence. Patient preference and adherence, 9, 1219.
AGYEI, W., MUKIZA-GAPERE, J. & EPEMA, E. 1994. Sexual behaviour, reproductive health and contraceptive
use among adolescents and young adults in Mbale District, Uganda. J Trop Med Hyg, 97, 219-27.
ATUYAMBE, L. M., KIBIRA, S. P., BUKENYA, J., MUHUMUZA, C., APOLOT, R. R. & MULOGO, E. 2015.
Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation
in Wakiso district, Uganda. Reproductive health, 12, 35.
BARTER, C., MCCARRY, M., BERRIDGE, D. & EVANS, K. 2009. Partner exploitation and violence in teenage intimate
relationships, NSPCC London.
BARYAMUTUMA, R. & BAINGANA, F. 2011. Sexual, reproductive health needs and rights of young people with
perinatally acquired HIV in Uganda. Afr Health Sci, 11, 211-8.
BARYAMUTUMA, R. & BAINGANA, F. 2012. Sexual, reproductive health needs and rights of young people with
perinatally acquired HIV in Uganda. African health sciences, 11.
BEARINGER, L. H., SIEVING, R. E., FERGUSON, J. & SHARMA, V. 2007. Global perspectives on the sexual
and reproductive health of adolescents: patterns, prevention, and potential. The Lancet, 369, 1220-1231.
BLANKENSHIP, K. M., BRAY, S. J. & MERSON, M. H. 2000. Structural interventions in public health. Aids, 14,
S11-S21.
BLANKENSHIP, K. M., FRIEDMAN, S. R., DWORKIN, S. & MANTELL, J. E. 2006. Structural interventions:
concepts, challenges and opportunities for research. Journal of Urban Health, 83, 59-72.
BOERMA, J. T., URASSA, M., NNKO, S., NG'WESHEMI, J., ISINGO, R., ZABA, B. & MWALUKO, G. 2002.
Sociodemographic context of the AIDS epidemic in a rural area in Tanzania with a focus on people's mobility
and marriage. Sexually Transmitted Infections, 78, i97-i105.
D. ALENE, G., G. WHEELER, J. & GROSSKURTH, H. 2004. Adolescent reproductive health and awareness of
HIV among rural high school students, North Western Ethiopia. AIDS care, 16, 57-68.
DESMOND, N., ALLEN, C. F., CLIFT, S., JUSTINE, B., MZUGU, J., PLUMMER, M. L., WATSON-JONES, D.
& ROSS, D. A. 2005. A typology of groups at risk of HIV/STI in a gold mining town in north-western
Tanzania. Social Science & Medicine, 60, 1739-1749.
DIXON‐MUELLER, R. 2008. How young is “too young”? Comparative perspectives on adolescent sexual, marital,
and reproductive transitions. Studies in Family Planning, 39, 247-262.
FINE, M. 1988. Sexuality, schooling, and adolescent females: The missing discourse of desire. Harvard educational review,
58, 29-54.
FROHLICH, K. L., CORIN, E. & POTVIN, L. 2001. A theoretical proposal for the relationship between context
and disease. Sociology of health & illness, 23, 776-797.
GUPTA, G. R., PARKHURST, J. O., OGDEN, J. A., AGGLETON, P. & MAHAL, A. 2008. Structural approaches
to HIV prevention. The Lancet, 372, 764-775.
HAUB, C. & GRIBBLE, J. 2011. The world at 7 billion. Population Bulletin, 66, 1-12.
HOGGART, L. & PHILLIPS, J. 2011. Teenage pregnancies that end in abortion: what can they tell us about
contraceptive risk-taking? Journal of Family Planning and Reproductive Health Care, 37, 97-102.
ICW 2011. HIV positive young women, The International Council of Women Living with HIV/AIDS.
IMPETT, E. A. & TOLMAN, D. L. 2006. Late adolescent girls’ sexual experiences and sexual satisfaction. Journal of
Adolescent Research, 21, 628-646.
KAAYA, S. F., FLISHER, A. J., MBWAMBO, J. K., SCHAALMA, H., AARØ, L. E. & KLEPP, K.-I. 2002. Review
article: a review of studies of sexual behaviour of school students in sub-Saharan Africa. Scandinavian Journal
of Public Health, 30, 148-160.
KIPP, W., CHACKO, S., LAING, L. & KABAGAMBE, G. 2007. Adolescent reproductive health in Uganda: issues
related to access and quality of care. International journal of adolescent medicine and health, 19, 383-394.
LEWIN, K. & CAILLORDS, F. 2001. Financing secondary education in development: strategic for sustainable
growth. International Institute for Education Planning.
LIVE, W. A. W. 2010. Facts on the sexual and reproductive health of adolescent women in the developing world.
MASON, L. 2005. ‘They haven’ta clue!’A qualitative study of staff perceptions of 11–14 year-old female clinic
attenders. Primary Health Care Research and Development, 6, 199-207.
MBONYE, A. K. 2000. Abortion in Uganda: magnitude and implications. African Journal of Reproductive Health, 4, 104-
108.
MCROBBIE, A. 2009. The aftermath of feminism: Gender, culture and social change, Sage.
MOH 1999. Uganda National Health Policy. In: UGANDA, M. O. H. (ed.). Kampala.
MINISTRY OF HEALTH AND ICF INTERNATIONAL. 2012. 2011 Uganda AIDS Indicator Survey: Key Findings.
Calverton, Maryland, USA: MOH and ICF International.
MOH 2011. Uganda AIDS Indicator Survey (UAIS) Kampala Uganda: Ministry of Health.
107
FINAL REPORT
MOH 2012. Adolescent Health Policy Guidelines and Services Standards In: DEPARTMENT OF COMMUNITY
HEALTH, M. O. H. (ed.). Kampala Uganda: Ministry of Health.
NATIONAL PLANNING AUTHORITY (2014). Harnessing the Demographic Dividend. Accelerating
Socioeconomic Transformation in Uganda. Kampala, Uganda
NDYANABANGI, B., KIPP, W. & DIESFELD, H.-J. 2004. Reproductive health behaviour among in-school and
out-of-school youth in Kabarole District, Uganda. African journal of reproductive health, 55-67.
NEEMA, S., MUSISI, N. & KIBOMBO, R. 2004. Adolescent sexual and reproductive health in Uganda: a synthesis of research
evidence, Alan Guttmacher Institute.
NNKO, S., BOERMA, J. T., URASSA, M., MWALUKO, G. & ZABA, B. 2004. Secretive females or swaggering
males?: An assessment of the quality of sexual partnership reporting in rural Tanzania. Social science & medicine,
59, 299-310.
NSUBUGA, Y. 2003. Development and examination of secondary school education in Uganda.
PMA 2015. Performance, Monitoring and Accountability study
ROSS, D. A., CHANGALUCHA, J., OBASI, A. I., TODD, J., PLUMMER, M. L., CLEOPHAS-MAZIGE, B.,
ANEMONA, A., EVERETT, D., WEISS, H. A. & MABEY, D. C. 2007. Biological and behavioural impact
of an adolescent sexual health intervention in Tanzania: a community-randomized trial. Aids, 21, 1943-1955.
SHAW, D. 2009. Access to sexual and reproductive health for young people: bridging the disconnect between rights
and reality. International Journal of Gynecology & Obstetrics, 106, 132-136.
SHOVELLER, J. A. & JOHNSON, J. L. 2006. Risky groups, risky behaviour, and risky persons: Dominating
discourses on youth sexual health. Critical public health, 16, 47-60.
SINGH, S., MOORE, A., BANKOLE, A., MIREMBE, F. & WULF, D. 2006. Unintended pregnancy and induced
abortion in Uganda: causes and consequences.
SUMARTOJO, E., DOLL, L., HOLTGRAVE, D., GAYLE, H. & MERSON, M. 2000. Enriching the mix:
incorporating structural factors into HIV prevention. Aids, 14, S1-S2.
TOLMAN, D. L. & TOLMAN, D. L. 2009. Dilemmas of desire: Teenage girls talk about sexuality, Harvard University Press.
TYLEE, A., HALLER, D. M., GRAHAM, T., CHURCHILL, R. & SANCI, L. A. 2007. Youth-friendly primary-care
services: how are we doing and what more needs to be done? The Lancet, 369, 1565-1573.
UBOS 2011. Uganda Demographic and Health Survey 2011. Kampala: Uganda Bureau of Statistics (UBOS) and ICF
International
UBOS 2014. National Population and Housing census. Kampala.
UNICEF 2011. The State of the World's Children 2011-Executive Summary: Adolescence an Age of Opportunity, Unicef.
UNITED NATIONS 1994. United Nations. International Conference on Population and Development. Programme
of Action. Cairo.
WAMOYI, J., WIGHT, D., PLUMMER, M., MSHANA, G. H. & ROSS, D. 2010. Research Transactional sex
amongst young people in rural northern Tanzania: an ethnography of young women's motivations and
negotiation.
WIENER, L. S., BATTLES, H. B. & WOOD, L. V. 2007. A longitudinal study of adolescents with perinatally or
transfusion acquired HIV infection: Sexual knowledge, risk reduction self-efficacy and sexual behavior.
AIDS and Behavior, 11, 471-478.
WIGHT, D., PLUMMER, M. L., MSHANA, G., WAMOYI, J., SHIGONGO, Z. S. & ROSS, D. A. 2006.
Contradictory sexual norms and expectations for young people in rural Northern Tanzania. Social science &
medicine, 62, 987-997.
WORLD BANK 2011. World Development Indicators. Washington, DC: World Bank.
ZORRILLA, C., FEBO, I., ORTIZ, I., ORENGO, J. & MIRANDA, S. 2003. Pregnancy in perinatally HIV-infected
adolescents and young adults--Puerto Rico 2002. MMWR. Morbidity and Mortality Weekly Report, 52, 149-151.
108
FINAL REPORT
6. APPENDICES
Appendix 6.1: List of the forty four districts selected for the study
Table 6.1.1: Central 1 District and Sampled households

District in Central 1 No. of Households No. of HHs Young people
Region (UBOS 2014) Sampled (10-24 years)
KALANGALA 20,143 12 17
KALUNGU 41,606 25 36
LYANTONDE 20,855 13 14
RAKAI 117,077 70 70
WAKISO 504,620 304 378
Total 704,301 424 515
Table 6.1.2: Central 2 Districts, and sampled households and Young people
District in Central 2 No. of Households No. of HHs Young people
KAYUNGA 77,405 55 76
LUWERO 106,235 76 102
MUBENDE 151,985 109 125
MUKONO 145,575 104 138
Total 481,200 344 441
Table 6.1.3: East Central Districts, and sampled households and Young people
District in East No. of Households No. of HHs Young people
Central Region (UBOS 2014) Sampled (10-24 years)
BUSIA 65,487 68 110
KAMULI 93,789 98 122
MAYUGE 97,513 102 214
NAMAYINGO 44,813 47 97
Total 301,602 315 543
Table 6.1.4: Eastern Region Districts, and sampled households and Young people
District in Eastern No. of Households No. of HHs Young people
BUDAKA 37,247 37 58
BUTALEJA 44,311 44 54
KAPCHORWA 21,652 21 24
KATAKWI 30,721 30 49
KIBUKU 35,867 35 77
MBALE 109,537 108 146
PALISA 66,802 66 66
SOROTI 55,195 54 58
Total 401,332 395 532
Table 6.1.5: Kampala unique Region District, and sampled households and Young people
No. of
Kampala unique
Households No. of HHs Young people (10-
region District
(UBOS 2014) Sampled 24 years)
KAMPALA 418,787 170 201
Total 418,787 170 201
109
FINAL REPORT
Table 6.1.6: Karamoja Region Districts, and sampled households and Young people
Karamoja region No. of Households No. of HHs Young people
District (UBOS 2014) Sampled (10-24 years)
ABIM 18,297 18 36
KOTIDO 26,847 27 38
MOROTO 22,506 23 35
Total 67,650 68 109
Table 6.1.7: North Region Districts, and sampled households and Young people
North region No. of Households No. of HHs Young people
DOKOLO 34,781 27 37
GULU 87,687 70 101
KITGUM 39,959 32 48
LIRA 89,165 71 100
OYAM 77,435 61 70
PADER 34,905 28 42
Total 416,543 289 398
Table 6.1.8: South West Region Districts, and sampled households and Young people
South West region No. of Households No. of HHs Young people
BUSHENYI 52,029 45 73
KABALE 119,631 103 196
KANUNGU 56,217 49 71
MBARARA 113,164 98 180
NTUNGAMO 103,232 89 157
Total 444,273 383 677
Table 6.1.9: Western Region Districts, and sampled households and Young people
Western region No. of Households No. of HHs Young people
BUNDIBUGYO 44,769 34 49
HOIMA 125,907 98 133
KABAROLE 108,179 84 103
KASESE 140,697 110 147
KYENJOJO 92,011 72 94
Total 511,563 398 526
Table 6.1.10: West Nile Region Districts, and sampled households and Young people
West Nile region No. of Households No. of HHs Young people
ARUA 147,483 98 208
NEBBI 75,422 50 61
YUMBE 63,722 43 76
Total 286,627 191 345
110
FINAL REPORT
Appendix 6.2: Sample distribution of households and health facilities by region
Appendix 6.2a: Response rates from the interview with young people at household level per
region
Region Number of Number of Sampled Response Actual number of No. of

Interviewed Households rate (%) Young People aged 10-24
Households years interviewed
Central 1 411 424 96.9 515
Central 2 336 344 97.7 441
East Central 296 315 94 543
Eastern 394 395 99.7 532
Kampala 166 170 97.6 201
Karamoja 69 68 101.5 109
North 282 289 97.6 398
South West 380 383 99.2 677
Western 403 398 101.3 345
West Nile 190 191 99.5 526
TOTAL 2,927 2,977 98.3 4287
Appendix 6.2b: Sample distribution of health facilities visited by region and ownership
Characteristic Ownership of health facility

Government PNFP Total
Level of health facility No. of HFs % No. of HFs % No. of HFs %
RRH 8 6.3 2 1.6 10 7.9
District/General Hospital 20 15.7 3 2.4 23 18.1
HCIV 39 30.7 2 1.6 41 32.3
HCIII 49 38.6 4 3.1 53 41.7
Total 116 91.3 11 8.7 127 100
Region No. of HFs % No. of HFs % No. of HFs %
Central 1 13 10.2 2 1.6 15 11.8
Central 2 10 7.9 2 1.6 12 9.5
East Central 12 9.4 0 0.0 12 9.4
Eastern 22 17.3 2 1.6 24 18.9
Kampala 2 1.6 1 0.8 3 2.4
Karamoja 6 4.7 1 0.8 7 5.5
North 15 11.8 0 0.0 15 11.8
South Western 14 11.0 1 0.8 15 11.8
Western 14 11.0 1 0.8 15 11.8
West Nile 8 6.3 1 0.8 9 7.1
Total 116 91.3 11 8.7 127 100
111
FINAL REPORT
Appendix 6.3: Additional result tables
Appendix 6.3a: Proportion of young people that have ever heard about SRH
Background Ever heard about SRH

characteristics Aged 10-14 years Aged 15-19 years Aged 20-24 years Overall aged 10-24 years
No. of YPs % No. of YPs % No. of YPs % No. of YPs %
Gender
Female 554 66.2 830 91.6 527 94.4 1911 83.1
Male 476 65.7 661 89.2 488 93.8 1625 81.8
Region
Central 1 142 75.1 184 92.9 120 93.8 446 86.6
Central 2 94 54.0 154 93.9 98 95.1 346 78.5
East Central 122 58.7 194 85.1 99 92.5 415 76.4
Eastern 92 58.2 189 86.7 146 93.6 427 80.3
Kampala 43 87.8 67 91.8 73 92.4 183 91.0
Karamoja 12 44.4 28 65.1 32 82.1 72 66.1
North 99 63.1 142 92.8 87 98.9 328 82.4
South West 171 72.2 237 92.9 170 91.9 578 85.4
Western 140 67.6 170 94.4 138 99.3 448 85.2
West Nile 115 73.7 126 93.3 52 96.3 293 84.9
Residence
Urban 178 80.2 243 93.1 224 94.9 645 89.7
Rural 852 63.6 1248 90.0 791 93.9 2891 81.0
Schooling status
In School 986 66.5 1072 90.5 244 94.6 2302 78.7
Out of school 42 56.8 417 90.5 765 94.0 1224 90.7
Education
No formal education 12 44.4 14 70.0 21 95.5 47 67.1
Primary 932 65.0 732 87.9 390 92.4 2054 76.4
Secondary+ 86 84.3 745 93.8 604 95.4 1435 93.9
Marital status
Never married 1026 65.9 1337 90.1 535 92.9 2898 80.1
Ever married 4 80.0 153 94.4 479 95.6 636 95.2
Overall 1030 69.1 1491 15.1 1015 28.7 3536 13.8
112
FINAL REPORT
Appendix 6.3b: Proportion of young people aware of STIs by age, gender, marital and schooling
status, and location
AGE GROUP
Demographic Characteristic
Aged 10-14 years Aged 15-19 years Aged 20-24 years Overall
(Aged 10-24 years)
No. of YP % No. of YP % No. of YP % No. of YP %
Gender Female 444 53.0 741 81.8 500 89.6 1685 73.2
Male 377 52.0 585 78.9 464 89.2 1426 71.8
Location Urban 124 55.9 217 83.1 210 89.0 551 76.6
Rural 697 52.0 1109 80.0 754 89.5 2560 71.7
Education No formal education. 8 33.3 9 50.0 20 95.2 37 58.7
level Primary 736 51.4 637 76.5 369 87.4 1742 64.8
Secondary + 75 73.5 678 85.4 573 90.5 1326 86.7
Region Central 1 113 59.8 166 83.8 112 87.5 391 75.9
Central 2 80 46.0 136 82.9 96 93.2 312 70.7
East Central 78 37.5 155 68.0 92 86.0 325 59.9
Eastern 53 33.5 156 71.6 142 91.0 351 66.0
Kampala 24 49.0 58 79.5 67 84.8 149 74.1
Karamoja 10 37.0 29 67.4 30 76.9 69 63.3
North 86 54.8 138 90.2 84 95.5 308 77.4
South West 164 69.2 235 92.2 172 93.0 571 84.3
West Nile 96 61.5 106 78.5 46 85.2 248 71.9
Western 117 56.5 147 81.7 123 88.5 387 73.6
Schooling In-school 790 53.3 972 82.1 231 89.5 1993 68.1
Status Out of School 28 37.8 353 76.6 727 89.3 1108 82.1
Marital Single/Never married 820 52.7 1199 80.8 516 89.6 2535 70.1
Status Ever married 1 25.0 126 77.8 447 89.2 574 85.9
OVERALL 821 52.6 1326 80.5 964 89.4 3111 72.6
Appendix 6.3c: Proportion of sexually active young people aware about STIs
Background Characteristic Aged group of sexually active young

Overall (%)
people aware of STIs (%) No. of sexually active
10-14 years 15-19 years 20-14 years 10-24 years Young people
(%) (%) (%) (%)
Gender
Female 76.47 85.96 92.89 89.23 737
Male 72.09 87.91 91.77 89.02 657
Residence
Urban 53.33 81.0 92 86.21 250
Rural 79.03 87.9 92.46 89.8 1,144
Schooling status
In school 76.56 88.86 94.38 89.02 543
Out of school 61.54 84.0 91.82 89.14 845
Overall 74.03 86.86 92.36 89.13 1,394
113
FINAL REPORT
Appendix 6.3d: Proportion of young people that have ever heard about HIV/AIDS
Background Aware of HIV/AIDS Overall

Characteristic 10-14 No. of 15-19 No. of 20-24 No. of 10-24 No. of Young
years (%) YPs years (%) YPs years (%) YPs years (%) people
Gender
Male 89.1 613 96.8 701 98.5 505 94.5 1819
Female 88.0 707 97.1 848 98.0 536 94.1 2091
Region
Kampala 100 49 98.6 72 98.7 78 99.0 199
Central 1 94.1 176 96.7 187 98.4 126 96.3 489
Central 2 92.6 163 96.5 164 100.0 103 95.8 430
East Central 84.0 158 98.6 213 99.0 103 93.3 474
Eastern 85.3 133 97.2 211 99.4 154 94.3 498
Karamoja 96.4 27 95.3 41 97.4 38 96.4 106
Northern 84.6 121 98.7 150 100 86 93.7 357
West Nile 80.1 125 91.0 122 94.5 52 86.7 299
Western 87.6 148 98.6 142 96.0 121 93.6 411
South Western 92.0 220 96.9 247 97.3 180 95.3 647
Residence
Urban 92.3 205 96.9 253 99.1 234 96.2 692
Rural 87.9 1115 97.0 1296 97.9 807 93.8 3218
Schooling status 8
In school 89.0 1259 97.3 1123 98.0 251 93.2 2633
Out of school 77.8 56 96.1 424 98.2 784 96.4 1264
Education
No formal education 73.9 17 88.9 16 95.0 19 85.2 52
Primary 88.3 1205 96.5 769 98.1 404 92.4 2378
Secondary+ 94.1 95 97.7 762 98.4 616 97.7 1473
Marital status
Never married 88.5 1315 97.0 1398 97.9 558 93.5 3271
Ever Married 100 5 97.4 150 98.6 482 98.3 637
Overall 88.5 1320 97.0 1549 98.2 1041 94.3 3910
114
FINAL REPORT
Appendix 6.3e: Main sources of information on SRH and modern Family Planning methods for young people aged 10-14 years
SRH Services
Source information
Post-abortion counselling
Male circumcision ( boys)
Cervical cancer screening

Mental health, drugs and
violence and abuse (500)
and contraception ( 183)

(HPV) vaccination (177)
Human Papilloma Virus
Breast cancer screening

antenatal and postnatal
Contraception with an
HIV counselling (846)
Pregnancy testing and

Counselling on sexual
Tetanus Toxoid (TT)
rehabilitation (370)
management (574)
STI diagnosis and
emphasis on dual
vaccination (412)
protection (297)
alcohol abuse,
care (593)
(304 )
(818)
(328)
Radio e.g. FM Radios 13.5 8.7 12.0 9.1 4.3 3.8 2.8 2.6 5.3 15.3 6.8 6.3
School/Academic institution 13.5 20.1 25.5 15.2 8.3 14.1 5.4 5.3 11.0 14.4 7.3 7.0
Parent /Guardian 1.0 1.9 2.6 2.4 0.6 1.2 0.5 0.8 0.9 2.2 0.6 0.5
Other Relative 0.3 0.6 0.7 0.5 0.4 0.3 0.3 0.2 0.4 1.3 0.3 0.3
Health Facility/Health Worker 1.0 2.6 6.9 7.0 2.6 4.7 1.4 1.5 2.3 7.9 2.9 1.9
Friend/Peers 1.1 1.0 1.9 1.5 1.4 0.3 0.3 0.3 1.1 3.3 0.5 0.6
Television 0.5 0.4 0.8 0.9 0.7 0.4 0.2 0.3 1.0 0.7 0.9 1.2
Internet Websites 0.1 0.1 0.1 0.1 0.1
Village Health Team (VHT) 0.4 0.3 0.6 0.6 0.5 0.4 0.3 0.1 0.2 1.2 0.1 0.1
Youth friendly corners 0.1 0.2 0.1 0.1 - - 0.1 0.1 0.1 --
Community Loud Speakers 0.1 0.3 0.2 0.3 0.3 0.3 0.3 0.3 1.5 0.6 0.3
Traditional Birth Attendant - - - - 0.1 - 0.1 0.1 0.1
Telephone - - - - - - 0.1 0.1 0.1 - - 0.1
Social media 0.1 - 0.1 - 0.1 0.1 0.1 0.1 0.1
Newspaper or Magazine 0.1 0.1 0.1 0.1 - 0.1 - 0.1 0.1 0.1 0.1 0.3
IEC Materials Displayed - - - 0.1 - - - - 0.1 0.1 - -
Youth group/ youth Centre 0.1 0.1 0.1 - - - 0.1 0.1 0.1 0.1 - -
Peer Educators 0.1 0.1 0.1 0.2 0.1 - - 0.1 0.3 0.1 0.1
Community outreaches 0.1 0.1 0.6 0.2 0.1 0.1 - - 0.1 0.7 0.1
Duty bearers - - 0.1 0.1
CBOs 0.1 0.1 0.3 0.1 0.1 0.1 0.1 0.1 0.1
Cultural Institution - - -- - - - - 0.7 0.1
Religious leaders 0.1 0.1 - 0.1 - - - 0.2 0.8 0.1 0.1
Political leaders 0.1 - - - - 0.1 - - 0.1 - -
Others 0.1 - - - - - - 0.1 - - 0.1
115
FINAL REPORT
Appendix 6.3f: Main sources of information on SRH and modern Family Planning methods for young people aged 15-19 years
Sources of SRH services
Sources of information Counsel STI HIV Pregnancy Contraceptio Tetanus Human Post-abortion Mental Male Cervical Breast
ling on diagnosis counselling testing and n with an Toxoid Papilloma counseling health, drugs circumcision cancer cancer
sexual and (1,411) antenatal emphasis on (TT) Virus and and alcohol ( boys) screening screening
violence management and dual vaccination (HPV) contraceptio abuse, (1,224) (708) (694)
and (1,131) postnatal protection (896) vaccination n ( 517) rehabilitation
abuse care (805) (489) (695)
(1,014) (1,133)
Radio e.g. FM Radios 21.9 20.0 21.3 15.7 9.7 10.4 8.4 6.8 9.2 18.9 15.7 14.7
Parent /Guardian 1.7 2.1 2.9 2.9 1.4 1.4 0.8 1.4 1.7 3.1 0.3 0.8
Other Relative 1.0 0.7 1.2 1.2 1.2 0.5 0.2 0.8 0.7 1.5 0.9 1.1
Friend/Peers 1.9 1.6 2.7 2.6 3.2 0.9 0.7 2.2 2.2 3.8 1.2 1.0
Television 0.6 0.4 0.7 1.2 1.5 1.0 0.6 0.4 0.8 0.6 1.3 1.5
Internet Websites 0.1 0.1 0.1 0.1 0.1 1.2 0.1 0.1 0.3 0.1 0.1 0.1
Village Health Team 0.4 1.2 1.9 1.2 1.7 0.2 0.7 0.4 0.7 1.3 0.6 0.4
Youth friendly corners 0.2 0.1 0.3 0.0 0.2 0.5 0.1 0.1 0.1 0.3 0.2 0.1
Community Loud Speakers 0.2 0.6 0.9 0.4 0.4 0.0 0.2 0.3 1.0 2.9 1.7 1.7
TBAs 0.2 0.1 0.0 0.2 0.1 0.1 0.0 0.2 0.1 0.0 0.0 0.0
Telephone 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1
Social media 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.3 0.2 0.3 0.2 0.0
Newspaper or Magazine 0.3 0.0 0.0 0.0 0.3 0.1 0.1 0.4 0.3 0.1 0.3 0.3
IEC Materials Displayed 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.1 0.1
Youth group/ youth Centre 0.0 0.0 0.0 0.3 0.1 0.1 0.1 0.2 0.7 0.2 0.1 0.1
Peer Educators 0.1 0.0 0.1 0.2 0.2 0.1 0.2 0.5 0.4 0.5 0.2 0.2
Community outreaches 0.7 0.1 0.5 0.3 0.6 0.7 0.4 0.2 0.2 1.9 0.5 0.5
Duty bearers 0.2 0.2 1.1 0.1 0.0 0.0 0.1 0.0 0.0 0.1 0.1 0.0
CBOs 0.2 0.8 0.0 0.1 0.1 0.1 0.2 0.2 0.4 0.4 0.2 0.3
Cultural Institution 0.1 0.2 0.2 0.0 0.0 0.1 0.0 0.0 0.0 0.7 0.1 0.0
Religious leaders 0.4 0.1 0.0 0.1 0.1 0.2 0.0 0.2 0.1 0.4 0.1 0.2
Political leaders 0.1 0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Others 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.1
116
FINAL REPORT
Appendix 6.3g: Main sources of information on SRH and modern Family Planning methods for young people aged 20-24 years
SRH services
Sources of information
Contraception with an
HIV counselling (990)
Pregnancy testing and

Counselling on sexual
Tetanus Toxoid (TT)
Mental health, drugs

contraception (445)
postnatal care (887)
management (848)
rehabilitation (547)
violence and abuse
and alcohol abuse,
Male circumcision
Human Papilloma
STI diagnosis and
emphasis on dual
vaccination (709)
vaccination (397)
protection (699 )
screening (613)
counselling and
Cervical cancer
screening (586)
Post-abortion
Breast cancer
antenatal and
Virus (HPV)
(boys) (875)
(762)
Radio e.g FM Radios 31.3 23.5 23.3 17.4 15.9 12.1 11.4 10.3 14.0 22.0 19.7 20.3
Parent /Guardian 2.0 1.4 2.1 1.7 1.1 1.2 0.6 0.7 1.7 2.4 0.9 0.6
Other Relative 0.6 0.5 0.6 1.1 0.8 0.8 0.5 0.6 0.7 1.6 0.7 0.5
Friend/Peers 1.9 3.0 2.8 2.8 3.8 1.3 0.8 2.4 3.9 3.7 1.5 2.0
Television 1.4 1.2 1.2 1.5 1.4 0.8 0.7 0.7 1.5 0.7 1.5 1.9
Internet Websites 0.1 0.1 0.1 0.1 0.2 1.9 0.3 0.1 0.1 0.2 0.1 0.7
Village Health Team (VHT) 0.8 0.7 2.0 2.2 1.3 0.2 0.7 0.6 0.7 2.0 1.1 0.2
Youth friendly corners 0.3 0.2 0.4 0.4 0.5 0.7 0.2 0.2 0.3 0.2 0.3 1.5
Community Loud Speakers 0.6 0.4 0.8 0.6 0.6 0.0 0.5 0.7 0.7 2.8 1.7 0.0
Traditional Birth Attendant 0.0 0.1 0.1 0.1 0.0 0.5 0.1 0.1 0.1 0.0 0.0 0.0
Telephone 0.0 0.0 0.0 0.1 0.3 0.1 0.0 0.0 0.5 0.0 0.0 0.1
Social media 0.4 0.1 0.0 0.5 0.6 0.3 0.5 0.4 0.0 0.0 0.1 0.1
Newspaper or Magazine 0.3 0.2 0.2 0.0 0.2 0.2 0.0 0.7 0.2 0.1 0.5 0.4
IEC Materials Displayed 0.0 0.1 0.0 0.2 0.1 0.3 0.1 0.0 0.0 0.3 0.2 0.3
Art murals 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Youth group/ youth Centre 0.1 0.3 0.2 0.4 0.2 0.3 0.1 0.5 0.4 0.4 0.2 0.4
Peer Educators 0.5 0.2 0.7 0.3 0.5 0.5 0.4 0.4 0.3 0.7 0.1 0.1
Community outreaches 0.9 0.7 1.0 0.6 0.7 0.9 0.2 0.4 0.8 2.1 0.9 0.5
Duty bearers 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0
Community Based Organizations 0.4 0.1 0.2 0.0 0.2 0.0 0.3 0.3 0.4 0.4 0.1 0.3
Cultural Institution 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.1 0.8 0.0 0.1
Religious leaders 0.6 0.1 0.4 0.2 0.0 0.0 0.0 0.0 0.0 0.8 0.4 0.5
Political leaders 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0
Others 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.2 0.0 0.2 0.1
117
FINAL REPORT
Appendix 6.3h: Proportion of young people whose parents/guardians discussed SRH issues with
them by age group and demographic characteristics
Background Overall (aged 10-24

Aged 10-14 Years Aged 15-19 Years Aged 20-24 Years
Characteristic years)
No. of YPs % No. of YPs % No. of YPs % No. of YPs %
Gender
Male 180 24.8 361 48.72 253 48.7 794 39.98
Female 351 41.9 640 70.64 380 68.1 1371 59.58
Region
Kampala 36 73.5 55 75.3 55 69.6 146 72.6
Central 1 70 37.0 136 68.7 74 57.8 280 54.4
Central 2 50 28.7 98 59.8 49 47.6 197 44.7
East Central 76 36.5 136 59.6 69 64.5 281 51.7
Eastern 34 21.5 105 48.2 93 59.6 232 43.6
Karamoja 12 44.4 24 55.8 18 46.2 54 49.5
Northern 38 24.2 88 57.5 54 61.4 180 45.2
West Nile 78 50.0 86 63.7 41 75.9 205 59.4
Western 77 37.2 128 71.1 88 63.3 293 55.7
South Western 60 25.3 145 56.9 92 49.7 297 43.9
Residence
Urban 110 49.5 185 70.9 159 67.4 454 63.14
Rural 421 31.4 816 58.9 474 56.3 1711 47.95
Schooling status
In school 510 34.4 759 64.1 163 63.2 1432 49.0
Out of school 20 27.0 241 52.3 466 57.2 727 53.9
Marital status
Never married 530 34.0 904 60.9 342 59.4 1776 49.1
Ever Married 1 20.0 96 59.3 290 57.9 387 57.9
Overall 531 34.0 1000 60.8 632 58.7 2165 50.5
Appendix 6.3i: Rating of risk perception to suffer from SRH problems by age group
Background Characteristic Females at risk (%) Males at risk (%)

High Moderate Low No chance High Moderate Low No
chance
SRH problems amongst 10-14 years
HIV/AIDS: 6.5 7.1 5.6 3.4 6.3 4.9 6.3 3.5
STIs 4.4 8.2 6.8 3.0 5.1 5.2 7.0 3.3
Pregnancy (for females) or making a girl 4.6 5.7 7.2 4.5 3.9 4.5 5.7 5.5
pregnant (for males):
Sexual Gender based violence (SGBV): 1.7 4.6 8.3 7.3 1.7 3.8 7.3 7.4
Mental health problems: 1.0 2.9 7.5 10.0 2.0 3.3 4.9 9.8
HIV/AIDS: 16.0 13.2 13.8 4.8 14.6 17.8 13.1 4.1
STIs 14.3 16.3 13.4 3.6 11.3 17.1 15.8 4.0
HIV/AIDS: 23.8 19.4 15.7 4.2 15.2 21.3 22.2 4.6
STIs 19.0 23.0 17.4 3.5 13.4 23.4 21.6 4.4
118
FINAL REPORT
Appendix 6.3j Discussion of reproductive choices with partner before pregnancy among young
people aged 15-24
Background Characteristic Females discussed RH Males discussed RH No. of No. of Males Total No. of
choices (%) choices (%) females Young people
Aged 15-19 Aged 20-24 Aged 15- Aged 20- Aged 15- Aged 15-24 Aged 15-24 years
years years 19 years 24 years 24 years years
Region
Kampala 0.0 60.0 0.0 41.7 7 12 19
Central 1 52.9 38.5 0.0 47.1 43 17 60
Central 2 12.5 23.5 100.0 100 26 10 36
East Central 66.7 47.4 0.0 33.3 25 12 37
Eastern 33.3 46.7 33.3 54.5 21 14 38
Karamoja 0.0 20.0 100 16.7 13 8 21
Northern 100 36.4 50.0 66.7 14 13 27
West Nile 25.0 50.0 100 50.0 10 5 15
Western 0.0 66.7 33.3 33.3 13 15 28
South Western 47.1 36.0 16.7 55.0 42 26 68
Residence
Urban 45.4 42.1 0.0 31.6 30 19 49
Rural 39.0 39.5 30.8 46.0 184 113 297
Schooling status
In school 25.0 25.0 30.0 35.7 17 24 41
Out of school 41.9 41.0 31.2 44.6 196 108 304
Education
No formal education 0.0 60.0 100 60.0 7 6 13
Primary 38.3 44.6 21.4 48.7 122 53 175
Secondary+ 47.6 33.3 36.4 38.7 84 73 157
Marital status
Never married 20.8 25.7 15.4 36.8 60 51 111
Married or Living together 53.7 45.7 46.1 50.8 135 76 211
Divorced/Separated/Widowed 20.0 35.7 0.0 100 19 5 24
Overall 40.0 39.9 30.8 43.4 214 132 346
Appendix 6.3k: Proportion of young people who believe they can take an HIV test at any time
Background Can test any time
Characteristic Yes (%) No (%) Total Number of Young people
Gender
Male 73.1 26.9 2266
Female 71.6 28.4 1971
Age groups
10-14 52.8 47.2 1536
15-19 80.3 19.7 1629
20-24 88.6 11.4 1072
Region
Central 1 72 28 503
Central 2 70.5 29.5 444
East Central 63.4 36.6 511
Eastern 68.2 31.8 532
Kampala 88.9 11.1 199
Karamoja 65.1 34.9 109
North 73.8 26.2 389
South West 77.7 22.3 677
Western 73.8 26.2 343
West Nile 74.2 25.8 530
Residence
Urban 83.6 16.4 714
Rural 70.2 29.8 3523
Schooling status
In school 67.3 32.7 2884
Out of school 83.5 16.5 1340
Education
No formal education 62.9 37.1 62
Primary 64.9 35.1 2649
Secondary+ 86.2 13.8 1519
Marital Status
Never married 88.3 11.7 664
Ever married 69.5 30.5 3571
Overall 72.43 27.57 4237
119
FINAL REPORT
Appendix 6.3l: Median Age at first marriage among young people ever married
FEMALES MALES OVERALL (10-24 years)

Background Characteristic Median No. of YP Median age No. of YP Median age No of YP
age (Years) married (Years) married (Years) married
Age group 10-14 years* 3 2 5
15-19 years 17 104 17 21 17 125
20-24 years 18 281 20 146 19 427
Residence Urban 18 52 20 23 18 75
Rural 18 335 19 144 18 479
Region Central 1 18 33 20 12 18 45
Central 2 18 26 18 9 18 35
East Central 17 38 20 18 18 56
Eastern 18 71 20 18 18 89
Kampala 18 12 18 5 18 17
Karamoja 18 20 19 13 18 33
North 18 50 19 22 18 72
South West 18 57 19 34 19 91
Western 18 59 19 25 18 84
West Nile 18 21 19 11 18 32
Education No formal education 17 11 19 6 17 17
Level Primary 17 250 19 74 18 324
Secondary + 18 126 20 87 19 213
OVERALL 18 387 19 167 18 554
*Data for young people aged 10-14 years omitted because of a very small number of respondents
Appendix 6.3m: Percentage of young people who reported taking alcohol

Age groups
Characteristic No. of Young people
10-14 years (%) 15-19 years (%) 20-24 years (%)
Gender
Female 3.2 58.1 38.7 31
Male 3.1 32.3 64.6 65
Region
Kampala 0.0 28.6 71.4 7
Central 1 0.0 66.7 33.3 3
Central 2 6.2 31.2 62.5 16
East Central 0.0 50.0 50.0 4
Eastern 0.0 18.8 81.2 16
Karamoja 20.0 60.0 20.0 5
Northern 0.0 40.0 60.0 5
West Nile 0.0 25.0 75.0 8
Western 5.3 52.6 42.1 19
South Western 0.0 61.5 38.5 13
Residence
Urban 3.3 30.0 66.7 30
Rural 3.0 45.5 51.5 66
Schooling status
In school 8.1 59.5 32.4 37
Out of school 0.0 28.8 71.2 59
Education level
No formal education 0.0 0.0 100 3
Primary 6.8 47.7 45.5 44
Secondary + 0.0 36.7 63.3 49
Marital Status
Ever married 0.0 12.5 87.5 32
Never married 4.7 54.7 40.6 64
120
FINAL REPORT
Appendix 6.3n: Proportion of young people who experienced Gender based Violence by Age group and Gender
AGE GROUP GENDER OVERALL

Background Characteristic 10-14 years 15-19 years 20-24 years Female Male (10-24 years)
No. of % No. of YP % No. of % No. of % No. of % No. of %
YP YP YP YP YP
Physical abuse 591 37.8 604 36.7 306 28.4 808 35.1 693 34.9 1501 35.0
Emotional abuse 323 20.8 455 27.8 262 24.5 572 25.1 468 23.7 1040 24.4
Economic abuse 60 3.9 154 9.4 115 10.7 176 7.7 153 7.8 329 7.7
Sexual abuse 26 1.7 87 5.3 97 9.0 169 7.3 41 2.1 210 4.9
Discrimination or denial of opportunities/services 38 2.4 70 4.3 67 6.2 81 3.5 94 4.7 175 4.1
Forced marriage 14 0.9 52 3.2 54 5.0 84 3.7 36 1.8 120 2.8
Child marriage 13 0.8 49 3.0 57 5.3 94 4.1 25 1.3 119 2.8
Trafficking in persons (for Domestic work, baby-sitting, etc.) 56 3.6 67 4.1 31 2.9 97 4.2 57 2.9 154 3.6
Female Genital Mutilation (FGM) 6 0.4 11 0.7 6 0.6 20 0.9 3 0.2 23 0.5
Dowry violence 4 0.3 10 0.6 16 1.5 19 0.8 11 .0.6 30 0.7
Denial of access to exercise and enjoy civil and political rights 12 0.8 25 1.5 32 3.0 36 1.6 33 1.7 69 1.6
Appendix 6.3o: Percentage distribution of reasons justifying GBV among young people aged 10-14 years by background characteristics
Background Reasons for justifying partner violence /GBV amongst young people aged 10-14 years (%)
Characteristic
Argues Goes out Refuses Extra marital
Food gets Neglects the Delays to return Mismanages family Fails to share household Fails to do household
with without telling sexual affairs/Infidel Others
burnt children home resources income from agriculture work/chores
partner the partner relations ity
Gender
Male 6.6 7.3 5.1 6.5 3.2 9.0 4.6 2.8 8.3 3.6 0.8
Female 7.7 9.6 7.3 8.1 3.7 9.4 5.6 3.5 7.1 6.2 1.7
Residence
Urban 6.3 9.9 5.0 8.6 3.2 9.5 4.1 2.3 4.5 7.2 0.5
Rural 7.3 8.3 6.5 7.2 3.5 9.2 5.3 3.3 8.2 4.6 1.4
Region
Kampala 8.2 2..0 0 4.1 0 10.2 0 0 4.1 12.2 0
Central 1 6.4 9.1 4.3 5.9 3.2 8.6 5.4 2.1 8.0 5.9 0
Central 2 0 7.3 5.1 6.8 0.6 10.7 2.8 1.1 17.5 2.3 2.3
East Central 17.4 12.6 12.6 11.6 8.7 16.4 9.7 4.4 6.8 4.4 1.9
Eastern 4.4 0.6 1.3 1.3 0 5.1 1.3 0 3.8 1.9 0.6
121
FINAL REPORT
Characteristic
Argues Goes out Refuses Extra marital
Food gets Neglects the Delays to return Mismanages family Fails to share household Fails to do household
with without telling sexual affairs/Infidel Others
burnt children home resources income from agriculture work/chores
partner the partner relations ity
Karamoja 14.3 7.1 3.6 7.1 7.1 10.7 0 0 3.6 3.6 0
Northern 7.4 9.4 4.7 7.4 3.4 4.0 5.4 8.1 8.1 5.4 0
West Nile 14.7 17.3 2.1 2.9 8.3 14.1 10.9 9.0 9.6 13.5 1.3
Western 2.8 9.9 4.7 8.0 4.3 8.0 6.1 2.4 6.1 5.2 1.4
South Western 3.8 4.6 19.2 17.3 0 5.9 2.1 1.3 4.6 1.7 2.5
Schooling status
In School 7.0 8.4 6.3 7.3 3.4 9.1 5.0 3.0 7.5 5.0 1.2
Out of School 10.8 9.5 5.4 9.5 5.4 10.8 8.11 6.8 12.2 5.4 2.7
Education
No formal
0 8.3 4.2 4.2 4.2 8.3 4.2 0 0 0 4.2
education
Primary 7.3 8.1 6.1 7.3 3.1 9.2 5.0 3.1 7.5 4.5 1.3
Secondary+ 6.9 14.7 8.8 9.8 7.8 9.8 6.9 4.9 12.8 13.7 1.0
Marital Status
Never married 7.1 8.5 6.3 7.4 3.5 9.3 5.1 3.1 7.7 5.0 1.3
Ever Married 20.0 0 0 0 0 0 0 20.0 0 0 0
Appendix 6.3p: Percentage distribution of reasons justifying GBV among young people aged 15-19 years by background characteristics
Characteristic food gets Argues Goes out Neglects Refuses sexual Delays to Mismanages Fails to share Fails to do Extra marital Other reasons
burnt with without telling the children relations return family household income from household affairs/Infidelity
partner the partner home resources agriculture or business work/chores
Gender
Male 6.6 13.0 13.4 9.0 9.2 12.2 7.2 5.0 8.8 10.7 1.5
Female 7.7 12.8 12.6 11.6 9.2 12.9 7.4 4.4 10.3 14.0 3.3
Residence
Urban 3.8 11.1 10.0 10.3 7.3 10.0 5.0 4.6 8.4 15.7 1.9
Rural 7.9 13.2 13.5 10.5 9.5 13.1 7.7 4.7 9.8 11.9 2.6
Region
Kampala 1.4 6.9 2.7 6.9 4.1 2.7 1.4 2.7 4.1 17.8 2.7
122
FINAL REPORT
Characteristic food gets Argues Goes out Neglects Refuses sexual Delays to Mismanages Fails to share Fails to do Extra marital Other reasons
burnt with without telling the children relations return family household income from household affairs/Infidelity
partner the partner home resources agriculture or business work/chores
Central 1 1.6 17.1 11.4 13.0 10.9 11.9 6.2 4.2 10.4 12.4 2.1
Central 2 1.2 11.2 15.3 5.9 2.9 12.4 4.7 2.4 4.1 12.4 1.8
East Central 14.9 21.5 23.7 19.3 19.7 25.9 11.8 8.3 15.8 8.8 2.6
Eastern 4.6 6.9 9.2 5.5 6.4 11.0 6.9 3.2 10.6 9.6 4.6
Karamoja 18.6 18.6 7.0 4.7 16.3 7.0 2.3 9.3 18.6 16.3 0
Northern 6.5 11.1 10.5 7.8 7.2 7.2 9.8 3.3 7.2 17.7 0
West Nile 14.9 18.7 20.9 17.2 13.4 17.9 10.5 9.0 14.2 19.4 5.2
Western 5.6 7.8 10.0 12.8 7.8 9.4 6.7 4.4 7.2 15.6 2.2
South Western 8.2 10.6 9.4 6.3 5.1 9.0 5.9 3.1 7.1 7.5 2.0
Schooling status
In School 7.4 11.8 12..3 10.7 8.7 12.2 6.3 4.6 8.9 12.7 2.8
Out of School 6.9 15.6 14.8 9.8 10.2 13.7 9.8 5.0 11.5 11.9 1.7
Education
No formal 0 5.6 0 5.6 5.6 16.7 5.6
education 0 11.1 0 0
Primary 8.4 12.4 12.4 9.0 9.5 12.6 7.8 3.6 9.6 10.4 2.6
Secondary+ 6.2 13.5 13.9 12.2 9.1 12.7 6.9 5.8 9.7 14.6 2.3
Marital Status
Never married 7.2 12.1 12.5 10.2 8.6 12.1 6.7 4.5 9.0 12.1 2.6
Ever Married 7.4 20.4 16.7 12.4 14.2 16.7 13.0 6.2 14.8 16.1 1.9
Appendix 6.3q: Percentage distribution of reasons justifying GBV among young people aged 20-24 years by background characteristics
Background Reasons for justifying partner violence /SGBV amongst young people aged 20-24 years (%)
Characteristic food gets Argues Goes out Neglects the Refuses Delays to Mismanages Fails to share Fails to do Extra marital Others
burnt with without children sexual return home family resources household income household affairs/Infidelity
partner telling the relations from agriculture or work/chores
partner business
Gender
Male 9.4 15.8 17.7 11.0 10.4 14.4 10.2 5.2 10.4 18.7 3.5
Female 6.8 12.9 13.8 10.9 8.2 9.3 7.9 4.5 8.4 12.5 1.3
123
FINAL REPORT
Background Reasons for justifying partner violence /SGBV amongst young people aged 20-24 years (%)
Characteristic food gets Argues Goes out Neglects the Refuses Delays to Mismanages Fails to share Fails to do Extra marital Others
burnt with without children sexual return home family resources household income household affairs/Infidelity
partner telling the relations from agriculture or work/chores
partner business
Residence
Urban 7.6 16.5 17.8 9.3 8.5 11.4 9.3 4.2 9.3 20.8 1.3
Rural 8.2 13.7 15.1 11.4 9.5 11.9 8.9 5.0 9.4 14.0 2.6
Region
Kampala 5.1 11.4 11.4 7.6 6.3 7.6 7.6 1.3 2.5 20.3 3.8
Central 1 5.5 16.4 15.6 10.2 10.2 11.7 7.0 3.9 7.8 14.8 1.6
Central 2 2.9 12.6 15.5 3.9 7.8 13.6 2.9 2.9 4.9 22.3 0
East Central 17.9 24.5 28.3 22.6 18.9 29.3 16.0 7.6 17.0 13.2 4.7
Eastern 7.1 8.3 16.7 7.1 8.3 11.5 7.7 5.1 7.7 12.2 4.5
Karamoja 15.4 15.4 7.7 10.3 5.1 10.3 10.3 5.1 18.0 15.4 2.6
Northern 6.9 5.8 5.8 5.8 6.9 4.6 5.8 4.6 6.9 16.1 0
West Nile 18.2 16.4 27.3 21.8 20.0 21.8 20.0 12.7 14.6 27.3 1.8
Western 5.7 15.7 14.3 13.6 5.7 8.6 6.4 4.3 9.3 11.4 0.7
South Western 7.0 16.2 13.5 10.8 7.6 6.0 11.4 4.3 10.8 13.5 2.7
Schooling status
In School 5.8 13.2 12.0 10.5 9.7 11.2 8.1 3.1 19.1 15.1 3.1
Out of School 8.7 14.6 16.8 11.2 9.2 12.0 9.3 5.4 9.5 15.7 2.1
Education
No formal education 23.8 23.8 23.8 23.8 23.8 4.8 28.6 4.8 19.1 23.8 0
Primary 10.2 15.6 16.4 13.0 8.5 10.7 10.0 6.2 9.5 13.0 2.4
Secondary+ 6.0 13.1 15.0 9.2 9.3 12.8 7.7 4.0 9.0 16.9 2.4
Marital Status
Never married 6.6 12.7 14.6 8.7 8.5 11.3 8.0 4.3 7.8 15.3 3.0
Ever Married 9.8 16.2 17.0 13.6 10.2 12.4 10.2 5.4 11.2 15.8 1.6
124
FINAL REPORT
Appendix 6.3r: Average distance to the nearest facility
Background Characteristic Average Distance (Km) to

nearest health facility
Region
Kampala 2.0
Central 1 5.0
Central 2 2.0
East Central 2.0
Eastern 1.0
Karamoja 2.0
Northern 3.0
West Nile 3.0
Western 2.0
South Western 2.0
Residence
Urban 1.0
Rural 3.0
Overall Average distance (Km) 2.0
Appendix 6.3s: Ownership of the health facilities accessed by young people

Background Public Private not for Private for Profit Others Number of young
Characteristic (%) Profit-PNFP (%) –PFP (%) Specify (%) people (#)
Gender
Male 82.0 5.0 12.5 0.5 2284
Female 83.2 5.4 11.1 0.4 1971
Age groups
10-14 82.1 5.1 12.4 0.5 1544
15-19 82.9 5.2 11.3 0.5 1640
20-24 82.5 5.4 11.9 0.2 1071
Residence
Urban 67.8 6.0 25.6 0.6 712
Rural 85.5 5.0 9.1 0.4 3543
Region
Central 1 47.9 11.1 41.0 0.0 505
Central 2 78.5 7.4 12.8 1.3 447
East Central 93.0 1.9 5.1 0.0 530
Eastern 91.0 5.8 2.3 0.9 532
Kampala 45.6 14.9 38.5 1.0 195
Karamoja 100 0.0 0.0 0.0 110
North 89.7 1.5 8.7 0.0 389
South West 97.0 0.6 2.4 0.0 672
Western 70.6 10.2 18 1.2 344
West Nile 93.8 3.2 2.8 0.2 531
Schooling status
In school 81.4 5.2 12.9 0.5 2901
Out of school 85.1 5.1 9.6 0.2 1341
Education
No formal education 87.3 4.8 7.9 0.0 63
Primary 85.0 5.0 9.6 0.3 2661
Secondary+ 78.0 5.6 15.9 0.6 1524
Marital Status
Never married 86.6 3.9 9.5 0.0 666
Ever married 81.7 5.4 12.3 0.5 3587
Overall 82.5 5.2 11.9 0.4 4255
125
FINAL REPORT
Appendix 6.4: References under Vulnerability mapping

1
Refer to OECD (2008). Handbook on Constructing Composite Indicators. Methodology and User Guide,
pp.20-21.
2
Underwood, C. & Schwandt, H. (2011). Go Girls! Initiative Vulnerable Girls’ Indices Guide: Data from the
2009 Baseline Survey and 2010 Endline Survey in Botswana, Malawi and Mozambique. Johns Hopkins
Bloomberg School of Public Health/Center for Communication Programs. Baltimore, Maryland. Developed
under the terms of USAID Contract No. GHH-1-00-07-00032-00, Project SEARCH, Task Order 01
3
Dellar RC, Dlamini S, Karim QA. “Adolescent girls and young women: key populations for HIV epidemic
control.” Journal of the International AIDS Society, 18(1).
4
Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. (2004). “Transactional sex among
women in Soweto, South Africa: prevalence, risk factors and association with HIV infection.” Soc Sci Med.,
59:1581–92. MacPherson EE, Sadalaki J, Njoloma M, Nyongopa V, Nkhwazi L, Mwapasa V, et al. (2012).
“Transactional sex and HIV: understanding the gendered structural drivers of HIV in fishing communities
in Southern Malawi.” J Int AIDS Soc., 15(Suppl 1):1–9.
5
Gregson S, Nyamukapa CA, Garnett GP, Mason PR, Zhuwau T, Carael M, et al. (2002). “Sexual mixing
patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe.” Lancet, 359:1896–
903.
Pettifor A, Macphail C, Rees H, Cohen M. (2008). “HIV and sexual behavior among young people: the South
African paradox.” Sex Transm Dis., 35:843–4.
Kelly RJ, Gray RH, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, et al. (2003). “Age
differences in sexual partners and risk of HIV-1 infection in rural Uganda.” J Acquir Immune Defic Syndr.,
32:446–51.
Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, et al. (2005). “Young
people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally
representative household survey.” AIDS, 19:1525–34.
Kaiser R, Bunnell R, Hightower A, Kim AA, Cherutich P, Mwangi M, et al. (2011). “Factors associated with
HIV infection in married or cohabitating couples in Kenya: results from a nationally representative study.”
PLoS One., 6:e17842.
6
Pettifor AE, Measham DM, Rees HV, Padian NS. (2004). “Sexual power and HIV risk, South Africa.” Emerg
Infect Dis., 10:1996–2004.
7
Guptaa, GR, Ogdenb J and Warnera A. (2011). “Moving forward on women's gender-related HIV
vulnerability: The good news, the bad news and what to do about it.” Global Public Health, 6(3): S370-
S382.
8
UNAIDS. (2015). Empower young women and adolescent girls: Fast-Track the end of the AIDS epidemic in
Africa. Geneva: Joint United Nations Programme on HIV/AIDS.
Jewkes RK, Dunkle K, Nduna M, Shai M. (2010). “Intimate partner violence, relationship power inequity,
and incidence of HIV infection in young women in South Africa: a cohort study.” Lancet, 376:41–48.
Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, et al. (2015). “Effectiveness of an
integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an
intervention in an existing cluster randomised cohort.” Lancet Glob Health, 3:e23–e33.
9
Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, and Luo C. (2014). “Epidemiology of HIV and
AIDS among adolescents: Current status, inequities, and data gaps.” J Acquir Immune Defic Syndr, 66:S147
10
Dellar RC, Dlamini S, Karim QA. “Adolescent girls and young women: key populations for HIV epidemic
control.” Journal of the International AIDS Society, 18(1)
11
Madise N, Zulu E, Ciera E. (2007). “Is poverty a driver for risky sexual behaviour? Evidence from national
surveys of adolescents in four African countries.” African Journal of Reproductive Health, 11(3): 83-98.
12
Idele et al. (2014):S147
13
UNICEF (2008). “Young People and Family Planning: Teenage Pregnancy.” Fact Sheet, World Population
Day, 11 July 2008. Available online at: http://www.unicef.org/malaysia/Teenage_Pregnancies_-
_Overview.pdf
14
Mkwananzi S and Odimegwu C. Teen Pregnancy in Sub-Saharan Africa: The Application of Social
Disorganisation Theory. Extended Abstract, Population Association of America 2015 Annual Meeting.
Molosiwa, S., & Moswela, B. (2012). “Girl-pupil dropout in secondary schools in Botswana: Influencing
factors, prevalence and consequences.” International Journal of Business and Social Science, 3(7): 265-271.
126
FINAL REPORT
15
Quinlivan JA, Tan LH, Steele A & Black K. (2004). ”Impact of Demographic Factors, Early Family
Relationships and Depressive Symptomatology in Teenage Pregnancy.” Australian and New Zealand
Journal of Psychiatry, 38(4): 197-203.
16
Mkwananzi S and Odimegwu C. Teen Pregnancy in Sub-Saharan Africa: The Application of Social
Disorganisation Theory. Extended Abstract, Population Association of America 2015 Annual Meeting.
Molosiwa, S., & Moswela, B. (2012). “Girl-pupil dropout in secondary schools in Botswana: Influencing
factors, prevalence and consequences.” International Journal of Business and Social Science, 3(7): 265-271.
17
Bruce JE, Bates JE, Dodge KA, Fergusson DM, Horwood LJ, Pettit GS, and Woodward L. (2003). “Does
Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy?” Child
Development, 74(3): 801–821.
18
Woodward L, Fergusson DM and Horwood LJ. (2001). “Risk Factors and Life Processes Associated with
Teenage Pregnancy: Results of a Prospective Study From Birth to 20 Years.” Journal of Marriage and Family,
63(4): 1170–1184.
19
Saewyc EM, Magee LL and Pettingell SE. (2004). “Teenage Pregnancy and Associated Risk Behaviors
among Sexually Abused Adolescents.” Perspectives on Sexual and Reproductive Health, 36(3): 98–105.
20
Youth.gov. Risk and Protective Factors. Available online at: http://youth.gov/youth-topics/teen-
pregnancy-prevention/risk-and-protective-factors#_ftn
21
Were M. (2007). “Determinants of teenage pregnancies: The case of Busia District in Kenya.” Economics
& Human Biology, 5(2): 322-339.
22
WHO (2012). “Safe and unsafe induced abortion. Global and regional levels in 2008, and trends during
1995–2008.” Information Sheet. Geneva: World Health Organization, p.1
23
Bankole et al (1998). “Reasons Why Women Have Induced Abortions: Evidence from 27 Countries,”
International Family Planning Perspectives, 1998, 24(3): 120-121
24
Lema VM , Rogo KO , Kamau RK. (1996). “Induced Abortion in Kenya: Its Determinants and Associated
Factors.” East African Medical Journal, 73(3):164-168.
25
Bankole et al (1998):123
26
Bankole et al (1998): 121-122
27
Bankole et al (1998):123
28
Lema et al. (1996):164-168.
29
Bankole et al (1998):117, 122, 123, 124
30
Bankole et al (1998) cited in Grimes et al (2006). “Unsafe Abortion: The Preventable Pandemic.” Sexual
and Reproductive Health 4. Geneva: World Health Organization, p.2
31
Haddad & Nour (2009). “Unsafe Abortion: Unnecessary Maternal Mortality.” Reviews in Obstetrics &
Gynecology, Vol. 2(2): 125.
32
Lema et al (1996):164-168.
33
UNFPA (2012). Marrying Too Young. End Child Marriage. P.11
34
UNFPA (2012): Pp.18, 34
35
USAID (2012). Ending Child Marriage & Meeting the Needs of Married Children. P.3
36
UNFPA (2012): 56-57; Asrari (2015). Preventing Child Marriage in the Commonwealth: The Role of
Education. P.8, IPPF (2006).
37
UNFPA (2012): 58.
38
IPPF (2007): 18.
39
IPPF (2007). Ending Child Marriage. A Guide for Global Policy Action. P.17
40
Heise LL. (1998). “Violence against women: an integrated, ecological framework.” Violence Against
Women, 4(3): 262-290.
41
UNFPA. “Causes of gender-based violence.” Strengthening Health System Responses to Gender-based
Violence in Eastern Europe and Central Asia. A resource package. Available online at: http://www.health-
genderviolence.org/guidance-for-health-care-professionals-in-strengthening-health-system-responses-
to-gender-based-vi-0
Ravindran KS, Bhushan A, Fritsch K, Hickey B. (2005). Integrating Poverty and Gender into Health
Programmes, A sourcebook for Health Professionals Module on Gender-Based Violence. Geneva: WHO.
Butchart A, Garcia-Moreno C, Mikton C. (2010). Preventing intimate partner and sexual violence against
women, Taking action and generating evidence. WHO and London School of Hygiene and Tropical
Medicine.
127

Final AYSRH Survey Report - AHC Team - 10th Feb 2017

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Final AYSRH Survey Report - AHC Team - 10th Feb 2017

Uploaded by

Copyright:

Available Formats

REPUBLIC OF UGANDA

UNITED NATIONS POPULATION FUND MINISTRY OF HEALTH

ACRONYMS AND ABBREVIATIONS

ADH - Adolescent Health

3.2.12 Child marriage, pregnancy, childbearing and abortion ................................................................... 48

Table 1: Allocation of sampled households by region ........................................................................................................ 11

Table 38: Prevalence of vulnerability by background characteristics ................................................................ 66

Figure 1: Age at which parents first talked about AYSRH ................................................................................. 31

1.2 Overview of Adolescent and Youth SRH issues in Uganda

1.2.1. Overview of young people’s SRH in Uganda

1.2.2. Sexual debut and sexual behaviors among young people

1.2.5. SRH in the Ugandan education system

2 Situation analysis on school health programmes and clubs in Uganda, 2011

1.2.6. Reproductive Health policies in Uganda

1.2.7. Effective interventions addressing young people’s SRH

1.3. Statement of the problem

1.4. Rationale for the study

1.5. Objectives of the Study

2. APPROACH AND METHODOLOGY

2.1 Summary of the approach

2.2 Study area and study population

2.3. Approval of the study by the Institutional Review Board

2.4. Study design

2.5. Sample size determination and selection

2.5.1. Sample size for the Household Survey

Table 1: Allocation of sampled households by region

2.5.2. Selection of Key Informants

2.5.3 Focus Group Discussions (FGDs)

2.6 Team preparations, Training, Pretesting and Refinement of tools

2.7 Fieldwork/Data collection

2.8 Data management and analysis

2.9 Ethical Issues

3.1 Background Characteristics of Respondents

3.1.1 Response rates

3.1.2 Socio-demographic characteristics of respondents

Table 3: Background characteristics of Survey respondents

3.2.1 Knowledge and sources of information on Sexual and Reproductive Health

SRH Service (%), n=1491.

SRH Service (%), n=1015.

3.2.2 Knowledge about Family Planning

Awareness about family planning methods by demographic characteristics

Table 9: Knowledge of family planning methods by background characteristics

Female sterilization (%)

Contraceptive Pill (%)

contraceptive pill (%)

Female condom (%)

3.2.3 Knowledge of STIs

a) Awareness about STIs;

3.2.4 Knowledge of HIV/AIDS

a) Awareness about HIV;

d) Comprehensive knowledge about HIV;

Table 13: Percentage of respondents with comprehensive knowledge of HIV/AIDS

e) Knowledge of where to test for HIV;

3.2.5 Sources of SRH information among young people

Health Worker (%)

3.2.6 Self-perceived SRH risk

3.2.7 Sexual behavior

a) Exposure to sexual activity;

UDHS 2011 AYSRH Survey 2015

b) Age at first sexual intercourse;

Background Characteristic Females Males Overall

c) Pressured to have sex;