DEMOGRAPHIC DETERMINANTS OF RISKY SEXUAL BEHAVIOUR AMONG IN-SCHOOL ADOLESCENTS IN WUKARI LOCAL GOVERNMENT AREA, TARABA STATE NIGERIA

CHAPTER ONE

Introduction

Background to the Study

Risky sexual behaviour among in-school adolescents is a major public health problem worldwide. United Nations Population Fund (UNFPA, 2004) pointed that sexual activity among young unmarried people worldwide is on the increase. The consequence of risky sexual behaviour is that it increases the likelihood of contracting sexually transmitted infections (STIs), teen pregnancy and low self-esteem. In addition, adolescents’ brain structures are less developed and less well equipped to make rational judgments on complex sexual relationships, thereby predisposing them to heightened risk (Gardener, Steinberg & Peer, 2005).  For these reasons, the United Nations Children Emergency Fund (UNICEF, 2011) continues to highlight youth’s vulnerability to unplanned pregnancy, sexually transmitted infections, unsafe abortions and calls for a better understanding of the factors that increase the risky sexual behaviour with the intention to come up with better interventions to modify these behaviours.

Literature revealed that young people are sexually active and are at high risk of contracting HIV/AIDS. Manju and Lule (2004) observed that involvement in risky sexual behaviours including the early transition to sexual activity and unprotected sex, makes adolescents particularly vulnerable to sexually transmitted infections including HIV/ AIDS, as well as unplanned and unwanted pregnancies, abortions, and the complications of early childbearing.

Research conducted in African countries also confirmed and noted the increase in risky sexual behaviour among in-school adolescents. Studies in South Africa have reported high levels of unsafe sexual activity among adolescents (MacPhail & Campbell, 2001; Eaton, Flisher & Aaro, 2003). According to the South African Household Survey on HIV prevalence, Incidence, and Behaviour report released by Human Sciences Research Council (HSRC, 2011), increasing number of adolescents are starting sexual activities early, reporting multiple sexual partners, and inconsistently using condoms (Kaplan, Jones, Olson  & Yunzal-Butler 2013;  Shisana,  Rehle,  Simbayi, Parker & Zuma, 2009). It was estimated that condom usage among males aged 15 to 24 years declined between 2008 and 2012 from 85 per cent to 68 per cent (Kaplan et al., 2013), while about 50 per cent of young people were estimated to be sexually active by the age of 16 years in 2002 (Eaton et al., 2003). Reports of multiple sexual partnerships among youths aged 15-24 years show an increase from 15.9 per cent in 2002 to 18.0 per cent in 2008 even though it was not a significant change (Shisana et al., 2009).  Similarly, Abma, Martinez and Copen (2010) observed that not all sexually active adolescents take part in risky sexual behaviours. Thirty-nine percent of females and 33 per cent of males who have ever had sex have only had one partner.  Centre for Disease Control and Prevention (CDC,2011)  asserted that when in-school adolescents engage in risky sexual activity, many forgo the use of condoms. The CDC (2011) further stated that nearly 40 per cent of sexually active adolescents did not use condoms during sexual activity.

Studies in Nigeria have focus on risky sexual behaviour among adolescents. For instance, Ariba (2001) found that risky sexual behaviour contributes to many preventable reproductive health problems such as unwanted pregnancy and unsafe abortion. Ugwu (2015) submitted that adolescents perceive sexual relationship as extremely desirable because music, movies, television, magazines and advertisements present sexuality in a way that glorifies and normalizes sexual behaviour of young people.  Omeje and Ekwueme  (2013)  posited that risky sexual behaviour is the major factor in the rising rate of STIs and adolescents are the major victims of this menace.

Sexual behaviours are things we do with others like kissing, erotic touch, intercourse, oral sex, anal sex and manual sexual stimulation (Robinson, 1999). Sexual behaviour is an individual’s ability to experience or express sexual feeling, (Abah & Echodu, 2004). Sexual behaviour in this study refers to feeling of urge, seeking pleasure, sexual actions and reactions related to pleasure seeking. Sexual behaviour could be healthy or risky. Any romantic and pleasurable act or coitus that increases the risk of contracting sexually transmitted infections or becoming pregnant is a risky sexual behaviour.

Risky sexual behaviour refers to any pleasurable coital activity that increases the risk of contracting STIs or becoming pregnant. Risky sexual behavioursare activities that involve sex which end with consequences that negatively affects in-school adolescents’ health. Risky sexual behaviour means having first sex before 16 years, inconsistent condom use and having multiple sexual partners. Many in-school adolescents indulge in risky sexual behaviour especially unprotected sex and having multiple sexual partners.

Unprotected sex means having sexual intercourse without the use of condom. Schwartz, Forthum, Rvert, Zamboanga, Umana-Taylor and Filton (2010) identified unprotected sex, oral sex, anal sex, possession of multiple sexual partners, casual sex, early sexual debut and sex while intoxicated as practices that constitute risky sexual behaviour. It is through these risky sexual behaviours that infections like STIs including HIV/ AIDS are spread.Gabsby (2003) opined that unprotected sexual intercourse is the act of having sex without protective device such as condom and other methods which could result to contracting STIs.

Forms or components of risky sexual behaviours are oral sex, anal sex, sex under intoxication, transactional or survival sex, unprotected sex, and multiple sexual

partners. These behaviours are associated with serious and detrimental outcomes such as unwanted and unplanned pregnancy, sexually transmitted infections (STIs), including HIV/AIDS and sometimes infertility for life.  In the context of this study, risky sexual behaviour refers to all actions involving coitus or intercourse among in-school adolescents that may result to adverse health outcomes.

Many adolescents, in-school adolescents inclusive engage in some forms of sexual behaviours other than vaginal intercourse. For example, between 2007 and

2010, 11 per cent of male adolescents and 13 per-cent of female adolescents reported that they had engaged in anal sex with someone of the opposite, (Copen, Chandra & Martinez, 2012).Chandra, Mosher, Copen andSionean  (2011) observed thatmany adolescents are engaging in other sexual behaviours other than vaginal intercourse. They argued that nearly half have had oral sex and just over one in 10 have had anal sex. Many adolescents are engaging in oral sex prior to having sexual intercourse. About 51 per cent of 15- to 24-years-old had oral sex before they first had sexual intercourse (Barber & Eccles, 2003).They found that oral sex and anal sex do not put adolescents at risk of pregnancy; however, unless precautions are taken, risky sexual behaviours can put youth at increased risk of STDs, particularly since the use of condoms or other barrier methods remains lower for oral and anal sex than for vaginal sex.

Many in-school adolescents engage in sexual intercourse with sexual partners who inject drugs. Thus, they engage in sexual behaviours that place them at risk of sexually transmitted diseases (STDs), including HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2002). Mathers, Degenhardt and Phillips (2008) pointed out that globally, an estimated three million people who inject drugs are living with HIV, representing roughly one in 10 infections worldwide. An estimated 49,273 individuals in the U.S. were infected with HIV in 2011 and injection drug users (IDUs) remain at high risk for HIV transmission. Since the epidemic began, nearly 182,000 injection drug users with an AIDS diagnosis have died, including an estimated 4,218 in 2010.

Sexual intercourse at an early age, having multiple sexual partners and unprotected sex put teens at the risk of sexually transmitted infections (STIs) and unwanted pregnancy  (Central Bureau of Statistics – CBS ,2004). Therefore, the younger the person becomes sexually active the higher the exposure to unwanted pregnancy and sexually transmitted infections. In Canada, 43 per cent of teens aged 15-19 reported that they had sexual intercourse at least once by 2005 down from 47 per cent in 1996. This is in line with the trend in Kenya where the median age of sexual debut decreased from 18.8 years to 16.8 years according to KDHS (2003) and finding of the research.During the 1990s, the proportion of adolescents in the United States who reported having had sexual intercourse before the age of 15 began to increase. Santelli, et al. (2000) argued that although some recent surveys indicate that this trend may be stabilizing, the U.S. age of sexual onset has continued to decline. This is of concern because early initiation of sexual intercourse places adolescents, particularly females, at elevated risk of being involved in an unintended pregnancy, of acquiring HIV or another sexually transmitted infections (STIs), and of other negative social and psychological outcomes (Hofferth, & Hayes, 2001).Centre for Disease Control(1999) opined that it is also troubling because early sexual debut, as well as the overall level of sexual initiation and recent intercourse, is especially high among black and Hispanic youth, and thus contributes to on-going health disparities between minority and white teenagers and young adults. Notably, rates of HIV and other STIs, such as chlamydia and trichomoniasis, are increasing most rapidly among minority youth, and unintended pregnancies, while in decline overall, remain disproportionately high in these populations.

Unprotected vaginal-penile intercourse has been known to be the predominant route for HIV and STIs transmission. However, it is becoming evident that youth are

involved in oral and anal intercourse  (Markham, Peskin,  Addy, Baumer & Tortolero, 2009).  Lindberg, Jones and Santelli (2008) opined that although the oral and anal sex behaviour of adolescents have been researched in the United States (US) for more than two decades, Kazaura and Masatu (2009) submitted that it was only recently that research evidences in some parts of Africa revealed the practice of oral and anal sex.

Some adolescents engage in risky sexual behaviours such as having multiple sexual partners. Some go to the extent of having sexual intercourse with multiple

partners, under the influence of drugs or alcohol that put them at higher risk of

getting pregnant or acquiring STDs (Kelley, Borawski, Flocke, & Keen, 2003). Cook and Clark (2005) found that in 2001, according to a national survey of high school students, 18 percent of male and 13 percent of female students reported having had four or more sexual partners in their lifetime.

While not confined to the continent, the practice of transactional sex has been documented in many countries in Sub-Saharan Africa (Morley, 2011).Barnett, Maticka-Tyndale (2011) opined that distinguished from sex work, transactional sex is often used by female adolescents to achieve a standard of living beyond subsistence. Extreme poverty is less often described as a motivator of transactional sexual encounters (Luke & Kurz  2002)  as compared to commercial sex work; rather, some scholars attribute the practice to female in-school adolescents’ desire to seek modernity, exercise agency, or to engage in conspicuous consumption (Leclerc-Madlala, 2003).   At least some sexual activity does happen as a result of economic circumstances. There is little disagreement here among researchers who study the topic. Anthropologists, demographers, sociologists, and economists agree: “…direct need for material support plays a role in poor female in-school adolescents ‘decisions to readily accept sexual proposals from male adolescents (Verheijen, 2011).

Transactional sex refers to sexual relationships where the giving of gifts or services is an important factor. For the purpose of this study, transactional sex is defined as engaging in sex primarily for the purpose of obtaining material goods, financial support, or grades.

Adolescents’ risky sexual behaviours are capable of being influenced by some factors or determinants.These determinants are social and cultural factors, (for example, some cultures encourage premarital sex and early sexual intercourse, the social factors are technological advancement and modernization e.g. media). The effect of social and cultural determinants on adolescents is great. Unfortunately today’s adolescents are ill-informed on sexual orientation. They learn sexual activities from bad movie/films, watching pornographic films and pictures, sex seducing music, novels and magazines. In line with the above, Bassen, Engquist and Parcel (1999) in Ugwu (2015)  affirmed that ‘‘adolescents from their earliest years watch television shows and movies that insist that ‘sex appeal’ which is a personal quality that people need to develop to the fullest’’.  In contrast, Haffiners (1999) asserted that TV movies and music are not the only influence; the internet also provide the adolescents with seemingly unlimited access to information on sex as well as steady supply of people willing to talk about sex with them.

Authorities have defined demography in different ways. Paul and Geoffrey (2003) stated that demography is the statistical study of population structure, especially human beings, encompassing age, sex, marital status, socioeconomic level, educational level, location, religious affiliation. Meanwhile Goetz (2005) posited that demography refers to the statistical study of human population especially with reference to the size and density, distribution and vital statistics of birth, marriage, death and diseases.  Demography is the scientific study of changes in the distribution of characteristics of a population or society over a period of time (Briggs, 2010). Demographic determinants or variables therefore are characteristics in a population distribution which are capable of changing or causing changes in a study. They are gender, location, educational level, age and religion. Demography as applied to this study therefore refers to characteristics of in-school adolescents which determine their risky sexual behaviour.

National Adolescent Health Policy (2008) in Nigeria defines adolescents as individuals between the ages of 11 and 24 years. Risky sexual behaviour among in-school adolescents leads health challenges among adolescents globally.  Okoro (2002) posited that adolescent is a person who is in the transition to acquire biological features peculiar to the adult group.  Adolescent is a person who is within the period of transition from childhood to adulthood and the adolescent age range fall between the ages of 10 and 19 years (Nwoarali, 2004).  Operational definition of adolescent is adapted from Nwoarali (2004), a person who is within the period of transition from childhood to adulthood with age range between 10 and 19 years.

In-school adolescent is a collection of young students at school. In-school adolescents could be either at boarding or day school. In-school adolescent is a group of secondary school children or youth (encompassing early, middle and late adolescents). In-school adolescents are chosen as subjects for this study because adolescents prefer an autonomous and independent life that is free from adult control, there by engaging in various delinquent acts (drug abuse, unsafe sex, and vandalism and so forth) that are dangerous to health, the home, community, school and the nation. adolescents’ life can be very stressful, experimenting in striving to discover self-identity with poor coping skills that can lead to adolescents using other avenues (risky sexual behaviour) to escape.  Besides, at this point in development, risk-taking behaviours in adolescents is often described as abnormal developmental phenomenon marked by the major changes in biological, psychological and social processes (Stanton, Spirito, Donaldson & Boergers, 2003).   In this study,in-school adolescents refers to a group of youngpeople who are actually in school.

In describing factors capable of influencing adolescents’ risky sexual behaviour, Brynes, Miller, and Schafer (1999) identified gender as having an association with risky sexual behaviour. The authors stressed that gender difference varies with age and context. Violence, insults, and disapproval of condom use during dating for instance, is more common with in-school adolescent male and increases with age. This therefore means that in-school adolescent males are more involve in risky sexual behaviours than in-school adolescent females. An apparent lack of discernment among men and boys, that is, male take risk much greater even when it is clearly a bad idea. Probably due to gender gap, females including in-school adolescent females indulgence in risky behaviours and even in apparently safe situations is minimal, hence the usual experience of less success. Gender is seen by Basson (1991) in Anumba (2013) as a psychological term describing behaviour and attributes expected of individual on the basis of being born either male or female. Gender contextually refers to behaviour and attributes of being a male or female even in Wukari LGA.

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