Risky sexual behaviours and associated factors among undergraduates at a Ugandan public university

Introduction: Undergraduate students may engage in sexual practices that place them at risk of HIV, other sexually transmitted infections, unintended pregnancy and unsafe abortion. This study estimated how common risky sexual behaviour was and identified associated factors among students enrolled at a Ugandan public university. Methods: A quantitative cross-sectional survey was carried out from 8 March to 5 April 2025. Undergraduate students were recruited consecutively and completed a self-administered questionnaire with fixed-response and free-text items. Data were analysed in Stata version 17.0. Continuous variables were summarised as medians with interquartile ranges, while categorical variables were presented as frequencies and percentages. Factors related to risky sexual behaviour were examined using modified Poisson regression with robust standard errors. Results: Data from 414 undergraduates were analysed. The median age was 23 years (IQR: 22-25), and 270 (65.2%) participants were male. Fourth-year students accounted for the largest academic-year group (30.9%). Just over half lived off campus (55.1%) and the same proportion had an active scholarship (55.1%). Risky sexual behaviour was reported by 19.3% (95% CI: 15.1-24.4). Overall, 67.6% had been sexually active in the previous six months. Among sexually active students, 46.0% (95% CI: 40.2-52.0) did not use a condom at their most recent sexual encounter, and 27.3% (95% CI: 23.2-31.8) had more than one sexual partner during the previous six months. In the adjusted analysis, later sexual debut was associated with a lower prevalence of risky sexual behaviour (aPR 0.90; 95% CI: 0.85-0.95), while drug use just before sex was associated with a higher prevalence (aPR 1.68; 95% CI: 1.02-2.76). Conclusion: About one-fifth of undergraduates met the study definition of risky sexual behaviour. Condom non-use and multiple partnerships were important areas of concern. Later sexual debut was associated with a lower prevalence of risky sexual behaviour, whereas drug use just before sex was associated with a higher prevalence. Universities should provide early, age-appropriate sexual health interventions, particularly for students entering their first year, and integrate youth-friendly HIV and STI services with condom and PrEP counselling, substance-use prevention and screening, and support for safer sexual decision-making.