Original Research Report Exploring Health Behaviors in Ugandan Adolescents Living in Rural Fishing Communities Tom D. Ngabirano, MS, RN 1 , Melissa A. Saftner, PhD, CNM, FACNM 2 , and Barbara J. McMorris, PhD 2 Abstract Adolescents in rural Uganda face unique opportunities and challenges to their health. The primary goal of this exploratory cross-sectional survey study was to describe the health behaviors of adolescents of age 13–19 living in four Ugandan fishing communities as a foundation for developing programs to reduce risky health behaviors and HIV/AIDS transmission. The majority of boys (59.6%) and one third of girls reported lifetime sexual intercourse; girls reported earlier sexual debut than boys, as well as higher rates of sexual assault, rape, and/or coerced intercourse. Sexually active youth were more likely to have viewed pornography, be tested for other sexually transmitted infections, and attend boarding schools. Alcohol use was prevalent among both sexes; however, the use of other substances was infrequently reported. Since the majority of ado- lescents in Uganda attend boarding school, there is an opportunity to expand the school nurse scope of care to include health promotion education and counseling. Keywords adolescent, risk behavior, global health, fishing villages, HIV transmission, school nursing Background Engaging in unhealthy behaviors can have devastating effects for adolescents. Long-term impacts of unhealthy behaviors include the transmission of sexually transmitted infections (STIs) such as human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS), addic- tion, violence (Swahn et al., 2018; Swedo et al., 2019), stress and psychiatric diagnosis (Slavich et al., 2019), and compli- cations related to early childbearing (Maly et al., 2017). Understanding risk behaviors in adolescence is a critical first step in intervening to support healthy growth and develop- ment, regardless of where on the globe young people live. HIV/AIDS infection is still a public health problem among the general Ugandan population, and the country as a whole is classified as a “high burden country” (The Joint United Nations Programme on HIV and AIDS [UNAIDS], 2015) despite the World Health Organization’s (WHO, 2016) ambitious goal to end the AIDS epidemic as a public health threat by 2030. Uganda is not currently meeting United Nations (UN) AIDS 90-90-90 goal to have 90% of people know their HIV status, 90% of people diagnosed with HIV receiving antiretroviral therapy (ART), and 90% of people receiving ART with viral suppression (UNAIDS, 2019). Despite efforts for HIV testing, 16% of all people in Uganda still do not know their HIV status (AVERT, 2018) and those living in rural areas are more likely to be disadvantaged and underserved (Mafigiri et al., 2017). For the purposes of the current study, rural is defined by Chomitz et al.’s (2005) concept of rurality as distinguished by two dimensions: low population density and remoteness from large cities. Rural fishing communities have higher rates of HIV infection than other communities in Uganda, with some HIV infection estimates ranging from three to five times higher than the general population and others ranging from 5 to 10 times higher (Burgos-Soto et.al., 2020; Mafigiri et al., 2017; Opio et al., 2013; Tumwesigye et al., 2012). In fact, Ssetaala et al. (2015) found that women in fishing commu- nities are more likely to be affected by HIV/AIDS. Addi- tionally, Sabri and colleagues (2019) found that being 1 Department of Nursing, Makerere University, Kampala, Uganda 2 School of Nursing, University of Minnesota, Minneapolis, MN, USA Corresponding Author: Melissa A. Saftner, PhD, CNM, FACNM, School of Nursing, University of Minnesota, 308 Harvard Street SE, WDH 5-140, Minneapolis, MN 55455, USA. Email: msaftner@umn.edu The Journal of School Nursing 1-13 ª The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1059840520947142 journals.sagepub.com/home/jsn