Sexual behaviours and associated factors among students at Bahir Dar University: a cross sectional study

In adolescents and young people risky sexual behaviour has been recognized as an important health, social and demographic concern in the developing world[1]. Adolescent and youth are vulnerable to many health problems. Because they often have multiple sexual relationships and inconsistent use of condoms[2]. Young men may have their first sexual experiences with prostitutes, while young females may have their first sexual experiences with older men, both of which increase the chance of getting sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV)[1, 2]. Substance abuse exposes the users to risky sexual behaviours such as having unprotected sex which can have economic, social, physical, psychological, and health problems[2, 3].

University students are in the youth age category and are exposed to risky sexual behaviours such as unprotected sexual intercourse leading to HIV, other STIs and unwanted pregnancies[4‐6]. Female youths are prone to unwanted pregnancies that lead unsafe abortions, severe illness, infertility and death[3, 7].

Young people aged 10–24 years constitute around 1.8 billion and represent 27% of the world’s population[7]. Studies noted that as they are in the youth age category, their modest or dynamic behaviour vulnerable them to risky sexual behaviours[7, 8]. Sexually transmitted diseases like HIV/AIDS and other reproductive health (RH) problems are the greatest threats to the well-being of adolescents and youth[7, 9].

Globally, one-third of the 340 million new STIs cases occur per year in people under 25 years of age. Each year, more than one in every 20 adolescents contracts a curable STI. Studies reported that more than half of all new HIV infections occur in people between the ages of 15 and 24 years[7, 10].

In Ethiopia, young people (aged 15–24) represented one of the country’s largest groups, comprising about 35% of the population[11]. To enhance the sexual and reproductive health and well-being of the young’s population, Ethiopia had a national strategies and activities. Some of the strategies are delivery of all youth RH-related interventions and policies by gender, age, marital status, and residence; addressing the immediate and long-term RH needs of young people; and strengthening multicultural partnerships to respond to young women’s heightened vulnerability to sexual violence and non-consensual sex[7, 12]. Some of the activities are creating awareness of sexual health, providing youth friendly services, increasing human resource capacity, explore new opportunities and expand multtisectorial coordination[7, 12]. However, most related interventions targets the general public as a result it do not directly respond to higher education institution students need and expectation, making actual coverage of behavioural and biomedical interventions extremely low[13]. Therefore, sexual behaviour among adolescents and the youth is still a major issue in Ethiopia[11].

Previous studies conducted in other universities of Ethiopia showed a 26.9% to 34.2% of students ever had sexual intercourse. Of them, 45.2% had more than one sexual partner and 59.4% had first sex at high school. Moreover, the mean age at first sexual practice was 17.9 year and 4.4% of participants had sex with commercial sex workers[4, 14‐16]. Inadditon, different scholars also reported that different factors are responsible for the sexual behaviours of adolescents. Among those, use of alcohol and chewing khat are the common factors[4, 17‐19].

Although Ethiopia is in a concerted effort to enhance the sexual behaviour of youths using different strategy, activities and policies at the national level, the epidemic still continues to grow steadily in the country especially in educational setting claiming the lives of the most productive segments of the Ethiopian society that can lead to high social and economic costs, both immediately and in the years ahead. Moreover, dynamicity of adolescent’s behaviour; it is assumed that student’s sexual behaviour varies interms of locality, civilization, urbanization and socio cultural context of the societies. Specifically, Bahir Dar University is located in areas where there is high flow of tourists, comfortable pensions and night clubs that will expose the students to be engaged in different sexual risk behaviours. However, with the above problems, there is paucity of multicentered data representing the sexual behaviours of students in higher level institution at national level and also among Bahir Dar University students.Therefore, the purpose of this study was to assess the sexual behaviours and associated factors among students of Bahir Dar University, Ethiopia.

In this study 36.4% of the students ever had sexual intercourse. This result is comparable to a study conducted in Nigeria (34%)[24]. However, this proportion was higher than findings of BSS-II (9.9%)[23], studies of other universities (26.9% to 34.2%), Ethiopia[4, 14‐16] and a study conducted in Indian university (5% for female and 15% for male students)[25]. In contrast, it is the lowest compared to other studies in Africa. For instance, 49% to 59% of ever had sex in College and University students was reported in South Africa[26] and Uganda[27]. The possible explanation for the disparity in the proportion of sexual intercourse among adolescents of different studies could be due to different in traditional cultural back ground, sociodemographic characterstics, as well as difference in knowledge, attitude and practice towards HIV/AIDS.

Age at first sexual practice is an important indicator of exposure to the risk of unwanted pregnancy and STIs. The mean age at first sexual practice (18.6 years) for both males and females in this study is comparable to the reports of EDHS (18.2 years)[22], other universities in Ethiopia[14‐16] and students of Madagascar (18.4 years)[26]. In contrast, the mean age of first sex was a bit higher than findings of Jimma University (17.7 years)[4] and Gomo Gofa (17 years)[28]. Moreover, more than half (58.6%) of sexually active students had first sex during secondary school. This conforms with studies of other Universities in Ethiopia ranged from 58.5% to 75.2%[4, 14‐16]. This might indicate that early sexual imitation problem is the issue not only at university level, but also at high school and elementary level. Therefore, secondary school students should be targeted with preventive interventions as youth to discourage premature initiation of sexual activity. The result of multiple logistic regression model revealed an age related increased proportion of ever had penile vaginal sex where as age increased the proportion of sexual experience was increased. Respondents aged 20 years and older significantly more likely than those below 20 years to report that they had sexual experience. This is in line with reports from 2011 EDHS[22].

The proportion of ever had multiple sexual partners among those who had sexual intercourse was 42.7%. Similar comparable finding was noted in Bahir Dar city at private college students[29] and in Gonder[30]. However, high rate of multiple sex partners was reported in Wolaita University[31]. In contrast, a study in Haramaya[15] and Jimma University[4] reported lower rate of ever had multiple sexual partners. The difference could be due to difference in sample size, study population and comprehensive university based behavioural change interventions.

Engaging in risk behaviours such as Khat chewing, drinking alcohol, attending night clubs and watching porno videos were independently associated with likely hood of ever had sex and having multiple sexual partners. It is in line with study from Slovakia[32] and other universities in Ethiopia[4, 14‐16]. This could be due to risk perception ability decreases with alcohol and khat consumption as a result students may not be capable of rational judgment and they also may not be able to predict the serious consequence of their action.

The frequency of unprotected sexual practice in this study (62%) was comparable with study done in Jimma University (57.6%)[4] and higher education of Cambodia[33]. However, it was higher than study from Medawolabu University (40.4%), Ethiopia[34]. Moreover, the level of consistently use of condom (38%) among sexually active students was lower than other studies, Ethiopia[15, 29, 34] that documented 48% - 81% of consistently condom use. This may be because of dynamicity of adolescent’s behaviour, difference in knowledge on risky sexual behaviours, reproductive health issues and skills of condom use.

According to this study, 7.4% of the sexually active students had sexual intercourse with commercial sex workers. This is lower than findings of other Universities in Ethiopia[4, 31, 34] where the rate of sex with commercial sex workers was 13.9% to 24.9%. This difference might be difference in awareness about mode of transmission and risk sexual behaviours among students in different Universities. Although attending night clubs was the only risk factor for engaging in sexual intercourse with commercial sex workers, Bahir Dar University has been started regulation mechanism that might limits the students from attending night clubs. The rules prevent students not to stay out of the campus during the night time.

In this study, the occurrence of exchanging sex for the sake of money was 4%. It is comparable with the cumulative proportion of other Universities of Ethiopia (4.4%)[4, 14, 15]. In contrast, it is lower than other study in Bahir Dar city[35] private college students and Addis Ababa where exchange sex among adolescents was 20.6%[36] and among university students was 14.5%[37]. Exchanging sex for money was significantly practiced in female than males.

In many societies young women have sexual relationship with men who are considerably older than them. This practice can contribute to the spread of HIV and other STIs because older men are more likely to have been exposed for those diseases. In this study, 21.5% of sexually active respondents had sex with older individuals. Similarly, according to EDHS study, over all 21% of women age 15–19 who had sexual intercourse had sex practice with a man ten or more years older than them and very few young men, <1% had sex with older women[22].

The proportion of watching porn videos in this study (65.4%) is comparable with other finding in Ethiopia (47.2%)[30]. However, our finding was significantly higher than studies done at Medawolabu (15.6%)[34] and Jimma Universities (32.4%)[4]. The highest proportion of watching porn videos detected among males and those whose age > 24 years old respondents. This might be associated with existence of sub cultural difference.

In this study, the proportion of attending night clubs is comparable with study in Bahir Dar city private college[29] and Jimma university students[4]. Male respondents were 2.2 times to attend night clubs than females. This might be associated with males feel more freedom and comfort to attend night clubs than females because of local cultural influence. Ethnical difference was also significantly associated with attending night clubs (Table 5). This might be associated with sub cultural difference and influence of the values and norms of the local community.

The major limitation of this study was the nature of cross sectional study which may not explain the temporal relationship between the outcome variable and some explanatory variables. The study topic by itself assesses personnel and sensitive issues related to sexuality which might have caused social desirability bias. Thus, the finding of this study should be interpreted with these limitations.

The study revealed a more comprehensive understanding of the sexual behaviours of Bahir Dar University students. Risky sexual behaviours such as early age sex, having multiple sexual partners, unprotected sex, and sex with commercial sex workers are significantly practiced among students in Bahir Dar University. Substance use, attending night clubs and watching porno video were predictor factors for the existence of different sexual behaviours. Therefore, preventive intervention programmes should be strengthened, effectively implemented and monitored both in the earlier school and at the university level.

WML Assistant professor at College of Medicine and Health Sciences, Bahir Dar University in Medical Microbiology. BAB Associate professor of Medical microbiology, department head of Microbiology, Immunology and Parasitology at College of Medicine and Health Sciences, Bahir Dar University. MYM Assistant professor at College of Medicine and Health Sciences, Bahir Dar University in Medical Parasitology.