title: Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience.
abstract: BACKGROUND
  Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited.
  
  
  OBJECTIVE
  To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality.
  
  
  METHODS
  In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex.
  
  
  RESULTS
  Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7-5.7; OR 2.0, 95% CI: 1.3-3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1-4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7-3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9-5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04-3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1-8.5; AOR 2.8, 95% CI: 1.3-5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6-7.1; AOR 2.7, 95% CI: 1.4-5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking.
  
  
  CONCLUSIONS
  These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental health and trauma response are critical to meet the health needs of this population.
authors.affiliation: Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden; markus.larsson@med.lu.se.
authors.forename: Markus
authors.initials: M
authors.lastname: Larsson
authors.affiliation: Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ross
authors.affiliation: Department of Obstetrics and Gynaecology, St Francis Hospital Nsambya, Kampala, Uganda.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Tumwine
authors.affiliation: Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Agardh
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D003376:Counseling; D005260:Female; D006301:Health Services Needs and Demand; D006716:Homosexuality; D006801:Humans; D008297:Male; D008603:Mental Health; D012725:Sexual Behavior / Q000523:psychology*; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014454:Uganda; D055815:Young Adult
keywords: East Africa; healthcare access; sexuality; young people