Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data

Abstract

Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa—with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010–2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15–24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47–1.90; young women AOR 1.28 95% CI 1.08–1.53; older men AOR 1.54 95% CI 1.41–1.69; older women AOR 1.44 95% CI 1.26–1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57–0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17–1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17–1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07–1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05–1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.

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Acknowledgements

We would like to thank the Rakai community cohort participants and the Rakai Health Sciences researchers who conducted the surveys. We would also like to thank Dr. Susie Hoffman and the members of the HIV Center Manuscript workshop for their contributions to the development of this manuscript. We would like to thank Margaret Berrigan and Alyssa Basmajian for their assistance formatting the references, and Esther Spindler for her assistance with copyedits and the manuscript submission.

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FN, PK and JS conceptualized the study. SH, XZ, and YW created the statistical models. SH, XZ, QW, and IC, computed the statistical analyses. PK drafted the manuscript. SG, SDK, GK, TL, JK, LWC, MJW, RHG, JSS, provided essential comments and revisions. RS, HN, SDK, GK, TL, JK, LWC, MJW, and RHG, designed the measures and tools.

Corresponding author

Correspondence to Philip Kreniske.

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Conflicts of interest

This project was supported by an Award Number R01HD091003 (Principal Investigator, John Santelli, M.D., M.P.H.) from the National Institute of Child Health and Human Development. In addition, Philip Kreniske’s contribution was supported by an Award Number T32 MH019139 (Principal Investigator, Theodorus Sandfort, Ph.D.) from the National Institute of Mental Health and a Grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Robert Remien, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institute of Mental Health or the National Institutes of Health or Columbia University.

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Appendix

Appendix

See Tables 5 and 6.

Table 5 Crude and adjusted associations of cell phone ownership with demographic factors for younger and older RCCS participants, 2010–2016
Table 6 The association between cell phone ownership and sexual behaviors for sexually active RCCS participants stratified by gender, and 5-year age groups, from 2010 to 2016

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Nalugoda, F., Kreniske, P., Hofer, S. et al. Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data. AIDS Behav 24, 1574–1584 (2020). https://doi.org/10.1007/s10461-019-02665-8

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Keywords

  • Cell phones
  • Sexual behaviors
  • HIV prevalence
  • Sub-Saharan Africa