Ethnic differences in sexual behaviour among unmarried adolescents and young adults in Zimbabwe

Sexual and reproductive health and rights of "last mile" adolescents: a scoping review

Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.

HIV testing and ethnicity among adolescent girls and young women aged 15-24 years in Ghana: what really matters?

Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15-24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15-24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46-6.08) or previously married (aOR = 4.30, CI: 2.00-9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20-0.85) and condom use (aOR = 0.56, CI: 0.38-0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.

Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation

BACKGROUND

While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations.

METHODS

The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15-24). Logistic regression was used to predict condom use at last sexual activity and MSP.

RESULTS

The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15-19 and elevated risk of first sex was higher among Yoruba males.

CONCLUSION

This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.

Prevalence and correlates of HIV-risky sexual behaviors among students attending the Medical and Social Welfare Center of the University of Maroua, Cameroon

BACKGROUND

Data on sexual behaviors in Cameroonian youths are needed to design and implement effective preventive strategies against HIV/AIDS. This study aimed at assessing sociodemographic and religious factors associated with sexual behaviors among university students in Cameroon.

METHODS

In 2011, 411 university students were surveyed by a self-administered questionnaire at the Medical and Social Welfare Center of the University of Maroua. Logistic regression analyses were used to determine correlates of sexual behaviors.

RESULTS

80.8 % of students were sexually active. The mean age at sexual debut was 18.1 years (SD = 3.1). The frequency of premarital sex was 92.8 %. Pornography viewing [adjusted odds ratio (aOR): 4.0, 95 % CI 2.1-7.6; p < 0.0001] and an increased age of 1 year (aOR: 1.3, 95 % CI 2.0-7.6; p < 0.0001) were significantly associated with having previously had sex. The likelihood to have a lower (<18) age at sexual debut was increased by male gender (aOR: 2.5, 95 % CI 1.7-5; p < 0.001), and urban origin (aOR: 2.9, 95 % CI 1.5-5.7; p < 0.01). The probability to have a high number (#3) of lifetime sexual partners was increased by age (aOR: 1.1, 95 % CI 1.0-1.2; p < 0.001), pornography viewing (aOR: 4.3, 95 % CI 1.9-9.5; p < 0.001), an early sexual debut (aOR: 2.8, 95 % CI 1.6-5.0; p < 0.001), having had occasional sexual partners (aOR: 7.0, 95 % CI 3.7-13.1; p < 0.0001), and was decreased by Muslim religious affiliation (aOR: 0.2, 95 % CI 0.1-0.9; p < 0.05). Having had casual sexual partners was associated with less inconsistent condom use (aOR: 0.5, 95 % CI 0.2-0.9; p < 0.05).

CONCLUSIONS

Our findings indicate that there is an alarming level of risky sexual behaviors among the study population. Strong and efficient measures should be undertaken to handle such harmful behaviors, this for the prevention and control of HIV/AIDS and other STIs in this vulnerable population.

Substance Use and Risky Sexual Behaviors Among Young Men Working at a Rural Roadside Market in Malawi

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.

An association between ethnic diversity and HIV prevalence in sub-Saharan Africa

This paper investigates whether ethnic diversity at the Demographic and Health Surveys (DHS) cluster level predicts HIV serostatus in three sub-Saharan African countries (Kenya, Malawi and Zambia), using DHS household survey and HIV biomarker data for men and women aged 15–59 collected since 2006. The analysis relates a binary dependent variable (HIV positive serostatus) and a weighted aggregate predictor variable representing the number of different ethnic groups within a DHS Statistical Enumeration Area (SEA) or cluster, which roughly corresponds to a neighbourhood. Multilevel logistic regression is used to predict HIV prevalence within each SEA, controlling for known demographic, social and behavioural predictors of HIV serostatus. The key finding was that the cluster-level ethnic diversity measure was a significant predictor of HIV serostatus in Malawi and Zambia but not in Kenya. Additional results reflected the heterogeneity of the epidemics: male gender, marriage (Kenya), number of extramarital partners in the past year (Kenya and Malawi, but probably confounded with younger age) and Muslim religion (Zambia) were associated with lower odds of positive HIV serostatus. Condom use at last intercourse (a spurious result probably reflecting endogeneity), STD in the past year, number of lifetime sexual partners, age (Malawi and Zambia), education (Zambia), urban residence (Malawi and Zambia) and employment (Kenya and Malawi) were associated with higher odds of positive serostatus. Future studies might continue to employ multilevel models and incorporate additional, more robust, controls for individual behavioural risk factors and for higher-level social and economic factors, in order to verify and further clarify the association between neighbourhood ethnic diversity and HIV serostatus.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

High-risk sex and displacement among refugees and surrounding populations in 10 countries: the need for integrating interventions

INTRODUCTION

Between 2004 and 2012, the United Nations High Commissioner for Refugees conducted behavioural surveillance surveys in 27 separate communities in 10 countries.

METHODS

Random systematic or two-stage cluster sampling was used among participants of age 15-49 years, using a modified standard questionnaire. We conducted descriptive data analysis and multivariable logistic regression to identify factors independently associated with multiple sexual partnerships.

RESULTS

Of 27 sites surveyed comprising 24 219 individuals, 11 refugee and surrounding communities were paired. Recent displacement comprised less than 10% of participants. Visiting neighbouring communities varied from 8.6 to 74.4%. Multiple sexual partnerships varied from 2.7% in Sudan to 32.5% in Tanzania. Condom use during last sex was low in most of the communities (<5%). The prevalence of forced sex was similar in paired sites, with intimate partner violence being the most frequent, ranging between 1.0 and 4.6% in camps and 0.8 and 3.6% in communities, with the exception of Nepal (10.8 and 9.8%). Being away from home for more than 1 month and having lived in community for less than 12 months was associated with multiple partnerships in six and five of 16 sites, respectively.

CONCLUSION

In the largest study of paired sites of refugees in protracted refugee camps and surrounding nationals, data showed no consistent difference in levels of risky sexual behaviour and there was much variation among the different groups. The prevention strategies should be targeted in a highly integrated manner for both the communities. Forced sex among women was reported at similar levels among refugees and nationals, with intimate partner violence being the most common. These findings should reduce stigma and discrimination against refugees.

Individual and contextual socioeconomic determinants of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria: a multilevel analysis

BACKGROUND

Nigeria has the highest number of people living with HIV/AIDS in the world after India and South Africa. HIV/AIDS places a considerable burden on society's resources, and its prevention is a cost-beneficial solution to address these consequences. To the best of our knowledge, there has been no multilevel study performed to date that examined the separate and independent associations of individual and community socioeconomic status (SES) with HIV prevention knowledge in Nigeria.

METHODS

Multilevel linear regression models were applied to the 2008 Nigeria Demographic and Health Survey on 48871 respondents (Level 1) nested within 886 communities (Level 2) from 37 districts (Level 3).

RESULTS

Approximately one-fifth (20%) of respondents were not aware of any of the Abstinence, Being faithful and Condom use (ABC) approach of preventing the sexual transmission of HIV. However, the likelihood of being aware of the ABC approach of preventing the sexual transmission of HIV increased with older age, male gender, greater education attainment, a higher wealth index, living in an urban area and being from least socioeconomically disadvantaged communities. There were significant community and district variations in respondents' knowledge of the ABC approach of preventing the sexual transmission of HIV.

CONCLUSION

The present study provides evidence that both individual- and community-level SES factors are important predictors of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria. The findings underscore the need to implement public health prevention strategies not only at the individual level, but also at the community level.

A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update

PURPOSE

To conduct a literature review of studies that examined risk and protective factors related to adolescent sexual and reproductive health in developing countries.

METHODS

A literature search was conducted using multiple databases, including PubMed, PsycINFO, Scopus, JSTOR, and the Interagency Youth Working Group. Review criteria included publications that: were conducted in a low- or middle-income country; had a sample size of at least 100 young people aged 10-24 years, and used multivariate analysis. All studies that were identified were also conducted between 1990 and 2010, a 20-year time frame. The literature search and initial review yielded a total of 244 studies that met the criteria and analyzed risk and protective factors related to the following outcomes: sexual initiation, number of sexual partners, condom use, contraceptive use, pregnancy and early childbearing, human immunodeficiency virus, sexually transmitted infections, and sexual coercion.

RESULTS

Most studies that were conducted on adolescent sexual and reproductive health in developing countries were largely focused in Sub-Saharan African contexts, and primarily examined factors related to sexual initiation and condom use. Most factors that examined an adolescent sexual and reproductive health outcome were also focused on the individual level, although an increasing number of studies within the past 10 years have focused on family-level factors. Few studies examined factors at the community or neighborhood level, which, to date, has largely been ignored in developing country contexts.

CONCLUSIONS

The review not only summarizes what is currently known in terms of risk and protective factors that relate to adolescent sexual and reproductive health in developing countries, but also highlights the gaps. Implications for future research are discussed.

Preventing HIV by providing support for orphan girls to stay in school: does religion matter?

OBJECTIVE

The paper examines the influence of religion on attitudes, behaviors, and HIV infection among rural adolescent women in Zimbabwe.

DESIGN

We analyzed data from a 2007 to 2010 randomized controlled trial in rural eastern Zimbabwe testing whether school support can prevent HIV risk behaviors and related attitudes among rural adolescent orphan girls; supplementary data from the 2006 Zimbabwe Demographic and Health Survey (ZDHS) were also analyzed. The present study design is largely cross-sectional, using the most recent available survey data from the clinical trial to examine the association between religious affiliation and religiosity on school dropout, marriage, and related attitudes, controlling for intervention condition, age and orphan type. The ZDHS data examined the effect of religious denomination on marriage and HIV status among young rural women, controlling for age.

RESULTS

Apostolic Church affiliation greatly increased the likelihood of early marriage compared to reference Methodist Church affiliation (odds ratio = 4.5). Greater religiosity independently reduced the likelihood of school dropout, increased gender equity attitudes and disagreement with early sex, and marginally reduced early marriage. Young rural Apostolic women in the ZDHS were nearly four times as likely to marry as teenagers compared to Protestants, and marriage doubled the likelihood of HIV infection.

CONCLUSIONS

Findings contradict an earlier seminal study that Apostolics are relatively protected from HIV compared to other Christian denominations. Young Apostolic women are at increased risk of HIV infection through early marriage. The Apostolic Church is a large and growing denomination in sub-Saharan Africa and many Apostolic sects discourage medical testing and treatment in favor of faith healing. Since this can increase the risk of undiagnosed HIV infection for young married women and their infants in high prevalence areas, further study is urgently needed to confirm this emerging public health problem, particularly among orphan girls. Although empirical evidence suggests that keeping orphan girls in school can reduce HIV risk factors, further study of the religious context and the implications for prevention are needed.

Community-level HIV risk behaviors and HIV prevalence among women and men in Zimbabwe

Most studies on HIV risk in sub-Saharan Africa focus on individual-level sociodemographic and behavioral correlates of risk. Only recently have researchers and programmers considered the context within which individuals live. This study uses the 2005-6 Zimbabwe Demographic and Health Survey to examine the correlation between the prevalence of HIV at the community level and the prevalence of HIV risk-taking behaviors. Results show that women and men living in communities with higher HIV prevalence in the opposite sex are at increased risk of HIV. In addition, rural women and men living in communities with greater premarital and nonmarital sex are at greater risk of HIV. Finally, HIV prevalence is higher among women and men living in urban areas with higher intimate partner violence. Programs should address community-level social norms that make high-risk behaviors acceptable and thus increase all women and men's risk of HIV, not just those engaged in high-risk behaviors.

The impact of socio-demographic and religious factors upon sexual behavior among Ugandan university students

INTRODUCTION

More knowledge is needed about structural factors in society that affect risky sexual behaviors. Educational institutions such as universities provide an opportune arena for interventions among young people. The aim of this study was to investigate the relationship between sociodemographic and religious factors and their impact on sexual behavior among university students in Uganda.

METHODS

In 2005, 980 university students (response rate 80%) were assessed by a self-administered questionnaire. Validated instruments were used to assess socio-demographic and religious factors and sexual behavior. Logistic regression analyses were applied.

RESULTS

Our findings indicated that 37% of the male and 49% of the female students had not previously had sex. Of those with sexual experience, 46% of the males and 23% of the females had had three or more sexual partners, and 32% of the males and 38% of the females did not consistently use condoms. For those who rated religion as less important in their family, the probability of early sexual activity and having had a high number of lifetime partners increased by a statistically significant amount (OR = 1.7; 95% CI: 1.2-2.4 and OR = 1.6; 95% CI: 1.1-2.3, respectively). However, the role of religion seemed to have no impact on condom use. Being of Protestant faith interacted with gender: among those who had debuted sexually, Protestant female students were more likely to have had three or more lifetime partners; the opposite was true for Protestant male students.

CONCLUSION

Religion emerged as an important determinant of sexual behavior among Ugandan university students. Our findings correlate with the increasing number of conservative religious injunctions against premarital sex directed at young people in many countries with a high burden. of HIV/AIDS. Such influence of religion must be taken into account in order to gain a deeper understanding of the forces that shape sexual behavior in Uganda.