Peer pressure, alcohol consumption, watching pornographic materials, early sexual initiation, multiple sexual partnerships, inconsistence use of condoms, chewing ‘khat’ and substance use, depression, poor living arrangement, educational status of parents, family connectedness, having sex with CSWs, and poor knowledge towards HIV/AIDS are the major predictors of risky sexual behaviors among youths (Tadesse and Yakob, 2015; Alamrew et al., 2013;

Mariam et al., 2018; Nigatu et al., 2018; Fentahun and Mamo, 2014; Abebe et al., 2013; Manee and Aria, 2018; Mullu et al., 2016). Alternatively, interpersonal processes like succumbing to peer-norms, intergenerational gaps regarding beliefs about sexual behavior, the socio-economic context of students, and the interplay between desiring love. Also, included are material gain, power, and social status, HIV/AIDS messaging and programs, and the gendered nature of sex information played a great role in sexual risk-taking and exposure to risky sexual behaviors (Ndumiso et al., 2016).

Very few studies have assessed youth and particularly preparatory school student’s risky sexual behavior.  Most of these studies were conducted in major towns and used different categories of population. Therefore, the main aim of this study was to assess risky sexual behaviors and associated factors in Arba Minch town, Southern Ethiopia.

 

Study setting and period

This study was conducted using preparatory schools students of Arba Minch town from 20th April to 2nd June, 2018. Arba Minch town is the administrative and trading center of the Gamo Gofa Zone, located at 505 km from Addis Ababa the capital city of Ethiopia and 275 km southwest of Hawassa, the regional town of South Nations Nationalities and Peoples Republic. The topography of the land is characterized by undulating feature that favors for the existence of different climatic zones. The general elevation of the zone ranges from 680 to 4207 m above sea level. Mount Gughe, the highest mountain peak in the zone as well as in the SNNPR stretches 4207 m above sea level. The climate here is tropical. In winter, there is less rainfall in Arba Minch than in summer. The climate here is classified as Aw by the Köppen-Geiger system (Figure 1). According to the 2007 Census conducted by the Central Statistical Authority (CSA), the town has a total population of 74,879, of whom 39,208 are men and 35,671 women. The annual  population  growth  rate  is  found to be 4.8% with 15 years doubling time and the population density of the town is 13 people per hectare.

 

 

Study design

An institution-based cross-sectional study design was used to address the objectives.

Study population and sample collection

All preparatory school students (grades 11 and 12) of Arba Minch town were the source population and those selected were study population for this study. Those students who were attending class during data collection period were included; whereas those who were seriously ill and unable to respond were excluded from this study. The sample size for this study was calculated using Epi info7 software Stat Cal. Sample size for each objective was determined separately. For the first objective (to determine the status of risky sexual behaviors), single population proportion and identify associated factors with two sample comparison proportion was used. The sample size used for this study was 495, after adding 10% to the larger sample size from two objectives. The calculated sample size of this study was proportionally allocated to each preparatory school based on the number of students in each school. Then, separate sampling frame (student list from director’s office) was used to select the study participants from each grade (grades 11 and 12) as well as each section. Finally, study participants for this study were selected using a systematic random sampling method.

Data collection methods

A structured pretested self-administered questionnaire, adapted and modified from other similar studies was used to collect data. The tool had four main parts: socio-demographic, sexual and reproductive history, substance abuse and knowledge about HIV/AIDS. Four BSc holder nurses who are fluent in the local language, after taking informed consent, collected the data. Two MSc holder nurses supervised them. A three-day extensive training regarding the objectives of the study, ethical issues on research and data collection procedures was given for both data collectors as well as supervisors.

Measurements

Respondents have risky sexual behaviors if they had at least one of the following: multiple sexual partners; early sexual start, before the age of 18; inconsistent use of condom (incorrect use of condom or failure to use condom at least once during sexual intercourse); and sexual intercourse with commercial sex workers (Tadesse and Yakob, 2015; Alamrew et al., 2013; Mullu et al., 2016). Respondents, who mentioned three or more transmission and prevention ways of HIV/AIDS in addition to the other HIV/AIDS related questions correctly, were categorized to have good knowledge; while those who mentioned below were classified as having poor knowledge towards HIV/AIDS.

Data quality control

The questionnaires were first drafted in English then  translated  to the local language “Amharic” by a languages expert and finally before data entry again re-translated back to English in order to ensure consistency and quality. Questionnaires were pre-tested in an area with similar characteristics and possible modifications and amendments were done before actual data collection. Data were checked for completeness, accuracy, clarity and consistency at spot by data collections, after data collection by supervisors and before entry into software by principal investigator. Proper coding and categorization of data were maintained for the quality of the data to be analyzed. Double data entry was done for its validity and compared to the original data (data entered by the other data clerk).

Data processing, management and analysis

The data were coded and entered into Epi data version 3.1 in order to maintain logical errors and skipping patterns. Then, the data were exported to SPSS window version 22 for cleaning, editing and analysis. A descriptive analysis was done by computing proportions and summary statistics. The information was presented using simple frequencies, summary measures, tables and figures. Bi-variate s and multivariate analysis was done to see the association between each independent variable and the outcome variable using binary logistic regression. The goodness of fit was tested by Hosmer-Lemeshow statistic and Omnibus tests. All variables with P<0.2 in the bivariate analysis were included in the final model of multivariate analysis in order to control all possible confounders. In addition, variables that were significant in previous studies and from context point of view included in the final model even if the aforementioned criteria was not followed. During multivariate analysis, backward logistic regression was used. Multi co-linearity test was carried out to see the correlation between independent variables using standard error and collinearity statistics. The direction and strength of statistical association was measured by odds ratio with 95% CI. Adjusted odds ratio along with 95% CI was estimated to identify associated factors for risky sexual behaviors. In this study, P-value < 0.05 was considered to declare a result as statistically significant association.

Ethical considerations

Ethical clearance was obtained from Arba Minch University, College of Medicine and Health Sciences, Institutional Ethical Review Committee (AMU-IERC). All the study participants were informed about the purpose of the study, their right to refuse and the signed voluntary consent was obtained from all study participants prior to offering the data collection instruments. The respondents were also been told that the information obtained from them was treated with complete confidentiality and will not inflict any harm on them.

 

 

Socio-demographic characteristics of study participants

Of the total questionnaire, 465 participants responded with a response rate of 93.9%. From the total respondents, 255 (54.8%) were male. Regarding marital status,  421 (90.5%)  were  single, while 44 were married (9.5%). The mean age of study participants was 17.92 (±1.34SD). Protestant religion followers constituted 306 (65.8%), 413 (88.8%) lived with family and 412 (88.6%) had participated in religious education. Table 1 shows the other socio-demographic characteristics.

 

 

Sexual and reproductive history of respondents

Out of the total respondents, 122 (26.2%) had sexual intercourses and 52 (42.6%) started sex for personal desire. Ninety-four (77%) of the respondents started sex before the age of 18 years, with mean age of 16.18±1.81. Ninety-three (76.2%) had first sex with their partners. From those who had sexual intercourses, 11 (9%) had sex with CSWs. Seventy two (59%) had 1 sexual partner in their lifetime and 74 (66.7%) had sex within 12 months prior to study period. Those who watched pornographic movies made up 213 (45.8%). One hundred forty seven (31.6%) had discussed about sexual intercourse with a family member, relatives and friends (Table 2).

 

 

Of the respondents who had sexual intercourse, 93 (76.2%) had used condom in lifetime and 91(82%) used condom for the sexual intercourse within 12 months prior to study period. From those who sometimes used, 45 (49.4%), 4 (4.4%) and 42 (46.2%) used often, constantly and consistently, respectively. Forty-three (62.3%) stated that using a condom decreases satisfaction (Figure 2).

 

 

Regarding family planning, 77 (16.6%) used any type of method for family planning, while 67 (87%) used condom (Figure 3). Overall, in this study, 22.4% (95% CI: 18.6, 26.2) study participants had risky sexual behaviors (Figure 4). One hundred fifty one (32.5%) had drinking alcohol (Table 3).

 

 

 

Knowledge about HIV/AIDS among respondents

All the study participants displayed basic knowledge about HIV/AIDS, transmission and prevention ways. As regards to testing knowledge of transmission, 447 (96.1%) stated unprotected sexual intercourse and 397 (85.4%) stated needles. Thirty three (7.1%) of the study participants had reported that HIV/AIDS is curable and 253 (54.4%) thought that healthy looking individuals may have HIV. Overall, 142 (30.5%) respondents had poor knowledge about HIV/AIDS (Table 4).

 

 

Factors associated with risky sexual behaviors among study participants

After controlling  for  possible  cofounders    in   the multivariate model marital status, educational and occupational status of father, occupation of the mother, watching pornographic movies, drinking alcohol, using hashish/shisha and knowledge about HIV/AIDS were significantly associated with risky sexual behaviors. However, sex, age, grade level, educational status of mother, living with family, participation in religious education, chewing chat and smoking cigarette were not.

Married respondents were 3.28 times more likely and students with fathers with a low educational status as compared to others were 5.96 times more likely to be engaged in risky sexual behaviors (AOR=3.28, 95%CI: 1.24, 8.70) and (AOR=5.96, 95%CI: 1.35, 26.25), respectively. Students with fathers who were employed in government were 67% more likely, and those whose mother’s occupational were merchants as compared to others were 78% less likely to be engaged in risky sexual behaviors. The odds of engaging in risky sexual behaviors were 8.8 among respondents who watch pornographic movies (AOR=8.80, 95%CI: 4.04, 19.17) and 2.71 among respondents consuming alcohol (AOR=2.71, 95%CI: 1.35, 5.46). Study participants who had used hashish/shisha were 14.88 times more likely to practice risky sexual behaviors. Additionally, those who had poor knowledge about HIV/AIDS were 2.89 times more likely to practice risky sexual behaviors (AOR=14.88, 95%CI: 4.52, 48.96) and (AOR=2.89, 95%CI: 1.42, 5.88), respectively (Table 5).

 

 

 

 

 

 

 

Sex, current age of participants, grade level, live with family and participation in religious education were not significantly associated with risky sexual behaviors. This was congruent with studies conducted in Ethiopia (Negeri, 2014; Mariam et al., 2018; Mullu et al., 2016; Ali, 2017). However, it contradicts studies conducted in three Asian countries (Hanoi, Shanghai, and Taipei), Nigeria, Bahamas, Cambodia and else were in Ethiopia (Nigatu et al., 2018; Dadi and Teklu, 2014; Kahsay et al., 2017; Ifeadike et al., 2018; Wang et al., 2015). Maternal educational status was not a significant contributing factor to student’s risky sexual behaviors. This agreed with studies done in Cambodia and Ethiopia (Derbie et al., 2016). In addition, chewing chat and smoking cigarettes were not significant after controlling for confounders in this study.

 

This finding noted that significant numbers of students were engaged in risky sexual behaviours. Those students had multiple sexual partners, inconsistent use of condoms, sex with risky individuals and an early sexual start (by ages 13 to 14). Marital status, educational and occupational status of father’s, occupational status of mother’s, watching pornographic movies, drinking alcohol  and  using  shisha/hashish  and poor knowledge about HIV/AIDS were associated factors for risky sexual behaviours in this study. Awareness creation for youths to reduce substance abuse, HIV/AIDS and sexual and reproductive health within the school system should be promoted. Further research should identify other contextually specific factors that contribute to risky sexual behaviours in youth, and develop and tailor programs accordingly.

 

The authors’ unreserved thanks go to Arba Minch University, College of Medicine and Health Sciences for financial assistance. They would like to forward their deepest appreciation and thanks to Zonal Educational Office of Gamo Gofa and schools’ director, data collectors and study participants. Also, they would like to appreciate all who supported directly or indirectly. Arba Minch University, College of Medicine and Health and Sciences funded the research for the data collection and stationary materials.

 

The authors have not declared any conflict of interests.