title: Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies.
abstract: Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Agardh
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Ross
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Östergren
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Larsson
authors.affiliation: Department of Obstetrics and Gynaecology, St Francis Hospital, Nsambya, Uganda.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Tumwine
authors.affiliation: Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden.
authors.forename: Sven-Axel
authors.initials: SA
authors.lastname: Månsson
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simpson
authors.affiliation: Centre for Adolescent Health, Royal Children's Hospital, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Victoria, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Patton
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D018452:Homosexuality, Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012307:Risk Factors; D013334:Students; D011795:Surveys and Questionnaires; D014454:Uganda; D014495:Universities; D055815:Young Adult