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Mukanga B, Dlamini SB, Mwanabute N, Taylor M. Adolescents' risky sexual behaviours and practices: Implications for sexuality education implementation in Zambia. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 39099271 PMCID: PMC11304187 DOI: 10.4102/phcfm.v16i1.4476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Adolescents' risky sexual behaviours (RSB) are detrimental to their sexual and reproductive health (SRH) well-being and present a serious public health threat, particularly in low- and middle-income countries (LMICs). AIM This study aims to assess RSB among Grade 12 school-going adolescents after exposure to comprehensive sexuality education (CSE). SETTING This study was conducted in Kitwe district, Zambia. METHODS This cross-sectional study included 807 Grade 12 pupils at 13 selected secondary schools. Data were collected using a structured questionnaire. Proportionate probability sampling involving 13 schools was employed. Risky sexual behaviours binary outcome variables were based on transactional sex, sex while drunk, multiple sexual partners, age-disparate sexual relationships, and condomless sex. We conducted univariate and bivariate analyses to summarise sociodemographic factors and fitted binary and multivariable logistic regression models. RESULTS The prevalence of RSB was 40.4%. Drinking alcohol (adjusted odds ratio [AOR] = 20.825; 95% CI [6.7-64.489]); ever had sex (AOR = 9.024; 95% CI [1.953-41.704]); school location (AOR = 6.50; 95% CI [1.61-26.24]); living with mother only (AOR = 4.820; 95% CI [1.328-17.493]); sex (male) (AOR = 2.632; 95% CI [1.469-4.713]), watching pornography (AOR = 1.745; 95% CI [1008-3.021]); religion (AOR = 0.472; 95% CI [0.250-0.891]) and attending religious functions (AOR = 0.317; 95% CI [0.118-0.848]) were significantly associated with RSB. Of the sexually active pupils, 221 (67.7%), 64 (19.6%) and 41 (12.5%) were in the low, medium and high-risk categories, respectively. CONCLUSION Close to half of the respondents engaged in RSB. This is a significant number that needs intervention. The CSE programme needs to be linked with structural programmes that address the social drivers of RSB among adolescents.Contribution: The study provides a backdrop for evaluating current CSE strategies in LMICs.
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Affiliation(s)
- Bright Mukanga
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; and Department of Public Health, School of Medicine, Copperbelt University, Ndola.
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Ssemata AS, Muhumuza R, Stranix-Chibanda L, Nematadzira T, Ahmed N, Hornschuh S, Dietrich JJ, Tshabalala G, Atujuna M, Ndekezi D, Nalubega P, Awino E, Weiss HA, Fox J, Seeley J. The potential effect of pre-exposure prophylaxis (PrEP) roll-out on sexual-risk behaviour among adolescents and young people in East and southern Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:1-7. [PMID: 35361057 DOI: 10.2989/16085906.2022.2032218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an HIV-prevention strategy recommended for those at high-risk of infection, including adolescents and young people (AYP). We explored how PrEP roll-out could influence sexual risk behaviour among AYP in East and southern Africa. Twenty-four group discussions and 60 in-depth interviews were conducted with AYP between 13 and 24 years old, recruited from community settings in Uganda, Zimbabwe and South Africa, from September 2018 to January 2019. Participants perceived that PrEP availability could change sexual behaviour among AYP, influencing: (1) condom use (increased preference for condomless sex, reduced need and decrease in use of condoms, relief from condom use discomfort, consistent condom use to curb sexually transmitted infections and pregnancies); (2) sexual activities (increase in sexual partners and sexual encounters, early sexual debut, sexual experimentation and peace of mind during risky sex, sexual violence and perversion); (3) HIV risk perception (neglect of other HIV prevention strategies, unknown sexual partner HIV status, adoption of PrEP). PrEP initiation may be associated with increased interest in sexual activities and risky sexual behaviour among AYP. PrEP should be included as part of a combination package of HIV prevention strategies for AYP with methods to prevent other sexually transmitted infections and unwanted pregnancies.
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Affiliation(s)
- Andrew Sentoogo Ssemata
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Richard Muhumuza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | | | | | - Nadia Ahmed
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, South Africa
- Mortimer Market Centre, Central North West London NHS Trust, London, United Kingdom
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Denis Ndekezi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Phiona Nalubega
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Esther Awino
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julie Fox
- King's College London, United Kingdom
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Afriyie J, Essilfie ME. Association between risky sexual behaviour and HIV risk perception among in-school adolescents in a municipality in Ghana. Ghana Med J 2019; 53:29-36. [PMID: 31138941 PMCID: PMC6527831 DOI: 10.4314/gmj.v53i1.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies considering the association between adolescents' risky sexual behaviour and how they perceive themselves to be at risk of HIV infection are scares in Ghana. The study assessed the association between HIV risk perception and risky sexual behaviour among in-school adolescents in a municipality in Ghana. METHOD A cross sectional study was conducted among 706 students, using a questionnaire. Logistic regression analyses were used to assess the association between HIV risk perception and risky sexual behaviour. RESULTS Of all the adolescents, 27.7% were sexually active. Among the sexually active, 51.8 % had sexual intercourse below 14 years, 65.4% did not used condom at their last sexual intercourse, and 37.2% had multiple sexual partners. Only 20.5% of the adolescents perceived themselves to be at risk of HIV infection. Being sexually active was independently associated with having HIV risk perception (OR 1.54; 95% CI: 1.03-2.27). Adolescents who had multiple sexual partners were more likely than their counterparts with single sexual partners to perceive themselves to be at risk of HIV infection (AOR 2.39; 95% CI: 1.10 - 5.20). Non-use of condom at least sexual intercourse and early sexual debut were not associated with HIV risk perception. CONCLUSION Except for those with multiple sexual partners, the adolescents generally did not perceive themselves to be at risk of HIV infection despite their involvement in risky sexual behaviour. Interventions that help adolescents to correctly assess their HIV risk perception and build on their susceptibility to HIV infection are needed. FUNDING Personal funding.
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Affiliation(s)
- James Afriyie
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Health, University of Cape Coast (UCC), P.M.B. Cape Coast, Ghana
| | - Maame E Essilfie
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Health, University of Cape Coast (UCC), P.M.B. Cape Coast, Ghana
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Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, Beksinska M, Smit JA, Hogg RS, Gray G, Miller CL, Kaida A. Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa. JOURNAL OF SEX RESEARCH 2018; 55:522-539. [PMID: 29466024 DOI: 10.1080/00224499.2017.1421607] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual self-efficacy (SSE), one's perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.
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Affiliation(s)
- Kalysha Closson
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Janan J Dietrich
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Nathan J Lachowsky
- b British Columbia Centre for Excellence in HIV/AIDS
- d School of Public Health and Social Policy , University of Victoria
| | - Busiwe Nkala
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
- e Faculty of Humanities , University of the Witwatersrand
| | - Alexis Palmer
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Mags Beksinska
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Jennifer A Smit
- f MatCH Research Unit [Maternal, Adolescent and Child Health Research Unit], Faculty of Health Sciences, University of the Witwatersrand
| | - Robert S Hogg
- a Faculty of Health Sciences , Simon Fraser University
- b British Columbia Centre for Excellence in HIV/AIDS
| | - Glenda Gray
- c Perinatal HIV Research Unit, Faculty of Health Sciences , University of the Witwatersrand
| | - Cari L Miller
- a Faculty of Health Sciences , Simon Fraser University
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Predictors of Abstaining From Sex and of Using Condoms for Rural Malawian Female Adolescents. J Assoc Nurses AIDS Care 2017; 29:93-100. [PMID: 29122429 DOI: 10.1016/j.jana.2017.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/24/2017] [Indexed: 11/20/2022]
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Miller CL, Nkala B, Closson K, Chia J, Cui Z, Palmer A, Hogg R, Kaida A, Gray G, Dietrich J. The Botsha Bophelo Adolescent Health Study: A profile of adolescents in Soweto, South Africa. South Afr J HIV Med 2017; 18:731. [PMID: 29568638 PMCID: PMC5843033 DOI: 10.4102/sajhivmed.v18i1.731] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/01/2017] [Indexed: 01/07/2023] Open
Abstract
Background Youth between the ages of 15 years to 24 years account for almost half of new HIV infections in South Africa. Objectives To describe the study details of the Botsha Bophelo Adolescent Health Study (BBAHS) which was an investigation of HIV risk among adolescents living in Soweto, South Africa. Methods Eligibility criteria for the BBAHS included being 14 years – 19 years old and living in one of the 41 identified formal and informal areas in the township of Soweto. A cross-sectional survey was developed between investigators and an adolescent community advisory board consisting of previously validated scales and original questions including demographics, sexual and reproductive health, health service utilisation and psychosocial behaviours. Results Between 2010 and 2012, interviewers administered surveys among 830 adolescents (57% females), whose median age was 17 years (Q1, Q3: 16, 18), and found that 43% of participants identified their ethnicity as Zulu, 52% reported high food insecurity, 37% reported at least one parent had died, 15% reported living in a shack and 83% identified as heterosexual. Over half of the participants (55%) reported ever having sex (49% of females and 64% of males), 11% of whom initiated sex at < 15 years of age (3% females and 21% males). Almost half (47%) reported ever testing for HIV, 3% (n = 12) of whom self-reported being HIV-positive and 33% (n = 4) were on antiretroviral therapy. Conclusion Our study highlights important individual, relational and structural level determinants of HIV risk for adolescent men and women growing up within HIV hyperendemic settings.
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Affiliation(s)
- Cari L Miller
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - Busisiwe Nkala
- Perinatal HIV Research Unit, Soweto, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Canada.,The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Alexis Palmer
- Faculty of Health Sciences, Simon Fraser University, Canada.,The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, Canada.,The British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit, Soweto, South Africa.,South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, Soweto, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Comparison of Sexual Knowledge, Attitude, and Behavior between Female Chinese College Students from Urban Areas and Rural Areas: A Hidden Challenge for HIV/AIDS Control in China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8175921. [PMID: 28101513 PMCID: PMC5215479 DOI: 10.1155/2016/8175921] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022]
Abstract
Currently, research in sexual behavior and awareness in female Chinese college students (FCCSs) is limited, particularly regarding the difference and the influencing factors between students from rural areas and urban areas. To fill the gap in available data, a cross-sectional study using anonymous questionnaires was conducted among 3193 female students from six universities located in Beijing, Shanghai, and Guangzhou, China, from February to June, 2013. Of the 2669 respondents, 20.6% and 20.9% of the students from urban and rural areas, respectively, reported being sexually experienced. The proportion of students who received safe-sex education prior to entering university from rural areas (22.4%, 134/598) was lower (P < 0.0001) than the proportion from urban areas (41.8%, 865/2071). Sexual behavior has become increasingly common among FCCSs, including high-risk sexual behavior such as unprotected commercial sex. However, knowledge concerning human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) transmission and the risks is insufficient, particularly for those from rural areas, which is a challenge for HIV/AIDS control in China. The Chinese government should establish more specific HIV/AIDS prevention policies for Chinese young women, strengthen sex education, and continue to perform relevant research.
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Nabunya P, Ssewamala FM, Mukasa MN, Byansi W, Nattabi J. Peer mentorship program on HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents: an evidence based practice. VULNERABLE CHILDREN AND YOUTH STUDIES 2015; 10:345-356. [PMID: 27042195 PMCID: PMC4814228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adolescents and young adults in sub-Saharan Africa (SSA) are particularly vulnerable to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) infection. Adolescents orphaned as a direct result of HIV/AIDS are at an elevated risk of acquiring HIV/AIDS and other sexually transmitted infections. However, limited empirical evidence exists on HIV knowledge and prevention programs, especially those designed to address HIV information gaps among adolescents. This study evaluates the effect of a peer mentorship program provided in addition to other supportive services on HIV/AIDS knowledge, beliefs, and prevention attitudes, among school-going orphaned adolescents in southern Uganda. We utilize data from the Bridges to the Future Study, a 5-year longitudinal randomized experimental study funded by the National Institute of Child Health and Human Development. Out of the 1410 adolescents enrolled in the study (average age = 12.7 at study initiation), 855 of them participated in a nine-session, curriculum based peer mentorship program. We analyzed data collected at baseline and 12-months post intervention initiation. The results from bivariate and regression analysis indicate that, controlling for socioeconomic characteristics, adolescents who participated in a peer mentorship program were more likely than non-participants to report increased scores on HIV/AIDS knowledge(b = .86, 95%CI = .47 - 1.3, p ≤ .001); better scores on desired HIV/AIDS-related beliefs (b = .29, 95%CI = .06 - .52, p ≤ .01); and better scores on HIV/AIDS prevention attitudes (b = .76, 95%CI = .16 - 1.4, p ≤ .01). Overall, the study findings point to the potential role a of peer mentorship program in promoting the much-desired HIV/AIDS knowledge, beliefs, and prevention attitudes among orphaned adolescents. Future programs and policies that support AIDS-orphaned adolescents in sub-Saharan Africa should consider incorporating peer mentoring programs that provide correct, age, and culturally appropriate HIV information to help protect orphaned adolescents and reduce the risk of HIV infections.
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Affiliation(s)
- Proscovia Nabunya
- School of Social Service Administration, The University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA
| | - Fred M. Ssewamala
- International Center for Child Health and Asset Development, School of Social Work, Columbia University, 1255 Amsterdam Avenue, Office # 1122, New York, NY 10027, USA
| | - Miriam N. Mukasa
- International Center for Child Health and Asset Development, School of Social Work, Columbia University, 1255 Amsterdam Avenue, Office # 1122, New York, NY 10027, USA
- McSilver Institute for Poverty Policy and Research, New York University, 1 Washington Square North, New York, NY 10003, USA
| | - William Byansi
- International Center for Child Health and Asset Development, School of Social Work, Columbia University, 1255 Amsterdam Avenue, Office # 1122, New York, NY 10027, USA
| | - Jennifer Nattabi
- International Center for Child Health and Asset Development, School of Social Work, Columbia University, 1255 Amsterdam Avenue, Office # 1122, New York, NY 10027, USA
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