Abstract
Sub-Saharan Africa is home to two-thirds of people living with HIV globally. Adolescent girls and young women are twice as likely to be living with HIV compared to young men. Sexual risk-taking behaviors put adolescent girls at risk for adverse health outcomes, including HIV/AIDS. In this study, we conducted semi-structured in-depth interviews to explore multi-level factors that influence decisions to engage in sexual risk-taking among 58 school-going adolescent girls in Uganda. Both protective and risk factors cut across personal, proximal, and distal contexts. At the personal level, future goals and fear of negative health outcomes were identified as the most common protective factors. Positive family relations and peers were cited most frequently as protective factors at the proximal level. At the distal level, poverty was the most common risk factor. Relatedly, families' ability to provide for adolescent girls' needs was a protective factor. Study results point to the need for multilevel combination interventions to reduce sexual risk-taking among adolescent girls in Uganda.