Recent trends in sexual behavior, demonstrated in most countries, continue to indicate that more people are adopting safer sexual behaviors. However, there are signs of an increase in risky sexual behaviors in several countries. This study aimed to assess sexual behaviors and associated factors among youths in Nekemte town, East Wollega, Ethiopia in 2017.
A community-based cross sectional study was conducted using a self-administered questionnaire. Then, the collected data were analysed using logistic regressions with 95% confidence interval (CI). Besides, the results of data analysis were `presented using appropriate descriptive measures and tables.
Almost half of the respondents, 144(48.6%) had practiced sexual intercourse. Factors associated with ever had sexual intercourse include: being in age group 20-24(AOR = 2.322, 95% CI (1.258, 4.284)), having pocket money (AOR = 1.938, 95% CI (1.057, 3.556)), not attending school (AOR = 2.539, 95% CI (1.182, 5.456)), watching pornography (AOR = 4.314, 95% CI (2.265, 8.216)) and drinking alcohol (AOR = 7.725, 95% CI (3.077, 19.393)).
Citation: Waktole ZD (2019) Sexual behaviors and associated factors among youths in Nekemte town, East Wollega, Oromia, Ethiopia: A cross-sectional study. PLoS ONE 14(7): e0220235. https://doi.org/10.1371/journal.pone.0220235
Editor: Andrew R. Dalby, University of Westminster, UNITED KINGDOM
Received: February 1, 2019; Accepted: July 11, 2019; Published: July 29, 2019
Copyright: © 2019 Zelalem Desalegn Waktole. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author received no specific funding for this work.
Competing interests: The author has declared that no competing interests exist.
Youths are defined as those belonging to the age group of 15 to 24 years. Many important life events and health-damaging behaviors start during the youth years. As a result, youth is a time of both risk and opportunity. The period between the initiation of sexual activity and marriage is often a time of sexual experimentation and may involve risky behaviors [1, 2, 3].
HIV/AIDS has become one of the world’s most serious health and development challenges for the last three decades. UNAIDS reported that globally 33.3 million people were living with HIV at the end of 2009. Sub-Saharan Africa has only 13% of the world’s population but home to more than two-thirds (68%) of people living with HIV which bears an inordinate share of the burden and young people form a significant number in the population [4, 5, 6]. Young people are at the center of the global AIDS epidemic and the 1.7 billion young people worldwide; 5.4 million are estimated to be HIV positive. Young people aged 15–24, account for 41% of new HIV infections (Among those 15 and over) [4, 7].
One of the most severe consequences of HIV/AIDS is the loss of young adults in their most productive years and Ethiopia is one of the most affected countries in East Africa. The expression of the pandemic in the country is primarily young, with the majority of the victims aged 15–24 years [8, 9, 10].
Risky sexual behavior is defined as unprotected vaginal, oral or anal intercourse. Young people who initiate sexual intercourse at an early age face a higher risk of becoming pregnant or contracting an STI than young people who delay the initiation of sexual activity [3, 11]. The burden of risky sexual behaviors is reflected in economic and psychological costs in addition to sexually transmitted infections (ISTs) [12, 13].
Recent trends in sexual behavior, demonstrated in most countries, continue to indicate that more people are adopting safer sexual behaviors. However, there are signs of an increase in risky sexual behaviors in several countries. Recent evidence indicates a significant increase in the number of sexual partners and a decline in condom use in some countries including Ethiopia .
Condom use during sexual intercourse is an effective method for avoiding pregnancy and infection from STIs ; however, a study showed that significant proportions of respondents do not always use a condom with non-regular partners, though they know that condom use protects from HIV infection. Some even thought that condom is less effective and /or potentially dangerous to disseminate HIV .
It is clear that youths living in an urban area are at higher risk because of their sexual behaviors . Accordingly, this study tried to identify factors associated with the sexual behaviors of youths in Nekemte town and the results would contribute as an input for a future intervention plan.
Methods and materials
The study was conducted in Nekemte town, which is the capital city of East Wollega Zone, Oromiya National Regional State. Nekemte town is located 331 km away from the capital city of the country (Addis Ababa), in the Western direction. The town has 97,877 total populations and divided into six sub-cities. The estimated number of youths in the town with age group 15–24 is 22,480. The study was conducted from July 24 to 29, 2017. Community based quantitative cross-sectional study design was used to collect data using a self-administered questioner.
The sample size was calculated using a single population proportion formula by taking 21.5% prevalence of premarital sexual intercourse , 5% margin of error and confidence interval of 95%. A design effect of 2 was considered and yielded a 298 final sample size by adding 15% for non-response. Those who had been living in the town at least for the last six months before data collection dates were included.
All households which are found in each sub-city were initially mapped and numbered. The study subjects were recruited using probability proportional to the number of households in all sub-cities. Every Kth (the proportion of total youths in each sub-city divided by their respective sample size) of pre-numbered households were visited, until the required number of youths was identified using systematic random sampling. The direction of the initial household was determined by a spinning pen at the center of each sub-city. In case, when more than one eligible study participant was present in a given household, one of them was selected by simple random sampling. When the study participant was not found at home during data collection, an appointment was arranged to go back for data collection. If there were no eligible youth in the selected household, the next household was recruited.
The questionnaire was taken from similar studies and adapted to the context of this study [17–20]. It was self-administered and consists of background information, sexual experiences and non-sexual behaviors. Six data collectors, grade 10 completed and above were selected and recruited for data collection. One day training was given for data collectors. The training was based on the guide that was developed for data collection and clarifying self-administered questionnaires. Besides, they were trained on the overall procedures of data collection. The questionnaire was prepared in English and translated to Afan Oromo to make it clear for the participants and reduce misunderstanding. Respondents were told to complete the questioners and data collectors clarify any doubts raised during filling the questioners. The principal investigator supervised all activities.
To assure quality of the data properly designed data collection instrument was prepared and pre-tested for its clarity. The questionnaire was pre-tested among youths visiting the Family Guidance Association of Ethiopia Nekemte branch and excluded from the actual study. Based on feedback from the pre-test modifications were made. Data were checked for completeness and responses for each question were coded and entered to Statistical Package for Social Sciences (SPSS) version 20.0 by the principal investigator.
Then, the collected data were analysed using logistic regressions with 95% confidence interval (CI). Variables that were statistically significant in bivariate analysis were entered to multivariate analyses to identify the associated factors where the entry value was 0.05. Besides, the results of data analysis were `presented using appropriate descriptive measures and tables.
Sexual behavior: condom use during sexual intercourse, number of sexual partners, age of starting sexual intercourse and sexual intercourse with commercial sex workers.
Risky sexual behavior- Youth who have at least one of the following: inconsistent condom use during each sexual intercourse, having multiple sexual partners, starting sexual intercourse before age of 18 years and sexual intercourse with commercial sex workers.
Sexual partner- Girl/boyfriend or any person with whom sexual intercourse is practiced by the youths
Regular sexual partner- spouse who have sexual contact with the youth for more than 12 months
Consistent condom use-using condom appropriately during or at every sexual encounter
Practiced HIV prevention methods: respondent who ever practiced the major HIV/AIDS prevention methods (abstinence, being faithful to one partner or condom use)
Religious participation: respondent who have a religion and active member of any religious organization
The ethical approval letter was obtained from Wollega University ethical approval committee. A formal letter was written by Wollega University to each sub-city for their cooperation during data collection. Written consent was obtained from each study participants with 18 years old and above and for those under 18 years, oral consent was obtained from parents or guardians.
Two hundred ninety-six (296) youths were participated in this study making a response rate of 99.33%. A total of 196 (66.2%) males and 100 (33.8%) females participated in this study. The mean age of the respondents was 19.70(+2.406). 141(47.6%) of the respondents were in the age group of 15–19 and 155(52.4%) were between 20–24 age group. 224(75.7%) of the respondents had religious participation while 72(24.3%) had not. Regarding the ethnicity of the respondents, 243(82.1%) were Oromo, 22(7.4%) Amhara, 13(4.4%) Tigre and 18(6.1%) were Gurage. Besides, 149(50.3%) had pocket money and 225(76.0%) of the youths had been attending school (Table 1).
Sexual and non-sexual behaviors of the respondents
Almost half of the respondents, 144(48.6%) ever had sexual intercourse. The majority, 102(70.8%) had their first sexual intercourse before 18 years with a mean age of 17.07(2.649). Out of those sexually active respondents, 73(50.7%) had regular sexual partners, 38(26.4%) had an occasional sexual partner and 33(22.9%) had no sexual partner during the study period. 30(20.8%) of them had sexual intercourse with commercial sex workers.
Besides, one hundred twelve (77.8%) of those sexually active respondents had practiced sexual intercourse in the last 12 months before data collection. 56(38.9%) had one sexual partner and 88(61.1%) had two or more sexual partners during the data collection period. 51(35.4%) of them had never used a condom, 32(22.2%) used sometimes, 18(12.5%) used most of the times and 43(29.9%) used always during the last 12 months before data collection. On the first sexual intercourse, 59(41%) had used a condom. The reasons mentioned for not using condom was not available 12(11.7%), dislike it 12(11.7%), partner refused 10(9.7%), trust on partner 18(17.5%), condom reduce pleasure 24(23.3%), I didn`t think of it 12(11.7%), condom may have virus 1(1%), condom is expensive 3(2.9%), in love with partner 7(6.8%) and others 4(3.9%).
On their last sexual intercourse, 76(52.8%) had used a condom. 57(39.6%) of the respondents had received money/gift to have sexual intercourse. Out of the total respondents, 158(53.4%) had viewed pornography, 73(24.7%) drink alcohol, 45(15.2%) chew khat and 22(7.4%) smoke cigarettes. The majority, 174(58.8%) had practiced major HIV/AIDS prevention methods and most of them, 207(69.9%) had checked serostatus (Tables 2 and 3).
This study tried to identify the sexual behaviors of youths in Nekemte town. Almost half of the respondents were ever had sexual intercourse, which indicates that youths are in high risk and need special attention. This result is similar to another similar study conducted in Dilla town . However, it is higher than studies conducted on Ugandan university students and university students in Ethiopia [18, 19]. This difference might be related to the characteristics of the study population and study area. However, it is lower than studies conducted in Yabello and Addis Ababa [20, 21]. The majority of those who ever had sexual intercourse started their first sexual intercourse before 18 years, which exposed them to more risks. This result is consistent with other similar studies [17, 20]. However, it is lower than the study results from Madawalabu University .
Out of those sexually active respondents, only half of them had a regular sexual partner. This means, half of them committed sexual intercourse with different people, which is another indicator that youths are in unsafe sexual behavior. This study also revealed that a significant number of respondents had sexual intercourse with commercial sex workers which are higher than a study conducted in Dilla town . This result shows that youths are practicing risky sexual behaviors that expose them to sexually transmitted diseases. However, it is lower than in other studies [19, 22].
The majority of those sexually active respondents, 77.8% had practiced sexual intercourse the last 12 months before data collection. This is higher when compared with the previous study conducted in the same area . This is also another alarming result for those who are working on this issue. Sticking to one sexual partner for those sexually active is better to reduce risks; however, this study revealed that the majority of the respondents had two or more sexual partners during the data collection period. This is higher when compared to results from other studies [17– 20, 22–23]. This difference might be due to the characteristics of the study participants and the study area.
Only less than one third among sexually active respondents had used condom consistently in the last 12 months before data collection. The main reasons mentioned for not using a condom were unavailability, dislike it, partner refused and condom reduces pleasure. The results are consistent with other similar studies [17, 19, 22, 24]. Consistent condom use is one of the major HIV/AIDS prevention methods. Those different reasons identified for not using a condom by this study would contribute to promoting consistent condom use.
Condom use on the last sexual intercourse was higher than the first sexual intercourse; this could be related to the fact that most of the first sexual intercourse is accidental. More than two-thirds had exchanged money or gift to commit sexual intercourse. This result is similar to other studies [17, 19, 24]. The reason could be related to that youths are attracted by silly materials. More than half of the respondents in this study had watched pornography. This might be related to easily accessible media and the internet. Concerning substance use, drink alcohol, chew khat and cigarette smoking were identified in order of its magnitude by this study.
Youths with age group 20–24 were more likely had sexual intercourse when compared to 15–19 age groups (AOR = 2.322; 95% CI: 1.258, 4.284). The difference might be due to less family supervision as age advanced. Those who had pocket money were more likely committed sexual intercourse than those who did not have pocket money (AOR = 1.938; 95% CI: 1.057, 3.556). The reasons could be related to the mishandling of money. Youths who were not attending school were more likely committed sexual intercourse than those who were attending school (AOR = 2.539; 95% CI: 1.182, 5.456). This difference might be due to more exposure of the youths to factors like peer pressure.
Those who watched pornography were more likely committed sexual intercourse than those who did not watch pornography (AOR = 4.314; 95% CI: 2.265, 8.216). This might be due to the motivation that the youths develop from viewing pornography to exercise sexual intercourse. Those who drink alcohol were more likely committed sexual intercourse when compared with those who did not drink (AOR = 7.725; 95% CI: 3.077, 19.393). This might be related to fail to self-control and commit unplanned sexual intercourse. Those who did not practice major HIV/AIDS prevention methods were less likely committed sexual intercourse when compared with their counterparts (AOR = 0.243; 95% CI: 0.128, 0.460) (Table 4).
Almost half of the respondents were sexually active and the majority had their first sexual intercourse before 18 years. A significant number of youths had sexual intercourse with commercial sex workers. About two third of them had two or more sexual partners during the data collection period. Only less than one third used condom consistently during the last 12 months before data collection.
Condom use of last sexual intercourse was slightly higher than first sexual intercourse but not satisfactory. There were misconceptions and other reasons identified for not using a condom that needs interventions. Being in the age group 20–24, having pocket money, not attending school, watching pornography and drinking alcohol were identified associated factors with ever had sexual intercourse.
Focusing on those identified variables in future intervention plan would improve the sexual behaviors of youths in the town. Production and distribution of IEC (Information, Education, and Communication) materials to avoid misconceptions of youths on condom use should be enhanced. Supporting peer education on HIV/AIDS prevention and consequences of teenage sexual debut would improve the sexual behavior of youths.
S1 Appendix. Study Questionnaire in English and Afan Oromo.
I would like to thank Wollega University and Family Guidance Association of Ethiopia, Nekemte branch for their support. I am also grateful to data collectors and study participants for their voluntary participation.
- 1. World Health Organization (WHO). 1989. The health of youth. Document A42/Technical Discussions/2. Geneva: WHO
- 2. Khan S. and Mishra V. (2008) ‘YOUTH REPRODUCTIVE AND SEXUAL HEALTH DHS COMPARATIVE REPORTS 19’, (August).
- 3. Agency C. S. and Ababa A. (2012) ‘Ethiopia Demographic and Health Survey’, (March).
- 4. UNAIDS, Report on the global HIV/AIDS epidemic, 2010
- 5. Population Reference Bureau, World Population Data Sheet, 2010
- 6. UNAIDS, Report on the global HIV/AIDS epidemic, 2004
- 7. UNAIDS, Report on the global HIV/AIDS epidemic, 2007
- 8. UNAIDS and World Health Organization (2003), “AIDS Epidemic Update, 2003”.
- 9. UNAIDS, Report on the global HIV/AIDS epidemic, 2002
- 10. Liskin L, Church CA, Piotrow PT, Harris JA. AIDS Education: a Beginning. Baltimore Centre for Communication Programs, Johns Hopkins School of Public Health, W.DC, USA; 1989; XVII: 1–18.
- 11. Glen-Spyron C., Risky Sexual Behavior in Adolescence, Belia Vida Centre, Namibia, 2015.
- 12. Cates W. (2000) ‘Sexually Transmitted Diseases among American Youth: Incidence and Prevalence Estimates, 2000’, pp. 6–10.
- 13. Tu M., Saraiva G. and Id F. (2018) ‘Factors associated with family, school and behavioral characteristics on sexual initiation: A gender analysis for Brazilian adolescents’, (1998), pp. 1–16.
- 14. UNAIDS, Report on the global AIDS epidemic, 2013
- 15. Beyene P, Solomon B, Yared M. AIDS and College students in Addis Ababa: A study of knowledge, attitude and behavior. Ethiopian Journal of Health Dev. 1997; 11 (2) 115–123.
- 16. Seme A., Wirtu Premarital sexual practice among school adolescents in Nekemte town, East Wollega, Ethiop.J.Health Dev. 2008;22(2):167–173
- 17. Abosetugn AE, Zergaw A, Tadesse H, Addisu Y (2015) Correlations between Risky Sexual Behavior and Parental Communication among Youth in Dilla Town, Gedeo Zone, South Ethiopia. Biol Med (Aligarh) 7: 253.
- 18. Agardh et al.: Experience of sexual coercion and risky sexual behavior among Ugandan university students. BMC Public Health 2011 11:527. pmid:21726433
- 19. Dingeta T, Oljira L, Assefa N, Patterns of sexual risk behavior among undergraduate university students in Ethiopia: a cross-sectional study.Pan African Medical Journal. 2012; 12:33 pmid:22891091
- 20. Beyene A, Seid A, Prevalence of premarital sex and associated factors among out of- school youths (aged 15–24) in Yabello town, Southern Ethiopia: A community based cross-sectional study. The Pharma Innovation Journal 2014; 3(10): 10–15
- 21. Girma D, Hailu G, Ayana M, Ketema K (2015) Factors Early Sexual Initiation among Governmental Preparatory School Students, Addis Ababa, Ethiopia. J Community Med Health Educ 5: 333.
- 22. Teferra T, Erena A, Kebede A: Prevalence of premarital sexual practice and associated factors among undergraduate health science students of Madawalabu University, Bale Goba, South East Ethiopia: institution based cross sectional study. Pan African Medical Journal. 2015; 20:209 pmid:26113940
- 23. Negeri : 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. pmid:24690489
- 24. Helen A, Mudzusi M., Asgedom T: The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University. Ethiopia health sa gesondheid 2 1 (2016) 179e186