Drivers of risky sexual behaviours among adolescents in Nebbi Municipality, Uganda: analytical cross-sectional study

Risky sexual behaviour among adolescents remains a major public health challenge in Uganda. In Nebbi Municipality, high rates of teenage pregnancy, early sexual debut, and HIV infections have compounded the problem. This study sought to determine individual, environmental, and family-level drivers associated with adolescents’ risky sexual behaviours. Analytical cross-sectional study was conducted from January 2022 to March 2022 using a mixed-methods approach. Multi-stage sampling was used to select 300 adolescents aged 10–19 years, who were interviewed using an interviewer-administered questionnaire. Quantitative data were analyzed using SPSS, while qualitative data were thematically coded and analyzed. We found that risky sexual behaviours were associated with multiple drivers, including school dropout (aPR = 2.27, 95% CI: 0.54–6.65), awareness of partner’s HIV status (aPR = 8.22, 95% CI: 3.11–33.19), and traditional beliefs (aPR = 5.48, 95% CI: 1.73–17.39). Qualitative findings revealed that many adolescents lacked the power to negotiate safe sex, were influenced by peers, social media, and financial hardship. Adolescents in Nebbi Municipality remain vulnerable to risky sexual behaviours due to a combination of factors. Our study highlighted the need for targeted preventive interventions that strengthen parental support, promote safe sexual negotiation skills, and engage schools and community structures.