Condom Use Rate and Associated Factors among Undergraduate Students of Gulu University, Uganda

Abstract

Background: Condoms have proven to be an effective contraceptive barrier method of family planning and have played a vital role in preventing sexually transmitted diseases including HIV. However, existing evidence shows that utilization of condoms remains low, especially among youth and adolescents. We aimed to determine the condom use rate and associated factors among the students of Gulu University in Uganda. Methods: A cross-sectional study was conducted among undergraduate students of Gulu University between June and December 2023. The students were accessed from their respective faculties and chosen using a simple random sampling method. Data were collected using a pretested self-administered structured questionnaire. Condom use was defined as use of either male or female condom in any sexual encounter within the previous six months. Results: A total of 404 participants, with a median age of 23 years (interquartile range (21.5–24) years) were enrolled in this study, 54.2% (n = 219) of whom were men. The response rate of the respondents was 94.1%. Overall, 81.4% (n = 329) of the participants were in senior classes (year 2, 3, 4, and 5), and 18.6% (n = 75) were in their first year of study. The condom use rate was 53.7% (n = 217). Condom use rate was 50.2% (n = 109) among male and 49.8% (n = 108) among female students. Sex (men) (aPR = 0.82, 95% CI = 0.71, 0.95, p = 0.01), nature of sexual relationship (married) (aPR = 1.4, 95% CI = 1.07, 1.85, p < 0.015), place of HIV testing (University health unit) (aPR =1.22, 95% CI = 1.06, 1.41, p = 0.005), and having sex in the absence of condoms (aPR = 1.22, 95% CI = 1.01, 1.46, p = 0.021) were significantly associated with consistent condom use. Conclusions: Just over half of undergraduate students of Gulu University used condoms in their sexual encounters in the past six months. There should be heightened campaigns on condom use to prevent unintended pregnancies and sexually transmitted infections.

1. Introduction

Correct and consistent condom use is one of the key behavioral HIV prevention interventions that not only limit the spread of sexually infections, including HIV prevention, but also prevent unintended pregnancy particularly among sexually active persons [1].

Consistent and correct use of a male latex condom reduces the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) transmission [2]. Condom effectiveness for STDs and HIV prevention has been demonstrated by both laboratory and epidemiologic studies [3]; for instance, laboratory studies have shown that latex condoms provide an effective barrier against even the smallest STD pathogens due to the absence of microscopic holes [4]; it has also been reflected that the current levels of HIV would have been five times higher if it had not been for condom use [5]. Similarly, epidemiologic studies have shown that condom use reduces the risk of many other STDs and provides greater protection against those that are transmitted only by genital fluids like gonorrhea, chlamydia, and trichomonas [3].

Currently, over 30% of all new HIV infections globally are estimated to occur among the youth of ages 15 to 25 years. Decreasing the number of sexual partners, increasing access to utilization of comprehensive prevention services, including prevention education, and increasing access to condoms are essential for sexually active young people [6].

Among university students, studies carried out on the prevalence of condom use and associated factors among female undergraduate students in Wuhan, China showed that a larger subset of Chinese female undergraduate students engaged in unprotected, premarital sex [7], and, hence, condom use among university students should be promoted from the onset of sexual activity to establish a habit of safe sex practices and improvement in self-efficacy [8]; on exploring the determinants of condom use among university students in Sudan, the significant barriers toward condom use included misconception about condom use, negative attitudes toward condom use, lack of social support, low self-efficacy to use condoms, and poor action planning [9]. In addition to this, risky sexual behavior was associated with sex, age at first sexual intercourse, frequency of alcohol consumption, consumption of psychoactive substances before the last sexual intercourse, and use of smartphone application for sexual purposes, which were found among the undergraduates of southern Brazil [10]; similarly, condom use in the last sexual intercourse among the undergraduate students of Rio Grande campuses in Brazil highlighted that male sex, lower age group, condom use at first sexual intercourse, older age of onset of sexual activity, not having a partner, and casual partner in the last sexual intercourse increased the likelihood of condom use [11].

The prevalence of HIV among adults aged 15 to 64 in Uganda is 6.2%, 7.6% among women and 4.7% among men; this corresponds to approximately 1.2 million people aged 15 to 64 living with HIV in Uganda, and HIV prevalence is higher among women living in urban areas (9.8%) than those in rural areas (6.7%) [12]. The prevalence of HIV among children aged 0–14 is 0.5%, which corresponds to approximately 95,000 children living with HIV in Uganda; looking more in depth at the HIV prevalence among young adults, the survey found that HIV prevalence estimates were higher among the 20 to 24 years age group than in the 15 to 19 years age group [12]; therefore, the above figures do show that condoms, which play a significant role in HIV prevention, have been used in a relaxed manner in the country.

Uganda as a nation has made considerable progress against the HIV epidemic in recent years through the provision of reproductive health services to its citizens. Condoms, as one of the barrier contraceptive methods, have been implemented by the Ministry of Health by advocating for nationwide distribution of condoms for free or at a relatively very low cost that is affordable by the citizens. Studies performed on condom use and its associated factors in Uganda, particularly among Ugandan university students, are still very few, and basing on the available literature, currently there is no evidence of such a study in the northern part of the country especially in Gulu district; yet it has the highest prevalence rate of HIV in the whole northern region and ranks among the top hotspots for HIV infection in the country.

This study is, therefore, undertaken to determine the condom use rate and associated factors among undergraduate students of Gulu University with a view of finding out public reaction and compliance toward the intervention of condom use as a strategy implemented by WHO, UNAIDS, and MoH to combat the transmission of HIV/AIDS and other STIs as well as unwanted pregnancy not only within countries but also globally. This research also aims to provide valuable information to guide future researchers in doing similar studies, provide relevant data for making policies and designing better interventions, as well as guide Gulu University in doing proper planning since it is not known whether the free condoms provided were utilized by the students or not.

2. Methods

2.1. Study Design

We conducted a cross-sectional study among the undergraduate students of Gulu University, Gulu, Uganda between June and December 2023.

2.2. Study Area

Gulu University consists of three branches or campuses, which include Gulu, Kitgum, and Hoima. This study was performed at the Gulu University main campus located at Pece-Laroo Division, Gulu City, Uganda.

The Gulu main campus is approximately 5 km, by road, northeast of the central business district of Gulu, the largest city in Uganda’s northern region. This is approximately 333 km by road, north of Kampala, Uganda’s capital and largest city. The coordinates of the university’s main campus are 2°47′19.0″ N, 32°19′01.0″ E (latitude: 2.788620, longitude: 32.316946) [13].

Gulu University’s main campus comprises six faculties: Medicine; Agriculture and Environment; Science, Business and Development Studies; Education and Humanities; Law; and an Institute of Peace and Strategic Studies. All six faculties are confined within the Pece-Laroo Division of Gulu City. Agricultural Business, Education, Management, Business Administration and Education, Communication Studies, Computer Education and Science, Agriculture, Art Education, Development Studies, Economics, Education, Food Bioscience, Humanities and Social Sciences Education, Information Technology, Medicine and Surgery, Public Health, Physical Education, Public Administration and Science Education are the various courses on the undergraduate scheme [14]. It has an estimated population of at least over 3500 students enrolled in various programs from the different faculties. Gulu’s main campus was chosen because it has the biggest population of all the three branches, and, hence, the required sample was easily met.

2.3. Study Population

The study participants were undergraduate students of Gulu University, Gulu district, Uganda who provided written informed consent.

2.4. Sample Size Determination

The modified Kish Leslie was used to determine the size of the sample and generate the minimum number of participants required to participate in this study using the following assumptions: a margin of error of 5% at 95% CI, and a 50% probable condom use was expected among the participants. Using a 0.95 response rate, the final estimated sample size was 404 participants.

2.5. Sampling Procedure

The Gulu University main campus comprises six faculties. The students were selected using a simple random sampling method following initial stratification of the different faculties into independent units. We obtained student lists from each faculty for all the students from the faculty Academic Registrars of the respective faculties, and each faculty was independently sampled. Sequential numbers were assigned to each of the students in their respective faculties to establish the different sampling frames and available population for each faculty. A random number table was generated using Microsoft Excel, and samples were continuously drawn until the required number of study participants for each faculty was met. The random numbers chosen from the generated random number table were matched against the student’s sequential numbers and names, and these were selected for this study.

2.6. Data Collection

Data were collected for a period of 6 months using a self-administered questionnaire to assess condom use together with the associated factors among the students of Gulu University. Upon arrival at the respective faculties, the research participants were approached in correspondence to their names and random numbers assigned to them. This was carried out before the students exited their lecture halls upon request from their lecturers and the students themselves as their lectures came to an end. Written informed consent was obtained from them prior to participating in this study, and whoever consented to take part in study was given the questionnaires to fill; those who declined consent were excused, and we moved on to identify the next participants. Brief instructions were given to the study participants before the filling process, and the investigators were available throughout the process to respond to any query and to collect and secure the filled-up questionnaires. Codes were used instead of participants’ names on the questionnaires to ensure confidentiality. Every session for filling the questionnaire took at least 5 to 10 min.

2.7. Data Analysis

The filled questionnaires were checked for completeness, and data were entered into, and then cleaned and coded in, Microsoft Excel. The coded dataset was exported to Stata version 18.0 for analysis. Categorical variables were summarized using frequency and the corresponding percentage. The condom use rate was measured as the number of students who used a condom of any kind in any sexual encounter within the past six months out of the total number of students that participated in this study, and this was presented as a pie chart. Consistent condom use was considered as constant and very consistent use of condom of any kind in every sexual encounter within the past six months, whereas condomless sex was considered as non- and inconsistent use of a condom of any kind during sexual encounter; comparison between the two was presented as a pie chart. Association between independent variables like year of study and faculty and the dependent variable (Consistent condom use vs. Condomless sex) was assessed using either chi-squared test or Fisher’s exact test depending on the number of cells on cross-tabulation and was reported as p value. Variables with p < 0.2 were taken for multivariable modified Poisson regression analysis to assess for factors significantly associated with condom use. These were presented as an adjusted prevalence ratio with corresponding 95% confidence interval and p value. A p value of <0.05 was considered statistically significant.

2.8. Ethical Considerations

This study received ethical approval from the Gulu University Research Ethics Committee (approval number: GUREC-2023-520). Written informed consent was obtained from all participants before the start of this study. Participants were informed of their right to withdraw from this study at any time and that their participation was voluntary. All data collected were kept confidential and anonymous. The ethical principles outlined in the Declaration of Helsinki were all adhered to.

3. Results

Figure 1 be summarizes the study enrollment.

3.1. Sociodemographic Characteristics

A total of 404 participants with a median age of 23 years (interquartile range (21.5–24) years) were enrolled in this study. More than half 54.2% (n = 219) were men, and 45.8% (n = 185) were women. Majority (81.4%, n = 329) were in senior classes (year 2, 3, 4, and 5), and 18.6% (n = 75) were in their first year of study. At least half (51.5%, n =208) of the respondents had sexual partners, and 63.9% (n = 133) of these were in stable relationship, 30.3% (n = 63) were casual, and 5.8% (n = 12) were married. Most of the participants 58.7% (n = 237) had their sexual partners out of campus, and 41.3% (n = 167) had theirs within the campus, and of these, the majority 68.1% (n = 275) had had sexual intercourse in the last six months of which 78.9% (n = 217) used a condom and 21.1% (n = 58) did not. Majority (96.5%, n = 389) did not engage in buying or selling sex. Most of the respondents knew their HIV status (87.6%, n = 354), and of these, 99.1% (n = 351) were negative. It was also found out that fewer respondents carried out HIV testing before sex (33.9%, n = 137), and 46% (n = 63) of these did their tests from the nearby clinic; 26.5% (n = 107) had ever heard of PrEP, whereas 41.6% (n = 168) had ever heard of PEP. Majority of the study participants (84.5%, n = 339) reported no experience of condom bursting, while 28.8% (n = 116) of the respondents reported the use of other methods of contraceptives, and majority of these (88.1%, n = 104) indicated emergency pills. Majority of the participants (62.1%, n = 251) reported no sex in the absence of condoms, and 68.8% (n = 278) of the participants reported no drinking of alcohol (

Table 1. Sociodemographic characteristics of the participants.

Variables/Response	Frequency	Percentage
Age, median (IQR), years	23	21.5–24
Sex
Women	185	45.8
Men	219	54.2
Faculty
Agriculture and environment	64	15.8
Business and development studies	55	13.6
Education and humanities	85	12.0
Medicine	56	13.9
Science	94	23.3
Law	50	12.4
Year of study
1	75	18.6
2	131	32.4
3	141	34.9
4	41	10.2
5	16	3.9
Have sexual partner?
No	196	48.5
Yes	208	51.5
If yes, nature of the relationship?
Casual	63	30.3
Married	12	5.8
Stable	133	63.9
Source of sexual partner?
Out of campus	237	58.7
Within campus	167	41.3
Had sex in the last 6 months?
No	129	31.9
Yes	275	68.1
If yes, did you use condom?
No	58	21.1
Yes	217	78.9
Engagement in buying or selling sex?
No	390	96.5
Yes	14	3.5
Aware of HIV status?
No	50	12.4
Yes	354	87.6
If yes, what is the HIV status?
Negative	351	99.1
Positive	3	0.9
Carrying out HIV testing before having sex?
No	267	66.1
Yes	137	33.9
If yes, from where?
From nearby clinic	63	46
From the university health unit	22	16.1
Self-testing	52	37.9
Heard of PrEP?
No	297	73.5
Yes	107	26.5
Heard of PEP?
No	236	58.4
Yes	168	41.6
Ever experienced condom bursting?
No	339	84.5
Yes	62	15.5
Do you use any other method of contraceptive?
No	287	71.2
Yes	116	28.8
If yes, which one?
Emergency pills	104	88.1
Injectables	14	11.9
In absence of condoms?
No sex	251	62.1
Proceed to have sex	153	37.9
Do you drink alcohol?
No	278	68.8
Yes	126	31.2
How often do you drink alcohol?
Daily	1	0.3
I don’t drink alcohol.	277	68.6
Occasionally	126	31.1
Been using condom under influence of alcohol?
No	397	98.3
Yes	7	1.7

).

3.2. Condom Use Rate among All the Study Participants

The condom use rate was 53.7% (n = 217), Figure 2.

3.3. Type of Condom Used by All the Study Participants

Male condoms was the most frequently used type of condom (43.5%, n = 176), Figure 3.

3.4. Consistency in Condom Use by the Participants

Most (43.8%, n =177) of the respondents used condoms consistently during sexual encounters (Figure 4).

3.5. Consistency in Condom Use Rate among Participants Who Had Sex in the Last Six Months

Out of the 68.1% (n = 275) participants who had sex in the last six months, 66.9% (n = 184) consistently used condoms (constant and very consistent) during sexual activities, while 33.1% (n = 91) reported condomless sex (nonuse and inconsistent; Figure 5).

3.6. Factors Associated with Condom Use

Variables such as having a sexual partner (p = 0.001), nature of sexual relationship (p < 0.001), source of the sexual partner (p = 0.010), has heard of PrEP (p = 0.016), having heard of PEP (p = 0.024), condom absence (p < 0.001), and where one can access condom while at the campus (p = 0.04) were all found to be statistically associated with consistent condom use. (

Table 2. Factors associated with utilization of condoms during sex among the participants.

Variable	ALL 275 (100%)	Consistent Condom Use 184 (66.9%)	Condomless Sex 91 (33.1%)	p Value
Age,
Median (IQR%), years	23 (22–25) years
20–22 years	110 (40.0%)	73 (26.6%)	37 (13.6%)	0.182
23–25 years	130 (47.3%)	92 (33.4%)	38 (13.8%)
>25 years	35 (12.7%)	19 (6.9%)	16 (5.8%)
Sex
Women	134 (48.7%)	84 (30.6%)	50 (18.8%)	0.147
Men	141 (51.3%)	100 (36.4%)	41 (14.9%)
Faculty
Agriculture and environment	45 (16.4%)	27 (9.8%)	18 (6.6%)	0.092
Business and development	33 (12.0%)	19 (6.9%)	14 (5.1%)
Education and humanities	50 (18.2%)	29 (10.6%)	21 (7.6%)
Law	44 (16.0%)	29 (10.6%)	15 (5.5%)
Medicine	72 (26.2%)	56 (20.4%)	16 (5.8%)
Science	31 (11.3%)	24 (8.7%)	7 (2.5%)
Year of study
1	26 (9.5%%)	18 (6.6%)	8 (2.9%)	0.818
2	88 (32.0%)	58 (21.1%)	30 (10.9%)
3	107 (38.9%)	70 (25.5%)	37 (13.5%)
4	38 (13.8%)	25 (9.1%)	13 (4.7%)
5	15 (5.8%)	13 (4.7%)	3 (1.1%)
Have sexual partner
Yes	185 (67.3%)	136 (49.5%)	49 (17.8%)	0.001
No	90 (32.7%)	48 (17.5%)	42 (15.3%)
If yes, what is the nature of the relationship
Casual	58 (31.4%)	45 (24.3%)	13 (7.0%)	<0.001
Married	10 (5.4%)	0 (0.0%)	10 (5.4%)
Stable	117 (63.2%)	91 (49.2%)	26 (14.1%)
Source of your sexual partner
Out of campus	40 (21.6%)	23 (12.4%)	17 (9.2%)	0.010
Within campus	145 (78.4%)	113 (61.1%)	32 (17.3%)
Had sex in the last 6 months
Yes	275 (100%)	184 (66.91%)	91 (33.09%)
Engagement in buying or selling sex
Yes	11 (4.0%)	8 (2.9%)	3 (1.1%)	0.676
No	264 (96.0%)	176 (64.0%)	88 (32.0%)
Aware of HIV status
Yes	243 (88.4%)	161 (58.6%)	82 (29.8%)	0.525
No	32 (11.6%)	23 (8.36%)	9 (3.3%)
If yes, what is the HIV status
Negative	241 (99.2%)	159 (65.4%)	82 (33.7%)	0.551
Positive	2 (0.8%)	2 (0.8%)	0 (0.0%)
Carrying out HIV testing before having sex
No	177 (64.4%)	118 (42.9%)	59 (21.5%)	0.909
Yes	98 (35.6%)	66 (24.0%)	32 (11.6%)
If yes, from where?
From nearby clinic	45 (45.9%)	26 (26.5%)	19 (19.4%)	0.127
From the university health unit	19 (19.4%)	13 (13.3%)	6 (6.1%)
Self-testing	34 (34.7%)	27 (27.6%)	7 (7.1%)
Heard of pre-exposure prophylaxis (PrEP)
Yes	77 (28.0%)	60 (21.8%)	17 (6.2%)	0.016
No	198 (72.0%)	124 (45.1%)	74 (26.9%)
Heard of post exposure prophylaxis (PEP)
Yes	120 (43.6%)	89 (32.4%)	31 (11.3%)	0.024
No	155 (56.4%)	95 (34.6%)	60 (21.8%)
Ever experienced condom bursting
Yes	50 (18.3%)	38 (13.9%)	12 (4.4%)	0.141
No	224 (81.7%)	146 (53.3%)	78 (28.5%)
Do you use any other method of contraceptive
Yes	90 (32.7%)	56 (20.4%)	34 (12.4%)	0.276
No	185 (67.3%)	128 (46.6%)	57 (20.7%)
If yes, which one
Emergency pills	80 (89.9%)	49 (55.1%)	31 (34.8%)	0.751
Injectables	9 (10.1%)	6 (6.7%)	3 (3.4%)
In absence of condoms
No sex	174 (63.3%%)	158 (57.5%)	16 (5.8%)	<0.001
Proceed to have sex	101 (36.7%)	26 (9.5%)	75 (27.3%)
Alcohol use
Yes	96 (34.9%)	63 (22.9%)	33 (12.0%)	0.740
No	179 (65.1%)	121 (44.0%)	58 (21.1%)
Condom use under influence of alcohol
Yes	7 (2.6%)	6 (2.2%)	1 (0.4%)	0.431
No	268 (97.5%)	178 (64.7%)	90 (32.7%)
Where can one access condoms from while at campus?
University health unit	112 (40.7%)	66 (24.0%)	46 (16.7%)	0.004
Friends	23 (8.4%)	15 (5.5%)	8 (2.9%)
Gents/ladies	16 (5.82%)	9 (3.3%)	7 (2.6%)
University health unit and friends	112 (40.7%)	89 (32.4%)	23 (8.4%)
I don’t know	12 (4.4%)	5 (1.8%)	7 (2.6%)

).

3.7. Factors Independently Associated with Condom Use

Using the multivariable modified Poisson regression analysis, sex, nature of sexual relationship, place where HIV was tested, and having sex in the absence of condoms were significantly associated with condom use. The findings showed that men were 0.82 times (aPR = 0.82, 95% CI = 0.71, 0.95, p = 0.01) more likely to use condoms than their female counterparts. Respondents who were married were just 1.4 times (aPR = 1.4, 95% CI = 1.07, 1.85, p < 0.015) more likely to consistently use condoms than those who were in a causal relationship. Likewise, those who had HIV test from the university health unit were 1.22 times (aPR =1.22, 95% CI = 1.06, 1.41, p = 0.005) more likely to use condoms than their colleagues who had their HIV tests from the nearby clinic. Respondents who proceeded to have sex in the absence of condoms were just 1.22 times (aPR = 1.22, 95% CI = 1.01, 1.46, p = 0.021) more likely to use condoms than those who withdrew from having sex (

Table 3. Factors significantly associated with utilization of condoms the participants.

Variable	Consistent Condom Use 184 (66.9%)	Condomless Sex 91 (33.1%)	aPR (95% Confidence Interval)	p Value
Age,
Median (IQR), years	23 (22–25) years
20–22 years	73 (26.6%)	37 (13.6%)	Reference	Reference
23–25 years	92 (33.4%)	38 (13.8%)	1.06 (0.89–1.25)	0.527
>25 years	19 (6.9%)	16 (5.8%)	1.33 (0.99–1.80)	0.057
Sex
Women	84 (30.6%)	50 (18.8%)	Reference	Reference
Men	100 (36.4%)	41 (14.9%)	0.82 (0.71–0.95)	0.011
nature of sexual relationship
Casual	45 (24.3%)	13 (7.0%)	Reference	Reference
Married	0 (0.0%)	10 (5.4%)	1.40 (1.07–1.85)	0.015
Stable	91 (49.2%)	26 (14.1%)	1.07 (0.89–1.27)	0.418
Source of sexual partner
Out of campus	23 (12.4%)	17 (9.2%)	Reference	Reference
Within campus	113 (61.1%)	32 (17.3%)	0.98 (0.99–1.85)	0.809
from where u had your HIV tested?
From nearby clinic	26 (26.5%)	19 (19.4%)	Reference	Reference
From the university health unit	13 (13.3%)	6 (6.1%)	1.22 (1.06–1.41)	0.005
Self-testing	27 (27.6%)	7 (7.1%)	1.13 (0.96–1.32)	0.134
Heard of pre-exposure prophylaxis
Yes	60 (21.8%)	17 (6.2%)	Reference	Reference
No	124 (45.1%)	74 (26.9%)	0.98 (0.74–1.31)	0.895
Heard of post exposure prophylaxis
Yes	89 (32.4%)	31 (11.3%)	Reference	Reference
No	95 (34.6%)	60 (21.8%)	1.04 (0.90–1.20)	0.581
Ever experienced condom bursting
Yes	38 (13.9%)	12 (4.4%)	Reference	Reference
No	146 (53.3%)	78 (28.5%)	1.03 (0.82–1.29)	0.781
In absence of condoms
No sex	158 (57.5%)	16 (5.8%)	Reference	Reference
Proceed to have sex	26 (9.5%)	75 (27.3%)	1.22 (1.01–1.46)	0.021
Where can one access condoms from while at campus?
University health unit	66 (24.0%)	46 (16.7%)	Reference	Reference
Friends	15 (5.5%)	8 (2.9%)	0.99 (0.71–1.38)	0.956
Gents/ladies	9 (3.3%)	7 (2.6%)	1.53 (0.93–2.51)	0.092
University health unit and friends	89 (32.4%)	23 (8.4%)	1.17 (0.85–1.63)	0.337
I don’t know	5 (1.8%)	7 (2.6%)	1.12 (0.77–1.62)	0.560

).

4. Discussion

Our study found out that the median age was 23 years, and this indicates that the majority of the undergraduate students enrolled on university programs have their ages ranging between 20 and 29 [11]. At least half of the respondents had sexual partners, and majority of these were in a stable relationship with only very few of them being married; also, majority had at least had sexual intercourse in the previous six months. A significant number of the students also indicated that their source of sexual partner was out of campus. About 3.5% of the students engaged in buying or selling sex, and this indicates that the practice of commercial sex work is very minimal among the students, though efforts to curb this vice should not be relaxed. Awareness on both PrEP and PEP was found to be high among the students; a possible explanation for this could be that education together with reproductive health service awareness and trainings can play a significant role in empowering youth to take charge of their reproductive health [15].

With the different studies that have been conducted so far about condom use among the population of students, the condom use rate has greatly varied from low to high, and this could be due to different study designs and methods used. This study found out that the condom use rate was 53.7% (n = 217), and this showed consistency with some of the previous studies within Africa and beyond. A systematic and meta-analysis study conducted on low condom use at the last sexual intercourse among university students in sub-Saharan Africa revealed that the condom use rate in the last sexual intercourse was 52.9% [16]. Our results were also comparable with the findings from studies conducted in Zimbabwe, Brazil, and the United States, where the condom use rate was found to range between 54.3% and 56.2% [10,17,18]. A possible explanation given to this trend in similarity and consistency in prevalence could be due to similar sociodemographic characteristics explored during this study, and a number of studies showed linkage between sociodemographic characteristics to condom use such as [11,17,19,20].

On the contrary, other studies found higher rates compared with the one that this study found, and this follows the studies conducted in Southern Brazil and southwest Ethiopia with estimated prevalence of 60% and 66,1%, respectively [21,22]; the possible explanation for this would be that condoms offer protection from both pregnancy and HIV infection [23].

In a similar way, some studies had a much lower rate compared with the one that this study found; a study conducted by Moreira and colleagues about condom use in the last sexual intercourse among undergraduates found a prevalence rate of 41.5% [11], whereas another study conducted about factors associated with condom use among high school students of Natitingou Agricultural Technical school in Benin in 2017 found out that the prevalence of condom use was 40.63% [24].

A cross-sectional survey of two Nigerian universities performed by Ajayi and his colleagues on factors associated with consistent condom use in Nigeria found out that the prevalence of condom use in the previous year was 38.6% [25], and another population-based study explored condom use and its associated factors among Iranian youth in Iran, and the prevalence of condom use was found to be 35.1%. The probable explanation that could have resulted into the low prevalence could have been abandoning condoms by the students for other contraceptive methods, which reduced the probability of using it by 60% [26].

4.1. Factors Associated with Condom Use among the Undergraduate Students

The following factors were found to be statistically significant and associated with condom use: sex (men), nature of sexual relationship (married), place where HIV was tested (university health unit), and having sex in the absence of condom.

This study found out that the male students in the university were more likely to use condoms compared with the female students, and a possible explanation put forward could be that unlike the male condoms, female condoms are more expensive and less accessible, and this is supported by a study conducted by Nelsensius Klau Fauk and his colleagues on perceptions of determinants of condom use behaviors among male clients of female sex workers in Indonesia [27]; on the other hand, another study carried out on the accessibility and availability of female condom by Seepaneng S. Phiri and his colleagues revealed that affordability, inefficient procurement, and lack of distribution measures, as well as absence of the female condoms in strategic points, were responsible for the low perception of female condoms as a contraceptive method, hence the lower rate of use among women [28].

This study also found out that participants who were in a married type of sexual relationship were less likely to use condoms than those who were in a casual type of sexual relationship, and this could be due to the fact that casual partners are not bounded by marriage; therefore, prevention of unplanned pregnancies and sexually transmitted diseases account for more consistent use of condoms [29,30]; on the other hand, both quantitative and qualitative results from a study conducted in Nakuru district of Kenya by Evasius K. Buani revealed that majority of married couples do not use condoms as their partner would not negotiate for its use since it would dread strain or break their relationship due to suspicions of mistrust; this fear is further amplified by religious beliefs that consider the use of condoms in marriage as a sin [31].

Students who carried out their HIV testing from the university health unit were more likely to use condoms compared with those who did their tests from the nearby clinic; a possible explanation to this could be that the university health unit is situated within the campus premises and offers HIV testing, guidance, and counselling at a free cost to the university, as well as other sexual health services including free male condom distribution; hence, these students received more guidance and counselling on sexual and reproductive health that could have empowered them to use condom unlike nearby clinics that offer these services at a cost, including condoms. Secondly, the condom distribution program targets all the students by placing condoms in appropriate places such as gents and ladies rooms to ensure privacy and easy access, hence encouraging condom use among the university students. These suggestions are further supported by various studies that showed that the presence of condom dispensers in designated areas within the university and college premises increased accessibility and encouraged more students to use condoms [32,33,34].

Lastly, in the absence of condoms, students were asked what they did in such situations, and those who said they proceeded to have sex with their partners stood a much lower chance of using condoms than their counterparts who reported no sex. A possible explanation could have been that condoms were not within their reach, and this is supported by a study conducted on condom distribution intervention in the U.S., which indicated that interventions, which increase the availability of or accessibility to condoms, along with condom distribution, were shown to be efficacious in increasing condom use behaviors [35].

4.2. Study Limitations

This study could have not been a full representative of all the undergraduate students of Gulu University because the main campus was chosen leaving the other two branches of the university that also have undergraduate students. This study was performed among an educated group of youth who were at their higher levels of education, and hence poses a problem of generalizability of the findings with the entire population; in addition to this, some specific variables associated with consistent condom use, like having HIV-tested at the university health unit, did not confer causal relationships for consistent condom use since this study was purely cross-sectional. The results of this study entirely relied on self-administered structured questionnaires, and there could have been cases of giving false information, hence creating bias.

5. Conclusions

The condom use rate was high (53.7%), and having a sexual partner, source of sexual partner, year of study, experience of condom bursting, absence of condoms, and drinking alcohol were the factors that were positively associated with condom use. Regarding this, 51.5% had sexual partners, and this gives an insight that, indeed, condom use was very likely; hence, interventions such as condom distribution could help in availing condoms to the students. In addition, reproductive health talks and training would seem so useful in creating awareness.