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Anley DT, Zemene MA, Gebeyehu AA, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Seid MA, Abebe EC, Gesese MM, Solomon Y, Moges N, Bantie B, Feleke SF, Dejenie TA, Chanie ES, Bayih WA, Tesfa NA, Taklual W, Tesfa D, Anteneh RM, Dessie AM. Hotspot areas of risky sexual behaviour and associated factors in Ethiopia: Further spatial and mixed effect analysis of Ethiopian demographic health survey. PLoS One 2024; 19:e0303574. [PMID: 38820433 PMCID: PMC11142568 DOI: 10.1371/journal.pone.0303574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/26/2024] [Indexed: 06/02/2024] Open
Abstract
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.
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Affiliation(s)
- Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Woliata Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Department of Biomedical Science, Unit of Physiology, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Wubet Taklual
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dessalegn Tesfa
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Rahel Mulatie Anteneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Carels C, Florence M, Adams S, Savahl S. Alcohol Use as a Predictor of Risky Sexual Behaviour among Young Adults in the Western Cape Province of South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7053. [PMID: 37998284 PMCID: PMC10671005 DOI: 10.3390/ijerph20227053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of this study was to investigate the relation between alcohol consumption and risky sexual behaviour (RSB). This study further aimed to examine whether alcohol use, gender, and employment status predicted RSB among young adults in the Cape Flats. A better understanding of these predictors could potentially lead to a more thorough comprehension of the relation between alcohol consumption and RSB among young adults within the South African context. The study employed a cross-sectional correlational survey design, with a sample of 1001 participants aged 18 to 25 (51% women), using the street-intercept method. Participants were selected using purposive sampling, with age and geographical location employed as inclusion criteria. We used the Self-Report Risky Sexual Behaviours Scale (SRSBS) and the Alcohol Use Disorder Identification Test (AUDIT), which were cognitively tested and modified, in English and Afrikaans. The data were analysed via multivariate multiple regression analysis in Stata. The key findings indicate that alcohol consumption is an important predictor of RSB. Alcohol consumption accounted for 23.22% of the variation in RSB. We also found that alcohol consumption and gender were significant (p < 0.1) predictors of RSB, but not employment status (p > 0.01). Being a woman decreased RSB. The model indicates that alcohol use and gender explain 18.41% of the variance in RSB. This study provides support for the growing body of research evidence that has established a significant link between alcohol consumption and RSB, highlighting the need for longitudinal research to determine patterns of risky drinking in the general population.
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Affiliation(s)
- Cassandra Carels
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
| | - Maria Florence
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
| | - Sabirah Adams
- Language Development Group, Centre for Higher Education Development, University of Cape Town, Cape Town 7701, South Africa
| | - Shazly Savahl
- Department of Psychology, University of the Western Cape, Cape Town 7535, South Africa
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Partap U, Assefa N, Berhane Y, Sie A, Guwatudde D, Killewo J, Oduola A, Sando MM, Vuai S, Adanu R, Bärnighausen T, Fawzi WW. The influence of depressive symptoms and school-going status on risky behaviors: a pooled analysis among adolescents in six sub-Saharan African countries. Front Psychiatry 2023; 14:1171231. [PMID: 37555002 PMCID: PMC10406520 DOI: 10.3389/fpsyt.2023.1171231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Evidence from sub-Saharan Africa (SSA) regarding risky behaviors among adolescents remains scarce, despite the large population (approximately 249 million out of 1.2 billion globally in 2019) of adolescents in the region. We aimed to examine the potential influence of depressive symptoms and school-going status on risky behaviors among adolescents in six SSA countries. METHODS We used individual cross-sectional data from adolescents aged 10-19 based in eight communities across six SSA countries, participating in the ARISE Network Adolescent Health Study (N = 7,661). Outcomes of interest were cigarette or tobacco use, alcohol use, other substance use, getting into a physical fight, no condom use during last sexual intercourse, and suicidal behavior. We examined the proportion of adolescents reporting these behaviors, and examined potential effects of depressive symptoms [tertiles of 6-item Kutcher Adolescent Depression Scale (KADS-6) score] and school-going status on these behaviors using mixed-effects Poisson regression models. We also assessed effect modification of associations by sex, age, and school-going status. RESULTS The proportion of adolescents reporting risky behaviors was varied, from 2.2% for suicidal behaviors to 26.2% for getting into a physical fight. Being in the higher tertiles of KADS-6 score was associated with increased risk of almost all risky behaviors [adjusted risk ratio (RR) for highest KADS-6 tertile for alcohol use: 1.70, 95% confidence interval (95% CI): 1.48-1.95, p < 0.001; for physical fight: 1.52, 95% CI: 1.36-1.70, p < 0.001; for suicidal behavior: 7.07, 95% CI: 2.69-18.57, p < 0.001]. Being in school was associated with reduced risk of substance use (RR for alcohol use: 0.73, 95% CI: 0.53-1.00, p = 0.047), and not using a condom (RR: 0.81, 95% CI: 0.66-0.99, p = 0.040). There was evidence of modification of the effect of school-going status on risky behaviors by age and sex. CONCLUSION Our findings reinforce the need for a greater focus on risky behaviors among adolescents in SSA. Addressing depressive symptoms among adolescents, facilitating school attendance and using schools as platforms to improve health may help reduce risky behaviors in this population. Further research is also required to better assess the potential bidirectionality of associations.
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Affiliation(s)
- Uttara Partap
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Mary M. Sando
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Guo Y, Yang Y, Deveaux L, Dinaj-Koci V, Schieber E, Herbert C, Lee J, Wang B. Exploring effects of multi-level factors on transitions of risk-taking behaviors among middle-to-late adolescents. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2023; 47:210-220. [PMID: 37746313 PMCID: PMC10516360 DOI: 10.1177/01650254221148117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Adolescents experiment with risk behaviors, including delinquency, substance use, and sexual activity. Multi-level social factors, such as having high-risk peers, neighborhood risks, and parental monitoring, influence adolescents' behaviors. We modeled transition patterns in Bahamian adolescents' risk behaviors across three high school years and examined the effects of multi-level factors. We collected data from 2,564 Bahamian adolescents in Grade 10 and follow-ups through Grade 12. We used latent transition model to identify adolescents' risk statuses. Further analyses used multinomial logistic regression to explore the effects of multi-level factors on assignment to those latent statuses and transitions. We identified four distinct statuses: "low risk" (47.9% of the sample at baseline), "alcohol use" (36.8%), "alcohol use and sexual activity" (5.5%), and "high risk" (9.8%). Males were more likely to be in higher-risk statuses at baseline and to transition from a lower-risk status in Grade 10 to a higher-risk status in Grade 11. Social risk factors were significantly associated with higher-risk statuses at baseline. Neighborhood risk and peer risk involvement continued to affect transitions from lower to higher risk; parental monitoring did not have a significant effect in later years. Our findings have important implications for developing targeted and developmentally appropriate interventions to prevent and reduce risk behaviors among middle-to-late adolescents.
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Affiliation(s)
- Yan Guo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Yinmei Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas
| | | | - Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - JungAe Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA 01605, USA
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Mugo C, Kohler P, Kumar M, Badia J, Kibugi J, Wamalwa DC, Agot K, John-Stewart GC. Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya. AIDS Behav 2023:10.1007/s10461-023-03982-9. [PMID: 36646929 PMCID: PMC9843110 DOI: 10.1007/s10461-023-03982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
HIV stigma remains a barrier in achieving optimal HIV treatment. We studied the prevalence and predictors of HIV stigma among adolescents and youth with HIV (AYWHIV) ages 15-24 years in Western Kenya. Of 1011 AYWHIV, 69% were female with a median age of 18 years. Most (59%) attended adolescent clinic days, and 40% attended support groups. One-quarter (27%) had experienced physical, 18% emotional, and 7% sexual violence. The majority of AYWHIV (88%) reported disclosure concerns, 48% reported perceived community stigma, 36% experienced, and 24% internalized stigma. Compared to AYWHIV attending adolescent clinics, those in general/adult clinics had higher internalized stigma. Similarly, having dropped out of school was associated with higher internalized stigma. AYWHIV in sexual relationships had higher experienced stigma and disclosure concerns. Lastly, exposure to violence was associated with higher experienced, internalized, perceived community stigma and disclosure concerns. These risk factors can be targeted when developing stigma-prevention interventions.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Manasi Kumar
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Cort DA, Reynolds K, Chakraborty D. HIV stigma beliefs and unprotected sex among teenagers and young adults in sub-Saharan Africa: The moderating role of mass media exposure. Soc Sci Med 2023; 317:115615. [PMID: 36527896 DOI: 10.1016/j.socscimed.2022.115615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/31/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Despite significant advances in the fight against HIV in sub-Saharan Africa, health experts remain concerned about new infections and risky sexual behavior among teenagers & young adults (T&YAs). These concerns have spurred efforts to buttress a voluminous literature on the social determinants of risky sexual behavior in Africa. Absent from this flurry of new scholarship is a consistent focus on associations between HIV stigma beliefs and risky sexual behavior, especially among T&YAs. Alongside health professionals' concerns about sexual behaviors is growing alarm about a dramatic expansion of sexual content in African mass media markets, which experts suspect may lead to T&YA risky sexual behavior. Yet, little work using multi-country data has confirmed whether mass media exposure increases the likelihood of risky sexual behavior. We fill these two gaps in the literature using a Demographic and Health Survey sample of unpartnered sub-Saharan African people, ages 15-24, in 30 countries. With this sample, we examine the direct relationships between HIV stigma beliefs, mass media exposure, and unprotected sex. We also explore whether the effect of stigma beliefs on unprotected sex is moderated by individual and regional-level exposure to mass media content. We first find that the effect of HIV stigma beliefs is harmful or associated with increases in the probability of unprotected sex. Second, contrary to past findings, individual-level mass media exposure is protective, or associated with declines in the likelihood of unprotected sex. Third, the harmful effect of stigma attitudes is weakest when individual and regional-level mass media exposure are low, but strongest when individual and regional-level mass media exposure are high. These findings suggest that stigma beliefs can shape the sexual behaviors of African T&YAs in counterintuitive ways. They also show that mass media exposure can be simultaneously protective and harmful for this population.
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Affiliation(s)
- David A Cort
- 838 Thompson Hall, Department of Sociology, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
| | - Kathryn Reynolds
- 738 Thompson Hall, Department of Sociology, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
| | - Debadatta Chakraborty
- 902 Thompson Hall, Department of Sociolog, University of Massachusetts, Amherst, Amherst, MA, 01003, USA.
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James PB, Osborne A, Bah AJ, Margao EK, Conteh-Barrat M. Sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia: a secondary analysis of the 2017 Global school-based student health surveys. Contracept Reprod Med 2022; 7:27. [PMID: 36566228 DOI: 10.1186/s40834-022-00193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/18/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sierra Leone and Liberia have experienced civil wars and, recently, Ebola outbreaks that led to profound economic hardship, psychopathologies and family disruptions. These factors are associated with sexual risk behaviours among youths. However, there is very little information on sexual risk behaviour among Sierra Leonean and Liberian school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-going adolescents (10-19 years) in Sierra Leone and Liberia. METHOD: We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Complex sample descriptive and regression analysis was used to analyse our data. RESULTS The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with a higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%). Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR = 0.572; 95%CI: 0.345-0.946). Male, compared to females, were more likely to engage in multiple sexual risk behaviour (AOR = 2.310;95%CI:1.543-3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR = 3.064; 95%CI: 2.137-4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who did not show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR = 1.655; 95%CI:1.133-2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR = 0.608; 95%CI: 0.435-0.850). Less parental support was only associated with ever had sex among adolescents in Sierra Leone (AOR = 2.027; 95%CI: 1.322-3.107) but not in Liberia (AOR = 1.034; 95%CI: 0.650-1.644). CONCLUSION Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Augustus Osborne
- Department of Biological Sciences, School of Environmental Sciences, Njala University, Njala Campus, Njala, Sierra Leone
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Emmanuel Kamanda Margao
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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de Souza TO, Tesser ZC, Hallal ALC, Pires ROM, Cascaes AM. Prevalence of unprotected sexual activity in the Brazilian population and associated factors: National Health Survey, 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022234. [PMID: 36197408 PMCID: PMC9887956 DOI: 10.1590/s2237-96222022000200027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To estimate prevalence of unprotected sexual activity and associated factors in the Brazilian population. METHODS This was a cross-sectional study with 61,523 adults aged 18 years or older who took part in the 2019 National Health Survey. We estimated prevalence of unprotected sexual activity in the last year. We analyzed association of socioeconomic and demographic variables with the outcome using Poisson regression, estimating prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Prevalence of unprotected sexual activity was 76.9% (95%CI 76.3;77.6), being higher in all the country's regions in comparison to the Northern region, as well as being higher among people living in rural areas (PR = 1.04; 95%CI 1.03;1.06), females (PR = 1.06; 95%CI 1.05;1.08), participants aged 60 years or older (PR = 1.33; 95%CI 1.27;1.38), married individuals (PR = 1.25; 95%CI 1.23;1.27) and those with less education (PR = 1.05; 95%CI 1.03;1.06). CONCLUSION Strategies aimed at groups with higher prevalence of unprotected sexual activity are necessary.
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Affiliation(s)
- Tiago Odilio de Souza
- Universidade Federal de Santa Catarina, Curso de Graduação em
Medicina, Florianópolis, SC, Brazil
| | - Zeno Carlos Tesser
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em
Odontologia, Florianópolis, SC, Brazil
| | - Ana Luiza Curi Hallal
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em
Saúde Coletiva, Florianópolis, SC, Brazil
| | | | - Andreia Morales Cascaes
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em
Saúde Coletiva, Florianópolis, SC, Brazil
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Hamidouche M, Ante-Testard PA, Baggaley R, Temime L, Jean K. Monitoring socioeconomic inequalities across HIV knowledge, attitudes, behaviours and prevention in 18 sub-Saharan African countries. AIDS 2022; 36:871-879. [PMID: 35190511 DOI: 10.1097/qad.0000000000003191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Socioeconomic inequalities in HIV prevention services coverage constitute important barriers to global prevention targets, especially in sub-Saharan Africa (SSA). We aimed at monitoring these inequalities from population-based survey data in 18 SSA countries between 2010 and 2018. METHODS We defined eight HIV indicators aimed at capturing uptake of HIV prevention services among adult participants. Country-specific wealth-related inequalities were measured using the Relative and Slope Index of Inequalities (RII and SII, respectively) and then pooled using random-effects meta-analyses. We compared inequalities between African regions using the Wilcoxon rank-sum test. RESULTS The sample consisted of 358 591 participants (66% women). Despite variability between countries and indicators, the meta-analysis revealed significant levels of relative and absolute inequalities in six out of eight indicators: HIV-related knowledge, positive attitudes toward people with HIV (PWH), condom use at last sexual intercourse, participation to prevention of mother-to-child transmission programs, medical male circumcision and recent HIV testing. The largest inequalities were reported in condom use, with condom use reported five times more among the richest versus the poorest [RII = 5.02, 95% confidence interval (CI) 2.79-9.05] and in positive attitudes toward PWH, with a 32-percentage point difference between the richest and poorest (SII = 0.32, 95% CI 0.26-0.39). Conversely, no significant inequalities were observed in multipartnership and HIV seropositivity among youth. Overall, inequalities tended to be larger in West and Central vs. East and Southern African countries. CONCLUSION Despite efforts to scale-up HIV-prevention programs, socioeconomic inequalities remain substantial over the continuum of HIV primary and secondary prevention in several SSA countries.
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Affiliation(s)
- Mohamed Hamidouche
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Pearl Anne Ante-Testard
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Kevin Jean
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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10
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Ssewanyana D, Abubakar A, Mabrouk A, Kagonya VA, Nasambu C, Dzombo JT, Angwenyi V, Kabue M, Scerif G, Newton CR. The Occurrence of Sexual Risk Behaviors and Its Association With Psychological Well-Being Among Kenyan Adolescents. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:659665. [PMID: 36303989 PMCID: PMC9580808 DOI: 10.3389/frph.2021.659665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factors that may play a role in the behavioral regulation mechanisms of adolescents. These factors are inadequately explored in sub-Saharan Africa. This study aimed at exploring patterns and associated factors for sexual risk behavior (SRB), self-esteem, and hopefulness among adolescents from a resource-poor setting in Kenya. Method: A cross-sectional study conducted in 2019 among 296 adolescents (12–17 years old) from rural Kilifi (n = 133) and urban informal settings of Nairobi (n = 163) in Kenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenberg self-esteem questionnaire, and Hope scale administered via computerized tablets. A binary outcome variable based on the experience of adolescents of at least one of the five forms of SRB: transactional sex, sexual violence, intergenerational sex, early sexual debut, and condom non-use was generated. Bi-variate analysis was conducted to summarize various social-demographic and psychosocial factors. A multivariable logistic regression model was fitted to investigate factors associated with the occurrence of SRB, self-esteem, and hopefulness among adolescents. Results: About 13% of the participants had experienced a form of SRB, and among these, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB was largely characterized by having experienced sexual violence, as well as intergenerational and transactional sex. Higher scores of hopefulness were reported among adolescents who never experienced SRB (P = 0.03) at bivariate analysis level. However, both self-esteem and hopefulness were not significantly associated with the occurrence of SRB in the adjusted logistic regression analysis. Having depressive symptoms (Adj. OR = 3.8, 95% CI: 1.39–10.4), feeling unsafe in the neighborhood (Adj. OR = 3.4, 95% CI: 1.6–7.2), and being in higher compared with lower primary education level (Adj. OR = 0.3, 95% CI: 0.1–0.8) were statistically significantly associated with the occurrence of SRB. Conclusion: Targeted reproductive health interventions, designed with the cognizance of structural and social drivers of adolescent SRB, are needed to concurrently tackle multiple forms of SRB. It is important to integrate mental health promotion within these interventions. More research is needed to understand the mechanisms and implications of self-esteem and hopefulness for adolescent sexual and reproductive health.
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Affiliation(s)
- Derrick Ssewanyana
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Derrick Ssewanyana
| | - Amina Abubakar
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- *Correspondence: Amina Abubakar
| | - Adam Mabrouk
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Vincent A. Kagonya
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Carophine Nasambu
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Judith Tumaini Dzombo
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Vibian Angwenyi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Margaret Kabue
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Charles R. Newton
- Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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