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


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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  1. 1.

    WIRB offers review services for more than 400 institutions around the world (http://wirb.com).


  1. 1.

    Yan Z. Child and adolescent use of mobile phones: an unparalleled complex developmental phenomenon. Child Dev. 2018;89(1):5–16. https://doi.org/10.1111/cdev.12821.

    Article  PubMed  Google Scholar 

  2. 2.

    Cell Phones in Africa: Communication lifeline. Pew Res Cent. April 2015. http://www.pewglobal.org/files/2015/04/Pew-Research-Center-Africa-Cell-Phone-Report-FINAL-April-15-2015.pdf.

  3. 3.

    Emerging Nations Embrace Internet, Mobile Technology: Pew Res Cent Glob Attitudes Proj. February 2014. http://www.pewglobal.org/2014/02/13/emerging-nations-embrace-internet-mobile-technology/.

  4. 4.

    Communications Technology in Emerging and Developing Nations: Pew Res Cent Glob Attitudes Proj. March 2015. http://www.pewglobal.org/2015/03/19/1-communications-technology-in-emerging-and-developing-nations/.

  5. 5.

    Putting young people at the centre of the response to HIV. UNAIDS. http://www.unaids.org/en/resources/presscentre/featurestories/2012/august/20120810youthday (2012).

  6. 6.

    Breakwell GM. Risk estimation and sexual behaviour: a longitudinal study of 16-21-year olds. J Health Psychol. 1996;1(1):79–91. https://doi.org/10.1177/135910539600100107.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Anderson KG, Beutel AM, Maughan-Brown B. HIV risk perceptions and first sexual intercourse among youth in Cape Town South Africa. Int Fam Plan Perspect. 2007;33(3):98–105. https://doi.org/10.1363/ifpp.33.098.07.

    Article  PubMed  Google Scholar 

  8. 8.

    Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(2 Suppl 1):19408.

    Article  Google Scholar 

  9. 9.

    Napierala Mavedzenge S, Olson R, Doyle AM, Changalucha J, Ross DA. The epidemiology of HIV among young people in sub-Saharan Africa: know your local epidemic and its implications for prevention. J Adolesc Health Off Publ Soc Adolesc Med. 2011;49(6):559–67. https://doi.org/10.1016/j.jadohealth.2011.02.012.

    Article  Google Scholar 

  10. 10.

    Pettifor AE, Rees HV, Kleinschmidt I, et al. Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19(14):1525–34.

    Article  Google Scholar 

  11. 11.

    Santelli JS, Edelstein ZR, Mathur S, et al. Behavioral, biological, and demographic risk and protective factors for new HIV infections among Youth, Rakai. Uganda. J Acquir Immune Defic Syndr 1999. 2013;63(3):393–400. https://doi.org/10.1097/qai.0b013e3182926795.

    Article  Google Scholar 

  12. 12.

    Santelli J, Mathur S, Song X, et al. Rising school enrollment and declining HIV and pregnancy risk among adolescents in Rakai District, Uganda, 1994-2013. Glob Soc Welf Res Policy Pract. 2015;2(2):87–103. https://doi.org/10.1007/s40609-015-0029-x.

    Article  Google Scholar 

  13. 13.

    Porter G, Hampshire K, Abane A, et al. Intergenerational relations and the power of the cell phone: Perspectives on young people’s phone usage in sub-Saharan Africa. Geoforum. 2015;64:37–46. https://doi.org/10.1016/j.geoforum.2015.06.002.

    Article  Google Scholar 

  14. 14.

    Porter G, Hampshire K, Abane A, et al. Connecting with home, keeping in touch: physical and virtual mobility across stretched families in sub-Saharan Africa. Africa. 2018;88(2):404–24. https://doi.org/10.1017/S0001972017000973.

    Article  Google Scholar 

  15. 15.

    Mmari K, Blum RW. Risk and protective factors that affect adolescent reproductive health in developing countries: a structured literature review. Glob Public Health. 2009;4(4):350–66. https://doi.org/10.1080/17441690701664418.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Toska E, Pantelic M, Meinck F, Keck K, Haghighat R, Cluver L. Sex in the shadow of HIV: a systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. PLoS ONE. 2017;12(6):e0178106. https://doi.org/10.1371/journal.pone.0178106.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore C, Kelley K, Fairlie L. Providing comprehensive health services for young key populations: needs, barriers and gaps. J Int AIDS Soc. 2015. https://doi.org/10.7448/ias.18.2.19833.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423–78. https://doi.org/10.1016/S0140-6736(16)00579-1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care. 2013;25(7):874–80. https://doi.org/10.1080/09540121.2013.774315.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Rana Y, Haberer J, Huang H, et al. Short message service (SMS)-based intervention to improve treatment adherence among HIV-positive youth in Uganda: focus group findings. PLoS ONE. 2015;10(4):e0125187. https://doi.org/10.1371/journal.pone.0125187.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Chang LW, Mbabali I, Kong X, et al. Impact of a community health worker HIV treatment and prevention intervention in an HIV hotspot fishing community in Rakai, Uganda (mLAKE): study protocol for a randomized controlled trial. Trials. 2017. https://doi.org/10.1186/s13063-017-2243-6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Moore L, Chersich MF, Steen R, et al. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Glob Health. 2014;10:47. https://doi.org/10.1186/1744-8603-10-47.

    Article  Google Scholar 

  23. 23.

    Kirby T, Thornber-Dunwell M. Phone apps could help promote sexual health in MSM. Lancet. 2014;384(9952):1415. https://doi.org/10.1016/S0140-6736(14)61849-3.

    Article  PubMed  Google Scholar 

  24. 24.

    Swendeman D, Rotheram-Borus MJ. Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion. Curr Opin Psychiatry. 2010;23(2):139–44. https://doi.org/10.1097/YCO.0b013e328336656a.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Uganda Bureau of Statistics. National population and housing census 2014: main report. Uganda: Kampala; 2016.

    Google Scholar 

  26. 26.

    Chang LW, Grabowski MK, Ssekubugu R, et al. Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study. Lancet HIV. 2016;3(8):e388–96.

    Article  Google Scholar 

  27. 27.

    Grabowski MK, Serwadda DM, Gray RH, et al. HIV prevention efforts and incidence of HIV in Uganda. N Engl J Med. 2017;377(22):2154–66. https://doi.org/10.1056/NEJMoa1702150.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Wawer MJ, Gray RH, Sewankambo NK, et al. A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. AIDS Lond Engl. 1998;12(10):1211–25.

    CAS  Article  Google Scholar 

  29. 29.

    Wawer MJ, Sewankambo NK, Serwadda D, et al. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet. 1999;353(9152):525–35.

    CAS  Article  Google Scholar 

  30. 30.

    Kankaka EN, Ssekasanvu J, Prodger J, et al. Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda. AIDS Care. 2018;30(8):990–6. https://doi.org/10.1080/09540121.2018.1437253.

    Article  PubMed  Google Scholar 

  31. 31.

    Kagaayi J, Gray RH, Whalen C, et al. Indices to measure risk of HIV acquisition in Rakai, Uganda. PLoS ONE. 2014;9(4):e92015. https://doi.org/10.1371/journal.pone.0092015.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Sherman M, le Cassie S. A comparison between bootstrap methods and generalized estimating equations for correlated outcomes in generalized linear models. Commun Stat. 1997;26(3):901–25. https://doi.org/10.1080/03610919708813417.

    Article  Google Scholar 

  33. 33.

    Stoebenau K, Nixon SA, Rubincam C, et al. More than just talk: the framing of transactional sex and its implications for vulnerability to HIV in Lesotho, Madagascar and South Africa. Glob Health. 2011;7(1):34. https://doi.org/10.1186/1744-8603-7-34.

    Article  Google Scholar 

  34. 34.

    Archambault JS. Cruising through uncertainty: cell phones and the politics of display and disguise in Inhambane, Mozambique. Am Ethnol. 2013;40(1):88–101. https://doi.org/10.1111/amet.12007.

    Article  Google Scholar 

  35. 35.

    Stark L. Transactional sex and mobile phones in a Tanzanian slum. Suom Antropol J Finn Anthropol Soc. 2013;38(1):12–36.

    Google Scholar 

  36. 36.

    Henny KD, Wilkes AL, McDonald CM, Denson DJ, Neumann MS. A rapid review of eHealth interventions addressing the Continuum of HIV Care (2007–2017). AIDS Behav. 2018;22(1):43–63. https://doi.org/10.1007/s10461-017-1923-2.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Daher J, Vijh R, Linthwaite B, et al. Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017). BMJ Open. 2017. https://doi.org/10.1136/bmjopen-2017-017604.

    Article  PubMed  PubMed Central  Google Scholar 

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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.

Author information




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