Association between household structure and parental co-residence, and adolescent HIV risk behaviors in a longitudinal cohort study in Uganda

Introduction: In sub-Saharan Africa, approximately six out of seven new HIV infections occur among adolescents aged 15-19 years. Adolescents face unique challenges that impact their sexual health and risk behavior. However, very few studies have systematically investigated the association between the household structure, parental co-residence and adolescent risky sexual behavior, yet understanding this association is key to designing supportive environment-specific interventions to improve these risky sexual behaviors. This study focused on the impact of household structure and coresidence on adolescent risky sexual behaviour. Methods: Data from a population-based HIV surveillance cohort was used. Household structure was defined by parents' vital status (alive or deceased), co-residence with parents, and living apart from parents. HIV risk behaviors included self-report of >=1 non-marital sexual partner, multiple sexual partners, unprotected sex with a non-marital partner, and transactional sex. Poisson regression was used to estimate prevalence ratios for each risk behavior. Results: Among adolescents 15-19 years (n=3,234), 35% lived with both parents, 2.5% were double orphans. HIV risk behaviors included non-marital sexual partnership (17.5%), multiple sexual partners (10.5%), and transactional sex (11.5%). Adolescents whose mothers were resident, with non-resident father had increased prevalence; [non-marital partner (aPR=1.46 95%CI: 1.18-1.80), unprotected sex with a non-marital partner (aPR=1.23 95%CI: 1.00-1.51)]. Adolescents with both parents outside the home had increased prevalence; [multiple sexual partners (aPR=1.35 95%CI: 1.04-1.75), transactional sex (aPR=1.51 95%CI: 1.11-2.05)] as compared to those living with both parents. Conclusion: Household structure and co-residence with parents play significant roles in shaping the sexual behaviors of adolescents.