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Wissenschaftliche Studie, 2019
LIST OF ABBREVIATIONS
1.2 Statements of the problem
1.3 Justifications for the study
1.4 Research Questions
1.5 Aims and Objectives
1.5.1 General Objectives
1.5.2 Specific Objectives
2.1 Knowledge of sexual and reproductive health issues
2.1.1 Knowledge and awareness of HIV infection
2.1.2 Awareness and Knowledge of HPV, Chlamydia, Syphilis and Gonorrhoea
2.1.3 Knowledge of contraceptive and use
2.2 Attitudes towards sexual activity and HIV Infection
2.2.1 Age at first sexual intercourse and reasons for sexual activity
2.2.2 Attitudes and Perceptions of HIV infection
2.3 Sexual behaviours and usage of contraceptives
2.3.1 Practices of abstinence
2.3.2 Form of sexual intercourse practiced
2.3.3 Reasons for adolescent sexual activity
2.3.4 Age of First Union/Marriage
2.3.5 Number of Sexual Partners
2.3.6 Early pregnancy and childbearing
2.3.7 Practice of abortion
2.3.8. Contraceptives &condoms use
2.4 HIV/AIDS ASSOCIATED RISK FACTORS IN ADOLESCENT SEXUALITY
2.4.1 Peer Pressure and Influence
2.4.2 Alcohols and Drugs
2.4.3 Mass Media
2.4.3 Socioeconomic Factors; Poverty and Unemployment
2.4.4 Parental influence
2.4.5 Parent - Child Communication:
3.1 Study Area
3.2 Study Design
3.3 Duration of study
3.4 Study Population
3.5 Selection Criteria
126.96.36.199 Inclusion Criteria
188.8.131.52 Exclusion Criteria
3.6 Sample size determination
3.7 Sampling technique
3.8 Data Management
3.8.1 Tools for data collection
3.8.3 Training of research assistants
3.8.4 Method of data analysis
3.9. Ethical considerations
RESULT AND DISCUSSION
Discussion of Findings
SUMMARY, CONCLUSION AND RECOMMENDATION
The study examines assessment of adolescents’ sexual behaviour as a risk factor for hiv infection in akoko northwest local government area of ondo state
The descriptive survey design was used for the study. A study sample of 378 adolescents in Akoko Northwest Local Government Area of Ondo State were randomly selected using the multi-stage random sampling technique. Primary data was collected and gathered with the aid of structured, self-administered questionnaire adapted from both the HIV Knowledge Questionnaire (HIV-K-Q) (45 item version)48 and John Cleland’s Illustrative Questionnaire for Interview-Surveys with Young People and subscale “sexual activity” of the Youth Risk Behaviour Surveillance System (YRBS)49 developed for the Center for Disease Control and Prevention (CDC) . Clarity of questions was tested by first conducting a pilot study Statistic. Retrieval of instrument from respondents was immediate yielding a 100% return rate. SPSS was then combined with EPI Info to make a comprehensive result that was outlined in the results section. Descriptive statistics such as frequencies and percentage distribution shall be used to show the distribution of the study population according to selected study variables.
Result: There is there is no evidence of association between adolescents’ gender, class, and ethnicity while there is an association between adolescents’ age, religion and adolescent sexual behaviour. That majority of the adolescents were aware of HIV, Majority of the adolescents were aware of HIV/AIDS via peer group, Major prevalent risky sexual behaviours among adolescents is virginal sex , Majority of the respondent had their first sex at age 11-13 years, Majority of the respondent had never used condom.
There is significant association between the level of awareness of HIV/AIDS and prevalent risky sexual behaviours of the adolescents
Conclusion Based on the findings of this study one can candidly conclude that Major prevalent risky sexual behaviours among adolescents is virginal sex . That majority of the adolescents were aware of HIV. Majority of the adolescents were aware of HIV/AIDS via peer group. That majority of the adolescents were aware of HIV and mostly through friends/peer group. Majority of the respondent had their first sex at age 11-13 years , Majority of the respondent had never used condom.And that th ere is significant association between the level of awareness of HIV/AIDS and prevalence of risky sexual behaviours of the adolescents.
Recommendation There is need introduce HIV Voluntary Counseling and Testing services in schools through the School and Adolescent Health Programmes, while more attention should be given to proper implementation of the existing programs that reduce stigma, and inculcate a more positive attitude to People Living with HIV/AIDS.
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Adolescence, the transition from childhood to adulthood, is one of the most dynamic stages of human development.1 It is a time of marked physical, emotional, and intellectual changes, as well as changes in social roles, relationships and expectations.1 It is a time of opportunity and risk during which attitudes, values and behaviours that form a young person's future begin to develop and take shape.1
The Adolescents are persons aged 10-19years, however in the real sense adolescents are not just teenagers but they include 10-24 year-olds.2 Adolescence is not one developmental stage, but three developmental stages: Early adolescence (10-14 years of age); Middle adolescence (15-17 years of age); and Late adolescence and young adults (18-24 years of age).1 Expert opinion about the age range for adolescence varies by organization and agency. The health resources and services administration’s bright futures guidelines for health supervision define the age range for adolescence as 11-21 years.2 The Centers for Disease Control and Prevention (CDC) defines the age range for adolescents as 10-19 and refers to 20-24 year olds as young adults, but often groups adolescents and young adults together, recognizing that 20-24 year olds have many developmental and health needs similar to adolescents.2 The three separate stages are important to consider when planning strategies and programs to meet the developmental needs of adolescents.1
One in every five people in the world is an adolescent.1 Current estimates put the population of adolescents worldwide at 1.2 billion and 85% of them live in developing countries.1 Adolescents are not a homogenous group; their needs vary enormously by age, gender, region, socioeconomic condition, cultural context, etc. Similarly, their sexual and reproductive health needs vary considerably across different groups, cultures and religion.2
The World Health Organization (WHO) defines adolescent health as optimal state of well being in all areas of life physical, emotional, cognitive, social and spiritual.3 In the last three decades, a substantial increase has been observed in adolescents' sexual activities and it is rapidly emerging as a public health concern.4 Sexual risk behaviours are sexual activities that may expose an individual to the risk of sexually transmitted infections (STIs) including HIV and unplanned pregnancies.4 Some of these behaviours include unprotected sexual intercourse, multiple sexual partners, forced or coerced sexual intercourse and sexual intercourse for reward.4 Adolescents are known to often engage in risky behaviours such as smoking, drinking alcohol, using drugs, early unprotected sexual activity and lesbianism.5 The sexual behaviour of adolescents is shaped by the parents and families, health care systems, peers, wealth of uncensored information, intensifying wave of westernization, the internet, and electronic media, neighborhoods and communities, employers, schools, social norms, community organizations, government, policies and laws and faith communities.5 Perhaps this explains why adolescence has also been described as a time of ‘storm and stress’.5
There is consensus that adolescents engage in high risk sexual behaviour as a result of physiological and psychological changes that cause them to desire sexual intercourse and take risks, leading to unfavourable sexual and reproductive health indices including unintended pregnancies, unsafe abortions, early childbearing, sexually transmitted diseases and acquired immune deficiency syndrome (AIDS).6 Though the traditional norms in most Nigerian cultures demand premarital sexual abstinence until entry into marital unions; nevertheless, these values are changing rapidly, for the worse, in all ethnic groups and thuds sexually transmitted infections (especially HIV/AIDS) and complications of unwanted pregnancies remain a significant public health problem among adolescent.7
The rising cases of sexually transmitted infections especially HIV in sub-Saharan Africa particularly among the adolescent population8, an undoubtedly a large group of people with increasing population that cannot be ignored or neglected in the health care scheme as it presently constitutes one-fifth (1.2 billion) of the world population and one third of Nigeria’s total population of 180million, hence making sexual and reproductive health among this age group critical. 9 Young people are considered to be particularly vulnerable to the HIV/AIDS epidemic, as about one third of people living with HIV/AIDS are between 15 and 24 years8 and nearly half of new HIV infections worldwide affect young people aged 15–24 years, with girls disproportionately affected.8
In Nigeria, over 35 million people are aged 10–19 years and 3% of 15-19year olds are HIV positive7 ; Sexual abstinence among adolescents a critical preventive strategy against Human Immunodeficiency Virus (HIV) infection and the cultural demand for premarital sexual abstinence until entry into marital unions are rapidly neglected.
23% of female adolescents aged 15–19 years are already mothers or were pregnant with their first child, in the Northwest zone of Nigeria teenage childbearing is as high as 45% of women aged 15 to 19.9 It was noted in 2008 that 20% of women in Nigeria were sexually active by age 15, and the median age for first sex stood at 17.7 years for women and 20.6 years for men, while early sexual initiation lengthens the period of exposure to unwanted pregnancies, HIV, and other sexually transmitted infections. 9 Studies from across Nigeria have reported high level of sexual activity among unmarried adolescents of both sexes with progressively decreasing age of debut with more than 50% of the population having unprotected penetrative sex before the age of 16 and sometimes with multiple partners10 without contemplating the consequences and without accurate information10 and, Girls, most often, bear the consequences of early sexual activity in: unwanted pregnancies, teenage births and abortions, often by quacks.10 About 16 million girls, aged 15-19 years, give birth every year, most in low- and middle-income countries and a large proportion of these pregnancies are unplanned.7 An estimated 3 million girls of the same age group undergo unsafe abortions every year in many countries10 and teen mothers are twice as likely as older women to die of pregnancy-related causes7 and conditions such as malnutrition and anaeamia place teen mothers’ children at higher risk of illness and death.8
Sexually transmitted diseases occur in both sexes and when inadequately treated, result in chronic reproductive tract infections and infertility10.
Despite the availability of free family planning services, mobile/outreach HIV Counseling and Testing (HCT) services across the ten wards of Akoko Northwest Local Government Of Ondo State and the obvious dangers associated with adolescent pregnancy such as school drop-out, adolescent single parenthood and death from unsafe abortion and prolonged obstructed labour, and prevalence of HIV/AIDS and other sexually transmitted infections consequent to unprotected sexual intercourse, adolescents still engage in unhealthy sexual behaviours such as early age at sexual debut, unsafe sex and multiple sex partners with resultant unwanted pregnancy and high incidence of sexually transmitted diseases. Preventive efforts of providing information through the news media and awareness of sexually transmitted diseases high, yet even where condoms have been freely available, outcome of such campaigns have often had disappointing result.9
While young people have the potential to reduce the spread of HIV/AIDS and are also the most vulnerable to HIV infection, they are also the most affected as they are often called to carry the burden of caring for sick family members. Knowledge about sexual behaviour among Secondary school students in the LGA is essential for planning meaningful implementation of adolescent reproductive health strategies in the LGA. This must be done through first seeking to assess the sexual behaviours of young people and addressing the issue of HIV prevention among young people. The information gained from the study will be used to make recommendations to the State Agency for the Control of AIDS, State Ministry of Education, and Non-governmental Organizations working in HIV and AIDS among youth. This will provide useful and necessary information to policy-makers, planners, program managers, researchers and stakeholders working on adolescent and youth sexual and reproductive health programme that will enhance the broad understanding of the sexual and reproductive health issues that adolescents and youth face today, as well as an understanding of how the sexual and reproductive health needs of adolescents and youth vary across sub-groups and over time. And the need to ensure implementation of various formulated plans, policies, and programs for adolescent and young person in Nigeria.
From an international perspective, any study on the sexual health of Nigerian adolescents is of significance to sub-saharan Africa, because a third of African adolescents live in Nigeria since adolescent sexual behaviour affects economic prosperity, investing in the health and development of young people not only is the right thing to do but also is the smart thing to do for countries that want their economies to grow faster.8
1. What are the prevalent risky sexual behaviours among the adolescents in Akoko Northwest Local Government Area of Ondo State?
2. What is the effect of adolescent sexual behavior toward HIV in Akoko Northwest Local Government Area of Ondo State?
3. What is the level of awareness of HIV/AIDS among adolescent in Akoko Northwest Local Government Area of Ondo State?
4. What are the sources of awareness of HIV/AIDS among adolescents in Akoko Northwest Local Government Area of Ondo State?
5. What is the Age of 1st Sexual Debut of sexually active among adolescents in Akoko Northwest Local Government Area of Ondo State?
6. What is the level of usage of condom among the adolescents in Akoko Northwest Local Government Area of Ondo State?
7. Is there any significant relationship between level of awareness of HIV/ AIDS level and prevalent risky sexual behaviours of the adolescents in Akoko Northwest Local Government Area of Ondo State?
A major aim of this study was to determine whether the current sexual behaviour of in-School adolescents in Akoko Northwest Local Government Area, Ondo State might put them at risk of HIV Infection.
Assessment of adolescents’ sexual behaviour as a risk factor for HIV infection among Secondary School Students in Akoko Northwest Local Government Area, Ondo State
1. To determine the socio-demographic characteristics of in-school adolescents.
2. To assess their knowledge of HIV infection.
3. Examining the prevalent risky sexual behaviours of adolescents.
4. To find out their knowledge about and usage of contraceptives
Adolescents' sexual activities are on the rise and rapidly emerging as a public health concern. There is consensus that adolescents engage in high risk sexual behaviour that predisposes them to reproductive health problems10.
Findings from a Mongolian Study illustrate the overall lack of knowledge on sexual issues among adolescents. About 25% of adolescents do not have a basic knowledge of reproductive health11, and fewer than half of the adolescents interviewed had some knowledge of STIs.
According to Marriestopes International, a 1999 survey showed most of the girls and boys interviewed (80%) were unable to talk with their parents about reproductive health and sex.12 Teachers do not often have sufficient knowledge, and were therefore unable to discuss reproductive health with their students. Such a situation has led many adolescents to adopt risky sexual behaviour and become vulnerable to STIs, including HIV. The Adolescent Reproductive Health Survey, conducted in 1996, showed that almost 26% of 17-18 year-old adolescents had experienced sexual intercourse. However, by 1999 that figure had increased to 34.5%.12
A similar study in Nigeria by Duru et al13 showed that Sixty percent of the respondents, did not have formal education about sexual issues and out of the numbers that have heard about it formally, 85.7% were able to mention at least one sign of female sexual maturation and 60.0% mentioned at least one sign of male maturation. Most of the respondents, 47.2% got information about sexual issues from their friends and peer group. This was followed by television, 30.0% parents, 10.4%, newspapers and magazines, 7.4% and school 5.0%. About one third of the respondents, 34.37% were sexually active as at the time of this survey with 65.7% being males and 34.3% being females.13
Baseline study to measure HIV knowledge among 4 111 young people aged 12-20 years in the Philippines found that knowledge of HIV increases with age and is high among those with high education.14 Another study conducted in the USA among high school students, showed no relationship between high levels of HIV knowledge and participation in high-risk.15
Also a quantitative descriptive study conducted in Kenyan Schools among 176 eighth grade learners between the ages of 15-19 years revealed a critical lack of knowledge of HIV transmission via body fluids16 despite good knowledge on HIV signs and symptoms among youth in Kenya, only a small proportion has good knowledge on the prevention of HIV.17 This is however similar to the finding of Nigeria study by Folayan et al that reported that 58.3% of sexually active adolescents had poor knowledge of HIV transmission via body fluids while 73.4% had good knowledge of HIV prevention.18 There were no significant sex differences in the percentage of sexually active adolescents who had good knowledge on HIV transmission and HIV prevention irrespective of the HIV status. Knowledge and awareness was quite high in a study conducted in a mixed sex Secondary School in Ilorin Metropolis reporting on HIV/AIDS, with more than 90% of the adolescents being able to identify the disease as an STD from a given list or in response to the direct question “have you ever heard of HIV/AIDS? 19 In one study where the open question “which STDs do you know or have you heard of?” Was used, 88% of respondents mentioned HIV/AIDS. In the studies where this was asked, a large majority of the adolescents knew that HIV is caused by a virus, is sexually transmitted, and that sharing a needle with an infected person may lead to infection with the virus.19
The reported awareness of HPV among the surveyed adolescents in Italy was generally low ranging from 5.4% in the study by Höglund et al to 66% in the study by Pelucchi et al.20
Two of the studies reported awareness of 35% and 43%20 while the third study mentioned that awareness of Condylomata was lower than that for Chlamydia without stating the corresponding figures.20 A Swedish study reported that most adolescent were able to identify Chlamydia, Syphilis, Herpes and Gonorrhoea as sexually transmitted diseases21 by identification from list of STDs or direct question using (which STDs do you know/have you heard of?)21 participants knew that STDs in general can be symptom-free and that use of condoms can protect against contraction of STDs in general subjective rating of risk of contracting STD in general.21
In Nepal Nearly 98% of married young women aged 15-19 know of modern contraceptive methods. Most of them know of condoms, IUDs and calendar methods. Their basic sources of information on contraception are books, journals and friends. Seventy three per cent of adolescents do not receive information from TV or radio. Among married women aged 15-19 years, 18.8% use some kind of modern contraceptives and 4.7% use traditional methods.22
From a Nigerian study by Duru et al13, fifty two percent of respondents were aware of contraception and about 50.2% were able to mention at least one or more contraceptive methods. The most common methods mentioned by respondents were abstinence 46.3%, male condom, 41.2%, oral contraceptive, 2.0% and IUCD 5.6.%, while none of the respondents mentioned diaphragm, surgical methods, breast feeding or any form of traditional methods.13 Among those who are aware of contraception, 45.9% mentioned that it could be used to prevent teenage pregnancy, 25.9% mentioned that it could prevent sexually transmitted disease, 23.4% said it prevents HIV/AIDS, while 4.8% could not remember its importance. 13
2.1.4 Sources of adolescents’ sexual information
In the United States of America studies have shown that 59% of adolescents learnt about sexuality from their parents and those adolescents want to constantly receive sexual information from their parents and teachers.23 This is similar to the ‘senga’ practise, in Uganda, where exist a traditional channel for sex education to be passed from older women to younger women, albeit in weakened form, but the sex education provided is limited in nature maintaining one’s virginity before marriage and labia elongation are commonly discussed, but risk practices for HIV are frequently not.24 Since these traditional systems of communicating information about sex are weakening, peer groups, schools, churches, the media, traditional health practitioners, and NGOs have emerged as the most prominent sources of health information for young people in Uganda.24
In a study of 350 in-school adolescents in Nnewi, Anambra state, 47.2% got information about sexual issues from friends and peer group. Other sources were television 30%; and school – 5%.25 In Niger State, out of 896 adolescents (only 3.6% married), about 23% obtained information from friends, 23.2% sought information from physicians, while 18.3% got information from parents.26
In the US according to US CDC’s Youth Risk Behavioral Survey (YRBS), many young people begin having sexual intercourse at early ages: 47% of high school students have had sexual intercourse, and 7.4% of them reported first sexual intercourse before age 1327 in contrast to what is obtainable in Latin America, partially due to the influence of the Roman Catholic Church, the average age at first sex for girls is older, at 18-20 years of age.27 However, certain segments of the adolescent population may be sexually active at younger ages as well as revealed in a small sample of young people in Chile 32% had already had sex by age 15.27
Although the attainment of adulthood is getting later in most parts of the world, the age at first sex continues to be early among girls in certain parts of Africa first sexual experience usually takes place at 15-16 years of age.16 These findings are similar to studies conducted in four African countries (Cameroon, Benin, Zambia and Kenya) among 15-20-year-olds through interviewing high school learners on their past and present sexual experiences, which found the medium age at first intercourse to be 16 years.16 Also in South Africa, among a large sample of girls in kwazulu natal, almost half had already had first sexual intercourse at an age of 16.16 Similarly, in a smaller study in Maputo in Mozambique, the mean age at first sexual intercourse for girls of both poor and middle-class socioeconomic level was 1516. In certain population subgroups, e.g. Young people in Peri-urban Areas in Zambia or Zimbabwe, first sex for both boys and girls may occur as early as the age of nine.16
In 2008, according to a survey by NPC and ORC Macro, 20% of women in Nigeria were sexually active by age 15, and the median age for first sex stood at 17.7 years for women and 20.6 years for men.28 Also a study of 350 in-school adolescents in Nnewi, Anambra State, 34.4% of the adolescents have had sexual contact. Of these, 68.3% of them had their first sexual intercourse between the ages of 13 and 16 years13 same applies to a study of 516 in-school adolescents in Delta State.13 Early sexual initiation is consistent with results from studies done in other states in the country. A study of 768 adolescents in Rivers State showed that 78.8% adolescents have been sexually exposed.29 This is higher than reported in other studies. In another study in Rivers State, 34.3% of the sexually active girls have intercourse at least once a week. In Niger State, majority 84.4% noted that they had sexual encounters between 1 and 6 times during the study period. There was a gender difference in the time of initiation of sexual intercourse with a higher percentage of girls initiating intercourse before age of 18 years.30 In a similar study of sexual behaviour in adolescents and young people attending a sexually transmitted disease clinic, Ile Ife, Nigeria, girls were found to be more likely to be exposed to older male counterparts and cross-generational sex and prone to sexual abuse at a very early age and the initiation of sexual activity may have been non-consensual31, 2%-20% of adolescents and young women are subject to the experience of forced sexual relations over the course of their lifetime.31
In India, Mcmanus and Dhar examined 251 adolescent high school girls’ knowledge, perception and attitudes towards STI/HIV, safer sex and sex education in New Delhi32. The knowledge that girls had regarding the transmission and prevention of HIV was good. About 22% of the participants did not believe that there was anything amiss with girls engaging in sex with boys, so long as they loved each other. There were 49% participants who thought condoms should not be made available to adolescents, as they foster their engaging in sex. 32
A study on HIV/AIDS in Ugandans revealed there were 15% HIV/AIDS Ugandans33, which as a result of intervention was reduced to 5%, an unprecedented success rate worldwide.33 Most of the decline on HIV/AIDS infection was among adolescents aged 15 to 19 years. 33 This is significant, taking into account that, in most parts of the world, adolescents aged between 15 to 24 years constitute the largest population of HIV infected persons. In contrast, Kibombo et al correctly argued that perception of being susceptible to contracting HIV/AIDS works as catalyst for undertaking the necessary precautionary measures for the prevention of HIV transmission. They undertook a study of 5,112 (from different parts of Uganda).34 Majority of participants perceived themselves to be vulnerable to HIV infection and guarded against engaging in sexual behaviour that would make them susceptible to contracting the disease.34
Sexual behaviour is important in curbing new HIV infections among young people as revealed by a study of Nigerian adolescent students’ perceptions of HIV/AIDS and their attitudes to prevention methods.35 The results were that the adolescents showed that they had positive perceptions and attitudes toward HIV/AIDS, and that they were also familiar with methods used for guarding against contracting HIV/AIDS. In another study by Durojaiye et al that explored the Nigerian youth knowledge, perception and behaviour and practice in the city of Lagos, the level of knowledge of HIV/AIDS stood at 8.3 out of 10 points.36 Close to 73.5% did not believe that they were at risk of contracting HIV/AIDS with those who had low perception of contracting HIV/AIDS, and there was no commitment to behaviour change.37
Public policies in the US revolved around sexual abstinence12 but, normative adolescent sexual behavior continues to be sexual intercourse as shown in the Centers for Disease Control reports that 54.2% of students in grades 9 through 12 have had sexual intercourse during the last 3 months and, by 12th grade, 71.9% have had sexual intercourse. And that adolescent are practicing more preventive sexual behaviors such as use of contraceptive at first intercourse though some still becomes pregnant and acquiring sexually transmitted diseases, including HIV/AIDS. Most adolescents have positive attitudes about sexual experiences as study shows that 87% of males and 64% of females did not feel pressured to have their first intercourse.12
A Uganda study reported that major predictors of sexual abstinence were being female, not having a boyfriend/girlfriend, not using alcohol, having a positive attitude towards abstinence and high self-esteem. Sexual abstinence was also significantly associated with perceived self efficacy to refuse sex and negative perception of peers who engage in sexual activities.37. This study reported that Uganda has been able to halt and reverse the HIV pandemic through individual behaviour change, abstinence, being faithful and condom use.37
A study of 407 secondary school students (93.7% of them being single) in Sagamu, Ogun State showed that 64.9% had not initiated sexual activity (primary abstinence) 38 while a similar study in Niger State showed majority of the respondents (73%) favoured remaining a virgin until marriage while in Ogun State, more than 76.2% of adolescents agreed that youths should remain virgins until marriage.14 Irrespective of their previous sexual experience, 62.7% of the respondents intended to abstain until they marry, 30.7% were undecided while 156.6% would not14. Various reported misconceptions about abstinence among adolescents in Ogun State as below.14
Among the public health concerns are some of the reported types of sexual practices that increase the risk for adverse health outcome. This includes penetrative vaginal sex and anal sex. In Osogbo, Osun State, in a study of 521 students who were single, oral and anal sex contributed 13.3% and 12.4% of the sexual preferences of the sexually active adolescents respectively.39 Similarly in a study by Duru et al in Anambra State among sexually active adolescents method of sexual intercourse commonly practiced by respondents were vaginal/penile sex which accounted for 74.1% (89) of intercourse, this was followed by masturbation 16.7% (20), while none of the respondents had practiced lesbianism nor homosexuality and only 29.2% (35) of respondents had used any form of contraceptive method at their first sexual intercourse.13 Another type of sex engaged in by adolescents is same-sex intercourse, gay and lesbianism. These were not reported in the reviewed articles. This may be due to the fact that people do not openly acknowledge their preference for same sex partners in our country.
The reasons given for premarital sex in Anambra were peer group pressure (50%), monetary gain (27.5%), personal satisfaction (16.7%), curiosity (4.2%), and lack of home guidance from parents and relatives (1.7%).14 In Niger State the case is different; pleasure contributes 58% of the reasons, 22% to test fertility and 7% to enhance sexual proficiency14. In Abia State, the context for sexual intercourse is worrisome. The study revealed that 5.4% of the girls were drugged; 4.1% raped; 7.4% coerced and 14.2% deceived. 23.0% of the girls did it out of curiosity and 4.1% 25biological urge, other reasons accounted for the rest.14 The sex partners of adolescents have been found to vary. In Bida, Niger State, 56.4% of the sexually active adolescents engaged in sex with their boyfriend/girlfriend; 7.4% did with their fiancé/ fiancée; 3.6% with a sugar daddy/mummy; 1.3 % had sex with any man/woman and 31.3% gave no response.14 In Abia State, among sexually active adolescents, the findings were different: 35.8% with classmate/playmate; 25.9% with boyfriend/girlfriend; 10% (boys) with prostitute; 9.3% with sugar daddy/mummy; 4.9% with proposed spouse; 1.2% 25with strangers and 12.4% with others.14
Early marriage exposes adolescent girls to risks of early pregnancy that might result in complications such as prolonged labor, stillbirth, postpartum hemorrhage, maternal distress and mortality.2 Adolescent mothers who are single are at higher risk of incurring complications related to pregnancy since many adolescent single mothers do not attend antenatal care because they are either ashamed of their pregnancies or they do not realize they are pregnant.2 Consequently, complications related to pregnancy are often not detected early enough amongst this population, thus increasing the severity of pregnancy complications. These factors may explain why the highest percentage of births delivered by caesarean section is to mothers under age 20.1 In some parts of the world, for instance in the Muslim countries of North Africa and in parts of Asia, most sexual activity reported even a decade ago among young people still took place within marriage.18 Overall, however, age at marriage appears to have risen more rapidly than age at first sexual experience, thereby significantly increasing the numbers of young people who have sex before marriage. Early marriage for adolescents in Uganda remains common but is declining as Data from the 2000–2001 UDHS showed that 48% of females and 11% of males aged 15-19 had ever been in a union.13 Relatively few adolescents marry at the youngest ages: 7% of women aged 15-19 were married by age 15 and by age 20, 74% of women had ever been in a union compared to only 26% of men. It also showed that the median age at first marriage was 17.7 years for women 20–24 years old and 21.9 years for men 25–29 years old.13
However, in a study conducted in Northern Nigeria, early marriage was found to prevent or significantly reduced adolescent risky sexual activities.19 Seventy-three percent of girls within ages 13 and 19 are married in the North-east States of Nigeria. These marriages are usually aimed at reinforcing family linkages which in turn foster/enhance political, economic, and social alliances.19 Early marriage is promoted in the belief that it serves as a preventive mechanism against pre-marital sex as revealed in a study in Bauchi state, 30 out of 100 traditional leaders interviewed said that early marriage serves as a preventive mechanism against pre-marital sex.19 However, early marriage has implications for reproductive health problems and increased risk of HIV infection.19 The consequences of early marriage include early first birth that increases the risk of dying in pregnancy as exemplified by studies which show that 6 out of 100 married girls in North-East Nigeria die during pregnancy19. Also infants of adolescent mothers are more likely to die before age 5 thus contributing to high infant mortality rates. Furthermore, adolescents are prone to obstructed labor and studies show that obstructed labor is responsible for 9 out of 10 vesicovaginal fistulae cases in North East Nigeria.19
14 percent of all U.S. high school students have had sexual intercourse with 4 or more partners over their lifetimes16 as similar to the Tanzanian study where adolescents reported number of current sexual partners ranging from none to seven.20 About 15% of sexually active adolescents reported having multiple sexual partners-significantly more males 18% than females 6.3% reported having multiple sexual partners.20
In Uganda, multiple sexual partners are not uncommon among adolescent males13 as 4% of sexually experienced 15-19year old females had 2 or more sex partners in the 12 months prior to the survey compared to 15% of sexually experienced males.14 Trend analysis shows that these numbers have been declining among sexually active adolescents, the proportion with two or more sexual partners declined substantially for females and for males.14 A study by Busulwa and Neema in Mubende, Central Uganda, revealed that one in four adolescent females (15-24) admitted to having had a sexual partner who they knew had other concurrent sexual partners.14
Duru et al in a study conducted in Anambra State Nigeria reported that 40.80% of the 120 adolescents with sexual knowledge have had sex with more than one person.13 The percentage is slightly higher in other parts of the country; 50.50% of 605 adolescents in Rivers State have more than one partner, with up to 6% exposed to more than 5 sexual partners.13 Similarly, out of 294 adolescents in Niger state, 54% have more than one sex partner. In Cross River State, the proportion is lower; 22.6% of the sexually active adolescents have more than one sexualpartner13 ; whereas in Delta State, about one-third of sexually active adolescents have had more than onepartner.13
Unwanted adolescent pregnancy and childbearing and the associated consequences pose a serious public health concern and contribute to rapid population growth in developing world.
Data from a US Youth Risk Behavior Survey23 showed that teenage girls with history of pregnancy were more likely than their sexually active counterparts who did not become pregnant to engage in other problem behaviors. 46.3%of the 1280 female respondents recruited from Ohio public and private high schools (median age, 16.2 years) were sexually active and 7.7% had been pregnant and that girls who had been pregnant differed significantly from their sexually active counterparts who did not become pregnant in terms of several recent risk behaviors, age of onset of behavior, and general behavior. Also pregnancy risk increases for each additional sexual partner during the previous 3 months and each year following initiation of sexual activity.23 In a Serbia study of adolescent sexual behaviour reported that 3.2% of adolescent has had delivery, 4.1% induced abortion (1.6% of the adolescents aged from 17 to 19 had one or more induced abortions), and spontaneous abortion in 0.8%.24
1 World Health Organization. Adolescent health and development. Availablefrom:http://www.searo.who.int/en/section13/section1245_4980.htm (Accessed 12 June 2016)
2 African Population and Health Research Center Policy brief: Protecting in-school adolescents from HIV/AIDS, STI and unwanted pregnancy. Online at: www.realising.rights.org/ docs/newsletter/adolescents policy brief final pdf (2)pdf (2009) [Accessed 20 June 2016].
3 AIDS. A basic introduction. Online at: www.belstat.be/viewst.asp?UserID=halcyon. (2010). [accessed 25 June 2016].
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