Predictors of Risky Sexual Behavior among Adolescents in Tanzania

Studies on sexual behavior among adolescents are fundamental in understanding and fighting against outcomes of unprotected sex that include unplanned/unwanted pregnancies and sexually transmitted diseases. This survey conducted among in- and out-of-schools adolescents measured prevalence of sexual behavior variables, including risky sexual behavior and associated factors. Risky sexual behavior was defined as having first sex before 16 years, inconsistent condom use and having multiple sexual partners. About 30% of adolescents reported being sexually active; a higher proportion being among males than females and 24.5% of sexually active adolescents reported having multiple sexual partners. More males (37%) reported having multiple sexual partners than females (26%). Nearly 48% of unmarried sexually active adolescents reported having used a condom during the most recent sexual intercourse. Predictors of risky sexual behavior were being male, young age (10–14 years) and being inschool. Preventive information and education should take into consideration these factors.     

From Coitus to Concurrency: Sexual Partnership Characteristics and Risk Behaviors of 15–19 Year Old Men Recruited from Urban Venues in Tanzania

Understanding the uptake and patterns of sexual partnerships of adolescent males reveals their risky behaviors that could persist into adulthood. Using venue-based sampling, we surveyed 671 male youth ages 15–19 from an urban Tanzanian neighborhood about their sexual partnerships during the past 6 months. The proportion of males who had ever had sex increased with age (21 % at age 15; 70 % at age 17; 94 % at age 19), as did the proportion who engaged in concurrency (5 % at age 15; 28 % at age 17; 44 % at age 19). Attendance at ≥2 social venues per day and meeting a sexual partner at a venue was associated with concurrency. Concurrency was associated with alcohol consumption before sex among 18–19 year olds and with not being in school among 15–17 year olds. We find that concurrency becomes normative over male adolescence. Venue-based sampling may reach youth vulnerable to developing risky sexual partnership patterns.     

HIV Risk Among Patients Attending Sexually Transmitted Disease Clinics in China

HIV and other sexually transmitted diseases (STDs) are spreading rapidly in China. However, little is known about HIV risk among STD patients. In October–November 1997, we recruited a consecutive sample of 1,371 STD clinic patients from 16 different provinces and municipalities across the country and examined their sexual practices and condom use. We found that the median age for sexual initiation was 22 years for men and 21 years for women, and only a small proportion of men (12%) and women (15%) had used a condom during this first sexual intercourse. Eighty-one percent of men and 53% of women had two or more sexual partners in the past year. During the same period, 78% of men and 44% of women had both steady and nonsteady partners; of those with both types of partners, only 1% of men and 7% of women always used a condom with these partners. Multiple sexual partnerships in the past year were more common among men, older men (over 35 years), and those who had initiated sex at an earlier age. More frequent condom use was associated with being younger, having nonsteady partners, and having used a condom during a first sexual encounter. Our findings underline a need for patient education and condom promotion among STD clinic patients as a part of efforts to prevent the spread of HIV in China.     

Determinants of age at sexual debut and associated risks among South African youths

The research uses data from a representative national survey to explore the determinants of age at sexual debut among South African youths in the age group 15–24 years. A random sample of 5 708 youths were interviewed and 92% responded to questions on whether or not they had ever had sex and their age at first sex for those who had. The research used survival analyses techniques to combine ‘current status data’ and ‘recall data’ for respondents who reported ever having had sex. The females were more likely than the males to report ever having had sex (p≤0.001). The median age at sexual debut was 18 years for both males and females. The hazard ratio pertaining to early sexual debut was 0.81-times less for those in the age group 15–19 as compared to those in the age group 20–24 (p≤0.001). Age, race, geographical location, and level of education were found to be important determinants of age at sexual debut. The ‘hazards of sexual debut’ (θ=0.112; p≤0.001) varied significantly between geographical areas (rural or urban). Youths with an earlier age of sexual debut were less likely to have used condoms, a behaviour which increases their risk of HIV infection. HIV prevalence was consistently higher among the females than among the males. We recommend that HIV-prevention interventions target community sets rather than only individuals at higher risk of exposure to HIV.     

Sexual Risk Behavior in Urban Populations of Northeastern Africa

Three representative 2-stage cluster sample surveys on sexual risk behavior and its correlates were conducted in Djibouti City and selected urban sites in Ethiopia and Sudan during 1994–95. The analysis in this paper is based on data collected from adults aged 15–49 on topics concerning marriage and regular partnerships (i.e., lasting 12+ months), nonregular sexual partnerships in the preceding 12 months, condom use, and related topics. In Djibouti City and urban sites in Ethiopia, about 10% of males reported 1 or more nonregular partnerships in the last 12 months, compared with 3% in Sudan. Between 20 and 30% of most recent nonregular contacts involved payment of money. Men with no schooling are less likely to report nonregular partnerships than other men in all 3 populations. Less than 5% of females in all 3 populations reported a nonregular partner in the preceding 12 months, but in all settings, the level is higher in divorced, separated, and widowed women. Condom use during the most recent sex act with nonregular partner ranges from 70% in Djibouti to 50% in Ethiopia and 20% in Sudan. In Sudan, the survey results suggest that the risks of rapid spread of HIV/STDs in the general population are low in Khartoum and the town of El Fashir but much higher in El Gadaif, where there is a large refugee population. In Djibouti and urban Ethiopia, risks are more generalized. Because of the lengthening interval between sexual debut and marriage, single males emerge as a priority group and further efforts are badly needed to promote condom use among the less educated.     

Incidence and Prevalence of Type 1 Diabetes in Children and Adolescents in Benghazi,Libya

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981–1990. Results showed an annual incidence (per 100 000) of 7.0 (6.0–8.2) (males 6.3(5.0–7.9) females 7.8(6.3–9.7)) in 0–14 year olds and 8.8(7.8–10.0) (males 8.3(6.9–10.0), females 9.2(7.7–11.0)) in 0–19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15–19 years. Annual variations were significant in the 0–14 years age group (p < 0.001) and non-significant in the 0–19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100 000) were 23.5 (17.1–31.5) (males 21.2(13.1–32.3), females 25.9(16.8–38.3)) in 0–14 year olds and 36.2(29.1–45.1) (males 31.4(22.2–43.2), females 41.0(30.2–54.5)) in 0–19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5–45.5) (males 40.7(30.8–53.3), females 33.8 (24.6–45.3)) in 0–14 year olds and 59.5(51.6–58.5) (males 60.3(49.3–73.6), females 58.6 (47.7–72.1)) in 0–19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001). Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.     

Cardiovascular disease risk factors related to sexual maturation: The Oslo youth study

This paper focuses on cardiovascular disease risk factors as they are influenced by sexual maturation. Serum total cholesterol, HDL-cholesterol, fasting triglycerides, blood pressure, height, weight and triceps skinfold thickness were investigated longitudinally in a population of 550 Norwegian adolescents aged 10–14 years at the onset. Two identical surveys were conducted, the first in 1979 and the last in 1981. Included in the study was a measure of developmental age, assessed by using sex maturity ratings formalized by Tanner. The physiological endpoints (except triglycerides) were more strongly related to developmental age than to age in years. Among 11 and 12 year old males, values not adjusted for sexual maturation stage underestimated height, weight and blood pressure and overestimated skinfold thickness, total cholesterol and HDL-cholesterol. In 15 and 16 year old males, unadjusted values overestimated height, weight and blood pressure, and underestimated total and HDL cholesterol. For females, unadjusted Values underestimated height, weight, body mass index, triceps skinfold thickness and blood pressure among 11–12 year olds and overestimated the same variables for 15 and 16 year olds. These findings indicate that for adolescents, an index of physiological development more precise than chronological age should be included in epidemiological studies.     

AIDS-related knowledge and sexual behaviour among married and previously married persons in rural central Mozambique

HIV prevalence in central Mozambique is the highest in the country with high urban rates impacting on the rural areas. To identify potential factors influencing the spread of HIV in three sparsely populated districts in southern Sofala province, 847 married and previously married persons were surveyed for their knowledge, practices and beliefs regarding HIV/AIDS and STIs. 21.9% and 6.5% of males and females, respectively, were engaged in casual sexual partnerships in the past year. Being male, married, educated, and having genital discharge and ulcers in the last year were significantly associated with risky sexual activity. Risky behaviour was significantly associated with being Catholic or Protestant when compared with those from Zionist churches. Knowledge of ABC prevention strategies and condom usage was significantly associated with being male, married, having an STI in the past year, and being educated, particularly at the secondary level (Grade 8+). Attitudes and behaviour were influenced by cultural and religious involvement, as well as sex and marital status. It is imperative that prevention strategies take into account the cultural, economic and religious conditions present in rural African settings to create HIV prevention programmes that are culturally relevant and acceptable to the participants.     

Randomized controlled trial to investigate impact of site-based safer sex programmes in Kingston, Jamaica: trial design, methods and baseline findings

Objective To describe the design, methods and baseline findings of a multi‐level prevention intervention to increase consistent condom use among persons at public social sites in Kingston, Jamaica, who have new or concurrent sexual partnerships. Methods A two‐arm randomized controlled trial (RCT) of 147 sites where persons meet new sex partners. Sites were identified by community informants as places where people meet new sexual partners, which include bars, street locations, bus stops, malls and others. Sites were sorted into 50 clusters based on geographic proximity and type of site and randomized to receive a multi‐level site‐based intervention or not. Intervention components include on‐site HIV testing, condom promotion and peer education. Effectiveness of the intervention will be measured by comparing the proportion of persons with new or multiple partners in the past year who report recent inconsistent condom use at intervention vs. control sites. Results Baseline surveys were conducted at 66 intervention (711 men, 845 women) and 65 control sites (654 men, 738 women). Characteristics of intervention and control sites as well as the characteristics of patrons at these sites were similar. The outcome variable was balanced with approximately 30% of men and 25% of women at intervention and control sites reporting a new partner or more than one partner in the past year and recent inconsistent condom use. Conclusions The baseline findings confirm that the population is an appropriate target group for HIV prevention and that randomization will provide the means to estimate programme effectiveness.     

Individual- and Family-Level Psychosocial Correlates of HIV Risk Behavior Among Youth in Rural Kenya

Associations between individual- and family-level psychosocial factors and sexual behavior were examined among 325 adolescents ages 10–18 in rural Kenya. History of sexual activity was reported by 51% of males and 30% of females. Among those reporting sex within the past year, 64% of males and 32% of females had multiple partners; 85% of males and 54% of females reported not using a condom at last sex. Multivariate logistic regression modeling demonstrated sexually active adolescents were significantly more likely to be older, male, more accepting of risky behavior, and have greater perceived HIV risk, caregiver social support, social support related to HIV, and emotional problems. Youths reporting high-risk behavior (unprotected sex or multiple partners) were significantly more likely to be younger, male, and have lower sex-related self-efficacy, lower caregiver monitoring, and more externalizing problems. Future studies should evaluate HIV prevention interventions targeting improvements in mental health and family relationships.     

Sexual transmissibility of HIV among opiate users with concurrent sexual partnerships: an egocentric network study in Yunnan, China

Aims To investigate the patterns of concurrent sexual partnerships among young opiate users and sexual transmissibility of human immunodeficiency virus (HIV) in concurrent sexual partnerships in drug‐use and sexual networks. Design Cross‐sectional design. Participants A total of 426 young opiate users in Yunnan, China. Setting Young opiate users recruited from their network ties. Measurement Respondent‐driven sampling (RDS) was used to recruit participants. Multiple logistic regressions were performed to analyze the relationships of concurrent sexual partnerships with egocentric social network components, risky sexual behavior for HIV and drug‐use practices. Findings The RDS‐adjusted prevalence of concurrent sexual partners was 42.9% among opiate users. Opiate users with concurrent sexual partnerships were more likely to engage in risky HIV‐related sexual behavior, compared to those without. Specifically, they were more likely to report having had four or more sexual partners (26.3% versus 2.0%), having had a spouse or boy/girlfriends who also had concurrent sexual partnerships (28.1% versus 8.2%), having exchanged drug for sex (12.4% versus 3.8%), having had sexual partners who were non‐injection drug users (22.6% versus 10.1%), having had sexual partners who were injection drug users (25.3% versus 13.5%) and having used club drugs (26.3% versus 13.5%). There were no significant differences in consistent condom use between opiate users with sexual concurrency and those without. The same proportion (25.8%) of opiate users in the two groups reported having consistently used condoms when having sex with regular partners, and 46.3% of opiate users with sexual concurrency and 36.4% of those without such concurrency consistently used condoms with non‐regular partners. Conclusion The expansion of the human immunodeficiency virus epidemic from high‐risk populations to the general population in China may be driven by concurrent sexual partnerships. Behavioral interventions targeting safer sex should be integrated into harm reduction programmes.     

Effect of consistent condom use on 6‐month prevalence of bacterial vaginosis varies by baseline BV status

Objectives Bacterial vaginosis (BV) is a condition characterized by a disturbed vaginal ecosystem which fluctuates in response to extrinsic and intrinsic factors. BV recurrence is common. To explore whether consistent condom use was associated with BV occurrence or recurrence, we compared the effect of condom use on BV prevalence after 6 months, among women with and without BV at baseline. Methods We used data from a randomized controlled trial, conducted among female sex workers in Madagascar during 2000–2001, that assessed the impact of adding clinic‐based counselling to peer education on sexual risk behaviour and sexually transmitted infection incidence. BV was diagnosed at two time points (baseline and 6 months) according to modified Amsel criteria. Consistent condom users were women reporting no unprotected sex acts with clients in the past month or non‐paying partners in the past year. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using multivariable regression models. Results At baseline, 563 (56%) women had BV. Of those, 360 (72%) had BV at 6 months, compared to 158 (39%) without BV at baseline. The adjusted 6‐month PR for BV comparing consistent to inconsistent condom users was 0.99 (95% CI: 0.85–1.13) among women with BV at baseline and 0.57 (95% CI: 0.30–0.94) among women without BV at baseline. Conclusions Consistent condom use was associated with reduced BV prevalence at 6 months for women who were BV‐negative at baseline, but had no effect among women who were BV‐positive at baseline. Male condoms appeared to protect against BV occurrence, but not BV recurrence.     

Factors associated with HIV infection among sexually experienced adolescents in Africa: a pooled data analysis

The article examines the factors associated with HIV status among adolescents aged 15–19 years in 13 African countries: Côte d'Ivoire, Democratic Republic of Congo, Guinea, Kenya, Liberia, Mali, Malawi, Rwanda, Sierra Leone, Swaziland, Tanzania, Zambia and Zimbabwe. The data were derived from demographic and health surveys or AIDS indicator surveys conducted between 2004 and 2009. The levels of HIV prevalence among adolescents varied considerably across the countries. There was significantly higher HIV prevalence among female adolescents as compared with their male counterparts. For male adolescents, circumcision was the only variable significantly associated with HIV status. Nonetheless, the data suggest that the association between male circumcision and HIV status may be exaggerated. Indeed, regional-level random effects became insignificant once male circumcision was introduced into the estimated models, indicating a strong correlation between unmeasured regional-level factors and male circumcision. For female adolescents, multiple sexual partnerships, time elapsed since sexual debut, marital status, household wealth, and the regional prevalence of male circumcision were strongly and positively associated with HIV status. Moreover, for female adolescents there appear to be significant unmeasured variables operating at the regional level which influence the levels of HIV infection. The implications of the findings for HIV-prevention programming, policy and research are discussed.     

Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents

ABSTRACT

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N?=?267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.     

Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in León, Nicaragua: implications for HIV prevention

There are few peer-reviewed studies of HIV/AIDS-related knowledge, attitudes, beliefs and practices among adolescents in Central America. A population-based cross-sectional survey was conducted among 246 adolescents in León, Nicaragua, where there is reason for concern about a rise in HIV infections. In many respects, León adolescents were typical of those in other Latin American countries, with a mixture of correct and incorrect knowledge about transmission of HIV and sexually transmitted infections, a higher proportion of males than females reporting having had sex or using condoms, and inconsistent condom use. While some sexual attitudes conformed to the ideology of machismo, others did not, providing an opening for prevention interventions. Some dimensions of HIV/AIDS stigma were high, and most adolescents disapproved of same-sex sexual behaviour. Intervention against homosexuality-related stigma is particularly urgent because a concentrated HIV epidemic may be emerging in Nicaragua among men who have sex with men. Personal religious beliefs did not appear to pose a barrier to condom use. In a multivariate model, being out of school was a significant correlate of having had sex and of insufficient HIV/AIDS-related knowledge. Accordingly, HIV prevention interventions must reach adolescents both in and out of school. A multi-component approach to prevention is needed, including programmes based in schools, communities, the mass media and health facilities.     

Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15–24 years in Zambia: An in-depth analysis of the 2001–2002 and 2007 Zambia Demographic and Health Surveys

Abstract

HIV and AIDS still pose a major public health problem to most countries in sub-Saharan Africa, Zambia included. The objective of the paper is to determine changes in selected sexual behaviour and practice and HIV prevalence indicators between 2001–2002 and 2007. We used the Demographic and Health Survey Indicators Database for the computation of the selected indicators. We further used STATA 10.0 to compute significance tests to test for statistical difference in the indicators. The results indicate some changes in sexual behaviour, as indicated by an increase in abstinence, use of condoms and the decrease in multiple partnerships. The overall percentage of abstinence among never-married young men and women aged 15–24 years in Zambia increased significantly by 15.2% (p?=?.000) and 5.9% (p?=?.001) respectively, between 2001–2002 and 2007. A statistically significant increase of 6.6% (p =?.029) was observed in the percentage of young women who reported having used a condom during the last time they had had premarital sex. A statistically significant decrease of 11.0% (p?=?.000) and 1.4% (p?=?.000) was observed among young men and women, respectively, who reported having multiple partners in the preceding 12 months. The factorial decomposition using multivariate analysis reveals that the indicators which contributed to the statistically significant 2.6% decline in HIV prevalence among young women aged 15–24 years in Zambia include proportion reporting condom use during premarital sex (+6.6%), abstinence (+5.9%), sex before age 15 (?4.5%), premarital sex (?2.6%), sex before age 18 (?2.4%) and proportion reporting multiple partnerships (?1.4%). Remarkable strides have been achieved towards promoting responsible sexual behaviour and practice among young people in Zambia. Further research focusing on factors that predispose young women in Zambia to higher risk of infection from HIV is required. The results from this paper should be useful in the design of programmes to control the spread of HIV and AIDS, particularly among young people in Zambia and other sub-Saharan countries.     

Health care provider and self-assessment of health status and sexual behaviour in HIV-seropositive young men with haemophilia

We hypothesized that persons with HIV who perceive themselves as having waning health status may participate in fewer sexual behaviours than HIV-infected persons without HIV-related health problems. The object-ives of this study were to compare health care provider responses with participant responses for health status and for sexual activity and to examine the relationship of HIV-related health status to the sexual behaviour of HIV-seropositive adolescents and young men with haemophilia. A detailed questionnaire designed by researchers from 11 participating US haemophilia treatment sites and CDC personnel was administered to 306 HIV-seropositive young men with haemophilia aged 12–25 years. A health care provider from the haemophilia treatment centre also completed a questionnaire on each respondent. Self-assessment of HIV-related health status was similar to provider assessment of health status. Providers accurat-ely assessed participant sexual activity (overall Kappa = 0.62). Participation in vaginal intercourse and condom use was independent of health status. Following extensive educational efforts, most HIV-seropositive adolescents and young men with haemophilia are aware of the relationship between their HIV seropositivity and health status. Waning health status does not reduce participation in penetrative sexual behaviours or increase use of condoms. HIV prevention efforts should continue for this population.     

HIV/AIDS,poverty and risky sexual behaviour in South Africa

This paper employs data from the 1998 South African Demographic and Health Survey in exploring the nature of socio-economic inequalities in and determinants of risky sexual behaviour. Risky sexual behaviour was associated with poverty only in the case of multiple partnerships. Affluent women that have engaged in risky sexual behaviour were shown to be more likely to have cited negative perceptions about condom use as main reason for not using a condom at last sex. Poor women in turn were more likely to cite lack of knowledge about condoms and abstinence from condom use as main reason. Poverty plays little part in explaining differences in risky sexual behaviour, although higher education in some cases was associated positively with risky sexual behaviour. Risky sexual behaviour was associated with differences in age, urban residence and marital status. Coloured, Asian and White women were less likely than African women to have engaged in risky sexual behaviour. Violence and coercion were also associated with risky sexual behaviour. Women in affluent households that had engaged in risky sexual behaviour were more likely to have been mistreated by a husband or partner compared to poor women. There is no evidence of a definitive one-way causal relationship between poverty, gender and sexual behaviour and further research is required to elucidate this complex relationship.     

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15–24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.