Inconsistent condom use among Ugandan university students from a gender perspective: a cross-sectional study

Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study

Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.

Alcohol use disorder among healthcare professional students: a structural equation model describing its effect on depression, anxiety, and risky sexual behavior

BACKGROUND

Mental health problems such as depression, anxiety and alcohol use disorders are among the leading causes of disability worldwide. Among university students, alcohol use and poor mental health are associated with risky sexual behavior. Given the syndemic occurrence of these disorders most especially in young adults, we describe the relationship between them so as to guide and intensify current interventions on reducing their burden in this population.

METHODS

This was a cross-sectional study based on an online survey among healthcare professional university students that captured sociodemographic characteristics, risky sexual behavior, alcohol use disorder, generalized anxiety disorder, and depression. Structural equation modelling was used to describe the relationship between these variables using RStudio.

RESULTS

We enrolled a total of 351 participants of which 11% (37/351) had Alcohol Use Disorder, 33% (117/351) had depressive symptoms and 32% (111/351) had symptoms of anxiety. A model describing the relationship between these variables was found to fit well both descriptively and statistically [χ² = 44.437, df = 21, p-value = 0.01, CFI = 0.989, TFI = 0.980, RMSEA = 0.056]. All observed variables were found to fit significantly and positively onto their respective latent factors (AUD, anxiety, depression and risky sexual behavior). AUD was found to be significantly associated with risky sexual behavior (β = 0.381, P < 0.001), depression (β = 0.152, P = 0.004), and anxiety (β = 0.137, P = 0.001).

CONCLUSION

AUD, depression and anxiety are a significant burden in this health professional student population and there's need to consider screening for anxiety and depression in students reporting with AUD so as to ensure appropriate interventions. A lot of attention and efforts should be focused on the effect of AUD on risky sexual behavior and continued health education is still required even among health professional students.

Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study

Background

Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray.

Methods

This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05.

Results

A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization.

Conclusion

The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.

Prevalence and determinants of inconsistent condom use among unmarried sexually active youth. a secondary analysis of the 2016-2017 Eswatini HIV incidence measurement survey

INTRODUCTION

In sub-Saharan Africa, youth continue to have a high burden of sexually transmitted infections and unplanned pregnancies that could be reduced through improved condom use. We aimed to investigate inconsistent condom use with the three most recent sexual partners among unmarried sexually active youth in Eswatini.

METHODS

Data were analysed for 1,324 youth from the 2016-2017 Swaziland HIV incidence measurement survey (SHIMS2) using multivariable logistic regression method.

RESULTS

The prevalence of inconsistent condom use among youth was 56.8% in 2017. Higher odds of inconsistent condom use were observed among youth aged 20-24, residents in the Lubombo region, those aged less than 18 years at sexual debut and those who had two or more sexual partners in the last 12 months before the survey. Lower odds of inconsistent condom use were observed among males, and those that knew their partners reported HIV status to be negative.

CONCLUSION

Our findings highlight a notable prevalence of inconsistent condom use among youth in Eswatini. Programs that aim to reduce the incidence of HIV infections and STIs among youth in Eswatini should focus on these factors associated with inconsistent condom use.

Awareness, Utilization and Perception of Sexually Transmitted Infections Services Provided to Out-of-School-Youth in Primary Health Facilities in Tshwane, South Africa

BACKGROUND

Despite the availability of different health care initiatives and interventions, young people are still faced with barriers in accessing reproductive health care services; thus, they are exposed to health-related issues such as sexually transmitted infections.

AIM

To determine the awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in primary health facilities in the Tshwane district, Gauteng Province, South Africa.

METHODS

The study employed a quantitative, cross-sectional descriptive survey with a sample size of 219 to determine the level of awareness, utilization and perceptions about sexually transmitted infections services provided to out-of-school-youth in Tshwane district.

RESULTS

Out-of-school-youth between the ages of 18-24 years participated in the study. Most of the participants (90.8%, n = 199) were female. Service utilization was high in females compared to their male counterparts. There is availability of youth-friendly services in primary health care facilities, however, the level of service utilization among young people is still a challenge evidenced by 12.1% (n = 74) of participants who never sought treatment for STIs, although they had STI symptoms. Furthermore, 52.0% reported that they were not happy with the health services they received when they had STIs. These findings clearly indicate a gap in service delivery for young people regarding reproductive health issues; thus, the low health care seeking behavior among the youth. Condom use was 69.1% and/or inconsistently used among the youth; about 80% of the participants had low perceptions of the risk of contracting STIs. The self-reported risks of HIV and AIDS was 46.8%. Approximately 20% reported that they would not refuse to have sex if their partner did not want to use condoms. These findings showed risky behavior among the participants, and shows that the level of awareness about the risk of contracting STIs is still poor.

CONCLUSIONS

Irrespective of facilities with youth-friendly services, out-of-school-youth still display poor perceptions about sexually transmitted infections services due to health care providers' attitudes, limited resources, and working hours. Furthermore, the level of awareness regarding sexually transmitted infections is poor, hence the display of risky sexual behaviors.

Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students

OBJECTIVES

The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use.

METHODS

A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university.

RESULTS

Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents.

CONCLUSIONS

Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.

Digital Health Screening in People With HIV in Uganda to Increase Alcohol Use Reporting: Qualitative Study on the Development and Testing of the Self-administered Digital Screener for Health

Background

Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting.

Objective

This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy.

Methods

We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy.

Results

A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener.

Conclusions

We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions.

Low condom use at the last sexual intercourse among university students in sub-Saharan Africa: Evidence from a systematic review and meta-analysis

Background

There is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA.

Methods

In this systematic review and meta-analysis, two reviewers independently searched electronic databases and grey literature for eligible studies published until July 30, 2020, extracted data, and assessed the risk of bias in the included studies. We used the Dersimonian-Liard random-effects model to pool the proportion of condom use at the LSI and the association between condom use at the LSI with sex, age, and condom negotiation efficacy, reported using risk ratio (RR). We assessed publication bias using funnel plot and Egger’s test, and explored sources of heterogeneity using sub-group and meta-regression analyses.

Results

We meta-analyzed 44 studies with a combined sample size of 27,948 participants.Of 14,778 sexually active participants, 8,744 (pooled proportion, 52.9%; 95% CI, 45.0–60.7; 95% prediction interval, 2.8–98.9; I-squared = 99.0%, p< 0.0001) reported condom use at the LSI and the proportion of condom use at the LSI remained stagnant between 2000 and 2019 (p = 0.512). Condom use at the LSI was not associated with being a female compared to a male (pooled RR, 1.08; 95% CI, 0.68–1.71), being of a younger age (≤24 years old) compared to older age (25 years and more) (pooled RR, 1.16; 95% CI, 0-85-1.57), and having a higher condom negotiation efficacy compared to a lower condom negotiation efficacy (pooled RR, 1.54; 95% CI, 0-81-2.94).

Conclusions

We found a low and heterogenous use of a condom at the LSI among university students in SSA which was not associated with sex, age, or condom negotiation efficacy. Accordingly, context-relevant interventions are needed to improve condom use at the LSI among university students in SSA.

Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

Explaining utilization of HIV prevention and testing services among university students in Mozambique: results from a mixed methods study

BACKGROUND

In Mozambique, HIV infection disproportionately affects young adults, particularly women. Despite awareness and knowledge of HIV transmission, many university students have not received HIV testing and continue to engage in high-risk sexual behaviors, including inconsistent condom use. Further understanding of patterns of engagement with HIV prevention and testing is key to reducing HIV transmission in this at-risk population.

METHODS

This study used a sequential mixed methods approach to examine patterns of engagement and perceptions of HIV prevention and testing services among higher education students in Mozambique. Survey data were collected from a representative sample of 501 students from Universidade Eduardo Mondlane (UEM) in Maputo, Mozambique to assess the primary outcomes of 1) HIV testing within the last 12 months; and 2) condom use during last sexual encounter. We employed univariate and multivariate regression models. The survey was followed by qualitative interviews with 70 survey participants which were analyzed using an inductive, content-focused analysis to further explain and contextualize survey findings.

RESULTS

Over 85% of students reported to be sexually active, among these 74% reported condom use during their last sexual encounter, and 64.2% reported an HIV test within the past 12 months. Females were more likely to have had HIV testing in the past 12 months in comparison to their male peers (aOR 1.82, 95% CI 1.11, 2.99), but were half as likely to have used a condom with their last sexual encounter (aOR 0.52, 95% CI 0.33, 0.83), when controlling for other factors. Qualitative data suggests that these discrepancies may be explained by differential perceptions in risk and trust/mistrust, with women being more concerned about infidelity by their male partner(s) and assuming more responsibility for knowing their own serostatus. Women were also subject to negative stereotypes for possessing condoms in comparison to men, which could explain lower propensity for use.

CONCLUSION

Given gendered differences in uptake of condom use and HIV testing, and perceived HIV risk, interventions tailored specifically to male and female students may impact engagement with HIV prevention and testing and empower informed choices about sexual behaviors.

Factors Associated with Condom Use Self-Efficacy Among Preparatory School Students in Sodo Town, Southern Ethiopia 2020: A Cross-Sectional Study

BACKGROUND

Condoms are playing a central role in the prevention of sexually transmitted infections, human immune virus, and unintended pregnancy particularly among young peoples. Therefore, this study aimed to assess factors associated with condom use self-efficacy among preparatory school youths in Sodo town, Ethiopia.

METHODS

This institution-based cross-sectional study was conducted among 424 study participants from January 25 to February 20, 2020. Data were collected using a validated pretested structured questionnaire. Descriptive analysis was done and results were presented in texts and tables. Those variables at bivariate analysis with p-value <0.2 at 95% confidence level were moved to a multivariate logistic regression model to control potential confounding variables. Odds ratio with 95% confidence interval was computed to ascertain association during multivariate analysis model. Statistical tests at P-value <0.05 were considered as cutoff point to determine statistical significance.

RESULTS

Out of a total of 424 youths, only 416 had participated in the study yielding a response rate of 98.1%. The prevalence of higher self-efficacy among respondents was 70%. Factors that were independently associated with condom use self-efficacy in multivariate analysis were having sexual experience (AOR=2.047,95% CI:1.141-3.675), having life goals (AOR=1.736, 95% CI: 1.021-2.951), having social support (AOR=2.395,95% CI:1.501-5.458), and having good knowledge about condoms (AOR=2.535,95% CI:1.499-4.282).

CONCLUSION

The finding of this study showed that participants who had sexual experience, social support, knowledge of the human immune virus, and having life goals were found to be significantly associated with condom use self-efficacy. These results suggest ways to increase self-efficacy for condom use among youth that can increase the effectiveness of future interventions for youth.

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa

Background

Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships.

Objectives

The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa.

Methods

Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal.

Result

Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors.

Conclusion

Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.

Factors associated with consistent condom use: a cross-sectional survey of two Nigerian universities

Background

Consistent condom use is central to the prevention of transmission of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), especially among young adults. This study drew from a cross-sectional survey of two Nigerian universities to determine the level of consistent condom use, explored the determinants of condom use consistency and reasons for inconsistent condom use.

Methods

We adopted a descriptive cross-sectional design, which involves the recruitment of 800 male and female students using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the factors associated with consistent condom use among a final sample of 498 students who engaged in sex in the last year preceding the study.

Results

Only 38.6% of sexually active participants (n = 498) used condoms consistently in the previous year. High condom self-efficacy score (AOR: 2.40; 95% CI: 1.58–3.64), discussion of HIV/STIs with sexual partner (AOR: 1.91; 95%CI: 1.29–2.83), knowing partner’s HIV status (AOR: 1.48; 95% CI: 1.02–2.16), being students of university located in a high HIV prevalence area (AOR: 2.86; 95% CI: 1.92–4.28) and engaging in sex with only steady partner (AOR: 1.74; 95% CI: 1.17–2.60) were associated with a higher odds of consistent condom use. Trust, unavailability of condoms, dislike of condoms and a perception that condoms reduced sexual pleasure were the main reasons for inconsistent use of condoms.

Conclusion

The study found a low level of consistent condom use among study participants. Counselling young adults in Nigeria on condom self-efficacy, providing condoms on campuses and encouraging the discussion of sexually transmitted infections with sexual partners are central to improving the level of consistent condom use among Nigerian university students.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7543-1) contains supplementary material, which is available to authorized users.

Contraceptive discontinuation: frequency and associated factors among undergraduate women in Brazil

BACKGROUND

In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months.

METHODS

This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models.

RESULTS

Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1-1.8]) and male condom discontinuation (OR = 1.3 [1.0-1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1-1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom.

CONCLUSION

Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.

Transactional Sex and HIV Risk among Adolescent School Girls in Ethiopia: Mixed Method Study

Background

Young people in Sub-Saharan Africa are affected by HIV pandemic to a greater extent than elsewhere. Transactional sex among adolescent school girls with older men commonly called "sugar daddies" is one of the major factors fueling the spread of the infection due to the extended sexual network. Thus, this study aimed to assess the magnitude and factors associated with transactional sex among adolescent girls and "sugar daddies" in relation to HIV/AIDS.

Methods

Mixed method cross-sectional study was done among 620 female students in Hawassa town, South Ethiopia, from September 2010 to May 2011. A structured questionnaire and in-depth interview check list were used to collect the quantitative and qualitative data, respectively. Survey participants were selected randomly from five preparatory schools whereas ten in-depth interview participants were recruited by a snowball sampling technique from the same schools. Data were entered using Epi-Info and analyzed by SPSS. A descriptive statistics followed by multivariable logistic regression analyses were conducted to identify factors associated with transactional sex with "sugar daddy". Both crude and adjusted odds ratios with 95% confidence interval were reported. We used OpenCode software for coding and categorizing the in-depth interviews and quotes that represent the informants opinion were used to support the quantitative findings.

Results

A substantial number of female students, 71(11.5%), reported to have had transactional sex with older men. Most of the respondents who dated "sugar daddies" (93%) had multiple sexual partners concurrently and sequentially, and among them, only 22.7% had consistent condom use. Girls who were in older age group [OR (CI) 6.87 (3.48-13.58)], who had lost both parents [OR (CI) 2.99 (1.14-7.84)], had perceived less economic status [OR: 25.41; 95% CI: 7.80-82.76] and engaged in substance abuse [OR (CO) 5.8 (2.1-15.77)] had higher odds of practicing transactional sex with "sugar daddies". In-depth interviewed participants also revealed that they were involved in transactional sex for monetary while having concurrent and subsequent sexual network with their schoolmates and other young partners.

Conclusion

Transactional sex among female students was high, and the sexual network they had with the young men put young people in the network at risk of HIV and other sexually transmitted infections. Therefore, HIV prevention programs shall focus on transactional sex among adolescent school girls to halt transmission of HIV among the generation.

Association between condom use and perspectives on contraceptive responsibility in different sexual relationships among sexually active college students in China: A cross-sectional study

China has increasing incidence of unplanned pregnancies among college students these years. Increasing students' sense of responsibility to protect sexual partners may help reduce the rate of unplanned pregnancies.A self-administered questionnaire was distributed to students from 3 colleges in Sichuan, China. Among them, 559 of male students and 267 of female students were included in this study. The questionnaire collected participants' characteristics, usage of condom, and investigated male and female students' perceptions of who should be responsible for contraception use.We found that relationship status was closely related to students perceiving responsibility for reproductive health and condom using. Male students who were in casual relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other male students (P < .001). Female students who were in steady relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other female students (P = .007). The multivariate analysis revealed condom use was associated with greater odds of sharing responsibility for contraceptive use in different types of sexual relationships.Improving students' attitudes toward responsibility for contraception may increase condom use among students at risk for unplanned pregnancies. Programs providing targeted health education and services may help reduce the rate of unplanned pregnancies among students in China.

Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior

BACKGROUND

In most Sub-Saharan African countries, little is known about young adolescents' sexual and reproductive health (SRH). Though some efforts have been made to understand and improve SRH of older adolescents, very young adolescents (VYAs) are often overlooked, and little is known about their sexual knowledge and behaviors. The goal of this study was to describe SRH knowledge, information-seeking, and sexual behavior of VYAs in Uganda.

METHODS

A cross-sectional survey was administered in 33 primary schools in June and July of 2016. Trained interviewers administered surveys to adolescents ages 10-14 regarding SRH knowledge, information-seeking, sexual behavior, and relevant covariates. Continuous variables were summarized as means (SD) or medians (IQR) whereas categorical variables were summarized as proportions (percentages).

RESULTS

A total of 1096 adolescents were included in this analysis, 81.8% of which were from rural areas, with a median age of 12. Regarding sexually transmitted infections (STIs) knowledge; 95% knew HIV while 37% knew other STIs apart from HIV. Although 47% knew at least one way in which HIV is acquired only 8% knew at least four ways. Regarding contraceptive knowledge, 56% mentioned at least one modern method of preventing pregnancy (condoms, pills, intrauterine devices, implants, or injections). The majority (85%) of VYAs reported accessing SRH information in the media with 35% reporting accessing media with sexual content while 10% vs 22% consulted their father or mother respectively and 31% a school source. At least 7.6% of VYAs had ever had sexual intercourse, 90% of which were not using any protection.

CONCLUSION

Comprehensive SRH knowledge was low among VYAs in this study. Media remains an important source of information for SRH for this age group though it may be misused as some adolescents reported accessing sexual content that may be inappropriate. A large proportion of sexually active VYAs reported sexual risky behaviors. This study highlights the need for an accurate and more comprehensive SRH education approach for VYAs in Uganda at an opportune age before the majority engage in sexual behavior.

Inconsistent Condom Use Among Male University Students in Northern Thailand

University students are at increased risk of HIV infection, but little is known about the determinants of inconsistent condom use among them. The study aims to assess the association of sociodemographic, individual, dyadic, and social factors with inconsistent condom use among male university students. Of 1091 participants, 67.0% had sexual intercourse, though 64.4% had inconsistent condom use. It was found that "did not use a condom at first sexual intercourse" (adjusted odds ratio [AOR] 6.1; CI, 3.7-10.1), "history of STIs" (AOR, 2.1; CI, 1.0-4.2), low "self-efficacy" (AOR, 2.4; CI, 1.3-4.7), "perception that condom use reduces pleasure" (AOR, 1.4; CI, 1.0-2.1), and "high subjective norm" (AOR, 1.9; CI, 1.3-2.8) were associated with increased odds of inconsistent condom use. Condom use should be promoted from the onset of sexual activity to establish a habit of safe sex practices and for improvement in self-efficacy of condom use. Emphasis must be laid on pleasure-enhancing benefits of condom use and changing social norms.