Ugandan adolescent perceptions of coerced sex and skills in addressing coercion: Implications for promotion of safer sexual behaviors

Background: With 67% of the world's cases, Sub-Saharan Africa is heavily affected by HIV. Adolescent women are disproportionately affected, with rates up to five times higher for teenage girls and three times higher for young women versus their male counterparts. Part of what places girls and women at risk is coercive sex. We lack clear understanding of the context for coercion and how to build skills to prevent it. Method: Focus group discussions with 20 adolescents (seven female, 13 male) aged 13-18 years enrolled in secondary schools in Mbarara, Uganda. We conducted a content analysis on transcribed data to describe the context for coerced sex and participant ideas for prevention. Results: Participants perceived coerced sex as common and recognized a continuum from subtle to violent coercion. Gift giving was a common cultural practice that was not always coercive; nonetheless, perceptions that sex was expected in response to some types of gifts were somewhat common. Participants also named age disparity between partners (e.g., "sugar daddies") as potentially coercive. Coercion between same-aged adolescents was less commonly articulated. Participants suggested that adolescents be given scenario-based education to anticipate when coercion may occur and to practice assertion skills to avoid it. Conclusions: Some but not all coerced sex is perceived as common among this sample of secondary students in rural Africa. Cultural norms around gift giving and age differential for sex partners may contribute to more subtle forms of coercion. Adolescents need skills in recognition of coercion and in asserting themselves to avoid it.