Sexual Risk Behaviour Among School-going Adolescents in Sierra Leone and Liberia. A Secondary Analysis of the 2017 Global School Health Survey

Background: There is very little information on sexual risk behaviour among Sierra Leone and Liberia school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-aged adolescents in Sierra Leone and Liberia. Method: We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Results: The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%), Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR=0.572; 95%CI: 0.345-0.946). Male compared to females were more likely to engage in multiple sexual risk behaviour (AOR=2.310;95%CI:1.543-3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR=3.064; 95%CI: 2.137-4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who do show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR=1.655; 95%CI:1.133-2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR=0.608; 95%CI: 0.435-0.850). Less parental support was only associated with ever had sex more likely to have ever had sex as seen among adolescents in Sierra Leone (AOR=2.027; 95%CI: 1.322-3.107) but not Liberia (1.034(0.650-1.644). Conclusion: Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.

Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: A cross-sectional study

Background Adolescent girls and young women (AGYW) are at increased risk of sexually transmitted infections (STIs). We assessed sexual-risk behaviours and HIV and syphilis prevalence among AGYW in Uganda to inform the design of target-specific risk-reduction interventions. Methods This analysis utilizes data from 8,236 AGYW aged 10–24 years, collected in 20 districts, between July and August 2018. AGYW engaged in sexual-risk behaviour if they: a) reported a history of STIs; or b) had their sexual debut before age 15; or c) engaged in sex with 2+ partners in the past 12 months; or c) did not use or used condoms inconsistently with their most recent partners. We diagnosed HIV using DetermineTM HIV-1/2, Stat-PakTM HIV-1/2 and SD Bioline. We used SD Bioline Syphilis test kits to diagnose syphilis and Treponema Pallidum Hemagglutination Assay for confirmatory syphilis testing. Comparison of proportions was done using Chi-square (χ2) tests. Data were analysed using STATA (version 14.1). Results Of 4,488 AGYW (54.5%) that had ever had sex, 12.9% (n = 581) had their sexual debut before age 15; 19.1% (n = 858) reported a history of STIs. Of those that had ever had sex, 79.6% (n = 3,573) had sex in the 12 months preceding the survey; 75.6% (n = 2,707) with one (1) and 24.2% (n = 866) with 2+ partners. Condom use with the most recent sexual partner was low, with only 20.4% (n = 728) reporting consistent condom use while 79.6% (n = 2,842) reported inconsistent or no condom use. In-school AGYW were significantly less likely to have ever had sex (35.6% vs. 73.6%, P<0.001), to have had sexual debut before age 15 (7.7% vs. 15.5%, P<0.001) or to engage in sex with 2+ partners (5.3% vs. 15.8%, P<0.001). Consistent condom use was significantly higher among in-school than out-of-school AGYW (40.1% vs. 12.7%, P<0.001). Overall, 1.7% (n = 143) had HIV while 1.3% (n = 104) had syphilis. HIV and syphilis prevalence was higher among out-of-school than in-school AGYW (HIV: 2.6% vs. 0.9%; syphilis: 2.1% vs. 0.5%, respectively). Conclusion In-school AGYW engaged in more protective sexual behaviors and had less HIV and syphilis than their out-of-school counterparts. These findings suggest a need for target-specific risk-reduction interventions stratified by schooling status.

Understand Sexual Risk Behaviours in Young Adults and Challenges in their Education

Sexual risk behaviours are considered sexual conducts that can cause biological, psychological and social damage. Therefore, sexuality education is considered the only effective way to avoid it. This project aims to understand sexual risk behaviour factors and their consequences in young adults and to explore strategies they would use to face them. To answer these questions, we conducted a qualitative study in which we interviewed 11 young adults using an asynchronous mail technique due to the Covid19 pandemic. We also carried out a thematic analysis and developed our key results: 1) Sexual attitudes and behaviours; 2) Sexual risk factors, 3) Sexual risk consequences; and 4) Educational approach and strategies. Similarities in the themes were verified with previous literature, exposing the importance of learning to identify factors and consequences to respond appropriately. Participants believe that comprehensive and egalitarian sexuality education applied at individual and community level is a solid method that can improve sexual health and well-being. To conclude, this study reveals the importance of listening to young adults’ perspectives towards these conduct variables and educational approaches in order to establish global health strategies that could be based on these results.

Sexual risk behaviour and its correlates among adolescents in Indonesia, Laos, Thailand and Timor-Leste: results from national school surveys in 2015

ObjectivesThe study aimed to assess the prevalence and correlates of sexual risk behaviours among adolescents in four Southeast Asian countries.MethodsIn the cross-sectional “Global School-Based Student Health Survey (GSHS)”, 24,423 adolescents (mean age 14.1 years, SD=1.7) from Indonesia, Laos, Thailand and Timor-Leste responded to a questionnaire in 2015.ResultsOverall, 8.5% of the students (11.0% males and 6.3% females) ever had sex, ranging from 5.3% in Indonesia to 26.4% in Timor-Leste. Among the sexually active, 49.3% (55.9% males and 36.8% females) had their first sexual intercourse before the age 14 years, ranging from 16.1% in Laos to 73.9% in Indonesia, 59.7% (62.6% males and 53.5% females) had multiple sexual partners, ranging from 55.5% in Timor-Leste to 63.4% in Indonesia, 46.9% (46.8% males and 46.5% females) did not use a condom at last sex, ranging from 37.0% in Thailand to 65.3% in Indonesia, 49.8% (53.7% males and 43.7% females) had not used or did not know of the use of birth control at last sex, ranging from 40.6% in Thailand to 61.5% in Timor-Leste, and 54.2% (54.9% males and 47.0% females) engaged in multiple sexual risk behaviour, ranging from 45.9% in Laos to 78.0% in Indonesia. In adjusted logistic regression analysis, male sex, older age, food insecurity, tobacco use, alcohol use, ever cannabis and/or amphetamine use, psychological distress, and school truancy were associated with two or more and/or multiple sexual risk behaviours.ConclusionsA high proportion of students engaged in various sexual risk behaviours calling for a scale up comprehensive sexuality education and integration of substance use and mental health into such intervention programmes in this adolescent school population.