Internet Use among Ugandan Adolescents: Implications for HIV Intervention

Published in PLoS Medicine, this 9-page article details the results of The Uganda Media and You Survey, a cross-sectional survey of internet use among adolescents (ages 12-18 years) in Mbarara, Uganda. The research was carried out in response to the observation that - while the internet has a number of characteristics that make it an attractive tool in health education and HIV prevention, especially for adolescents (e.g., interactivity, privacy, the overlap between education and play, and the ability to individualise information) - the internet's potential in resource-poor settings with higher HIV infection rates and limited access to other health care resources has not been explored.

The authors begin by sharing some background trends in order to lay the groundwork for their comparison of desired and actual use of the internet to seek sexual health and HIV/AIDS information among Western - i.e. United States - adolescents, on the one hand, and their peers living in Uganda, on the other. Namely, studies have shown that:

• An estimated 25%-31% of young people in the United States have looked for health information online in the last year; common topics are those that are "hard to talk about", such as sexual health, depression, and drug use. Among young people, 2 in 5 (41%) were found to have changed their behaviour because of information they found online, and almost half (49%) have contacted a health care provider as a result.
• The number of internet users in Uganda increased from 1.6 per 1,000 in 2000 to 7.2 per 1,000 in 2004; a total of 2,496 internet hosts were providing internet access to 200,000 users in 2005. Internet access likely is more prevalent in Mbarara (a town in the rural part of the country) than in smaller districts, but it is reportedly less prevalent than in larger districts such as Kampala and Jinja. "Mbarara thus likely reflects communities on the cusp of Internet integration."

As detailed here, researchers carried out a survey of 500 adolescent secondary students randomly selected from 5 participating boarding schools in Mbarara. They asked: To what extent are the adolescents exposed to computers and the internet? Are they interested in accessing health
information online? Who uses the internet and how?

They found that 45% (223) of the respondents reported ever having used the internet, 78% (175) of
whom reported going online in the previous week. (As maternal education increased, so too did the odds of adolescent internet use.) Most internet users (82%) reported going online at school; 57% said they use internet cafes; 17% access the internet at home; and 11% at someone else's house. Almost 2 in 5 (38% [189]) reported already having used a computer or the internet to search for health information. Over one-third (35% [173]) had used the computer or internet to find information about HIV/AIDS, and 20% (102) had looked for sexual health information. Among internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology.

The most commonly reported barriers to internet use are expense (43% [118]), not knowing where to access the internet (39% [107]), and not knowing how to use the internet (36% [101]). If internet access were free, 66% (330) reported that they would search for information about HIV/AIDS prevention online.

In short, approximately the same proportion - roughly one-third - of adolescents in a rural setting in Uganda reported having used the internet to look up health-related information as of young people in the United States. Together with the result that an additional third said that they would go online to educate themselves about HIV/AIDS if internet use was free, the study suggests that initiatives in Africa to improve online access for adolescents as well as to develop content tailored to meet young people's individual risk profiles in specific settings could "be a promising strategy to deliver low-cost HIV/AIDS risk reduction interventions in resource-limited settings with expanding Internet access."