Research | Open Access | Volume 9 (2): Article  88 | Published: 02 Jun 2026

Sexuality information completeness and risky sexual behaviour among young people in Uganda’s island communities

PDF in Progress

Views: 43

   Menu, Tables and Figures

Navigate this article

Table 1:  Sexuality Information Domains as per UNESCO (2018)

Table 2: Sociodemographic and Contextual Profile of Young People in Uganda’s Island Communities, May 2025

Table 3: Completeness of Sexuality Information among Young People in Uganda’s Island Communities, May 2025

Table 4: Risky Sexual Behaviour among Young People in Uganda’s Island Communities, May 2025

Table 5: Bivariate association between Socio-demographics, Mode of Sexuality Information, Sexuality Information Completeness, and the Sexual Behaviour of Young People in Uganda’s Island Communities, May 2025

Table 6: Multicollinearity check of the variables in the multivariate model

Table 7: Multivariate associates of sexual behaviour among young people in Uganda’s Island communities

Keywords

  • Sexuality information
  • Sexuality information completeness
  • Risky sexual behaviour
  • Young people

Venantius Bbaale Kirwana1,&, Cyprian Misinde1, Patricia Ndugga1, Christian Kakuba2, Stephen Wandera1, Allen Kabagenyi1

1Makerere University, School of Statistics and Applied Economics, Department of Population Studies, Kampala, Uganda, 2Makerere University, School of Statistics and Applied Economics, Department of Applied Statistics and Planning, Kampala, Uganda

&Corresponding author: Venantius Bbaale Kirwana, Makerere University, School of Statistics and Applied Economics, Department of Population Studies, Kampala, Uganda, Email: venbbak@gmasil.com,  kirwana.venantiusbbaale@students.mak.ac.ug,  ORCID: https://orcid.org/0000-0001-5036-0221

Received: 25 Feb 2026, Accepted: 26 May 2026, Published: 02 Jun 2026

Domain: Sexual and Reproductive Health

Keywords: Sexuality information, sexuality information completeness, risky sexual behaviour, young people

©Venantius Bbaale Kirwana et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Venantius Bbaale Kirwana et al., Sexuality information completeness and risky sexual behaviour among young people in Uganda’s island communities. Journal of Interventional Epidemiology and Public Health. 2026; 9(2):88. https://doi.org/10.37432/jieph-d-26-00062

Abstract

Introduction: Research on risky sexual behaviour (RSB) among young people has largely focused on access to sexuality information (SI), with limited attention to the completeness of SI.  We examine its association with RSB among young people in Uganda’s island communities, an under-researched, high-risk population.
Methods: A cross-sectional quantitative study surveyed 569 young people aged 10-24, selected using multistage sampling, in the Busanga and Bugombe parishes of Kkoome Islands subcounty, Mukono district, Uganda, in May 2025. Completeness of SI was categorized into four levels: Low SI (exposure to ≤2 domains), Moderate SI (3–4 domains), High SI (5–7 domains), and Complete SI (exposure to all eight domains). Engagement in at least one of the following: early sexual debut, multiple sexual partnerships, inconsistent or incorrect condom use, transactional sex, or sex under the influence of substances; defined RSB. Socio-demographic characteristics and SI delivery modes were included as covariates. Frequencies and percentages described univariate data. Crude Odds Ratios (cOR) assessed bivariate associations, while Adjusted Odds Ratios (aOR) determined multivariate associations. 
Results: Among the 569 young people interviewed, only 21 of 569 (3.7%) of participants received complete SI, while 90.3% reported at least one RSB. High SI (cOR = 0.1, 95% CI: 0.06–0.31, p < 0.001) and complete SI (cOR = 0.1, 95% CI: 0.02–0.15, p < 0.001; aOR = 0.16, 95% CI: 0.04–0.56, p = 0.004) were associated with lower odds of RSB. Receiving information through observation (cOR = 0.21, 95% CI: 0.09–0.50, p < 0.001; aOR = 0.22, 95% CI: 0.09–0.56, p = 0.001) was associated with reduced odds of RSB. Staying with parents, club membership, and being female had significantly (p>0.05) lower odds of RSB, while employment was associated with higher odds.
Conclusion: Completeness of SI, rather than mere exposure and observational learning, is strongly linked to reduced engagement in RSB. Sexuality education initiatives should prioritise practical and complete domain coverage across families, schools, and other mentorship platforms, while integrating Comprehensive Sexuality Education (CSE) into economic empowerment strategies targeting young people.

Introduction

Risky Sexual Behaviour (RSB) among young people (10-24 years) remains a global concern probed by scholars. It is more serious in sub-Saharan Africa, including Uganda. It refers to behaviours that increase vulnerability to adverse sexual and reproductive health outcomes, including early sexual debut, coerced sex, multiple sexual partnerships, inconsistent or incorrect condom use, transactional sex, and sexual activity under the influence of alcohol or drugs [1–2]. These behaviours expose young people to HIV, other sexually transmitted infections (STIs), unintended pregnancies, unsafe abortions, and broader social and economic consequences [3,4]. and other consequences beyond health. Across Africa, approximately two-thirds of young people initiate sexual activity by age 19, often under conditions that heighten these risks [5]. In Uganda, the situation is especially concerning due to the country’s youthful population, persistently high teenage pregnancy rates (approximately 25%), and early marriage prevalence of about 34% [6,7].

The burden of RSB is more pronounced in Uganda’s island communities, particularly those on Lakes Victoria and Albert. These settings are characterised by geographical isolation, limited access to education and health services, and high population mobility driven by fishing livelihood [8]. Such structural conditions create environments where young people are more exposed to sexual risk. Evidence shows that the median age of sexual debut in island communities is 16.1 years, lower than the national average of 16.9 years [9]. Teenage pregnancy rates in these areas reach 48.3%, nearly double the national average, while condom use remains critically low at 3.8% compared to 13.9% nationally [10]. These disparities highlight the heightened vulnerability of young people living in island contexts and underscore the need for targeted research and interventions.

Sexual behaviour does not occur in isolation; it is shaped by complex social and environmental influences. Bronfenbrenner’s bioecological systems theory provides a useful framework for understanding how behaviour develops through interactions within multiple layers of influence, particularly the immediate environments in which young people live and interact [11]. These include family members, peers, teachers, and community actors who directly shape norms, attitudes, and behaviours. Complementing this, Bandura’s social learning theory explains how young people acquire behaviours through observation, imitation, and interaction with others [12]. This process occurs through multiple channels, including interpersonal communication, media exposure, and educational content. Together, these theories explain both, offering a comprehensive lens for understanding how information translates into behaviour [13].

The provision of sexuality information remains a contested issue globally, often shaped by cultural, political, and religious considerations [14-16]. Importantly, sexuality information (SI), defined as knowledge and guidance related to human sexuality, relationships, rights, and health, is frequently misunderstood and narrowly delivered as sexual and reproductive health information alone. However, sexual and reproductive health is only one component of a broader framework. According to the United Nations Educational, Scientific and Cultural Organization, comprehensive sexuality education (CSE) encompasses eight key domains: 1) healthy relationships; 2) values, rights, and culture; 3) gender; 4) violence and safety; 5) communication, negotiation and decision making; 6) the human body and development; 7) sexual and reproductive health; and 8) the sexual life cycle [17]. When sexuality information is provided in a structured, age-appropriate, culturally relevant, and scientifically accurate approach, it is considered to be comprehensive [17,18].  When young people are exposed to all eight domains, the information can be considered complete; when one or more domains are missing, it is incomplete. Completeness is therefore a foundational requirement for achieving truly comprehensive sexuality education.

Despite this framework, most research and programming have focused primarily on access to sexuality information, with limited attention to whether the information provided is complete. In Uganda, sexuality education remains structurally partial, often emphasising abstinence while neglecting critical domains such as rights, negotiation skills, and healthy relationships [19, 20]. This imbalance may explain why many young people continue to engage in RSB despite being exposed to some form of sexuality information. While policies such as the National Sexuality Education Framework (2018) and the Adolescent Health Policy aim to promote accurate and age-appropriate information, implementation remains uneven [21].  Programmes like ‘Get Up Speak Out’ also attempted to improve young people’s voice and access to sexuality information [22]. Empirical evidence supports this concern: for example, Kemigisha et al. (2019) found that school-based CSE improved knowledge but delivered content inconsistently across schools, indicating gaps in coverage [23]. Most existing studies assess whether young people received sexuality information, but few examine whether that information covered all required domains.

This limitation is even more pronounced in island communities, where research has largely focused on structural vulnerabilities such as poverty, transactional sex, and weak health systems [24–26].  Very few studies have examined the content and completeness of the sexuality information available to young people in these settings. Existing evidence suggests important gaps: Mugabi et al. (2023) found that while sexual and reproductive health literacy was associated with safer practices among young people living with HIV, knowledge deficits persisted in areas such as family planning and rights [4]. Similarly, Anyanwu and Tamwesigire (2023) reported that although in-school youth were less likely to engage in RSB, many still lacked adequate knowledge of negotiation and gender norms[27]. Evaluations of sexuality education programmes have also identified insufficient coverage of critical domains such as gender equality, sexual rights, and consent [22]. Collectively, these studies suggest that partial or fragmented sexuality information may limit its protective effect, yet this dimension remains underexplored.

Focusing on the completeness of sexuality information is a critical precursor to achieving comprehensive sexuality education. While comprehensiveness emphasizes depth, skills-building, and integration across settings, it cannot be effectively realized if essential domains are missing or fragmented [17]. Completeness ensures that all eight domains are addressed, providing young people with the foundational knowledge required to make informed and safe sexual decisions. By prioritising completeness, researchers and policymakers can systematically identify gaps in content coverage, particularly in underserved or high-risk populations, thereby laying the groundwork for holistic and effective sexuality education programs [17,28].

This study addresses two key gaps. First, it responds to a measurement gap by moving beyond binary assessments of access to sexuality information and instead evaluating whether young people receive a complete package across all eight UNESCO domains. Second, it addresses a contextual gap by focusing on island communities, which remain underrepresented in sexuality education research despite their heightened vulnerability. This manuscript focuses on a specific research question within the framework of a larger ongoing study. While the parent study addresses multiple objectives, this paper presents a detailed analysis of sexuality information completeness and its association with risky sexual behaviour. By isolating this component, we provide in-depth insights that complement the broader study without duplicating its scope.

Methods

Study design
This study employed a cross-sectional analytical design to examine the association between completeness of sexuality information and RSB among young people aged 10-24 in Uganda’s island communities. This design was appropriate for generating population-level estimates in a geographically isolated and under-researched setting, and for assessing variation in exposure to different domains of sexuality information at a single time point. However, causal inference is not implied.

Study setting and study population
The study was conducted in the island communities of Lake Victoria, where geographical isolation, limited health and education services, mobility, and economic vulnerability contribute to heightened sexual and reproductive health risks. These settings remain underrepresented in national surveys and programme evaluations, despite persistent disparities in access to sexuality education and reproductive health services.

The study population comprised young people aged 10–24 years, consistent with global definitions used in adolescent sexual and reproductive health research[29]. National census estimates indicate that approximately 345,000 young people reside in the Lake Victoria Island communities [30].

Sampling and participants
A multistage sampling strategy incorporating probability proportional to size (PPS) was used to enhance representativeness. Mukono District was randomly selected from the seven districts in Uganda with islands on Lake Victoria, after which Mukono District, Kkoome Subcounty, the only island subcounty, was purposively selected. Two parishes were then randomly selected, followed by the selection of villages using PPS based on estimated youth population size to ensure proportional representation of landing-site and inland settings. Within each selected village, households were identified through listing, and systematic random sampling was used to select households. Where more than one eligible participant was found in a household, one individual was selected using simple random sampling. This approach ensured coverage of key ecological strata, although findings are generalizable primarily to similar island contexts. Participants were eligible if they were aged 10–24 years, had resided in the study area for at least 6 months and provided informed consent, and assent for those less than 18years of age.

Sample size
Sample size was determined using the Yamane and Israel formula for finite populations[31]:

$$n = \frac{N}{1 + Ne^2}$$

Where N represented the population of young people (345,000) and e the precision level (0.05). To account for clustering within geographically bounded island communities, a design effect of 1.5 was applied. A further 10% non-response adjustment yielded a target sample of 660 participants. A total of 569 young people participated, corresponding to an 86.2% response rate.

Data collection
Data were collected using structured interviewer-administered questionnaires programmed on KoboToolbox. Interviews were conducted in private settings to minimise social desirability bias and ensure confidentiality, particularly given the sensitivity of questions related to sexual behaviour and experiences of violence. Standardised data collection procedures and comprehensive interviewer training were implemented to enhance consistency and reduce information bias.  Participants were informed of their right to decline participation or skip any question without consequence. Data were encrypted at the point of collection, securely stored on password-protected servers, and anonymised before analysis.
 
Study variables definition and operationalisation
Sexuality information completeness was assessed using the eight domains outlined in the UNESCO International Technical Guidance on Sexuality Education[17], Table 1: healthy relationships; values, rights, and sexuality; gender equality; violence and safety (including bodily integrity and privacy); skills for health and well-being (including communication, negotiation, and decision-making); human body and development; sexuality and sexual behaviour (including pregnancy, HIV, and sexually transmitted infections); and sexual and reproductive health across the lifecycle. Participants were classified as having complete sexuality information if they reported exposure to all eight domains (8/8) and incomplete information if one or more domains were missing. The variable was further classified as: Low completeness: information received in ≤2 domains, Moderate completeness: information received in 3–4 domains, High completeness: information received in 5-7 domains all and completeness for all 8 domains. This operationalisation provides a stringent measure of full curriculum exposure, while considering differences among those who had incomplete information and ensures strong content validity, as it captures the breadth of domains defined by an internationally recognised framework. However, recognising that this threshold may underestimate partial but meaningful exposure, domain-specific coverage was also examined descriptively. Validity claims are therefore made cautiously, acknowledging that while the measure demonstrates acceptable internal consistency and strong content coverage.

Risky sexual behaviour (RSB) was operationalised as a composite binary outcome derived from multiple indicators reflecting exposure to sexual health risks. These included: (i) early sexual debut (defined as sexual intercourse before the age of 18 years), (ii) non-use or inconsistent use of condoms, (iii) having multiple sexual partners, (iv) engagement in transactional sex, and (v) substance use during sexual activity. Each indicator was coded as binary (1 = presence; 0 = absence), and participants reporting at least one indicator were classified as engaging in RSB. This approach prioritises sensitivity in identifying individuals exposed to any form of sexual risk or vulnerability. The RSB composite was treated as a formative index, as the included indicators represent distinct dimensions of risk that are not expected to be interchangeable or highly correlated. As such, internal consistency measures are interpreted cautiously.  The composite measure RSB demonstrated acceptable internal consistency, with an overall Cronbach’s alpha of 0.764. Most items exhibited moderate (0.2-0.6) inter-item correlations, indicating they measure related aspects of RSB. Exploratory factor analysis supported a unidimensional structure, with a single factor explaining 88% of the variance. These results suggested an appropriate composite RSB measure. To support content validity, the indicators were selected based on established literature and public health frameworks capturing diverse pathways of sexual risk. To minimise the risk of circularity and inflated associations, variables used to construct the RSB outcome were not included in the sexuality information completeness measure.

Covariates included age, sex, education level, schooling status, employment status, living arrangements, religion, residence type, and modes of receiving sexuality information. Modes of sexuality information delivery were assessed by asking participants whether they had received sexuality-related information through specific channels, including verbal communication, observation, reading materials, and digital media such as videos or games. Each mode of delivery was operationalised as a binary variable, with responses coded to indicate whether the participant had been exposed to sexuality information through that particular channel. These variables were selected based on theoretical relevance, particularly bioecological and social learning perspectives, as well as prior empirical evidence. To minimise overfitting, only variables with theoretical justification and evidence of association at the bivariate level were included in the final models.
 
Pretesting and instrument refinement
The questionnaire was pretested among 10 young people aged 10–24 years in Katosi landing site, stratified by age and sex. The pretest assessed comprehension, cultural appropriateness, and sensitivity. Terminology related to sexual and reproductive health was simplified to improve clarity, particularly for younger adolescents. One additional behavioural dimension was incorporated to capture transactional and coercive contexts better. The final instrument demonstrated good internal consistency (Cronbach’s alpha = 0.82) and required approximately 20–25 minutes to complete. 

Data analysis
Data were analysed using Stata (version 19). Descriptive statistics were used to summarise participant characteristics and key study variables. To examine factors associated with RSB, a multivariable logistic regression model was fitted with RSB specified as a binary outcome variable. Explanatory variables included socio-demographic characteristics (sex, schooling status, employment status, belonging to a club, and living arrangements), social participation (club membership), and sexuality information-related variables, which had a significant (p<0.05) bivariate association with RSB. All categorical variables were included using indicator (dummy) coding with appropriate reference categories.

Given the multistage sampling design and the potential for intra-cluster correlation among individuals within the same parish, cluster-robust standard errors were applied at the parish level to obtain valid statistical inference. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Model calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test based on deciles of predicted probabilities. Model discrimination was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Predicted probabilities were generated from the fitted model to construct the ROC curve. To assess robustness, alternative model specifications were explored and yielded substantively similar results, indicating stability of the estimated associations.

Ethical considerations
Ethical approval for the study was obtained from a relevant ethics committee, and the study was registered by the Uganda National Council of Science and Technology with permit number SS3785ES, after ethical approval by the TASO Research Ethics Committee, number TASO-2025-323. Written informed consent was obtained from participants aged 18–24 years, while participants aged 10–17 years provided assent alongside parental or guardian consent. Given the sensitivity of questions related to sexual behaviour and violence, all surveys were conducted in private settings to ensure confidentiality and comfort. Participants were informed of their right to skip any question or withdraw from the study at any point without consequence. Any disclosures of violence, including forced sex, were handled through referral to appropriate local safeguarding and health services, with the guidance of a child safeguarding protocol. To maintain confidentiality, data were collected in a de-identified format, stored securely in password-protected systems, and access was restricted to authorised members of the research team only.

Results

Socio-demographic and contextual characteristics of young people who participated in the study
A total of 569 young people participated in the study, with nearly equal representation from Bugombe (49.2%) and Busanga (50.8%) parishes. Young people’s ages ranged from 10 to 24 years, with a mean of 16.4 years (SD = 3.16); the largest age group was 18–24 years (37.6%), followed by 10–14 years (31.3%) and 15–17 years (31.1%). The sample was gender-balanced, with females comprising 51.3% and males 48.7%.  Most participants resided in peri-urban areas (83.5%), and the majority identified as Christian (88.4%). Nearly all participants (98.2%) had completed at least primary education, though 61.0% were not currently attending school. More than half of the respondents were unemployed (56.2%), while 43.8% reported some form of employment. Social engagement was relatively common, as 59.4% of participants belonged to a youth club or group.  Living arrangements varied considerably: 40.3% lived alone, 17.8% with biological parents, 16.3% with a spouse, and 25.7% with other relatives or guardians (Table 2) [32].

The most common channels for receiving sexuality information were verbal communication (75.6%) and observation (65.6%). Only 5.5% of participants reported receiving information through reading, and virtually none (0.2%) through videos or games.

Completeness of sexuality information among young people in Uganda’s Island communities
Findings show variations in the coverage of sexuality information across the eight UNESCO-recommended domains (Table 3). The most frequently reported domain was healthy relationships, with just over half of participants reporting exposure (295; 51.8%). This was followed by pregnancy, HIV, and sexually transmitted infections, which was reported by 220 respondents (38.6%), and communication, negotiation, and decision-making, reported by 215 participants (37.7%). Coverage of the human body and development was similarly limited, reaching only about one-third of respondents (196; 34.4%).

Only 161 participants (28.3%) reported receiving information on gender equality and equity, while exposure to sexual values, rights, and practices was reported by fewer than one-quarter of respondents (140; 24.6%). Similarly, privacy, bodily integrity, and safety, which are essential for safeguarding and violence prevention, were reported by 139 respondents (24.4%). The least covered domain was sexual lifecycle and response, reported by only 129 participants (22.6%).

Most young people lacked complete sexuality information. Over half of the respondents (53.1%) reported low completeness, 35.7% fell within the moderate category, only a small minority of participants demonstrated higher-quality information exposure: 7.5% had high completeness, while just 3.7% reported fully complete sexuality information.
 
Risky sexual behaviour among young people in Island communities
More than half (57.5%) of the respondents reported early sexual debut (Table 4). Slightly over one quarter (27.4%) had ever used a condom, but only 20.9% reported consistent condom use.  About 67.5% reported having multiple sexual partners.  Substance use during sex was relatively rare at 5.4%. Nearly three-quarters (73.3%) reported having exchanged sex for money, gifts, or favours. Overall, RSB was very high at 90.3% among study participants.
 
Bivariate association between social demographic characteristics, mode of sexuality information provision, sexuality information completeness, and sexual behaviour of young people
The results of the bivariate analysis conducted to examine the unadjusted associations between selected socio-demographic, behavioural, and information-related factors and RSB. Only sex, religion, schooling status, education level, employment status, belonging to a club, living arrangement, receiving SI by observation, and sexuality information completeness were significantly (p>0.05) associated with RSB (Table 5).

Female young people were significantly less likely to engage in RSB compared to males (cOR = 0.19, 95% CI: 0.09–0.39, p < 0.001). Young people currently in school were significantly less likely to engage in RSB compared to those who were out of school (cOR = 0.25, 95% CI: 0.14–0.45, p < 0.001). Employed young people were more likely to engage in RSB compared to those not employed (cOR = 6.10, 95% CI: 2.71–13.74, p < 0.001). Young people belonging to a club were less likely to engage in RSB (cOR = 0.51, 95% CI: 0.27–0.95, p = 0.032). Young people living with biological parents had significantly lower odds of risky sexual behaviour compared to those living alone (cOR = 0.14, 95% CI: 0.07–0.27, p < 0.001), while no significant differences were observed for those living with a spouse or in other arrangements. Receiving information through observation was significantly associated with reduced odds of RSB (cOR = 0.21, 95% CI: 0.09–0.50, p < 0.001). However, no significant associations were observed for verbal communication, reading materials, or digital media exposure.

Compared to participants with low completeness, those with high (cOR = 0.14, 95% CI: 0.06–0.31, p < 0.001) and complete (cOR = 0.05, 95% CI: 0.02–0.15, p < 0.001) levels of information were significantly less likely to engage in RSB.

Multivariate association between socio-demographics, sexuality information sources, completeness, and sexual behaviour of your people in Uganda’s Island communities.
Multicollinearity among independent variables significant at the bivariate level was assessed using Variance Inflation Factors (VIF), shown in Table 6. All VIF values ranged from 1.24 to 2.54, with a mean VIF of 1.74, indicating no evidence of problematic multicollinearity [33].

Multivariable (adjusted) logistic regression results indicated that sex, schooling status, employment, club membership, living arrangement, mode of information delivery, and sexuality information completeness were significantly associated with RSB (Table 7).  Females had significantly lower odds of engaging in risky sexual behaviour compared to males (aOR = 0.42, 95% CI: 0.38–0.47, p < 0.001). Employment was associated with increased odds of risky behaviour (aOR = 4.19, 95% CI: 1.29–13.66, p = 0.017), although the wide confidence interval suggests some instability in the estimate. Receiving sexuality information through observation was associated with substantially reduced odds of risky behaviour (aOR = 0.22, 95% CI: 0.09–0.56, p = 0.001). A gradient effect was observed for sexuality information completeness, with those receiving complete information exhibiting significantly lower odds of risky behaviour (aOR = 0.16 95% CI: 0.04–0.56, p = 0.004). Other variables, including schooling status, club membership, and living arrangement, were not significantly associated with the outcome. Notably, estimates for living arrangements showed wide confidence intervals, indicating potential instability due to sparse data.

The model demonstrated good calibration, as indicated by the Hosmer–Lemeshow test (χ² (8) = 10.000, p = 0.265), and strong discriminatory ability (AUC = 0.837), Figure 1. These findings suggest that the model performs well in distinguishing individuals with and without risky sexual behaviour within the study sample. However, given the composite nature of the outcome and the cross-sectional design, these results should be interpreted with caution, as model performance may be influenced by outcome definition and has not been externally validated.

Discussion

This study should be interpreted as exploratory and hypothesis-generating, with bivariate findings treated as the primary analytical lens and multivariable results considered supplementary. Within this framing, the results point to a clear and internally consistent pattern: higher levels of sexuality information completeness are associated with lower odds of risky sexual behaviour RSB. The observed gradient suggests that moving from low to complete sexuality information corresponds to incremental reductions in risk, reinforcing the idea that fragmented sexuality information may be insufficient for meaningful behavioural change. This aligns with evidence that CSE is most effective when delivered as an integrated package covering cognitive, relational, and normative domains [33,35]. However, existing literature has largely operationalised exposure as binary, limiting its usefulness in interpreting these graded effects. The present findings extend this evidence base by suggesting that completeness may function as a threshold condition, below which information does not translate into safer behaviour. From a theoretical perspective, Social Learning Theory provides a relevant lens, as it emphasises that behaviour change depends on coherent, reinforced learning rather than isolated informational inputs [12]. At the same time, the literature offers limited explanation for why partial exposure may fail so consistently. This study contributes by indicating that incomplete information may leave critical gaps in decision-making capacity, particularly in domains such as consent, negotiation, and gender norms, which are central to real-world sexual interactions.

The findings on mode of information delivery, again interpreted primarily at the bivariate level, suggest that observational learning is associated with lower odds of RSB, while verbal, written, and digital modes show no clear association. This is consistent with evidence that participatory and experiential approaches are more effective than passive information delivery in influencing adolescent sexual behaviour [36–38]. It also aligns with the modelling and reinforcement mechanisms described in Social Learning Theory. However, the broad categorisation of “observation” limits interpretability. It remains unclear whether this reflects parental modelling, peer influence, or exposure to the consequences of risky behaviour. This ambiguity is not well addressed in existing literature and represents an important gap. Notably, the absence of a detectable association for digital information contrasts with the growing emphasis on digital sexuality education [39–41]. In this context, the finding should not be over-interpreted but rather seen as indicative of potential limitations in access, engagement, or content quality, particularly in resource-constrained or high-risk settings. It highlights the need for more rigorous evaluation of how digital platforms function within specific socio-ecological environments, rather than assuming effectiveness.

Gender differences were also evident, with females reporting lower odds of RSB than males in both crude and adjusted analyses. This pattern is consistent with studies linking male risk-taking to dominant norms around masculinity and peer influence [42,43]. However, interpretation should remain cautious due to potential gendered reporting biases, where males may overreport and females underreport sexual behaviour [44,45]. The literature is therefore helpful in explaining the direction of the association but less conclusive in distinguishing behavioural differences from reporting effects. In this study, gender should be understood as operating within a broader system of norms, expectations, and disclosure patterns, rather than as a purely behavioural determinant.

Factors such as schooling status, club membership, and living with biological parents appeared protective in bivariate analysis but did not retain statistical significance in the multivariable model. This divergence underscores the interdependence of social and structural factors and cautions against interpreting bivariate associations as independent effects. Similar patterns have been reported in studies examining the social determinants of adolescent health, where apparent protective factors often operate through indirect pathways [46,47]. In this study, these variables may reflect underlying mechanisms such as supervision, social support, or access to information, rather than exerting direct effects on behaviour. Their loss of significance in adjusted models should therefore not be interpreted as absence of influence but as evidence of confounding and mediation, reinforcing the need for pathway-based analytical approaches.

Specifically, the importance of family context, particularly living arrangements. Young people living with biological parents were less likely to engage in RSB at the bivariate level, while living with a spouse remained protective in adjusted models. These patterns are consistent with ecological systems theory, which emphasises the role of the immediate social environment in shaping behaviour [11]. Recent studies in Uganda and similar contexts show that parental monitoring and communication are associated with reduced sexual risk [48–50]. However, the literature also highlights a critical limitation: many parents lack the capacity or confidence to provide complete and accurate sexuality information [53–53]. This creates a gap between presence and effectiveness. The present findings suggest that parental presence alone is protective, but its impact could be significantly enhanced if parents are equipped to deliver comprehensive and coherent sexuality education.

The findings also suggest that structured social environments, specifically schooling and club participation are associated with lower odds of RSB. Young people currently in school were substantially less likely to engage in RSB compared to those out of school, and a similar, though less pronounced, protective pattern was observed for club membership. Interpreted primarily at the bivariate level, these results point to the role of institutional attachment, routine, supervision, and peer regulation in shaping behaviour. Existing literature is broadly helpful in interpreting these findings. Studies across sub-Saharan Africa consistently show that school attendance is associated with delayed sexual debut, reduced number of partners, and increased uptake of protective behaviours [20,54,55]. Similarly, participation in youth clubs and organised groups has been linked to improved sexual health outcomes through peer support, mentorship, and access to information [41,56,57]. However, much of this literature treats schooling and social participation as independent protective factors, without sufficiently interrogating the mechanisms through which they operate. The Bioecological Model is useful here, as it situates schools and clubs within the microsystem, where regular interaction, social norms, and supervision directly influence behaviour [11]. At the same time, Social Learning Theory helps explain how peer norms, role modelling, and reinforcement within these settings shape behavioural choices [12,36]. The strong crude associations observed here did not persist in adjusted models, suggesting that schooling and club membership may not exert independent effects but rather operate through intermediary pathways, such as improved access to sexuality information, exposure to pro-social norms, or reduced idle time. This distinction is often underexplored in prior studies, which tend to report adjusted associations without examining why effects attenuate. In this sense, the current findings add to the literature by highlighting that the protective value of schooling and clubs may depend on what is transmitted within them, including the completeness and quality of sexuality information, the nature of peer interactions, and the presence of supportive adult guidance. This is a meaningful contribution, particularly in high-risk contexts, because it shifts the focus from mere participation to the content and dynamics of participation. The magnitude of the protective effect of schooling at the bivariate level, which is notably strong. While the direction of the association is consistent with prior evidence, the strength may reflect context-specific dynamics, such as the stark contrast between in-school and out-of-school youth in island communities. Those out of school may be more exposed to economic activities, mobility, and transactional relationships, all of which increase risk [58–60]. This suggests that schooling may function not only as a site of learning but also as a protective buffer against high-risk environments.

In fact, employment was associated with higher odds of RSB in both bivariate and multivariable analyses, although the adjusted estimate was characterised by a wide confidence interval, indicating substantial statistical uncertainty. This pattern is consistent with evidence from high-mobility settings, including fishing communities, where income, autonomy, and mobility increase exposure to transactional relationships and high-risk social networks [58,61–65]. The present findings support these contextual explanations, suggesting that economic participation in such environments may expand opportunity structures for risk, particularly in the absence of protective informational and social mechanisms. However, given the imprecision of the estimate, this association should be interpreted cautiously and viewed as indicative rather than conclusive.

At the same time, the attenuation of this effect in multivariable analysis indicates that it is not schooling per se, but the broader constellation of factors associated with being in school, that drives the relationship. This mixed pattern, strong in crude analysis, diminished when adjusted, is both similar to and different from existing literature. It is similar in that schooling is consistently protective; it is different in that this study explicitly demonstrates the fragility of that effect under adjustment, pointing to confounding and interdependence. This may be due to differences in population (high-mobility island communities), sample composition, or the inclusion of variables such as sexuality information completeness, which are often omitted in other studies.

The multivariable model, while useful for exploring adjusted relationships, should be interpreted as supplementary due to methodological constraints, particularly the low events-per-variable (EPV) ratio, which increases the risk of overfitting and unstable estimates. This limitation may inflate measures of model performance, including discrimination, and reduce the reliability of adjusted effect sizes. As such, the multivariable findings are best understood as exploratory extensions of the bivariate patterns rather than confirmatory evidence.

Limitations
Several limitations should be considered. The cross-sectional design limits causal inference and precludes assessment of temporal relationships between sexuality information and behaviour. Future research should prioritise longitudinal designs to establish causal pathways and examine how exposure to comprehensive information translates into behavioural change over time. The reliance on self-reported data introduces potential recall and social desirability biases, particularly for sensitive behaviours. The study also did not explicitly model causal pathways or mediating mechanisms, such as peer influence, alcohol use, or autonomy, which may link factors like employment and schooling to RSB. Future studies should incorporate causal pathway analysis to better understand these relationships. Additionally, while digital media exposure was assessed, its lack of association may reflect measurement limitations. Given the increasing role of technology, more detailed investigation into digital sexuality education is warranted. The focus on island communities, while contextually important, limits generalizability. Comparative studies across different settings are needed to assess the transferability of findings and identify context-specific versus universal drivers of behaviour. Finally, small subgroup sizes in some categories contributed to unstable estimates, highlighting the need for larger and more balanced samples in future research.

Conclusion

Taken together, these exploratory findings point to the importance of completeness, coherence, and mode through which that information is transmitted within young people’s immediate social environments, other than just exposure to sexuality information. The consistent gradient between sexuality information completeness and reduced RSB, reinforced by the protective signal from observational learning, suggests that fragmented or passive approaches are unlikely to produce meaningful behavioural change. Instead, behaviour appears to be shaped through integrated, socially embedded learning processes, operating across families, schools, and peer networks. At the same time, the attenuation of several associations in multivariable analysis, combined with statistical uncertainty due to low events-per-variable, underscores that these relationships are interdependent rather than independent, and should be interpreted as hypothesis-generating rather than causal. Within this framing, the study adds value by shifting the focus from access to sexuality education toward the completeness of content, its quality, delivery, and contextual embedding of that education, particularly in high-risk, resource-constrained settings such as island communities.

From a policy and programmatic perspective, the implications are direct but demanding. First, investments should move beyond expanding coverage of sexuality education to ensuring completeness and integration across cognitive, relational, and normative domains, with explicit attention to consent, negotiation, and gender dynamics. Second, delivery strategies should prioritise participatory and observational approaches, including mentorship, and parent–child engagement, rather than relying predominantly on didactic or digital formats whose effectiveness remains uncertain in such contexts. Third, schools and youth clubs should be leveraged not merely as access points but as active platforms for structured, high-quality engagement, with clear standards for content and facilitation. Fourth, family-based interventions are critical: strengthening parental capacity to communicate accurate and comprehensive sexuality information could significantly amplify the protective effect of co-residence. Finally, given the suggestive link between employment and increased risk, programmes in high-mobility economies should integrate economic empowerment with targeted risk-reduction and social protection strategies, rather than treating livelihoods and sexual health as separate domains. Future research should prioritise longitudinal and pathway-based designs, as well as rigorous evaluation of digital and hybrid delivery models, to move from exploratory associations to causally credible and context-sensitive interventions.

 

What is already known about the topic

  • Access to sexuality information is associated with safer sexual behaviour, including delayed sexual debut, negotiation of safe practices, and reduced unintended pregnancies [17,66].
  • Many adolescents receive fragmented or incomplete sexuality education, leaving gaps in critical domains such as sexual rights, consent, gender equity, and bodily integrity Re[66,68]
  • Parental presence and support are protective, providing supervision, guidance, and normative reinforcement that reduce engagement in risky sexual behaviour [47,48].
  • Schooling and economic participation are not uniformly protective; without complete, skills-based sexuality information, education and employment may increase exposure to risk networks and multiple sexual partnerships[69,70].

What this  study adds

  • Moves the field from “access” to “completeness” of sexuality information as per the UNESCO (2018) guidelines. Most studies treat sexuality education as a binary exposure, received vs not received.
  • This study introduces and empirically supports information completeness as a graded and potentially threshold concept, showing that partial exposure may be insufficient for behavioural change.

Competing Interest

The authors of this work declare no competing interests.

Funding

The authors did not receive any specific funding for this work.

Acknowledgements

We thank the respondents who took the time and effort to take the surveys.  

Authors´ contributions

Venantius Bbaale Kirwana conceptualized the study, collected and analyzed the data, interpreted the results, and wrote the manuscript. Dr. Patricia Ndugga, Dr. Cyprian Misinde, Dr. Allen Kabagenyi, Dr. Christian Kakuba, and Dr. Stephen Wandera contributed to writing and proofreading the manuscript. All authors read and approved the final manuscript.

Tables 

Table 1: Sexuality Information Domains as per UNESCO (2018)
Sexuality Information Domains Content
1. Health Relationships
  • Families
  • Friendships, Love, and Romantic Relationships
  • Tolerance. Inclusion and respect
  • Longterm Commitments and Parenting
2. Sexual Values, Rights, and practices
  • Values
  • Human rights
  • Culture and Society
3. Gender Equality and Equity
  • Social Construction of Gender and Gender Norms
  • Gender Equality, Stereotypes and Bias
  • Gender -Based violence
4. Violence and Staying Safe
  • Violence
  • Consent, Privacy and Bodily Integrity
  • Safe use of Information and Communication Technology
5. Communication, negotiation, and decision making
  • Norms and Peer Influence on sexual behaviour
  • Decision-making
  • Communication, Refusal and Negotiation Skills
  • Media Literacy and Sexuality
  • Finding Helps and Support
6. Human body and Development
  • Anatomy and Physiology
  • Puberty
  • Reproduction
  • Body Image
7. Pregnancy, HIV, and STIs. (Sexual and Reproductive Health)
  • Pregnancy and Pregnancy Prevention
  • HIV and AIDS Stigma, Care, Treatment and Support
  • Understanding, Recognizing and Reducing the Risk of STIs, Including HIV
8. Sexual Lifecycle and Response
  • Sex, and the Sexual Life Cycle
  • Sexual Response

Table 2: Sociodemographic and Contextual Profile of Young People in Uganda’s Island Communities, May 2025

Variablesn (%)
Biodata 
Parish 
Bugombe280(49.2)
Busanga289(50.8)
Age (years) 
Mean age (SD)16.4±3.12
10-14178(31.3)
15-17177(31.1)
18-24214(37.6)
Sex 
Female292(51.3)
Male277(48.7)
Residence 
Rural94(16.5)
Peri-Urban475(83.5)
Religion 
Christian503(88.4)
Non-Christians66(11.6)
Schooling status 
No347(61)
Yes222(39)
Education 
None10(1.8)
≥Primary559(98.2)
Employment 
No320(56.2)
Yes249(43.8)
Belong to a club/group 
No231(40.6)
Yes338(59.4)
Living arrangements 
Alone229(40.3)
Biological Parent101(17.8)
Spouse93(16.3)
Other146(25.7)
Mode of Receiving Sexuality Information 
Receiving SI by observation 
No139(24.4)
Yes430(75.6)
Receiving SI Verbally 
No196(34.5)
Yes373(65.6)
Receiving SI by Reading 
No538(94.6)
Yes31(5.5)
Table 3. Completeness of Sexuality Information among Young People in Uganda’s Island Communities, May 2025
Sexuality Information DomainCoverage n (%)
Domain 1: Healthy relationships295 (51.8)
Domain 7: Pregnancy, HIV, and STIs220 (38.6)
Domain 5: Communication, negotiation, and decision making215 (37.7)
Domain 6: Human body and development196 (34.4)
Domain 3: Gender equality and equity161 (28.3)
Domain 2: Sexual values, rights, and practices140 (24.6)
Domain 4: Privacy, bodily integrity, and safety139 (24.4)
Domain 8: Sexual lifecycle and response129 (22.6)
Sexuality Information Completeness among Young People n (%)
Low302 (53.1)
Moderate203 (35.7)
High43 (7.5)
Complete21 (3.7)
Note: This table has been adapted from Kirwana et al. (2025) with permission [74]
Table 4: Risky Sexual Behaviour among Young People in Uganda’s Island Communities, May 2025
Variables Frequency Percentage
Early sex
No (safe) 242 42.5
Yes (risky) 327 57.5
Ever used a condom
Yes (safe) 156 27.4
No (risky) 450 79.1
Consistent use of a condom
Yes (safe) 119 20.9
No (risky) 413 72.6
Number of Sexual Partners
One Partner (safe) 185 32.5
Multiple Partners (risky) 384 67.5
Alcohol and Substance abuse when engaging in sexual activity
No (safe) 538 94.6
Yes (risky) 31 5.4
Transactional sex
No (safe) 152 26.7
Yes (risky) 417 73.3
Overall Sexual Behaviour
Safer 55 9.7
Risky 514 90.3
Cronbach’s alpha =0.764 Moderate (0.2-0.6) inter-item correlation Exploratory factor analysis – 88% of variance
Table 5: Bivariate Association between Socio-demographics, Mode of Sexuality Information, Sexuality Information Completeness, and the Sexual Behaviour of Young People in Uganda’s Island Communities, May 2025
VariableRisky Sexual Behaviour n(%)CoR [CI]p-value
SaferRisky
Age-groups
10–14 years12 (6.7)166 (93.3)Reference 
15–17 years16 (9.0)161 (91.0)0.7 [0.33–1.59]0.423
18–24 years27 (12.6)187 (87.4)0.5 [0.25–1.02]0.057
Sex
Male10 (3.4)282 (96.6)Reference 
Female42 (15.6)227 (84.4)0.2 [0.09–0.39]<0.001*
Residence
Rural9 (9.6)85 (90.4)Reference 
Peri-urban46 (9.7)429 (90.3)0.9 [0.47–2.09]0.974
Religion
Christian53 (10.5)450 (89.5)Reference 
Non-Christian2 (3.0)64 (97.0)3.8 [0.90–15.84]0.070
Schooling Status
No17 (4.9)330 (95.1)Reference 
Yes38 (17.1)184 (82.9)0.3 [0.14–0.45]<0.001*
Education Level
≤ Primary20 (8.4)217 (91.6)Reference 
> Primary35 (10.5)297 (89.5)0.8 [0.44–1.39]0.403
Employment Status
No48 (15.0)272 (85.0)Reference 
Yes7 (2.8)242 (97.2)6.1 [2.71–13.74]<0.001*
Belonging to a Club
No15 (6.4)218 (93.6)Reference 
Yes40 (11.9)296 (88.1)0.5 [0.27–0.95]0.032*
Living Arrangement
Alone13 (5.7)216 (94.3)Reference 
Biological Parent31 (30.7)70 (69.3)0.1 [0.07–0.27]<0.001*
Spouse7 (7.5)86 (92.5)0.7 [0.29–1.92]0.534
Other4 (2.7)142 (97.3)2.1 [0.68–6.68]0.192
Receiving Sexuality Information by Observation
No6 (3.1)190 (96.9)Reference 
Yes49 (13.1)324 (86.9)0.2 [0.09–0.50]<0.001*
Receiving Sexuality Information Verbally
No14 (10.1)125 (89.9)Reference 
Yes41 (9.5)389 (90.5)1.0 [0.56–2.01]0.852
Receiving Sexuality Information by Reading
No53 (9.8)485 (90.2)Reference 
Yes2 (6.5)29 (93.6)1.6 [0.37–6.83]0.537
Receiving Sexuality Information through Video or Games
No5 (9.1)509 (90.9)Reference 
Yes1 (100.0)0 (0.0)11
Sexuality Information Completeness
Low17 (5.6)285 (94.4)Reference 
Moderate14 (6.9)189 (93.1)0.8 [0.39–1.67]0.561
High13 (30.2)30 (69.8)0.1 [0.06–0.31]<0.001*
Complete11 (52.4)10 (47.6)0.1 [0.02–0.15]<0.001*
*95% significant
Table 6: Multicollinearity Check of the Variables in the Multivariate Model
VariableVIF1/VIF
Schooling Status2.540.394
Employment Status2.120.472
Sex1.980.505
Receiving SI by Observation1.620.618
Belonging to a Club1.380.727
SI Completeness1.290.774
Living Arrangement1.240.807
Mean VIF1.74 
Table 7: Multivariate Associates of Sexual Behaviour among Young People in Uganda’s Island Communities
Risky Sexual BehaviouraOR [CI]p-values
Sex
MaleReference 
Female0.4 [0.38 – 0.47]<0.001*
Schooling Status
NoReference 
Yes1.5 [0.78 – 3.04]0.209
Employment Status
NoReference 
Yes4.2 [1.29 – 13.66]0.017*
Belonging to a Club
NoReference 
Yes1.3 [0.74 – 2.44]0.339
Living Arrangement
AloneReference 
Biological Parent0.6 [0.01 – 32.61]0.804
Spouse0.6 [0.06 – 5.26]0.610
Other1.3 [0.07 – 20.76]0.887
Receiving SI by Observation
NoReference 
Yes0.2 [0.09 – 0.56]0.001*
Sexuality Information Completeness
LowReference 
Moderate0.9 [0.51 – 1.55]0.688
High0.3 [0.09 – 1.05]0.059
Complete0.16 [0.04 – 0.56]0.004*
* 95% significant
 

References

  1. Jackson F, Haile ZT. Association between educational attainment and risky sexual behaviour among Ghanaian female youth. Afr Health Sci [Internet]. 2023 Mar [cited 2026 Jun 2];23(1):301-308. doi:10.4314/ahs.v23i1.32
  2. Tolmay J, Knight L, Muvhango L, Polzer-Ngwato T, Stöckl H, Ranganathan M. Women’s Economic Contribution, Relationship Status and Risky Sexual Behaviours: A Cross-Sectional Analysis from a Microfinance-Plus Programme in Rural South Africa. AIDS Behav [Internet]. 2022 Jul [cited 2026 Jun 2];26(7):2349-2362. doi:10.1007/s10461-021-03566-5
  3. UNAIDS. Unequal, unprepared, under threat: Why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics [Internet]. Geneva (Switzerland): UNAIDS; 2022 [cited 2026 Jun 2]. 71 p. Available from: https://www.unaids.org/sites/default/files/media_asset/2021_WAD_report_en.pdf
  4. Mugabi B, Nanyingi M, Kabanda R, Ndibazza J, Elyanu P, Asiimwe JB, Nazziwa G, Habaasa G, Kekitiinwa A. Prevalence and factors associated with sexual and reproductive health literacy among youth living with HIV in Uganda: a cross-sectional study. BMC Public Health [Internet]. 2023 Aug 7 [cited 2026 Jun 2];23(1):1497. doi:10.1186/s12889-023-16399-9
  5. Matemba M, Sadandaula R. Correlates and predictors of the development of sexual behaviors of young adolescent girls in the rural southern region of Malawi [doctorate thesis on Internet]. Coral Gables (Florida): University of Miami; 2021 May [cited 2026 Jun 2]. 261 p. Available from: https://scholarship.miami.edu/esploro/outputs/doctoral/Correlates-and-Predictors-of-the-Development/991031572881202976/filesAndLinks?index=0
  6. Mugeere A, Barford A, Magimbi P. Climate change and young people in Uganda: a literature review. J Environ Dev [Internet]. 2021 Dec [cited 2026 Jun 2];30(4):344–68. doi:10.1177/10704965211047159
  7. Uganda Bureau of Statistics. Uganda Demographic and Health Survey 2022 [Internet]. Kampala (Uganda): Uganda Bureau of Statistics; 2023 Nov [cited 2026 Jun 2]. 388 p. Available from: https://www.ubos.org/wp-content/uploads/publications/UDHS-2022-Report.pdf
  8. Ssemugabo C, Nalinya S, Lubega GB, Ndejjo R, Musoke D. Health Risks in Our Environment: Urban Slum Youth’ Perspectives Using Photovoice in Kampala, Uganda. Sustainability [Internet]. 2020 Dec 29 [cited 2026 Jun 2];13(1):248. doi:10.3390/su13010248
  9. Maharaj NR. Adolescent pregnancy in sub-Saharan Africa – a cause for concern. Front Reprod Health [Internet]. 2022 Dec 2 [cited 2026 Jun 2]; 4:984303. doi:10.3389/frph.2022.984303
  10. Bukenya JN, Ssekamatte T, Komuhendo R, Stillman M. Young people’s access to sexual and reproductive health services in Uganda: Understanding barriers and facilitators. Guttmacher [Internet]. 2025 Apr 28 [cited 2026 Jun 2]. [about 17 screens]. Available from: https://www.guttmacher.org/report/young-peoples-access-sexual-and-reproductive-health-services-uganda-understanding-barriers
  11. Bronfenbrenner U. Contexts of child rearing: Problems and prospects. American Psychologist [Internet]. 1979 Oct [cited 2026 Jun 2];34(10):844–50. doi:10.1037/0003-066X.34.10.844
  12. Bandura A. Social learning theory. Englewood Cliffs (New Jersey): Prentice-Hall; 1977 [cited 2026 Jun 2]. 247 p.
  13. LaBerge D, Samuels SJ. Basic processes in reading: Perception and comprehension. Routledge; 2017 [cited 2026 Jun 2].
  14. Ketting E, Brockschmidt L, Ivanova O. Investigating the ‘C’ in CSE: implementation and effectiveness of comprehensive sexuality education in the WHO European region. Sex Education [ Internet]. 2021 Mar 4 [cited 2026 Jun 2];21(2):133–47. doi:10.1080/14681811.2020.1766435
  15. Leung H, Shek DTL, Leung E, Shek EYW. Development of Contextually-relevant Sexuality Education: Lessons from a Comprehensive Review of Adolescent Sexuality Education Across Cultures. Int J Environ Res Public Health [Internet]. 2019 Feb 20 [cited 2026 Jun 2];16(4):621. doi:10.3390/ijerph16040621
  16. Schneider M, Hirsch JS. Comprehensive Sexuality Education as a Primary Prevention Strategy for Sexual Violence Perpetration. Trauma Violence Abuse [cited 2026 Jun 2]. 2020 May 2 [cited 2026 Jun 2];21(3):439-455. doi:10.1177/1524838018772855
  17. UNESCO, Joint United Nations Programme on HIV/AIDS, United Nations Children’s Fund, United Nations Entity for Gender Equality and the Empowerment of Women, World Health Organization. International technical guidance on sexuality education: an evidence-informed approach [Internet]. UNESCO; 2018 [cited 2026 Jun 2]. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000260770 doi:10.54675/UQRM6395
  18. Atuhairwe S, Gemzell-Danielsson K, Byamugisha J, Kaharuza F, Tumwesigye NM, Hanson C. Abortion-related near-miss morbidity and mortality in 43 health facilities with differences in readiness to provide abortion care in Uganda. BMJ Glob Health [Internet]. 2021 Feb [cited 2026 Jun 2];6(2):e003274. doi:10.1136/bmjgh-2020-003274
  19. Akumiah PO, Suglo JN, Sebire SY. Early Life Exposures and Risky Sexual Behaviors among Adolescents: A Cross-sectional Study in Ghana. Niger Med J [Internet]. 2020 Jul-Aug [cited 2026 Jun 2];61(4):189-195. doi:10.4103/nmj.NMJ_100_20
  20. Amo-Adjei J, Tuoyire DA. Timing of sexual debut among unmarried youths aged 15-24 years in sub-Saharan Africa. J Biosoc Sci [Internet]. 2018 Mar [cited 2026 Jun 2];50(2):161-177. doi:10.1017/S0021932017000098
  21. Ministry of Education and Sports (Uganda). National sexuality education framework 2018 [Internet]. Kampala (Uganda): Ministry of Education and Sports; 2018 [cited 2026 Jun 2]; 51 p. Available from: http://www.education.go.ug/files/downloads/UNFPA_68_090518.pdf
  22. Kakal T, Nalwadda C, van Reeuwijk M, van Veen M, Kusters L, Chatterjee O, Owekmeno C, Kok M. Young people’s choice and voice concerning sex and relationships: effects of the multicomponent Get Up Speak Out! Programme in Iganga, Uganda. BMC Public Health [Internet]. 2022 Aug 23 [cited 2026 Jun 2];22(1):1603. doi:10.1186/s12889-022-13919-x
  23. Kemigisha E, Bruce K, Ivanova O, Leye E, Coene G, Ruzaaza GN, Ninsiima AB, Mlahagwa W, Nyakato VN, Michielsen K. Evaluation of a school based comprehensive sexuality education program among very young adolescents in rural Uganda. BMC Public Health [Internet]. 2019 Oct 28 [cited 2026 Jun 2];19(1):1393. doi:10.1186/s12889-019-7805-y
  24. Wandera SO, Tumwesigye NM, Walakira EJ, Kisaakye P, Wagman J. Alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities of Lake Victoria, Uganda. BMC Public Health [Internet]. 2021 Mar 19 [cited 2026 Jun 2];21(1):544. doi:10.1186/s12889-021-10595-1
  25. MacGilleEathain R, Smith T, Steele I. Sexual well-being among young people in remote rural island communities in Scotland: a mixed methods study. BMJ Sex Reprod Health [Internet]. 2024 Jan 9 [cited 2026 Jun 2];50(1):7-12. doi:10.1136/bmjsrh-2023-201822
  26. Kwiringira JN, Mugisha J, Akugizibwe M, Ariho P. ‘When will the doctor be around so that I come by?!’ Geo-socio effects on health care supply, access and utilisation: experiences from Kalangala Islands, Uganda. BMC Health Serv Res [Internet]. 2021 Oct 26 [cited 2026 Jun 2];21(1):1163. doi:10.1186/s12913-021-07204-7
  27. Anyanwu MU, Tamwesigire I. A cross-sectional study of prevalence and predictors of risky sexual behavior among school-going adolescents in Mbarara municipality, Uganda. Afr Health Sci [Internet]. 2023 Sep [cited 2026 Jun 2];23(3):109-116. doi:10.4314/ahs.v23i3.14
  28. Sidze EM, Stillman M, Keogh S, Mulupi S, Egesa CP, Leong E, Mutua M, Muga W, Bankole A, Izugbara CO. From Paper to Practice: Sexuality Education Policies and Their Implementation in Kenya. Guttmacher [Internet]. 2017 Apr [cited 2026 Jun 2]. [about 40 screens]. Available from: https://www.guttmacher.org/report/sexuality-education-kenya.
  29. World Health Organization. Programming for Adolescent Health and Development [Internet]. Geneva (Switzerland): World Health Organization; 1999 May 25 [cited 2026 Jun 2]. 150 p. Available from: https://www.who.int/publications/i/item/9241208864
  30. Uganda Bureau of Statistics. National population and housing census 2024 – Final report [Internet]. Kampala (Uganda) 2024 [cited 2026 Jun 2]. Available from: https://www.ubos.org/wp-content/uploads/2024/12/National-Population-and-Housing-Census-2024-Final-Report-Volume-1-Main.pdf
  31. Israel GD. Determining Sample Size: PEOD6/PD006, rev. 4/2009. EDIS [Internet]. 2009 Apr 1[cited 2026 Jun 2];2009(5). doi:10.32473/EDIS-PD006-1992
  32. Kirwana VB, Misinde C, Ndugga P, Kakuba C. Factors associated with and barriers to completeness of sexuality information among young people in the Island Communities of Uganda. World J Adv Res Rev [Internet]. 2025 Oct 31[cited 2026 Jun 2];28(1):847–64. doi:10.30574/wjarr.2025.28.1.3474
  33. Jilcha Sileyew K. Research Design and Methodology. In: Abu-Taieh E, El Mouatasim A, H. Al Hadid I. Cyberspace [Internet]. IntechOpen; 2020 [cited 2026 Jun 2]. Available from: https://www.intechopen.com/books/cyberspace/research-design-and-methodology doi:10.5772/intechopen.85731
  34. UNESCO, United Nations Children’s Fund, Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, World Health Organization, United Nations Entity for Gender Equality and the Empowerment of Women. The journey towards comprehensive sexuality education: global status report [Internet]. Paris (France): UNESCO; 2021 [cited 2026 Jun 2]. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000379607?locale=en doi:10.54675/NFEK1277
  35. Ocran BE, Alldred P. Sexuality education, condoms and contradictions: The views of educators and students in Ghana. Health Educ J [Internet]. 2025 Nov 1[cited 2026 Jun 2];84(7):791–803. doi:10.1177/00178969251356649
  36. Pound P, Denford S, Shucksmith J, Tanton C, Johnson AM, Owen J, Hutten R, Mohan L, Bonell C, Abraham C, Campbell R. What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views. BMJ Open [Internet]. 2017 May 1 [cited 2026 Jun 2];7(5). doi:10.1136/bmjopen-2016-014791
  37. Somefun OD, Casale M, Haupt Ronnie G, Desmond C, Cluver L, Sherr L. Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: a systematic review and evidence map. BMJ Open [Internet]. 2021 Dec 20 [cited 2026 Jun 2];11(12):e055160. doi:10.1136/bmjopen-2021-055160
  38. Salam RA, Das JK, Lassi ZS, Bhutta ZA. Adolescent Health Interventions: Conclusions, Evidence Gaps, and Research Priorities. J Adolesc Health [Internet]. 2016 Oct [cited 2026 Jun 2];59(4S):S88-S92. doi:10.1016/j.jadohealth.2016.05.006
  39. Borji-Navan S, Maleki N, Keramat A. Efficacy of Digital Health Interventions Used for Adolescent’s Sexual Health: An Umbrella Review. Health Sci Rep [Internet]. 2024 Dec 4 [cited 2026 Jun 2];7(12):e70212. doi:10.1002/hsr2.70212
  40. Sewak A, Yousef M, Deshpande S, Seydel T, Hashemi N. The effectiveness of digital sexual health interventions for young adults: a systematic literature review (2010-2020). Health Promot Int [Internet]. 2023 Feb 1 [cited 2026 Jun 2];38(1):daac104. doi:10.1093/heapro/daac104
  41. Widman L, Nesi J, Kamke K, Choukas-Bradley S, Stewart JL. Technology-Based Interventions to Reduce Sexually Transmitted Infections and Unintended Pregnancy Among Youth. J Adolesc Health [Internet]. 2018 Jun [cited 2026 Jun 2];62(6):651-660. doi:10.1016/j.jadohealth.2018.02.007
  42. De Meyer S, Kågesten A, Mmari K, McEachran J, Chilet-Rosell E, Kabiru CW, Maina B, Jerves EM, Currie C, Michielsen K. “Boys Should Have the Courage to Ask a Girl Out”: Gender Norms in Early Adolescent Romantic Relationships. J Adolesc Health [cited 2026 Jun 2]. 2017 Oct;61(4S):S42-S47. doi:10.1016/j.jadohealth.2017.03.007
  43. Kaggwa MM, Muwanguzi M, Najjuka SM, Nduhuura E, Kajjimu J, Mamun MA, Arinaitwe I, Ashaba S, Griffiths MD. Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment. PLoS One [Internet]. 2022 Nov 16 [cited 2026 Jun 2];17(11):e0277129. doi:10.1371/journal.pone.0277129
  44. Kelly CA, Soler-Hampejsek E, Mensch BS, Hewett PC. Social desirability bias in sexual behavior reporting: evidence from an interview mode experiment in rural Malawi. Int Perspect Sex Reprod Health [Internet]. 2013 Mar [cited 2026 Jun 2];39(1):14-21. doi:10.1363/390141
  45. Mitchell KR, Mercer CH, Prah P, Clifton S, Tanton C, Wellings K, Copas A. Why Do Men Report More Opposite-Sex Sexual Partners Than Women? Analysis of the Gender Discrepancy in a British National Probability Survey. J Sex Res [Internet]. 2019 Jan [cited 2026 Jun 2];56(1):1-8. doi:10.1080/00224499.2018
  46. Gazendam N, Cleverley K, King N, Pickett W, Phillips SP. Individual and social determinants of early sexual activity: A study of gender-based differences using the 2018 Canadian Health Behaviour in School-aged Children Study (HBSC). PLoS One [Internet]. 2020 Sep 3 [cited 2026 Jun 2];15(9):e0238515. doi:10.1371/journal.pone.0238515
  47. Burke L, Nic Gabhainn S, Kelly C. Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation among Adolescents. Int J Environ Res Public Health [Internet]. 2018 Aug 27 [cited 2026 Jun 2];15(9):1851. doi:10.3390/ijerph15091851
  48. Ndugga P, Kwagala B, Wandera SO, Kisaakye P, Mbonye MK, Ngabirano F. “If your mother does not teach you, the world will…”: a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda. BMC Public Health [Internet]. 2023 Apr 11[cited 2026 Jun 2];23(1):678. doi:10.1186/s12889-023-15562-6
  49. Kisaakye P, Ndugga P, Kwagala E, Kayitale Mbonye M, Ngabirano F, Ojiambo Wandera S. Parent–child communication on sexual and reproductive health in border districts of Eastern Uganda. Sex Educ [Internet]. 2024 Jan 2 [cited 2026 Jun 2];24(1):125–37. doi:10.1080/14681811.2022.2135500
  50. Nanvubya A, Wanyenze RK, Kamacooko O, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price M, Van Geertruyden JP. Barriers and Facilitators of Family Planning Use in Fishing Communities of Lake Victoria in Uganda. J Prim Care Community Health [Internet]. 2020 Jan-Dec [cited 2026 Jun 2];11:2150132720943775. doi:10.1177/2150132720943775
  51. Ngabaza S. Parents resist sexuality education through digital activism. J educ (Univ KwaZulu-natal) [Internet]. 2023 Jan 10 [cited 2026 Jun 2];(89):1–21. doi:10.17159/2520-9868/i89a05
  52. Haakonde T, Chisumbe S, Chibwe M, Iwol K. An Assessment of Parents-Adolescents Communication on Sexual and Reproductive Health Matters between Evelyn Hone College Lecturers and their Adolescent Children, Lusaka, Zambia. EAST [Internet]. 2018 May 11 [cited 2026 Jun 2];219–24. doi:10.33805/2576-8484.142
  53. Othman A, Shaheen A, Otoum M, Aldiqs M, Hamad I, Dabobe M, Langer A, Gausman J. Parent-child communication about sexual and reproductive health: perspectives of Jordanian and Syrian parents. Sex Reprod Health Matters [Internet]. 2020 Dec [cited 2026 Jun 2];28(1):1758444. doi:10.1080/26410397.2020.1758444
  54. Seff I, Steiner JJ, Stark L. Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa. Glob Public Health [Internet]. 2021 Jul[cited 2026 Jun 2];16(7):1046-1056. doi:10.1080/17441692.2020.1814833
  55. Sing’oei V, Owuoth JK, Otieno J, Yates A, Andagalu B, Smith HJ, Copeland NK, Polyak CS, Crowell TA, Adongo R, Aguttu R, Akala H, Ake J, Bondo M, Broach E, Busisa C, Cowden J, de Souza M, Eller LA, Gogo M, Hassen Z, Hu D, Imbach M, Juma A, Kasera O, Li Q, Mbuchi M, Milazzo M, Modjarrad K, Ngonda E, Nwoga C, Nyariro J, Ochola J, Ohore R, Okumu T, Omondi M, Omondi T, Ooro L, Orando B, Owira V, Oyugi R, Robb M, Rono E, Tran C. Early sexual debut is associated with drug use and decreased educational attainment among males and females in Kisumu County, Kenya. Reprod Health [Internet]. 2023 Dec 1 [cited 2026 Jun 2];20(1). doi:10.1186/s12978-023-01639-3
  56. Kimera E, Vindevogel S, Rubaihayo J, Reynaert D, De Maeyer J, Engelen AM, Bilsen J. Youth living with HIV/AIDS in secondary schools: perspectives of peer educators and patron teachers in Western Uganda on stressors and supports. SAHARA J [Internet]. 2019 Dec [Internet];16(1):51-61. doi:10.1080/17290376.2019.1626760
  57. Adeagbo OA, Mthiyane N, Herbst C, Mee P, Neuman M, Dreyer J, Chimbindi N, Smit T, Okesola N, Johnson C, Hatzold K, Seeley J, Cowan F, Corbett L, Shahmanesh M. Cluster randomised controlled trial to determine the effect of peer delivery HIV self-testing to support linkage to HIV prevention among young women in rural KwaZulu-Natal, South Africa: A study protocol. BMJ Open [Internet]. 2019 Dec 23 [cited 2026 Jun 2];9(12). doi:10.1136/bmjopen-2019-033435
  58. Kwagonza L, Bulage L, Okello PE, Kusiima J, Kadobera D, Ario AR. Comprehensive knowledge of HIV prevention among fishing communities of Lake Kyoga, Uganda, 2013. BMC Public Health [Internet]. 2020 Jan 8 [cited 2026 Jun 2];20(1):29. doi:10.1186/s12889-020-8146-6
  59. Kwena Z, Nakamanya S, Nanyonjo G, Okello E, Fast P, Ssetaala A, Oketch B, Price M, Kapiga S, Bukusi E, Seeley J, Grosskurth H, Kamali A, Kaleebu P, Kibengo FM, Kidega W, De Bont J. Understanding mobility and sexual risk behaviour among women in fishing communities of Lake Victoria in East Africa: A qualitative study. BMC Public Health [Internet]. 2020 Jun 15 [cited 2026 Jun 2];20(1). doi:10.1186/s12889-020-09085-7
  60. Nakamanya S, Okello ES, Kwena ZA, Nanyonjo G, Bahemuka UM, Kibengo FM, Ssetaala A, Bukusi EA, Kapiga S, Fast PE, Seeley J. Social networks, mobility, and HIV risk among women in the fishing communities of Lake Victoria. BMC Womens Health [Internet]. 2022 Dec 1 [cited 2026 Jun 2];22(1). doi:10.1186/s12905-022-02144-8
  61. Seeley J, Nakiyingi-Miiro J, Kamali A, Mpendo J, Asiki G, Abaasa A, De Bont J, Nielsen L, Kaleebu P; CHIVTUM Study Team. High HIV incidence and socio-behavioral risk patterns in fishing communities on the shores of Lake Victoria, Uganda. Sex Transm Dis [Internet]. 2012 Jun [cited 2026 Jun 2];39(6):433-9. doi:10.1097/OLQ.0b013e318251555d
  62. Mlotshwa L, Plüg S, Simuyaba M, Chimbindi N, Govindasamy D, Simwinga M, Mirzoev T, Seeley J. Sexual and reproductive health interventions for mobile adolescents and young people in sub-Saharan Africa: a scoping review. BMC Public Health [Internet]. 2025 Nov 11[ cited 2026 May 29];25(1):3903. doi:10.1186/s12889-025-25119-4
  63. Kuteesa MO, Webb EL, Kawuma R, Naluwugge J, Thadeus K, Ndekezi D, Seeley J. ‘We shall drink until Lake Victoria dries up’: Drivers of heavy drinking and illicit drug use among young Ugandans in fishing communities. Glob Public Health [Internet]. 2022 Apr [cited 2026 Jun 2];17(4):538-554. doi:10.1080/17441692.2021.1873399
  64. Misinde C, Nansubuga E, Nankinga O. Out of school female adolescent employment status and sexually transmitted infections (STIs) risk in Uganda: Is it a plausible relationship? BMC Public Health [Internet]. 2018 Oct 12 [cited 2026 Jun 2];18(1). doi:10.1186/s12889-018-6094-1
  65. Amare T, Yeneabat T, Amare Y. A Systematic Review and Meta-Analysis of Epidemiology of Risky Sexual Behaviors in College and University Students in Ethiopia, 2018. J Environ Public Health [Internet]. 2019 Mar 20 [cited 2026 Jun 2];2019:4852130. doi:10.1155/2019/4852130
  66. Achen D, Fernandes D, Kemigisha E, Rukundo GZ, Nyakato VN, Coene G. Trends and Challenges in Comprehensive Sex Education (CSE) Research in Sub-Saharan Africa: a Narrative Review. Curr Sex Health Rep [Internet]. 2023 May 6 [cited 2026 Jun 2]:1-9. doi:10.1007/s11930-023-00362-1
  67. Renzaho AM, Kamara JK, Georgeou N, Kamanga G. Sexual, Reproductive Health Needs, and Rights of Young People in Slum Areas of Kampala, Uganda: A Cross Sectional Study. PLoS One [Internet]. 2017 Jan 20 [cited 2026 Jun 2];12(1):e0169721. doi:10.1371/journal.pone.0169721
  68. Kemigisha E, Ivanova O, Ruzaaza GN, Ninsiima AB, Kaziga R, Bruce K, Leye E, Coene G, Nyakato VN, Michielsen K. Process evaluation of a comprehensive sexuality education intervention in primary schools in South Western Uganda. Sex Reprod Healthc [Internet]. 2019 Oct [cited 2026 Jun 2];21:51-59. doi:10.1016/j.srhc.2019.06.006
  69. Ugwu NH, Odimegwu CO. Contextual determinants of multiple sexual partnerships amongst young people in South Africa: a multilevel analysis. BMC Public Health [Internet]. 2024 Dec 1 [cited 2026 Jun 2];24(1). doi:10.1186/s12889-024-18872-5
  70. Lucas AM, Wilson NL. Schooling, Wealth, Risky Sexual Behaviour, and HIV/AIDS in Sub-Saharan Africa. The Journal of Development Studies [Internet]. 2019 Oct 3 [cited 2026 Jun 2];55(10):2177–92. doi:10.1080/00220388.2018.1493195
Views: 43