Explaining Gender Disparity in Risky Sexual Behavior among Undergraduate University Students in Ethiopia A Decomposition Analysis
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Published
Aug 3, 2020
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Abstract
ABSTRACT
Objective: The aim of this research is to explain gender disparity in risky sexual behaviors among undergraduate students in Ethiopia.
Setting: this study was conducted at Dambi Dollo University undergraduate students in Ethiopia. Participants: From the total of 633 sample size 579 received and returned complete questionnaire from which 330 were males and 279 were females. Simple random sampling method was used to select the participants. Respondents enrolled under other programs than regular program were excluded.
Primary outcome: risky sexual behaviour is the primary outcome measured in this study. It is derived from any sexual act that can enhance the transmission of sexually transmitted infections including HIV and unplanned pregnancy. STATA 15 was used for data management and analysis. A multivariate decomposition analysis for non-linear model was used to determine the magnitude and drivers of gender disparity in risky sexual behavior. Latent class analysis was also used to produce latent class in HIV/AIDS related knowledge.
Result: There is a 33.2% extra risk in sexual behavior among males with a 95% CI (26.4, 39.9). Of this disparity, 32.6% with 95% CI (6.5 to 15.1), p<0.001, is attributable to differences in characteristics between boys and girls. The remaining 67.4% with a 95% CI (14.1 to 30.6), P<0.001, of the raw difference is, however, explained by the differences in response behavior to changes in characteristics between the sexes. Being Muslim, communication with parents, communication with friends, substance use and knowledge about HIV/AIDS explained the observed male-female gap in risky sexual behavior.
Conclusions: Addressing gender inequalities in risky sexual behavior among youth requires gender sensitive policies and strategies. Risk reduction strategies should focus on religions, parents and peers. Policy on substance ban should be in place and effectively administered. Gender sensitive awareness raising and educational programs about substance use and HIV/AIDS should be strengthened.
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Keywords
Risky Sexual Behaviour; Youth, Sexual and Reproductive Health
References
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29. Mamo, A. and N. Fentahun, Family environment and sexual behaviours in Jimma zone, south west Ethiopia Science Journal of Public Health 2014. 2(6): p. 539-545
30. Tura, G., F. Alemseged, and S. Dejene, Risky Sexual Behavior And Predisposing Factors Among Students Of Jimma University, Ethiopia. Ethiop J Health Sci., 2012. 22(3): p. 170-180.
31. Bogale, A. and A. Seme, Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia. Reproductive Health, 2014. 11(49).
32. Nibret, G., N. Mihret, and T. Dejene, Components of the Recent Fertility Decline in Amhara National Reginal State, Ethiopia: ADecomposition Analysis of Ethiopian Demographic and Health Survey. ERJSSH, 2016. 3(2): p. 57-68.
33. Kongsted, A. and A.M. Nielsen, An introduction to Latent Class Analysis in health research. Journal of Physiotherapy, 2016. 63: p. 55-58.
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39. World Health Organization Department of Child and Adolescent Health. Broadening the horizon: balancing protection and risk for adolescents. Geneva: WHO; 2002
40. Dutra, R., Miller, K.S., & Forehand, R. The process and content of sexual communication with adolescents in two-parent families: Associations with sexual risk-taking behavior. AIDS Behaviors. 1999; 3: 59-66.
41. Whitaker, D. J., Miller, K. S., May, D. C., & Levin, M. L. Teenage partners’ communication about sexual risk and condom use: Importance of parent-teenager communication. Family Planning Perspective. 1999; 31(3), 117–121.
42. Ayalew, M., B. Mengistie, and A. Semahegn, Adolescent - parent communication on sexual and reproductive health issues among high school students in Dire Dawa, Eastern Ethiopia: a cross sectional study. Reproductive Health, 2014. 11(17).
43. Ayehu, A., T. Kassaw, and G. Hailu, Young people’s parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia. Reproductive Health, 2016. 13(19).
44. I, O.P., A.O. Fatusi, and I.A. L., Perception of peers’ behaviour regarding sexual health decision making among female undergraduates in Anambra State, Nigeria. African Health Sciences, 2005. 5(2): p. 107 -113.
45. Fearon, E., et al., Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review. Social Science & Medicine 2015. 146(62e74): p. 62-74.
46. Rokhmah, D. and Khoiron, The Role of Sexual Behavior In The Transmission Of HIV and AIDS In Adolescent In Coastal Area, in International Conference on Tropical and Coastal Region Eco-Development 2014. 2015, Elsevier B.V. p. 99 - 104
47. Lamesgin, A., HIV/AIDS AND SEXUAL REPRODUCTIVE HEALTH AMONG UNIVERSITY STUDENTS IN ETHIOPIA: A POLICY INTERVENTION FRAMEWORK. November 2013.
48. Fennie, T. and A. Laas, HIV/AIDS-related Knowledge, Attitudes and Risky Sexual Behaviour among a Sample of South African University Students. Gender & Behaviour, 2014. 12(1): p. 6035-6044.
49. MOODLEY, C.G. and J.S. PHILLIPS, HIV/AIDS-related knowledge and behaviour of FET college students: Implications for sexual health promotion. African Journal for Physical, Health Education, Recreation and Dance (AJPHERD), 2011. June 2011 (Supplement): p. 49-60.
50. L.A.LEMA, R.S.KATAPA, and A.S.MUSA, Knowledge on HIV/AIDS and sexual behaviour among youths in Kibaha District, Tanzania. Tanzania Journal of Health Research, 2008. 10(2): p. 79-83.
2. Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, et al. Youth risk behavior surveillance-United States, 2009. Morbidity and mortality weekly report Surveillance summaries (Washington, DC: 2002). 2010;59(5):1–142.
3. Salam, R., et al., Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions. Journal of Adolescent Health, 2016. 59: p. S11e
4. Braxton, J., et al., Sexually Transmitted Disease Surveillance 2016, in Centers for Disease Control and Prevention. 2017, Atlanta: U.S. Department of Health and Human Services; .
5. Kharsany, A. and Q. Karim, HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities. The Open AIDS Journal, 2016. 10: p. 34-48.
6. Rutaremwa, G., et al., Association between Risky Sexual Behaviour and having STIs or HIV among young persons aged 15-24 years in Uganda. 2011, United Nations Economic Commission for Africa (ECA): Addis Ababa.
7. Mathews, C., et al., Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV: Cluster Randomised Controlled Trial. AIDS Behav, 2016. 20: p. 1821–1840.
8. Asmamaw, A., et al., Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis. Reproductive Health, 2017: p. 14:113.
9. Mamo, K., E. Admasu, and M. Berta, Prevalence and Associated Factors of Risky Sexual Behaviour among Debremarkos University Regular Undergraduate Students, Debremarkos Town North West Ethiopia. Journal of Health, Medicine and Nursing, 2016. 33: p. 40-50.
10. Gemeda, T., A. Gandile, and D. Bikamo, HIV/AIDS Knowledge, Attitude and Practice among Dilla University Students, Ethiopia. African Journal of Reproductive Health, 2017. 21(3): p. 50-61.
11. Setegn, T. and A. Takele, Sexual and reproductive health problems and service needs of university students in south east Ethiopia: Exploratory qualitative study. Science Journal of Public Health, 2013. 1(4): p. 184-188.
12. Derese, A., A. Seme, and C. Misganaw, Assessment of substance use and risky sexual behaviour among Haramaya University Students, Ethiopia. Science Journal of Public Health, 2014. 2(2): p. 102-110.
13. Helen, A. and T. Tesfay, The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University, Ethiopia. HEALTH SA GESONDHE, 2016. 21: p. 179-186.
14. Chandra-Mouli V, McCarraher DR, Phillips SJ, Williamson NE, Hainsworth G. Contraception for adolescents in low and middle income countries: Needs, barriers, and access. Reprod Health 2014;11:1.
15. Procope-Beckles M. Global School Health Survey (GSHS) 2007 Tobago Report. Global School Health Survey (GSHS) 2007 Tobago Report: Ministerio de Salud, Tobago; 2007.
16. Dingeta, T., L. Oljira, and N. Assefa, Patterns of sexual risk behaviour among undergraduate university students in Ethiopia: a cross-sectional study. Pan African Medical Journal, 2012: p. 12:33.
17. Zaw, T., et al., Gender differences in exposure to SRH information and risky sexual debut among poor Myanmar youths. BMC Public Health, 2013. 13(1122 ).
18. Department of Health and Human Services, Office of the Assistant Secretary for Health, Office on Women’s Health. HIV Prevention Toolkit: A Gender-Responsive Approach. Washington, D.C., 2016.
19. Kalu, A., et al., Premarital Sexual Practice and Associated Factors among Robe TVET Students at Robe Town, Bale Zone, Oromia Region, Southeast Ethiopia. MOJ Public Health, 2017. 5(6).
20. Tadesse, G. and B. Yakob, Risky Sexual Behaviors among Female Youth in Tiss Abay, a Semi-Urban Area of the Amhara Region, Ethiopia. PLoS ONE, 2015. 10(3).
21. Frank, S., et al., Risky sexual behaviours of high-school pupils in an era of HIV and AIDS. SAMJ, 2008. 98(5): p. 394-398.
22. F.Yan, A., et al., STD-/HIV-Related Sexual Risk Behaviors and Substance Use among U.S. Rural Adolescents. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, 2007. 99(12): p. 1386-1394.
23. Ritchwood, T.D., et al., Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis. Child Youth Serv Rev., 2015. 52: p. 74–88.
24. Khan, M.R., et al., Longitudinal Associations Between Adolescent Alcohol Use and Adulthood Sexual Risk Behavior and Sexually Transmitted Infection in the United States: Assessment of Differences by Race. American Journal of Public Health, 2012. 102(5): p. 867–876.
25. Lo, T.W., et al., The Association between Substance Abuse and Sexual Misconduct among Macau Youths. Int. J. Environ. Res. Public Health 2019. 16: p. 1643.
26. Tadesse, M., Substance abuse and sexual HIV-risk behaviour among Dilla University students, Ethiopia. Educational Research. Educational Research, 2014. 5(9): p. 368-374.
27. Legesse, E., Assessment of risky sexual behaviors and risk perception among youths in Western Ethiopia: the influences of family and peers: a comparative cross-sectional study. BMC Public Health, 2014. 14(301).
28. Shiferaw, K., F. Getahun, and G. Asres, Assessment of adolescents’ communication on sexual and reproductive health matters with parents and associated factors among secondary and preparatory schools’ students in Debremarkos town, North West Ethiopia. Reproductive Health, 2014. 11(2).
29. Mamo, A. and N. Fentahun, Family environment and sexual behaviours in Jimma zone, south west Ethiopia Science Journal of Public Health 2014. 2(6): p. 539-545
30. Tura, G., F. Alemseged, and S. Dejene, Risky Sexual Behavior And Predisposing Factors Among Students Of Jimma University, Ethiopia. Ethiop J Health Sci., 2012. 22(3): p. 170-180.
31. Bogale, A. and A. Seme, Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia. Reproductive Health, 2014. 11(49).
32. Nibret, G., N. Mihret, and T. Dejene, Components of the Recent Fertility Decline in Amhara National Reginal State, Ethiopia: ADecomposition Analysis of Ethiopian Demographic and Health Survey. ERJSSH, 2016. 3(2): p. 57-68.
33. Kongsted, A. and A.M. Nielsen, An introduction to Latent Class Analysis in health research. Journal of Physiotherapy, 2016. 63: p. 55-58.
34. Dean, N. and A.E. Raftery, Latent class analysis variable selection. Ann Inst Stat Math, 2010. 62: p. 11–35.
35. Federal Democratic Republic of Ethiopia; Ministry Of Health, National Reproductive Health Strategy: 2006-2015. March 2006: Addis Ababa, Ethiopia.
36. Adama, Y., et al., Sexual and reproductive health communication and awareness of contraceptive methods among secondary school female students, northern Ethiopia: a cross-sectional study. BMC Public Health, 2014. 14: p. 252.
37. Hindin, M.J. and A.O. Fatusi, Adolescent Sexual and Reproductive Health in Developing Countries: An Overview of Trends and Interventions. International Perspectives on Sexual and Reproductive Health, 2009. 35(2): p. 58-62.
38. Toefy, M.Y. (2002). Divorce in the Muslim community of the Western Cape: A demographic study of 600 divorce records at the Muslim Judicial Council and the National Ulama Council between 1994 and 1999. Cape Town: University of Cape Town.
39. World Health Organization Department of Child and Adolescent Health. Broadening the horizon: balancing protection and risk for adolescents. Geneva: WHO; 2002
40. Dutra, R., Miller, K.S., & Forehand, R. The process and content of sexual communication with adolescents in two-parent families: Associations with sexual risk-taking behavior. AIDS Behaviors. 1999; 3: 59-66.
41. Whitaker, D. J., Miller, K. S., May, D. C., & Levin, M. L. Teenage partners’ communication about sexual risk and condom use: Importance of parent-teenager communication. Family Planning Perspective. 1999; 31(3), 117–121.
42. Ayalew, M., B. Mengistie, and A. Semahegn, Adolescent - parent communication on sexual and reproductive health issues among high school students in Dire Dawa, Eastern Ethiopia: a cross sectional study. Reproductive Health, 2014. 11(17).
43. Ayehu, A., T. Kassaw, and G. Hailu, Young people’s parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia. Reproductive Health, 2016. 13(19).
44. I, O.P., A.O. Fatusi, and I.A. L., Perception of peers’ behaviour regarding sexual health decision making among female undergraduates in Anambra State, Nigeria. African Health Sciences, 2005. 5(2): p. 107 -113.
45. Fearon, E., et al., Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review. Social Science & Medicine 2015. 146(62e74): p. 62-74.
46. Rokhmah, D. and Khoiron, The Role of Sexual Behavior In The Transmission Of HIV and AIDS In Adolescent In Coastal Area, in International Conference on Tropical and Coastal Region Eco-Development 2014. 2015, Elsevier B.V. p. 99 - 104
47. Lamesgin, A., HIV/AIDS AND SEXUAL REPRODUCTIVE HEALTH AMONG UNIVERSITY STUDENTS IN ETHIOPIA: A POLICY INTERVENTION FRAMEWORK. November 2013.
48. Fennie, T. and A. Laas, HIV/AIDS-related Knowledge, Attitudes and Risky Sexual Behaviour among a Sample of South African University Students. Gender & Behaviour, 2014. 12(1): p. 6035-6044.
49. MOODLEY, C.G. and J.S. PHILLIPS, HIV/AIDS-related knowledge and behaviour of FET college students: Implications for sexual health promotion. African Journal for Physical, Health Education, Recreation and Dance (AJPHERD), 2011. June 2011 (Supplement): p. 49-60.
50. L.A.LEMA, R.S.KATAPA, and A.S.MUSA, Knowledge on HIV/AIDS and sexual behaviour among youths in Kibaha District, Tanzania. Tanzania Journal of Health Research, 2008. 10(2): p. 79-83.
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