Effectiveness of peer-led sexuality education in reducing risky sexual behaviors among adolescents attending secondary schools in Masaka City, Uganda

Adolescents in Uganda continue to experience high levels of risky sexual behaviours despite existing school‑based sexuality education programmes, with limited evidence on the effectiveness of peer‑led approaches. This study examined the effectiveness of peer‑led sexuality education on sexual behaviours among secondary school adolescents in Masaka City, Uganda. A two-arm cluster randomized controlled trial (cRCT), reported in accordance with CONSORT guidelines, was conducted among 912 students from eight secondary schools in Masaka City, Uganda. The intervention group received an eight‑week peer‑led sexuality education programme. Data were collected at baseline, post‑intervention, and three‑month follow‑up. The intervention significantly increased sexual abstinence (aOR = 2.070; p < 0.001) and reduced multiple sexual partnerships (aOR = 0.460; p < 0.001), alcohol/drug use (aOR = 0.440; p = 0.001), and unprotected sex. Peer-led sexuality education is an effective strategy for improving adolescent sexual behaviours. Participants reported high levels of satisfaction with the intervention.