Examining the applicability of the information-motivation-behavior skills model of HIV preventive behavior in Uganda

HIV/AIDS is a major contributor to morbidity and mortality in Uganda, and this is particularly true for adolescents and young adults. Thirty-eight percent of sexually active young men and 56% of sexually active young women in Uganda do not consistently use condoms, and HIV knowledge appears to be on the decline.  The information-motivation-behavioral skills (IMB) Model of HIV Preventive behavior posits that a trilogy of one’s information about how to prevent HIV, one’s motivation to engage in non-risky behaviors, and one’s skills and abilities in acting out these behaviors, together predict HIV preventive behavior over time.  The theoretical model has been shown to predict HIV preventive behavior among adolescents and young adults in the United States, but its applicability to the behavior of adolescents living in resource-constrained countries is less well understood.

Mbarara municipality, with a population of 69,000, is the 6^th largest urban center in Uganda.  It falls in the bottom half of Ugandan districts in terms of population density and is therefore best described as serving mainly a rural population in sub-Saharan Africa.  1200 adolescents 12 to 18 years of age attending secondary schools in Mbarara were randomly recruited to complete a sexual health survey.  Questions queried the information, motivation, and behavioral skills they had to engage in HIV preventive behavior.  Potential co-variates affecting sexual behavior, including social support and self-esteem, also were asked.  Using structural equation modeling, the relationship between one’s HIV information, motivation, and behavior skills and one’s self-reported sexual behavior (i.e., intercourse vs. abstinence, consistent condom use vs. not among those sexually active) is examined.  Localized factors that additionally predict the report of sexual behavior (e.g., intergenerational sex) are identified and contextualized within the greater model.  Findings have implications for the design of culturally appropriate evidence-based HIV prevention programs in resource-limited settings such as Uganda.