This dissertation examines the factors driving risky sexual behavior associated with reported high numbers of new HIV infections among young women in Uganda, using Mbarara District as a case study. Using the modified Social Ecological Model for Young Women's Vulnerability to HIV Infection, the study investigates the contextual and broader structural factors, their interactions within and across multiple levels, and how they influence the sexual behaviors of individual young women in ways that increase their vulnerability to contracting HIV. The objectives of the study are: 1) Evaluate individual-level factors associated with sexual risk-taking behavior, specifically having unprotected sex, among young women ages 15-35 years; 2) Describe contextual and broader structural factors that make young women vulnerable to HIV-related risky sexual behaviors, and assess how these contextual factors interact with individual-level factors in ways that perpetuate high levels of HIV infection; and 3) Re-examine the connection between poverty and other economic factors to risky sexual behavior and vulnerability in the context of high HIV transmission among young women. The study used mixed qualitative and quantitative methods, combining household surveys, focus group discussions, key informant interviews, and in-depth interviews.Household survey results show that risky sexual behavior i.e., having sex without a condom, is still high (over 48%) among the unmarried young women ages 15-35 years. Engagement in unprotected sex increased by age, with young adults reporting more unprotected sex encounters than adolescent girls. Those with primary or some secondary education were at an increased risk of having unprotected sex. Surprisingly, women with tertiary education were at higher risk of engaging in unprotected sex than those who had completed secondary education. Negative binomial regression analyses show that women with no employment and those with part-time employment were at an increased risk for unprotected sex compared to those with low paying but stable employment. These findings on education and HIV risk call for a careful reexamination of the link between higher education and HIV vulnerability to inform policy. Education policies and interventions need to focus on curricula that incorporate entrepreneurial skills at different educational levels from primary to college. Keeping girls in school under the protective eye of parents, guardians and teachers is key in reducing exposure to unprotected sex among young girls.Findings from the qualitative analysis revealed that sociocultural and structural factors, including social norms (premarital sex as taboo, early marriage pressures, subornation of girls and women), youth unfriendly HIV services (e.g., long waiting times, rude and unprofessional clinic staff), high unemployment rates, sexual harassment, exploitation by male employers, and discrimination were key factors perceived to drive risky sexual behavior in relation to HIV contraction among young women. The findings show that while many young women, especially those with children, engaged in risky transactional sexual behavior to meet basic needs, many younger women, including college-level ones, did so to meet materialistic wants and to fit-in with peers.Widespread availability of antiretroviral drugs (ARVs) caused complacency among young people. HIV was no longer perceived as life threatening due to ARVs, which prevent progression into full-blown AIDS, morbidity and death. In fact, some young women were more scared of getting pregnant than contracting HIV. We suggest that efforts to reduce new HIV infections among young women and young men should target individual risk perception, and balance HIV treatment and prevention messages.Findings reveal a complex mix of dynamic and interacting factors operating at different levels that create context specific sexual behavioral risk socioscapes that sustain or accentuate the high rates of new HIV infections among the young women. Using a Social Ecological Model for Young Women's Vulnerability to HIV as a guiding framework, we contend that efforts for addressing the high HIV infections among young women, including sexual behavioral change interventions, economic empowerment programs, should not only aim at individual women but also target factors operating at the sociocultural and structural levels.
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