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Chea SK, Kagonya VA, Oyugi EA, Nasambu C, Menza I, Ibrahim F, Abdullahi O, Anika A, Hassan AS, Abbeddou S, Michielsen K, Abubakar A. Sexual risk-taking behavior amongst emerging adults in a tertiary institution of learning in Coastal Kenya: A qualitative study of stakeholders' perspectives using causal loop mapping. PLoS One 2023; 18:e0284550. [PMID: 37816016 PMCID: PMC10564131 DOI: 10.1371/journal.pone.0284550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND It is known from previous studies that university students in sub-Saharan Africa (sSA) engage in sexual risk-taking behaviour (SRTB). However, there is paucity of data on factors contributing to SRTB among university students (emerging adults) at the Kenyan Coast thus hindering intervention planning. This study seeks to provide an in-depth qualitative understanding of the factors contributing to SRTB and their interconnectedness among university students at the Kenyan Coast combining qualitative research with a systems thinking approach. METHODS Using the ecological model, and employing in-depth interviews, we explored the perceptions of twenty-six key informants (twenty-one emerging adults and five other stakeholders) on what constitutes and influences SRTB among emerging adults at a tertiary institution of learning in Coastal Kenya. Data were analysed using a thematic framework approach. A causal loop diagram (CLD) was developed to map the interconnectedness of the correlates of SRTB. RESULTS Our findings show that unprotected sex, transactional sex, cross-generational sex, multiple sex partnerships, gender-based violence, sex under influence of alcohol/drugs, early sex debut, and sharing sex toys were common SRTBs. Based on the ecological model and CLD, most of the reported risk factors were interconnected and operated at the individual level. CONCLUSION Our study shows that emerging adults are frequently engaging in unprotected sex. Enhancing sexuality education programs for students in Kenyan universities and strengthening support systems including counselling for those using alcohol/drugs may help reduce SRTB among emerging adults in Kenyan universities.
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Affiliation(s)
- Stevenson K. Chea
- Department of Nursing Sciences, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Public Health Nutrition Unit, Ghent University, Ghent, Belgium
| | - Vincent A. Kagonya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Eunice A. Oyugi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Carophine Nasambu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Isaac Menza
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Osman Abdullahi
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - Alice Anika
- Department of Educational Psychology, School of Education, Pwani University, Kilifi, Kenya
| | - Amin S. Hassan
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - Souheila Abbeddou
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Public Health Nutrition Unit, Ghent University, Ghent, Belgium
| | - Kristien Michielsen
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Amina Abubakar
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
- Institute for Human Development, The Aga Khan University, Nairobi, Kenya
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Abstract
The study investigates the complex relationships between circumcision and HIV prevalence in Lesotho, using Demographic and Health surveys (DHS) conducted in 2004, 2009 and 2014. Before the HIV epidemic, about half of the male adult population was circumcised as part of a traditional custom, and this proportion increased markedly after 2008 with the campaigns of Voluntary Medical Male Circumcision (VMMC), while HIV prevalence stayed at the same level. In 2004, HIV prevalence was higher in circumcised groups than in intact groups (RR=1.49, 95% CI=1.20-1.86). This relationship changed over time, and was inversed in 2014 (RR=0.86; 95% CI=0.70-1.06). The changing relationship seems to be due to an interaction with education, with more educated men being more circumcised and having less HIV over time. A multivariate analysis showed no net effect of circumcision on HIV, after controlling for wealth, education, and indicators of marriage and sexual behaviour. A small net effect of VMMC was found, probably due to condom use. In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.
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