Research Article
General Science
Public Health

Risky sexual behavior for STIs/HIV infection among ALKAN University College students in Ethiopia

Endalew Gemechu Sendo1, Worku Bedada1,

Abstract

Background: Studies in Africa and elsewhere indicate that students of higher institutions are exposed to many risky behaviors including substance use, sexual coercion and unsafe sex which predispose them to STIs including HIV/AIDS. Little has been explored about the risky behaviors in the context of private higher education institutions in Ethiopia.
Thus, the present study assessed the risky sexual practices and associated factors for STIs/HIV infection among ALKAN University College students in Ethiopia.
Methods: Institution-based cross-sectional descriptive study was conducted from February to March 2014. A stratified sampling technique was used. Participants were sampled using the random sampling strategy. The dependent variable in this study was limited to “risky sexual behavior for STIs/HIV” (it included having more than one sexual partner or performing sexual intercourse with non-regular partner without condom, and having sex with commercial sex workers). The data was analyzed by bivariate and multivariate logistic regression analysis with SPSS version 20.
Results: Among 374 respondents, 160 (42.8%) reported that they had sexual experience (male: 74% vs. females: 26%). Majority of the study participants 220 (58.8%) were in the age range of 20–24 years with mean (± SD) age of 21.4 (± 1.7) years. The mean as (± SD) reported age at first sex was 17.6 (± 2.3) years.
Students who were sexually active before joining the college were two times risk to have multiple sexual partners compared to their counter parts (AOR = 2.15, 95% CI: 1.80–12.56). Students living in rented rooms were three times more likely to ever have multiple sexual partners as compared to those who were living with their parents (AOR = 3.82, 95% CI: 1.08–11.58). Students who watched pornography were two times more likely to ever have multiple sexual partners than those who didn’t watch it (AOR = 2.17, 95% CI: 1.82–5.93). Likewise, current substance users (including khat, alcohol and drug) were two times more likely to ever have multiple sexual partners as compared to non-users (AOR = 2.02, 95% CI: 1.74–12.32). Having history of sex with CSW was another predictor for multiple sexual partners, (AOR = 2.62, CI: 1.64–7.34). However, there is no statistical association between year of study, sex, childhood residence, and consistent condom use, and having multiple sexual partners.
Conclusions: The findings of this study showed that risky sexual behavior is rampant among the respondents. Therefore, interventions targeting on unsafe substance use, consistent condom use, and apt internet usage are recommended.

Keywords STIs/HIV, risky sexual behaviors, ALKAN University Colleges, Ethiopia.

Author and Article Information

Author info
1 Addis Ababa University, College of Health Science, School of Nursing and Midwifery, Addis Ababa, Ethiopia, Ethiopia.
2 Jimma University, College of Medical Sciences and Public Health, Department of Pharmacy, Jimma, Ethiopia.

RecievedMay 9 2014 AcceptedAug 5 2014 PublishedSep 10 2014

CitationSendo EG, Bedada W (2014) Risky sexual behavior for STIs/HIV infection among ALKAN University College students in Ethiopia. Science Postprint 1(1): e00031. doi:10.14340/spp.2014.09A0002

Copyright©2014 The Authors. Science Postprint is published by General Healthcare Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

FundingWe are indebted to ALKAN University College for its financial support to undertake this study.

Competing interestThe authors declare that they have no competing interests.

Donation messageGrant African researchers as their access to research grants are very limited. The problem of African researchers is NOT lack of research potentials but lack of funds to be fully engaged in research activities.

EthicsLetter of ethical approval was received from AUC Research and Quality Assurance Office (RQA). Verbal informed consent was obtained from the study participants before they were enrolled in the study. They were given clear options regarding voluntary participation. Confidentiality of information was ensured by removing personal identifiers from the completed questionnaires.

Corresponding authorEndalew Gemechu Sendo
AddressAddis Ababa University, College of Health Science, School of Nursing and Midwifery, Addis Ababa, Ethiopia, P.O. Box 1176, Ethiopia
E-mailendalewaau2012@gmail.com

Introduction

Ethiopia has a population size of 83.4 million of which young people accounts 1/3 (34.7%) of the total population 1. According to the report of Ethiopia Demographic and Health Survey 2011, in Ethiopia there are 800,000 people living with HIV/AIDS and 1.5% of population aged 15–49 is infected with HIV.

Young people are at the heart of HIV/AIDS pandemic; globally in 2010, out of estimated 2.7 million people newly infected with the virus 41% were young people 2, 3. In Ethiopia according to antenatal care sentinel surveillance (ANC), the prevalence of HIV/AIDS among young people of age 15–24 years was 2.6% 4.

Several studies documented the presence of high risk sexual behaviors among youth in public higher education institutions in Ethiopia, which might put them at high risk of HIV infection and other sexual and reproductive health (SRH) complications. For instance, a study from Gonder University 5, 23% of university students had reported sexual contact with Commercial sex workers but only 37.1% of them used condom.

Similarly, a study conducted in Bahir Dar University reported that 69.1% of students were sexually active; of which 25.3% started sexual intercourse before the age of 18 years. This study further indicated that 27.8% of students had multiple sexual partners and 34.4% had practiced unprotected sex, and about eight percent (7.8%) of students had sex with commercial sex workers 6.

Risky sexual behavior in adolescence is a behavioral pattern that increase risk for serious adolescent health problems 7, 8. Sexually active, unmarried adolescents and youths are at high risk for STIs not only for psychological and behavioral reasons but also for biological and social reasons. Psychological factors that put many adolescents at increased risk for STIs include a general sense of invulnerability and the desire to try new sexual and substance (drug) experimentations. Also the willingness to take risks, including changing sexual partners often or having a partner who has multiple partners makes them at increased risk of encounter STIs/HIV/AIDS 9,10. College Students might be at risk because they tend to be sexually adventurous, often with multiple partners and do not consistently use condoms 11.

The majority of students in tertiary institutions are single, young adults who easily fall prey to excitement coupled with the liberal nature of campus life that predisposes them to high risk sexual behavior 12,13. Though many studies have been carried out to determine the sexual behavior of adolescents in Ethiopia, most of these studies are conducted in the Public Universities and few documented studies have looked at the factors that determine risky sexual behavior among private university students in the country.

Unlike public universities, private colleges in Ethiopia do not have accommodations for their students. Most of the students come from rural areas and are living in the rented houses away from their supervising families, which could open a gate for having risky sexual practices. However, little has been explored about the magnitude of risky sexual behavior and associated factors for HIV/AIDS infection in the context of private higher education institutions in Ethiopia.
Thus, this study assessed the risky sexual practices and associated factors for STIs/HIV infection among ALKAN University College students in Ethiopia.

The number of public higher education institutions has grown from only two universities to 32 by 2011. The government has also facilitated and encouraged the establishment of private higher education institutions and there are now more than 60 such institutions in Ethiopia.

ALKAN University College (AUC) is a privately owned college under the ALKAN Private Limited Company (PLC) founded in December 2002. Its head quarter is located in Addis Ababa, capital city of Ethiopia. The college offers more than ten fields of studies in undergraduate including health sciences, business & economics, and social sciences, and 4 fields of study in postgraduate programs jointly with University of Gonder. According to the statistics obtained from the office of registrars of its three campuses (Addis Ababa, Bahir Dar and Dessie), there are a total of 1,962 regular students enrolled in all programs, with 1,328 (67.7%) female and 634 (32.3%) male students in ALKAN University College. Most of the students come from the rural areas of Ethiopia. The college was purposively selected to generate evidence for sexual and reproductive health intervention. This study was thus conducted with the aim of pointing out risky sexual behaviors so as to use findings as direction for designing targeted HIV/AIDS and SRH interventions for the students of ALKAN University College.

Methods

Study design, sample size and sampling technique

Institution-based cross-sectional descriptive study was conducted from February to March 2014. The study participants were all regular undergraduate students of ALKAN University College who registered for the academic year of 2014 in its three campuses.

A sample size of 374 students was obtained using a single population proportion formula,

n = (z2α/2 x p (1 − p))/d2

where: n = minimum sample size, Zα/2 = Z value at 95% CI: 1.96, p = estimated prevalence rate in 46.6% (0.466), d = margin of error tolerated is 5% (0.05).

The proportion of risky sexual behavior (40.6%) determined by study conducted among private college students in Bahir Dar city, northwest Ethiopia was considered for the present study 6.

The following assumptions were made: a level of confidence 95% and 5% marginal of error. Additional 10% allowance for none response. The final number of students included in the study was 374. To obtain a representative sample, stratified random sampling was applied to select study participants from the source population. According to the statistics obtained from the office of registrars of its three campuses, there are a total of 1,962 regular students enrolled in 2014 academic year in undergraduate programs, including 1,328 (67.7%) female and 634 (32.3%) male students. First the students were divided in to two practical strata, which were female students and male students. From each stratum, participants were selected by simple random sampling based on the proportion of the number of students in each stratum. All undergraduate except first year students at the University College were eligible for the study.

Data collection method

The dependent variable in this study was limited to “Risky sexual behavior for STIs/HIV” (it included having more than one sexual partner or performing sexual intercourse with non-regular partner without condom, and having sex with commercial sex workers). The independent variable included socio-demographic characteristics (including age, marital status, and religion), and childhood residence, current living condition, faculties, year of study; substance use, and watching pornography. The questionnaire was adopted from reviewed literatures 12-14 and comprises three sections: Section I contains socio-demographic characteristics of participants and their families. Section II comprises of sexual behaviors of the study participants such as ever started sex, number of sexual partners, condom use, and others. Section III contains sexual risk related variables of the study such as substance use (alcohol, khat, shisha), pornographic view, and sex with commercial sex workers (CSW) etc.

Data was collected by three academic staff using anonymous self-administered structured questionnaire. The questionnaire was prepared in English and then translated into Amharic (local language). The later version was used to collect the data.

Measures were taken to ensure the quality of collected data. The questionnaire was pretested among students of a department that was not sampled for the study and necessary changes were then made to maximize the reliability of the questionnaire. Reliability refers to the accuracy and consistency of information obtained in a study and the term is most associated with the methods used to measure research variables. In surveys, reliability problems commonly result when the respondents do not understand the question, are asked about something they do not clearly recall, or asked about something of little relevance. In this study, pre-test of data collection instrument and training of data collectors were some of the methods used to improve reliability.

Correspondingly, confidentiality and anonymity of the study was reassured. The data was collected while students were in class rooms. Finally, the questionnaires were gathered and checked for completeness by the principal investigators.

Data Analysis

Data was entered and analyzed by Statistical package for social science (SPSS) version 20. Categorical variables were presented as frequencies and percentages. Both bivariate and multivariate techniques were applied. Chi-square test was used to test an association between risky sexual behaviors and socio-demographic variables. All the variables that showed P-value up to 0.2 level of significance were included for multivariable analysis. A P-value of less than 0.05 was considered as statistically significant.

The variables were also examined in the multivariate analysis (binary logistic regression) in order to identify the significant predictors of risky sexual behaviors after controlling for other confounding variables. Odds ratios and 95% confidence intervals were also computed.

Ethical consideration

Letter of ethical approval was received from AUC Research and Quality Assurance Office (RQA). Verbal informed consent was obtained from the study participants before they were enrolled in the study. They were given clear options regarding voluntary participation. None of the approached students refused to participate in the study. Confidentiality of information was ensured by removing personal identifiers from the completed questionnaires.

Operational definitions and terms used in this study

Sexual experience: Practiced penetrative penile vaginal sex at least once.

Khat: Khat (Catha edulis) is an ever-green plant that is extensively cultivated in the highlands of Ethiopia. A student was considered a chewer if s/he responded yes to the question “Have you chewed khat previously?”

Risky sexual behavior: Risky sexual behavior in the present study was defined as having two or more sexual partners in the previous 12 months, inconsistent condom use with new partners and having sex with commercial sex worker.

Substance use: Use of at least any one of the following substances: alcohol, khat, cigarette, shisha, hashish or drug that are assumed to affect level of thinking and increase risk of involving in risky sexual behavior.

Results

Socio-demographic characteristics

Table 1 depicts the Socio-demographic characteristics of the respondents. A total of 374 respondents of which, 138 male and 236 female students were involved in the study. Of these respondents, 196 (52.4%), 106 (28.3%) and 72 (19.3%) were from Bahir Dar, Addis Ababa and Dessie campuses, respectively. Majority of the study participants 220 (58.8%) were in the age range of 20–24 years with mean (± SD) age of 21.4 (± 1.7) years.

Table 1Socio-demographic characteristics of ALKAN University College students, March 2014

More than half 246 (65.7%) were Christians and 273 (73%) of the respondents reported that they grew in rural areas. Concerning the marital status of the respondents, the majority 345 (92.3%) of them were single. Majority (73%) of students were living in rented rooms. Among the study population 256 (68.5%) were from health department while 118(31.5%) from non-health 40.6%, respectively. Of these, 139 (37.2%), 185 (49.5%) and 50 (13.3%) were 2nd year, 3rd year and 4th year students, respectively.

Respondents’ sexual behavior

As depicted in Table 2, from the total respondents, 160 (42.8%) reported that they had sexual experience (male: 74% vs. females: 26%). Majority of respondents (90.6%) started sexual intercourse after the age of 18 years old. The mean as (± SD) reported age at first sex was 17.6 (± 2.3) years. Of the total sexually active students, more than half (51.9%) had initiated sex after joining college. Majority (55.6%) of sexually active students reported falling in love as a reason to initiate sex. Fifteen percent had reported that they initiated sex due to peer pressure while 8.1% of students practiced sex to get money or grade to pass from their sexual partners.

Table 2Sexual experience of ALKAN University College students, March 2014

Sexual risk behaviors for STIs/HIV infection

Table 3a, b depicts sexual risk behaviors for STIs/HIV infection. When asked about the number of sexual partners, one hundred twenty one sexually active respondents (88% male and 68.6% female), reported that they had experienced more than two sexual partners in their life time. Of these, 33.1% (male: 39.6% vs. female: 29.4%) had ever used condom during first sexual intercourse. The study revealed also that amongst sexually active respondents, 65 students (62% males and 28.4% females) had sex in the last 12 months with two or more non-regular partners. Out of all respondents, only 59 (36.9%) respondents had used condom during their last sexual encounter.

Table 3a, bSexual risk behaviors for STIs/HIV among ALKAN University College students, March 2014

(a)

(b)

1: multiple responses; 2: CSW= commercial sex workers; 3: substance use = use of alcohol, khat, drugs etc.

The main reasons reported for having sex without condom was trusting one’s partner by 56.4% followed by 39.6% condom reduces sexual pleasure. One hundred one (63.1%) of sexually active students practiced unprotected sex. Of the total sexually active study population, 25% had risks for STIs/HIV infection.

The study further pointed out only 36.9% respondents (male: 29.3% vs. female: 41.2%) had used condom in their last sexual practice. Among fifty nine students responded to the frequency of condom use, 22% (8.5% male and 13.5% female) had used it always. Among 101 respondents who were not using condom consistently 57 (56.4%) reported that they trust their partners followed by condom decreases sexual pleasure, 40 (39.6%).

About thirty nine percent of respondents who started sex had been exposed to pornography. The prevalence of substance use (alcohol, khat, drug, or shisha) during sexual activity was found to be 57% among males and 35.3% among females, respectively.

Factors significantly associated with sexual risks for STIs/HIV infection

Table 4 depicts factors significantly associated with sexual risks for STIs/HIV infection. On multivariate logistic regression analysis, time of first sexual activity, current residence, substance use, watching pornography, and history of sex with CSW were significantly associated with risks for STIs and/or HIV infection. Students who were sexually active before joining the college were two times risk to have multiple sexual partners compared to their counter parts (AOR = 2.15, 95% CI: 1.80–12.56).

Table 4Factors associated with risks for STIs/HIV infections among ALKAN University College students, March 2014

1: COR = crude odds ratio; 2: AOR = adjusted odds ratio, 3: CSW = commercial sex workers
*: significant at P <0.05 (2-tailed), **: significant at P <0.01 (2-tailed)
Childhood residence, year of study, sex, and consistent condom use showed no statistical association.

Students living in rented rooms were three times more likely to ever have multiple sexual partners as compared to those who were living with their parents. (AOR = 3.82, 95% CI: 1.08–11.58). Students who watched pornography were two times more likely to ever have multiple sexual partners than those who didn’t watch it (AOR = 2.17, 95% CI: 1.82–5.93).

Likewise, current substance users (including khat, alcohol and drug) were two times more likely to ever have multiple sexual partners as compared to non-users (AOR = 2.02, 95% CI: 1.74–12.32). Having History of sex with CSW was another predictor for multiple sexual partners, (AOR = 2.62, CI: 1.64–7.34). However, there is no statistical association between year of study, sex, childhood residence, and consistent condom use, and having multiple sexual partners.

Discussion

Studies in Africa and elsewhere indicate that students of higher institutions are exposed to many risky behaviors including substance use, sexual coercion and unsafe sex which predispose them to STIs including HIV/AIDS. Little has been explored about the risky behaviors in the context of private higher education institutions in Ethiopia.

This study, therefore, assessed the risky sexual practices and associated factors for STIs/HIV infection among ALKAN University College students in Ethiopia. The study showed that among a sample of 374 students who participated in the study, almost half (42.8%) were sexually active. The finding of this is relatively lower than other studies done in Southern Ethiopia, which was 49% 12, 13 and a study from Uganda 14 showed (54%) for both sexes.

Nevertheless, the finding of this study is higher than the study from Jimma University, Ethiopia (33.2%). This finding is, however, very much lower than the findings in other countries. For instance, the study conducted among university students in Madagascar showed that 80% of students had sexual experience 15 and the study conducted in Nigerian University students (76.8%) 16.

The comparison of the present study with the findings of overseas should be weighed by taking some factors, including age differences, sample size, cultural uniqueness of the study participants, drug and substance abuse in colleges and the mishandling of internet in sharing information regarding dating culture and violent behavior across the world. Youths are especially at risk firstly, because they are adventurous and very sexually active, being at an age where sexual hits and conquests are perceived as important for self-esteem. Secondly, they have multiple sexual partners, and are more likely to practice “innovative” sexual and risky techniques. For instance, in Ethiopia the culture of campus life in many residential universities appears to be ambivalent or even open to a wide variety of high-risk activities such as sexual experimentation, prostitution on campus, unprotected casual sex, frequent partner change, and considerable physical and psychological violence against women.

The mean age at first sexual intercourse in this study was 17.6 (± 2.3) years. This is in agreement with the findings of the Ethiopian DHS 2011 in which the mean age at first sexual intercourse among 20–24 years was 18.2 years. It was also similar with the finding of the study conducted among Madawalabu university students from Ethiopia 17 and Madagascar in which the mean age at first sexual intercourse were 17.7 and 18.4 years, respectively. In the present study, majority of the students (38.1%) who ever had sexual intercourse started sex during high school level. This is comparable with other national studies 17-19.

In the current study, 36.9% of those who had sexual intercourse in the last 12 months had used condom during the last sexual contact. This is lower than the findings of a study conducted among Jimma University Students by Tura G et al., which was reported as 80%. The present study thus showed that unprotected sexual practice is common among college students, which can expose them to STIs and HIV infections for both sexes. Condom use is an important tool in the fighting against the spread of HIV/AIDS; a truly effective protection usefully requires condom use at every sexual encounter. Nonetheless, consistent condom use with non regular partner in the last 12 months in this study was 22%. This is lower than the study from Jimma University by Tura G et al., which was 69.1%.

This study was motivated by the fact that there was a dearth in information regarding sexual risk behaviors in private universities. In light of the results of this study, and previous research in public universities, students in private universities might be more at risk for STIs/HIV. For example, most of students were from rural areas, therefore most of them were living in rented residence, and renting was shown to be a risk factor for multiple sexual partnerships. The lack of parental supervision might have opened the gate to other exposure such as substance use and watching pornography. In connection to this, the findings of the current study showed that students living in rented rooms were three times more likely to ever have multiple sexual partners as compared to those who were living with their parents. (AOR = 3.82, 95% CI: 1.08-11.58). Having history of sex with CSW was another predictor for multiple sexual partners, (AOR = 2.62, 95% CI: 1.64–7.34).

Likewise, respondents who were substance users including khat, alcohol and drug were two times more likely to ever have multiple sexual partners compared to nonusers (AOR = 2.02, 95% CI: 1.74–12.32). This finding is comparable to a study from Slovakian college and Lund University students where alcohol consumption was associated with higher risk of having multiple sexual partners 20. This might be explained by the fact that risk perception ability decreases with alcohol consumption, signifying that individuals who use substance were more likely to get infected with HIV/AIDS and other sexually transmitted infections. Students who watched pornography were also two times more likely to ever have sexual intercourse than those who didn’t watch it (AOR = 2.17, 95% CI: 1.82–5.93).

The findings of this study should be interpreted in the light of its limitations. Firstly, the study was conducted in a single private higher education institution in Ethiopia. Similar institutions in the country may share some of its characteristics but they are by no means homogeneous and so any generalization of the results of this study must be made with caution. Secondly, the result of this study depended on self-report of a sensitive topic-sexuality issues. Sexually transmitted infections (STIs) and HIV/AIDS are sensitive topics that many young people are reluctant to talk about. As a result, there may be influence of social desirability bias. However, measures were taken to reduce this bias by granting confidentiality, maintaining privacy and explaining the purpose of the study to participants.

Thirdly, the sample size was calculated based on the descriptive formula, which may not be sufficient and may lack enough power to reliably estimate the measures of association. This is another important limitation as it is reflected on the precision of the estimates of odds ratio having relatively large confidence of intervals. The findings of this study thus mainly be only applied to similar population in the study area in Ethiopia.

Conclusions

The findings of this study showed that risky sexual behavior is rampant in our sample of university college students, as few (22%) of the sexually active students used any form of protection during their last sexual experience. The reported low utilization of condom in this study is an indication of the fact that high-risk behaviors are still widely practiced in the study setting. Substance use including alcohol consumption was found to be associated with having multiple sexual partners and inconsistent condom use with new partners among students who often used alcohol in relation to sexual activity. Therefore, interventions targeting on unsafe substance use, consistent condom use, and apt internet usage are recommended. Further, this survey is believed to provide the present image of adolescents’ risky sexual practice, which may help the concerned bodies to take actions based on the findings.

Acknowledgements

The authors would like to thank the study participants who took their time to participate in the survey. We are also thankful for the data collectors.

Author Contributions

Sendo EG: involved in the conception and design of the study, protocol writing, data collection, analysis and interpretation, and in drafting the manuscript.
Bedada W: involved in data collection and critically reviewed the manuscript. Both authors read and approved the final version of the manuscript.

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