ORIGINAL

Niger J Paed 2014; 41 (2): 86 - 89

John C

Okolo SN

Isichei C

Sexual risk behavior and HIV

infection among adolescents in

secondary schools in Jos, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v41i2,1

Accepted: 27th May 2013

Abstract Background: In adoles-

cents sexual risk behaviours are

believed to enhance the transmis-

sion of HIV infection. This study,

therefore aims to examine preva-

lent sexual risk behaviours of

adolescents in secondary schools

in a town in northern Nigeria and

its relation to HIV infection.

Method: A total of 883 subjects

drawn from 10 schools out of 37,

were recruited for the study.

Structured self administered

questionnaire was given to each

subject. Consenting subjects

were more sexually experienced as

against 13.4% of the females,

p<0.0001. Among the sexually

active37.6% had two or more sex

partners, and 63.9% of them never

used condoms.

In the sexually active, 54 (42.5%)

had nonconsensual sex (NCS),

with more of NCS occurring in

younger subjects p<0.0001, more

females p<0.0001, associated with

less condom use (p=0.02).

Nine (eight females and one male)

of the 883 subjects tested HIV

positive. among the sexually active

subjects, only four tested HIV

positive. Condom use among the

sexually active, HIV positive sub-

jects was 25%.

Conclusion: Prevalent sexual risk

behaviors noted were early sexual

debut, nonconsensual sex, unpro-

tected sex and multiple sex part-

ners.

(

)

John C

Okolo SN

Department of Paediatrics,

Isichei C

Department of Chemical Pathology,

University of Jos,

Jos, Plateau State

Nigeria.

Tel: +2348032822168

Email: cchibunkem@yahoo.com

received group pretest counseling

and had HIV screening using

Determine HIV test kits. HIV

positive subjects had confirmatory

test using Unigold test kit.

Result: Males accounted for

4

2.5% (374) out of the 883

students studied. Of this, 169

19.2%) were sexually active.

Mean age at sexual debut was

3.8±2.9 years; 13.3±2.7 years for

(

1

Key words: Adolescents, Sexual

males and 14.6±3.2 years for fe-

males, p=0.006. Males 101 (27%)

risk behavior, HIV infection, Jos

Introduction

sexual intercourse among adolescents is prevalent, plac-

ing them at risk for HIV infection, other₁s₀exually trans-

mitted disease and unintended pregnancy.

The first case of AIDS was reported in Nigeria in 1987

in a sexually active 13-year-old girl. Since this first

1

Hormones have effects on sexual motivation and behav-

ior and in both sexes these effects are primarily andro-

genic in origin. Adolescence is characterized by upsurge

report, the prevalence rate of HIV infection has been on

the increase in Nigeria; from 1.9% in 1993 to 5.8% in

2

3

11

2

1

001 and with a decline to 4.6% in 2010 In youths,

of such hormones as they begin puberty. This hormonal

2

5-24 years rates declined from 6.0% in 2001 to 4.1%

surge and the sexual exposures put adolescent at risk of

HIV, other STI and unwanted pregnancy.

This study was aimed at determining the sexual risk

behaviours of adolescents in secondary schools and the

relationship between these risk behaviours and HIV

infection among adolescents.

3

in 2010. One third of currently infected individuals are

youths aged 15 to 24 years₄, and half of all new infec-

tions occur in this same age.

Factors associated with increased HIV transmission in-

cludes; early sex, multiple sexual partners and unpro-

tected sex. Others are sexual p₅r_,₆actices such as forced sex

and female genital mutilation.

Method

Among adolescents, early sex, multiple sexual partners,

and unprotected sex as well as traumatic se_,₉xual practices

The study was a descriptive cross sectional study con-

ducted among secondary school students aged 10-19

7

such as forced sex have been reported. Unprotected

8

7

years in Jos metropolis, capital of Plateau state in

northern Nigeria. A multistage random sampling tech-

nique was employed in the selection of the participants

in this study. A list of all secondary schools in the me-

tropolis and environ was obtained from the state minis-

try of education and a random sample of 10 schools out

of 37 schools with both junior and senior secondary

classes was selected. In each school, from JSS 1-3 and

SSS 1-3 forms, two arms each were randomly selected

and from each an equally proportioned sample size of

nine students were randomly selected to participate in

the study. A parental consent form was given to each

student to receive parental/guardian consent. A self-

administered structured questionnaire was administered

to adolescent whose parents/guardians gave consent for

HIV screening.

Table 1: Sexual characteristics of subjects

Variables

Female

Male

Overall

P value

Age

10-14

137 (26.9)

372 (73.1)

509 (57.6)

106 (28.3)

268 (71.7)

374 (42.4)

243 (27.5)

640 (72.5)

883 (100.0)

0.64

15-19

Total

History of sex

No

Yes

Total

Mean age first 14.6

440 (86.5)

69 (13.5)

509 (57.6)

273 (73.0)

710 (80.8)

169 (19.2)

879 (100.00)

13.8 ±3.0yrs

0.000

0.006

101 (27.0)

374 (42.4)

13.3

sex

±3.2yrs

±2.7yrs

Condom us-

age

No

Yes

38 (62.3)

23 (37.7)

61 (64.9)

33 (35.1)

99 (63.9)

56 (36.1)

0.7

0.4

Sex partners

One

More than one 20 (33.3)

40 (66.7)

58 (59.8)

33 (40.2)

98 (62.4)

59 (37.6)

The questionnaire collected information on socio-

demographic characteristics, age at sexual debut, num-

ber of life time sex partner, nature of first sexual expo-

sure, and use of condoms, among others.

Sexual relationship was consensual in 73 (57.5%) of

sexually active subjects while 42.5% was nonconsen-

sual, with more of the nonconsensual sex (NCS) occur-

ring in the younger age group, 47.1% as against 40.9%

in the older age group, p<0.0001. Mean age in consen-

sual sex was higher than in NCS, p<0.0001

Group pretest counseling was given to the sampled stu-

dent while post test counseling was given indi₂vidually.

1

HIV test was done using Abbott Determine rapid test

strips. HIV positive te₃st by Abbott was re-tested using

Those who had consensual sex were more likely to use

condoms (49.3%) than those who received NCS (28.3),

p=0.02. Number of sex partners were not significantly

different in both groups p=0.12. Table 2

1

Unigold antibody test in line with the UNICEF recom-

mendation for the use of two rapid tests as confirmatory

test. Those who tested positive were referred for further

management.

Table 2: Sexual characteristics by nature of sexual relationship

Data collected was analysed using EPI info statistical

software. Frequencies were run for all categorical vari-

ables and means and standard deviation were calculated

for continuous variables to examine sample characteris-

tics. We examined differences between proportions us-

ing Chi square test and Student t-test was used to com-

pare differences between means. P value was set at

Variables

Consensual

Non consen-

sual

P value

Age group

10-14yrs

8 (52.9)

65 (59.1)

73 (57.5)

9 (47.1)

45 (40.9)

54 (42.5)

<0.0001

1

5-19yrs

All total

Sex

Males

Females

60(78)

13(26)

17 (22)

37(74)

13.5±3.3 yrs

<0.0001

0.1

<

0.05 for significance

Mean age at first sex 14.4±2.6 yrs

Ethical approval

Use of condom

No

Yes

Number of partners

One

37(50.7)

36(49.3)

38(71.7)

15(28.3)

0.02

0.12

The Jos University Teaching Hospital Ethical Commit-

tee; Plateau State Ministry of Education; the Chief In-

spector of Education, Jos North Local Government

Area, and the various schools’ Principals gave approval

for the study.

38 (52.8)

34 (47.2)

36 (66.7)

18 (33.3)

>

One

Nine (eight females and one male) of the 883subjects,

(1%), tested positive to HIV infection.

Four (2.4%) of the 169 sexually active subjects were

HIV positive while five (1.0%) out of 710 of those not

sexually active were HIV positive, p=0.054.

Result

Mean age at first sex of the HIV positive subjects is

16.8±2.1 years while that of the HIV negative sexually

active was 13.8±3.0 years, p=0.047.

Of those who had one sexual partner two percent tested

HIV positive, while 3.4% of those with more than one

sex partner tested HIV positive, p= 0.6.

A total of 883 adolescents in secondary schools within

Jos metropolis and environ were involved in the study.

of these, 243 (27.5%) were between the ages of 10 and

1

8

4 years and374 of the students were males. Out of the

83 subjects studied, 169, (19.2%) were sexually active,

with more males, 101 (27%), than females, 69(13.4%).

Mean age at first sex was 13.8±3.0 years overall; In

males 13.3±2.7 years and females 14.6±3.2 years,

p=0.006. Condom usage was 36.1% among the sexually

active subjects. Of these also, 37.6% had more than one

sex partner. Table 1.

8

Condom usage was similar in both groups. Table 3

and 48.3% of f₁e₆male adolescents and as reported by

Araoye in Ilorin. It is also lower than has been reported

elsewhere

1

6,22

Table 3: Sexual characteristics variable by HIV status

Variable

Positive

Negative

Overall

P value

Unprotected intercourse greatly enhances the risk of

transmission of HIV in sexually active individuals. In

the study population, we observed that less than half of

History of sex

Yes

No

4 (2.4)

5 (1.0)

165 (97.6) 169 (19.2) 0.054

705 (99.0) 705 (80.8)

st

9

Mean age 1 sex

16.8 ±2.1

13.8 ±2.9` 13.8±2.9

0.047

the subjects use condom. Slap et al , had reported a

Condom use

Yes

No

higher rate of usage of condoms, and yet others like

Osho and Olayinka report much lower rate of use.

7

1 (33.3)

2 (66.7)

55 (36.2)

97 (63.8)

99 (63.9)

56 (36.1)

1.0

One percent of the population studied tested positive to

HIV. This finding is well below the 2010 National HIV

Sex partners

1

2 (2.0)

2 (3.4)

122 (98.0) 98 (62.4)

31 (96.6) 59 (37.6)

0.6

3

sentinel report in which a median prevalence rate of

>

1

4

.1% in youths aged 15-24 years was reported.

Eight females against one male were noted to be HIV

positive₃. This finding compares with a UNAIDS

2

report that showed that seventy five percent of young

Discussion

people with HIV/AIDS are females. Although males

were noted to be more sexually experienced than

females 27% versus 13.4%, only one tested positive.

This study demonstrates that significant numbers of ado-

lescents are having sex, although this findings, 19.2%, is

less than reported earlier by Slap et al , 34% in Jos and

9

HIV related risk factors

as reported by₄Orji and Esimai, 50%, in Ilesha, South-

1

west Nigeria. In Tanzania, a higher prevalence of

15

8.7% was noted among adolescents, 16-19 years. This

Among sexually active adolescents, HIV prevalence rate

of 2.4% was noted compared with 1.0% in the not sexu-

ally active adolescents.

Mean age at first debut of the sexually active HIV posi-

tive subjects was noted to be 16.8±2.1 years compared

with 13.8±3.0 years in the HIV negative, sexually active

subjects, p=0.047. This does not seem to support the

thinking that early₂a₀ge at first sexual debut is risk factor

for HIV infection even though the number of HIV

positive subjects is too few to generalize.

4

lower levels may not be unconnected with recent up-

surge in media campaigns on safe sex and especially the

‘

Zip Up” campaign of a non-governmental organisation

in Nigeria. This advert was, from this author’s observa-

tion, well received by adolescents interacted with in the

school during the study. More of such media campaign

will go a long way in tackling issues of sex and the ado-

lescents.

In sexually active HIV positive subjects having more

than one sex partners showed a higher association with

HIV infection. This thus lends support to known fact

that having multiple sex par₂t₄ners is a very highly risky

behaviour for HIV infection.

However, age at first sex was earlier in this study than

previously reported in Jos , 13.8±2.9 years as against

9

1

4.8±2.8 years, with males beginning earlier than the

females. Others have reported a later age at first sex,

1

6

Olugbenga-Bello and co report 15.2 years while 14.7

years was rep₇orted by Araoye, though only in females

1

5-19 years. The implication of these findings are that

these adolescents are beginning sexual relationship long

before they are sufficiently informed about sexuality

issues and therefore putting themselves at risk of un-

want₁e₅d pregnancies and infection with HIV and other

STI.

Conclusion

This study has demonstrated occurrence of risky sexual

behaviours among adolescents in secondary schools. It

also demonstrates a significant association of this risky

behaviuor with HIV infection in the subjects.

There is therefore a need to intensify preventive effort in

adolescents and empower them on self-defense

measures against nonconsensual relations.

Females as seen in this study were much more engaged

in NCS than males. This finding is higher than the

1

0.2% found among female adolescent hawkers, 15-19

17

years,₈in Ilorin and higher than global estimates of 5-

1

5%. In Botswana higher rates of NCS were also re-

1

ported. This high rate of coercive relationship observed

may also be due to a tendency for older men (and

women) to seek younger sex partners to satisfy either

their lust, or even the mistak₁e₉n_,₂₀ belief that sex with

younger people can cure AIDS.

Conflict of interest: None

Funding: None

Multiple sexual partners₁have been known to be a risk

2

factor for HIV infection and this finding portray great

danger for the adolescents. It was observed that 37.6%

have had two or more sexual partners in their life. This

9

is little lower than reported by Slap, 57.1% of males

8

9

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