Risky Sexual Behaviors and Associated Factors among Jiga High School and Preparatory School Students, Amhara Region, Ethiopia

Hotspot areas of risky sexual behaviour and associated factors in Ethiopia: Further spatial and mixed effect analysis of Ethiopian demographic health survey

INTRODUCTION

Sexual behaviour needs to take a central position in the heart of public health policy makers and researchers. This is important in view of its association with Sexually Transmitted Infections (STIs), including HIV. Though the prevalence of HIV/AIDS is declining in Ethiopia, the country is still one of the hardest hit in the continent of Africa. Hence, this study was aimed at identifying hot spot areas and associated factors of risky sexual behavior (RSB). This would be vital for more targeted interventions which can produce a sexually healthy community in Ethiopia.

METHODS

In this study, a cross-sectional survey study design was employed. A further analysis of the 2016 Ethiopia Demographic and Health Survey data was done on a total weighted sample of 10,518 women and men age 15-49 years. ArcGIS version 10.7 and Kuldorff's SaTScan version 9.6 software were used for spatial analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Bernoulli-based purely spatial scan statistics were used to detect significant spatial clusters of RSB. Mixed effect multivariable logistic regression model was fitted to identify predictors and variables with a p-value ≤0.05 were considered as statistically significant.

RESULT

The study subjects who had RSB were found to account about 10.2% (95% CI: 9.64%, 10.81%) of the population, and spatial clustering of RSB was observed (Moran's I = 0.82, p-value = 0.001). Significant hot spot areas of RSB were observed in Gambela, Addis Ababa and Dire Dawa. The primary and secondary SaTScan clusters were detected in Addis Ababa (RR = 3.26, LLR = 111.59, P<0.01), and almost the entire Gambela (RR = 2.95, LLR = 56.45, P<0.01) respectively. Age, literacy level, smoking status, ever heard of HIV/AIDS, residence and region were found to be significant predictors of RSB.

CONCLUSION

In this study, spatial clustering of risky sexual behaviour was observed in Ethiopia, and hot spot clusters were detected in Addis Ababa, Dire Dawa and Gambela regions. Therefore, interventions which can mitigate RSB should be designed and implemented in the identified hot spot areas of Ethiopia. Interventions targeting the identified factors could be helpful in controlling the problem.

Risky sexual behavior and associated factors among reproductive age women in eastern African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Risky sexual behavior exposes an individual to the risk of contracting sexually transmitted infections including human immunodeficiency virus (HIV). Even though risky sexual behavior is a devastating problem in low- and middle-income countries, studies on risky sexual behavior and associated factors among reproductive-age women in Eastern African countries are limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and associated factors among reproductive-age women in Eastern African countries that help to target high-risk groups and set appropriate intervention.

METHOD

The appended and recent Demographic and Health Survey dataset of 10 Eastern African countries from 2012 to 2022 was used for data analysis. A total of 111,895 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results.

RESULT

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was 28.16% (95% CI 27.90%, 28.43%), which ranged from 3.80% in Ethiopia to 67.13% in Kenya. In the multivariable analysis, being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, drinking alcohol, and being an urban dweller were factors that were significantly associated with higher odds of risky sexual behavior.

CONCLUSION

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was high. Individual-level (being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, and drinking alcohol) and community-level (being an urban dweller) variables were associated with higher odds of risky sexual behavior. Therefore, policymakers and other stakeholders should give special consideration to urban dwellers, educated, worker and younger women. Better to improve the healthy behavior of women by minimizing alcohol consumption and strengthening HIV testing and counseling services to reduce the magnitude of risky sexual behavior.

Exposure to Parental Violence and Self-Reported Sexual Violence among Unpartnered Adolescent Girls in Nigeria: Evidence from a National Survey

Objectives

Despite the high prevalence of sexual violence among young and adolescent women in Nigeria, there is a paucity of studies on the extent of sexual violence among adolescent girls, especially unpartnered girls, and the role of parental violence. This study assesses the prevalence of self-reported sexual violence and the influence of exposure to parental violence among unpartnered adolescent girls (aged 15-19) in Nigeria.

Methods

The women's data (n = 5,145) from the 2013 and 2018 Nigeria Demographic and Health Surveys were pooled and analyzed with descriptive analysis and multinomial logistic regressions.

Results

Of all adolescent girls, 5.65% had ever experienced sexual violence, 94.09% said they never did, and 0.26% did not respond. Adolescent Girls exposed to parental violence were more likely to have ever experienced sexual violence than the unexposed girls (aRRR= 1.90; 95% CI: 1.29-2.79).

Conclusion

Interventions to prevent sexual violence among adolescent girls should sensitize parents on the potential negative implications of parental violence for their daughters' wellbeing.

Factors Associated with Early Sexual Activity in Adolescents Residing in an Urban Area of Northeastern Mexico Who Use WhatsApp or Facebook

Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31-16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44-5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03-2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.

Risky sexual behavior and associated factors among secondary and above-education-level students in Ethiopia: A systematic review and meta-analysis

Background

Risky sexual behavior is defined as the behavior that increases the susceptibility of an individual to problems related to sexuality and reproductive health. The main aim of this study was to determine the pooled prevalence of risky sexual behavior and its associated factors in Ethiopia.

Methods

Systematic review and meta-analysis (PRISMA) rules were used. During the searching period, MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, and CINAHL were used with search terms. The STATA form 14 program was utilized to perform the meta-analysis. I² statistics was used to test heterogeneity, and publication bias was assessed using Begg's and Egger's tests. Odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots.

Results

There were 24 studies, and 13,440 study participants were included in this meta-analysis. The pooled prevalence of risky sexual behavior in Ethiopia was 40% (95% CI: 32%, 48%). The associated factors for risky sexual behavior were substance use [OR: 2.41 (95% CI: 1.49, 3.89)], watching pornography [OR: 2.59 (95% CI: 1.01, 6.69)], and night club visit, [OR: 2.53 (95% CI: 1.64, 3.90)].

Conclusion

Risky sexual behavior among secondary school and above-education-level Ethiopian students was high.

Risky Sexual Practice and Associated Factors Among Youth Preparatory Students in Gondar City, Northwest Ethiopia

Background

Risky sexual practices can negatively affect the health of youths by predisposing them to a variety of sexually transmitted infections, including HIV/AIDS and unwanted pregnancy, which, in turn, would lead to serious lifelong deleterious health, social, and economic consequences. While youths tend to be less well-informed and require more information, little has been known in Ethiopia. Therefore, this study aimed to assess the prevalence of risky sexual practices and associated factors among youth students in Gondar city, northwest Ethiopia.

Methods

A cross-sectional study was conducted among 414 regularly attending youth students in Gondar city from April to May 2019. A simple random sampling technique was used to select the study participants. Data were collected by using a pre-tested, structured, and self-administered questionnaire. Bivariable and multivariable logistic regression analyses were employed, and a multivariable binary logistic regression model was used to identify the effect of independent variables on the outcome variable at p < 0.05 with its 95%CI.

Result

The prevalence of risky sexual practices was 49.3%. Peer pressure (AOR = 1.99, 95%CI: 1.21, 3.26), drinking alcohol (AOR = 4.88 95%CI: 3.06, 7.79), and watching pornography (AOR = 2.82, 95%CI: 1.74, 4.56) were positively associated with the risky sexual practice of youths. Whereas, age, gender, and pocket money did not have any association with risky sexual practice in this study.

Conclusion

In this study, the prevalence of risky sexual practices was found to be high. Thus, multisector collaboration efforts are needed from parents, schools, health facilities, and the government to tackle the exposure of in-school youth toward peer pressure, drinking alcohol, and watching pornographic films, which in turn helps to bring about healthy sexual practices among them.

Women's autonomy in refusing risky sex and associated factors in Ethiopia: evidence from 2011 to 2016 EDHS data

BACKGROUND

Risky sexual behavior is a major public health concern of Ethiopians. Although studying the autonomy of women in refusing risky sex is significant to take proper actions, the issue is not yet studied. Accordingly, this population-based nationwide study was aimed at assessing women's autonomy in refusing risky sex and its associated factors in Ethiopia.

METHOD

The sample was limited to married women of 2011 (n = 8369) and 2016 (n = 8403) Ethiopian Demographic and Health Survey data. Women's autonomy in refusing risky sex was measured based on wives' response to 'not having sex because husbands have other women. To examine associated factors, socio-demographic variables were computed using binary logistic regression.

RESULT

The finding revealed that the trend of women's autonomy in refusing risky sex had declined from 78.9% in 2011 to 69.5% in 2016. Women aged from 25 to 34 were less likely autonomous in refusing sex compared to those who aged less than 24 years old (AOR = .7064; 95% CI 0.605, 0.965). The autonomy of women with higher educational status was three times more likely higher than those who have no formal education (AOR = 3.221; 95% CI 1.647, 6.300 respectively. The autonomy of women who are from rich households was more likely higher in comparison to women from poor households (AOR = 1.523; 95% CI 1.28, 1.813). The autonomy of women those who live in Tigray 2.9 times (AOR = 2.938; 95% CI 2.025, 4.263), Amhara 4.8 times (AOR = 4.870; 95% CI 3.388, 7.000), SNNP 1.9 times (AOR = 1.900; 95% CI 1.355, 2.664), and Addis Ababa 3.8 times (AOR = 3.809; 95% CI 2.227, 6.516) more likely higher than those who reside in Dire Dawa.

CONCLUSION

The autonomy of women in refusing risky sex has declined from 2011 to 2016. This infers that currently, women are more victimized than previously. Hence, possible interventions like empowering women shall be taken to protect women from certain health problems of risky sexual behavior.

Risky sexual behavior and associated factors among sexually experienced secondary school students in Guduru, Ethiopia

Adolescents at secondary schools are susceptible to engaging in risky sexual behavior (RSB) due to their teenage stage and the new environment they face. Limited researches in district towns have evaluated the RSB among adolescents with various findings. This study aimed to assess the RSB and associated factors among sexually experienced secondary school students. School-based cross-sectional study was conducted in Guduru district from March 4-8, 2019. A total of 1236 secondary school students were undergoing a survey. The data were collected using a pretested anonymously self-administered questionnaire and students who reported having ever had sex were evaluated for RSB. From all participants, 352 (29.8%) had ever started sexual intercourse from which 240 (68.2%) students were involved in RSB. During the multivariable logistic regression analysis, sex (AOR: 3.73; 95%CI: [1.71-8.14]), father educational level (AOR: 0.37; 95%CI: [0.16-0.84]), drinking alcohol (AOR: 2.76; 95%CI: [1.29-5.69]), perceived peer pressure (AOR: 4.22; 95%CI: [1.59, 11.24]), communication with parents (AOR: 9.58, 95%CI: [3.53, 25.94]), and perceived parental monitoring (AOR: 0.33; 95%CI: [0.14-79]) were significantly associated with RSB. This study outlined that the majority of sexually active adolescents are involved in RSB. Interventions at the health facility and school level should focus on the identified determinants of sexual behaviors among adolescents to minimize the risky consequences.

Risky sexual behavior and its associated factors among daily laborers in Arjo-Didessa sugar factory, Jimma Arjo, Southwest Ethiopia: An institution-based cross-sectional study

Background:

Ethiopia is one of the sub-Saharan African countries where the young population is densely found. Many studies reveal that the magnitude of risky sexual behavior is high in the youth. The consequences of risky sexual behavior developed during youth life may affect the sexual behavior in adult life, such as increasing the risk of acquiring and transmitting sexually transmitted infections, and predisposing to unwanted pregnancies. Our objective was to assess the risky sexual behaviors among daily laborers in Arjo-Didessa Sugar Factory, Jimma Arjo district, East Wollega zone, Southwest Ethiopia.

Methods:

An institution-based cross-sectional study was conducted among 422 randomly selected daily laborers in the Arjo-Didessa sugar factory. For the quantitative and qualitative study, a simple random and purposive sampling technique, respectively, was employed to select the study participants. After data collection, data were checked manually for completeness, and then cleaned and entered into EPI info version 7. Statistical analyses like descriptive, bivariate, and multivariate logistic regression were performed using SPSS version 24 to determine the association between predictors and outcome variables with the help of the calculated frequencies and odds ratio with 95% confidence interval, while a p-value of less than 0.05 was taken as statistically significant.

Results:

The mean age of study participants was 22.15 and standard deviation of ±2.9 years. Among the study participants who responded to having sex in the past 12 months, 171 (57%) with 95% confidence interval (0.51, 0.63) had ever experienced risky sexual practices. The findings of this study indicated that age from 20 to 24 years (adjusted odds ratio = 3.9, 95% confidence interval: 1.19–12.90), marital status (single) (adjusted odds ratio = 5.5, 95% confidence interval: 1.98–15.70), khat chewing (adjusted odds ratio = 7.12, 95% confidence interval: 2.2–23.4), influence of alcohol for sex (adjusted odds ratio = 3.7, 95% confidence interval: 1.1–12.23), watching pornographic films (adjusted odds ratio = 4.2, 95% confidence interval: 1.5–12.2), and having income less than US$17 (adjusted odds ratio = 0.03, 95% confidence interval: 0.01–0.77) and US$17–US$52 (adjusted odds ratio = 0.23, 95% confidence interval: 0.06–0.85) were significantly associated with risky sexual behavior.

Conclusion:

This study indicated that there are high-risk sexual practices among the study population. Age, marital status, income level, khat chewing, the influence of alcohol consumption to have sex, and pornographic viewing were found to be predisposing factors of the risky sexual behaviors among daily laborers at the Arjo-Didessa sugar factory. Enhancing sexual education and consulting the targeted groups for the behavioral change is highly advisable, which can reduce the consequences of risky sexual practices that prevailed in the study area.

Knowledge, attitude and practice towards risky sexual behaviors among secondary and preparatory students of Metu town, south western Ethiopia

BACKGROUND

Sexual risk behaviors are defined as sexual activities that may make an individual liable to the risk of sexually transmitted infections including Human Immunodeficiency virus (HIV) and unplanned pregnancies. Adolescents are at high risk of developing sexual risk behavior. The rate of risky sexual behaviors and the spread of STIs continue to be increase among the adolescent population. Therefore this study aimed to assess Metu secondary and preparatory school adolescent knowledge, attitude, and practice of risky sexual behaviors.

METHODS

Institution based descriptive cross sectional study was conducted among Metu secondary and preparatory school students from 04 Feb 2019-07 June 2019. The study participants were selected through systematic random sampling techniques and the data was collected through self-administered questionnaires. A Total of 361 study subjects were included in the study. Data was entered in EpiData and analyzed by using SPSS version 21.

RESULTS

Three hundred sixty one respondents participated in this study. Of those, 75.9% of them have awareness about risky sexual behaviors and about 76.5. % of them has awareness on consequences of unsafe sex. Among the total study participants, about 22.7% of them had previously practiced in sexual activity; of these 61.7% of respondents had more than one sexual partner. From the respondents who had practiced sex, 19.8% of them had always used condom during their sexual intercourse with their partners, while 58% of them never used condom during sexual intercourse.

CONCLUSIONS

Even though the majority of the students have an awareness regarding sexual risk behaviors, a considerable number of students have practiced risky sexual behaviors that might predispose them for different sexual and reproductive health problems and peer pressure was revealed as a major factor that influences the respondents towards their first sexual intercourse. Peers have greater influence on the positive and negative behavior of their friends. Therefore the school should emphasize on promoting peer educators and peer discussion to protect adolescents and youth from risky sexual behaviors.

Quality of youth friendly sexual and reproductive health Services in West Gojjam Zone, north West Ethiopia: with special reference to the application of the Donabedian model

Background

Although there has been momentum in implementing sexual and reproductive health services in Ethiopia, young people remain underserved despite their demonstrated needs. Quality care improves utilization of health service and increases the likelihood of obtaining ongoing care. However, little is known about the quality of youth-friendly sexual and reproductive health service in Ethiopia. Therefore, this study sought to investigate the quality of youth-friendly sexual and reproductive health service in West Gojjam Zone, North West Ethiopia.

Methods

Health facility-based cross-sectional study was conducted in West Gojjam zone in 2018 to assess the quality of the service using the Donabedian model. The assessment was done through the triangulation of multiple methods: simulated client study; structured interviews with service providers; observations; and key informant interview with providers and expertise. Fifty-four visits were made to 18 randomly selected health facilities by three simulated clients trained to present three different scenarios (i.e., adolescent with sexually transmitted infection, pregnancy test request and a lady with dry cough). Data were entered and analyzed using SPSS version 21. Facility visit score of ≥ 75% in all quality component categorized as “good quality” otherwise classified as performing below the standard. Thematic analysis was done to analyze qualitative data.

Results

In this study, none of the health facilities achieved ≥ 75% in the three components of quality measurement. From 18 health facilities, 6(33.3%) provided low quality in all domains. Process component, which measures client-provider interaction and privacy/confidentiality, was the most compromised one. However, a promising result was reported in the input quality that measured the availability of trained providers, drugs, and supplies. The presence of community-based health insurance and age driven comprehensive youth-friendly service delivery approach were identified as challenges to deliver quality services.

Conclusions

The quality of the service ranges from low to medium, with adolescent related elements performing poorly. Minor renovations of health facilities, training on client handling, and contextual modifying the age driven youth-friendly service approach may improve the quality of the services.

Prevalence and personal predictors of risky sexual behaviour among in-school adolescents in the Ikenne Local Government Area, Ogun State, Nigeria

Risky sexual behaviour increases the vulnerability of an adolescents to reproductive health problems like sexually transmitted infections (STIs), unintended pregnancy and abortion. This study therefore investigated the prevalence and personal predictors of risky sexual behaviour among in-school adolescents in the Ikenne Local Government Area, of Ogun State, Nigeria. The study employed a descriptive cross-sectional design. A multi-stage sampling technique was used to select 716 participants for the study. A validated semi-structured questionnaire with a Cronbach's alpha score of 0.78 was used to collect data. Frequency and logistic regression analysis were conducted to give statistical responses to the research question and hypotheses using SPSS version 23. The mean age of the participants was 15.2 ± 1.4 years and 57.3% of the respondents were female. Above a quarter (35.5%) of the respondents were in senior secondary one (SS1) in high school. More than half (53.1%) of the respondents had a good level of knowledge about risky sexual behaviour and 54% of the respondents had a fair perception of it. The respondents' attitudes towards risky sexual behaviour was moderately high (61.2%). The respondents had moderately high (63.7%) self-esteem. The prevalence of risky sexual behaviour was 19.2%. The personal predictors of risky sexual behaviour are age [odds ratio (OR) = 3.21; p < 0.05); gender [OR = 1.86; confidence interval (CI): 1.26-2.69; p < 0.05]; perception (OR = 2.58; CI: 1.55-4.30; p < 0.05); attitude (OR = 4.58; CI: 1.61-13.05; p < 0.05); self-esteem (OR = 7.39; p < 0.05). In conclusion, the respondents' risky sexual behaviours are predicted by age, gender, attitude, perception and self-esteem. The study therefore recommends that educational materials about the negative effects of the risky sexual behaviours should be included in the curriculum of secondary schools.

Risky Sexual Behaviors and Associated Factors Among College Students in Lusaka, Zambia

Risky sexual behaviors are important factors driving the HIV/AIDS epidemic. Although Zambia experiences a high HIV prevalence, especially among youth, there is a dearth of information regarding risky sexual behaviors among young adults. Therefore, we investigated the prevalence and associated factors of risky sexual behaviors among college students in Lusaka, Zambia. A cross-sectional study was conducted in February 2017 among 427 college students at the University of Zambia. Participants reported their sexual behaviors, sexual attitudes, and lifestyle using self-administered questionnaires. Multinomial logistic regression models were employed to assess potential determinants of risky sexual behaviors. Among the 205 students who reported ever having sex, 148 (72.2%) engaged in risky sexual behaviors in the last 12 months. Participants who were older (OR 1.30, 95% CI 1.12-1.51), engaged in low physical activity (OR 2.25, 95% CI 1.05-4.84), and reported liberal sexual attitudes (OR 1.88, 95% CI 1.02-3.47) were more likely to engage in any risky sexual behavior, while frequent alcohol use (OR 8.38, 95% CI 4.60-15.27) and suicide attempts (OR 6.42, 95% CI 2.03-20.29) predicted multiple risky sexual behaviors. In conclusion, this study indicates that Zambian college students' risky sexual behaviors are associated with multiple behavioral health risks. Future research should consider using a multiple-behavior change intervention.

Predictors of risky sexual behaviour among pre-college students in Adama Town, Ethiopia

Introduction

The rate of sexually transmitted infection's, including HIV has increased in recent years in Ethiopia. Many adolescents and young people still do not protect themselves against unintended pregnancies and STIs. Therefore, this study was conducted to assess the predictors of risky sexual behavior among pre-college students in Adama Town, Ethiopia.

Methods

School based cross-sectional study was employed. In this study 364 students were recruited from all pre-college schools in Adama town, Ethiopia. Bivariate and multivariate logistic regression analysis were used to examine the relationship between the outcome variables and independent variables.

Results

The mean age at sexual debut was 16.1 years (± 2.72SD). Social media usage for sexual activity and having multiple sexual partners were observed among students. About 7% of students used social media for watching pornography. The odds of risky sexual behaviour were higher among social media users compared to the nonusers AOR = 1.23 (95% CI 1.13,3.12). Risky sexual behaviour was almost 4 times more likely among night club goers AOR = 4.294 (95% CI: 2.033, 9.073). Peer pressure and substance abuse were also a significant predictor for risky sexual behavior AOR = 6.97 (95% CI: 4.24, 9.69).

Conclusion

Social media use, peer pressure, substance abuse, and night club going were found to be significantly associated with risky sexual behaviour among pre-college students. Thus, schools need to establish and strengthen reproductive health clubs to be able to equip students with required skills and knowledge about sexuality. Parents should be aware of the dynamic behavioral change of their children, listen and attend to their needs.

Evaluating a Culturally Tailored HIV Risk Reduction Intervention Among Hispanic Women Delivered in a Real-World Setting by Community Agency Personnel

PURPOSE

To evaluate the effectiveness of Salud, Educación, Prevención, y Autocuidad/Health, Education, Prevention and Self-care (SEPA) to increase human immunodeficiency virus (HIV)/sexually transmitted infections (STI) prevention behaviors for Hispanic women delivered in a real-world setting.

DESIGN

Randomized controlled trial.

SETTING

Participants were recruited from the Miami Refugee Center, the Florida Department of Health, and public locations in Miami.

PARTICIPANTS

Three hundred twenty Hispanic women.

INTERVENTION

The SEPA is a culturally tailored intervention developed to address HIV/STI risk behaviors among Hispanic women. The SEPA intervention consisted of three 2.5 hour sessions per week conducted with small groups. The SEPA sessions consisted of group discussions, role playing, negotiation skills, partner communication, and skills building as part of the methodology.

MEASURES

Acculturation, HIV/STI risk behaviors, HIV knowledge, partner communication, intimate partner violence, drug/alcohol use, condom use.

ANALYSIS

Differences at baseline by group were assessed using Wilcoxon rank sum test, χ², and a negative-binomial model. Changes in dependent variables, compared to baseline, were analyzed in separate models. Log-binomial models and negative binomial models were used for dichotomous and count/rate-type dependent variables.

RESULTS

Significant outcome improvements were observed in the SEPA group at 6 and 12 months follow-up. The adjusted prevalence of any condom use was 30% and 37% higher at each follow-up. The adjusted prevalence of answering 10/12 HIV knowledge questions correctly rose by 57% and 63% at each follow-up. Intimate partner violence was significantly lower at each subsequent time point (62% and 41% of baseline). Moderate depressive symptoms were reduced to 50% and 42%, getting drunk was reduced to 20% and 30%, and condom use self-efficacy was significantly higher (84% and 96%).

CONCLUSION

The SEPA intervention reduced HIV/STI risk-related behaviors when delivered in a real-world setting. The results suggest that SEPA can be implemented in various settings to reach Hispanic women, and that SEPA could reach large numbers of women in an efficient, cost-effective way.

Condom use at last sex by young men in Ethiopia: the effect of descriptive and injunctive norms

Background

Condoms are an important prevention method in the transmission of HIV and sexually transmitted infections as well as unintended pregnancy. Individual-level factors associated with condom use include family support and connection, strong relationships with teachers and other students, discussions about sexuality with friends and peers, higher perceived economic status, and higher levels of education. Little, however, is known about the influence of social norms on condom use among young men in Ethiopia. This study examines the effect of descriptive and injunctive norms on condoms use at last sex using the theory of normative social behavior.

Methods

A cross-sectional survey was implemented with 15-24 year old male youth in five Ethiopian regions in 2016. The analytic sample was limited to sexually active single young men (n = 260). Descriptive statistics, bivariate and multivariate logistic regressions were conducted. An interaction term was included in the multivariate model to assess whether injunctive norms moderate the relationship between descriptive norms and condom use.

Results

The descriptive norm of knowing a friend who had ever used condoms significantly increased respondents’ likelihood of using condoms at last sex. The injunctive norm of being worried about what people would think if they learned that the respondent needed condoms significantly decreased their likelihood to use condoms. The injunctive norm did not moderate the relationship between descriptive norms and condom use. Young men who lived closer to a youth friendly service (YFS) site were significantly more likely to have used condoms at last sex compared to those who lived further away from a YFS site.

Conclusions

Social norms play an important role in decision-making to use condoms among single young men in Ethiopia. The interplay between injunctive and descriptive norms is less straightforward and likely varies by individual. Interventions need to focus on shifting community-level norms to be more accepting of sexually active, single young men’s use of condoms and need to be a part of a larger effort to delay sexual debut, decrease sexual violence, and increase gender equity in relationships.

Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis

BACKGROUND

Risky sexual practice is a major public health problem in Ethiopia. There are various studies on the prevalence and determinants of risky sexual practice in different regions of the country but there is no study which shows the national estimate of risky sexual practices in Ethiopia. Therefore, this review was conducted to estimate the national pooled prevalence of risky sexual practice and its risk factors in Ethiopia.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed to review published and unpublished studies in Ethiopia. The databases used were; PubMed, Google Scholar, CINAHL and African Journals Online. Search terms were; risky sexual behavior, risky sexual practice, unprotected sex, multiple sexual partner, early sexual initiation, and/or Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal. The meta-analysis was conducted using Review Manager software. Descriptive information of studies was presented in narrative form and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were used to test heterogeneity across studies. The pooled estimate prevalence and the odd ratios with 95% confidence intervals were computed by a random effect model.

RESULTS

A total of 31 studies with 43,695 participants were included in the meta-analysis. The pooled prevalence of risky sexual practice was 42.80% (95% CI: 35.64%, 49.96%). Being male (OR: 1.69; 95% CI: 1.21, 2.37), substance use (OR: 3.42; 95% CI: 1.41, 8.31), peer pressure (OR: 3.41; 95% CI: 1.69, 6.87) and watching pornography (OR: 3.6; 95% CI: 2.21, 5.86) were factors associated with an increase in risky sexual practices.

CONCLUSIONS

The prevalence of risky sexual practices is high in Ethiopia. Being male, substance use, peer pressure and viewing pornographic materials were found to be associated with risky sexual practices. Therefore, life skills training is recommended to reduce peer pressure among individuals. Interventions should be designed to reduce substance use and viewing pornography.

Problematic Alcohol Use among University Students

BACKGROUND

Alcohol is attributable to many diseases and injury-related health conditions, and it is the fifth leading risk factor of premature death globally. Hence, the objective of this study was to assess the proportion and associated factors of problematic alcohol use among University students.

MATERIAL AND METHODS

Cross-sectional study was conducted among 725 randomly selected University students from November to December 2015. Data were collected by self-administered questionnaire, and problematic alcohol use was assessed by Alcohol Use Disorder Identification Test. Chi-square test was used to show association of problematic use and each variable and major predicators was identified using logistic regression with 95% confidence interval (CI); and variables with p-value less than 0.05 were considered statistically significant.

RESULTS

About 83 (11.4%) of the samples were problematic alcohol users of which 6.8% had medium level problems and 4.6% had high level problems. Significantly associated variables with problematic alcohol use among students were presence of social phobia (AOR = 1.7, 95% CI: 1.0, 2.8), lifetime use of any substance (AOR = 6.9, 95% CI: 3.8, 12.7), higher score in students cumulative grade point average (AOR = 0.6, 95% CI: 0.4, 0.9), and having intimate friend who use alcohol (AOR = 2.2, 95% CI: 1.3, 3.8).

CONCLUSION

Problematic alcohol use among university students was common and associated with social phobia, poor academic achievement, lifetime use of any substance, and peer pressure. Strong legislative control of alcohol in universities is important to reduce the burden of alcohol.