Background to the Study
The globe is awash with expressions of increasing concerns about a world under threat of diseases, especially, communicable diseases of sexuality through unsafe sexual attitudes and practices. The continued decimation of population through afflictions and spread of diseases appears to compete favourably with continued flow of natural disasters and wars (Campbell, 2009). According to Park (2010) unsafe sexual attitudes and practices have reportedly reached alarming prevalence in several countries especially sub-Sahara Africa.
Globally, excluding HIV and AIDS there are about 333 million new cases of sexually transmitted infections (STIs) per year (Afsar, Mahmood, Kaddir, Barrey Bilgramir 2005) United Population Fund UNPF, (2007) reported that young people world-wide are at the centre of HIV and AIDS epidemic in terms of rate of infection and vulnerability. Out of about 1.5 billion people world-wide, 11.8 million were estimated to be living with HIV and AIDS and everyday between 5,000-6000 young people aged 15-24 years contract HIV. Sexually transmitted infections (STIs), HIV and AIDS is a devastating human tragedy and the greatest humanitarian challenge of our time. The pandemic is still a complex public health problem in sub-Saharan Africa which accounts for more than 65 percent of STIs and HIV infections worldwide (UNAIDS & WHO, 2009). This has been a painful reality, with noticeable impact on families, communities and the society at large. There has been an intense debate in the last two decades on the relative roles of unsafe sex and unsafe health care on STIs and HIV spread in Sub- Saharan Africa, but most public health experts believe that unsafe sexual behaviors (unprotected sex and multiple and concurrent sex partners) are the mechanism through which STIs and HIV is spreading in the region (Halperin and Epstein, 2007; Leclerc- Madlala, 2008). According to these authors, multiple sexual partnerships—particularly overlapping or concurrent partnerships—by both men and women lie at the root of the persistence or the severity of the STIs and HIV epidemic in sub-Saharan Africa.
The Nigeria national HIV prevalence rate had steadily increased from 1.8 per cent in 1991 to 5.8 per cent in 2001 with a decline to 5.0 per cent in 2003 and 4.4 per cent in 2005 (Sentinel Survey, 2005). However, there is wide variation in the prevalence rate across age groups, geographic locations and occupations. Fifteen states of Nigeria have HIV prevalence rates above the national average of 4.4 per cent with Benue State having the highest prevalence rate of 10 per cent, while Jigawa, Ekiti and Oyo states have the least prevalence rates of less than 2.1 per cent (UNAIDS, 2007). Furthermore, a prevalence rate of 5.2 per cent was reported for the age group 15-24 years, with adolescent girls being three times more vulnerable than boys. The infections burden among others includes hepatitis B, trichonomasis, genital herps, genital warts syphilis, gonorrhea, chlamydia, genital herpes, pelvic inflammation disease (PID). Most of these diseases are asymptomatic in women can lead to sterility if not treated (Lucas & Gilles, 2003). Laksaman (2003) opined that students of Nigerian tertiary institutions seem to continue to engage more in unsafe sex practices such as pre-marital sex, homosexuality, having multiple sexual partners and abortion more than ever before, perhaps because of their liberal sexual attitudes. Odu (2008) revealed that most students were sexually active and engaged in high risk sex such as casual sex, same sex, multiple sexual partners, and sex in exchange for money or favour. Similarly Centre for Diseases Control (2008) reported that student’s used of alcohol and drugs are in increase and likelihood of high-risk sexual behaviours when they are drunk and high seem to be prevalent. School students are less likely to use safe sex techniques such as condom, or may use it incorrectly or inconsistently, because, substance use can impair judgment and lead students to make high-risk decisions.
In the area of study through experience and observation, students of tertiary institutions, no more under the close supervision of parents easily fall prey to youthful exuberances. Some organize parties, social nights involving taking of alcohol and smoking, watching of pornographic movies, wearing of obnoxious dresses, mostly by female students which expose sensitive parts of their body. Also during holidays which coincides with festivities like Christmas, Easter and Sallah, students exhibit these habits, some put on expensive ornaments and dresses, organize expensive parties without any form of gainful employment or business. These practices of students may imply that they may be involved in unsafe sexual attitudes and practices. Despite these observations, there is no any statistical data to students involvement in unsafe sexual attitudes and practices in Nasarawa State institutions. Unsafe sexual practices often lead to consequences like unwanted pregnancies, unsafe and illegal abortions, and other sexually transmitted diseases. Therefore, it becomes necessary to study the unsafe sexual attitude and practices of the students to provide a base line data in their institutions.
An individual’s attitude is an embodiment of his or her personality. People’s attitudes to a great extent exert significant impact either negatively or positively on their actions (sexual practice inclusive), which are exhibited by humans. Allport (1995) described attitude as a mental or neutral state of readiness organized through experience, exerting a directive or dynamic influence upon the responses to all objects and situations with which it is related. Hornby (2007) defined attitude as the way one thinks, or feels, behaves towards somebody or something.
Attitudes can also be expressed or exhibited in relation to sexuality. When this phenomenon occurs it is called sexual attitude. Wikipedia Foundation (2011) views human sexual attitude as the manner in which humans experience and express their sexuality. Some sexual attitudes and practices are considered safe or unsafe, legal or illegal either universally or in some countries, and some are considered against the norms of a society. Such example, are sexual permissiveness, unfaithfulness with sexual partner, and lack of mutual respect for sexual partner (Erens, McManus, Field, Korovessis, Johnson, Fenton, & Wellings, 2001; & Waites, 2005).
Sex can only be described as “safe” or “unsafe” if something is known about the context in which it takes place and with whom. Having sex does not place a person at risk of contracting a disease unless that person’s partner has an infection, which he can transmit. Therefore, unlike many other risk factors, which are independent of the situation in the broader population, or with respect to other individuals, unsafe sex cannot be uniquely defined by the set of actions of an at-risk individual. Rather, a definition must be based on an analysis of the individual’s actions in the light of the background prevalence of disease (Rowley & Berkley, 1998).
Berkley (1998) conceptualized safe sex as consensual sexual contact with a partner who is not infected with any sexually transmitted pathogens and involving the use of appropriate contraceptives to prevent pregnancy unless the couple is intentionally attempting to have a child. Wikipedia Foundation (2011) viewed safe sex as sexual activity engaged in by people who have taken precautions to protect themselves against STIs and HIV and AIDS. Many activities are categorized as safe sexual activities.
Activities, such as kissing (with the mouth closed) and hugging are considered safe. Other forms of touching, such as body massage, are considered safe as long as there is no skin-to-skin contact that involves the genital area and buttocks and no contact with body fluids. Using a condom during sexual activities such as vaginal, anal or oral sex is considered safe and can also greatly reduce the risk of getting or spreading STIs. In addition, finding out more about the person before having sex, abstinence and sticking to one partner, however this study restricts itself to unsafe sex.
Hornby (2007) viewed unsafe sex as sexual activity engaged in without precautions to protect against STIs. Slaymaker, Walker, Zabia and Collumbien (2005) defined unsafe sex as sex between a susceptible person and partner who has a STI without taking preventive measures against it. Slaymaker et al. (2005) further stated that unsafe sex occurs if a susceptible person has sex with at least one partner who has an STI, without taking measures to prevent infection. Susceptible individuals are not yet infected, either because the infectious agent has not been successfully transmitted, or because the agent has been transmitted but infection has not yet been established. Therefore, in the context of the present study, unsafe sexual attitudes by students of tertiary institutions shall refer to the actions in which students experience and express their sexuality without adopting necessary precautionary measures to avoid contracting STIs/HIV, abortions, unintended pregnancies and emotional stress.
Erens, McManus, Field, Korovessis, Johnson, Fenton, and Wellings (2001) highlighted examples of unsafe sexual attitudes such as sexual permissiveness, unfaithfulness with sexual partner, lack of mutual respect and appreciation for sexual partner’s opinion, negative opinion of HIV blood test before sex (sero-positive status), negative opinion of STIs diagnoses, injection of non-prescribed drugs before sex and opinion of having abortion when pregnant. UNAID’ (2007) indicated that unsafe sexual attitudes are becoming more institutions. The report further mentioned that the consequences of this quagmire are very terrible.
Park (2009) and Samuel (2010) listed STIs that plague youths as a result of indulgence in unsafe sexual attitudes and practices. These include genital herpes, trichomonas, gonorrhea, syphilis, Chlamydia, non-specific or non-gonococcus arthritis, genital warts, pelvic inflammatory disease (PID), vaginal thrush, hepatitis B virus, human papillomavirus, candidacies and candidacies albicans. Others are trichomoniasis, and herpes genitalis. The aforementioned plagues that are associated with inordinate sexual practices could be prevented when youths adopt safe sexual practices.
Hornby (2007) defined practice as action not ideas. It is a way of doing something that is the usual or expected way in a particular organization. It could be habit or custom- something done regularly. Encarta (2009) defined practices as usual pattern of action especially one that has developed through experience and knowledge. Practices that are related to sexuality are known as sexual practices. Wordiq.com (2011) conceptualized sexual practice as a form of physical intimacy that may be directed to reproduction (one possible goal of sexual intercourse and/or to the enjoyment of activity) involving sexual gratification. In the context of this study, therefore, sexual practice shall be referred to as consensual/non consensual sexual activities engaged by students of tertiary institutions.
Some sexual practices are considered safe or unsafe, legal or illegal either universally or in some countries, and some are considered against the norms of a society. For example, anal sex or sexual activity with a person below some age of consent and sexual assault in general are criminal offenses in many jurisdictions (Wikipedia Foundation, 2011; Waites, 2005).
Although, substantial literature (Berkley, 1998; Rowley & Berkley, 1998; Waites, 2005; Slaymaker et al., 2005; Wikipedia Foundation, 2011) exemplifies two main dimensions of sexual practices, that is, safe and unsafe. Compact (2009) defined safe sexual practices as sexual activity engaged in by people who have taken precaution to protect themselves against sexually transmitted infections such as HIV and AIDS or pregnancy. Examples of safe sexual practices are use of condoms, hugging, kissing and massage, while unsafe sexual practices is sexual activity engaged in without precautions to protect against sexually transmitted infections It is pertinent to reiterate that the present study restricts its scope to unsafe sexual practices.
Slaymaker et al. (2005) viewed unsafe sexual practices as utilization of risky methods or procedures that expose susceptible persons who engage in diverse forms of sexual activities harmful to health. Consequently, unsafe sexual practice in the context of the present study refers to utilization of unsafe methods or procedures by students of tertiary institutions during engagement in diverse forms of heterosexual or homosexual activities that expose them to STIs/HIV infection. Examples of unsafe sexual practices prevalent among Nigerian youths as outlined by Fadiora, Oboro, Akinwusi, Adeoti, and Egbewale (2002) and UNAIDS (2007) include having multiple sexual partners, sexual relationship with sex hawkers (commonly called “aristos” in Nigerian tertiary institutions), engaging in sexual relations with prostitutes to have sexual experience, and engaging in penetrative sex (oral or anal or vaginal) without use of condoms.
With reference to adverse effects and burdens of unsafe sexual practices perpetration by youths globally, UNAIDS and WHO (2002) reported that most of the infections prevalent in 2001 were acquired through heterosexual sexual intercourse. Most people infected with HIV do not know they are infected, making prevention and control difficult. The other STIs included in the burden estimates as C. trachomatis, N. gonorrhoeae, HPV and T. pallidum (syphilis). They cause morbidity in all regions of the world including Sub-Sahara Africa. Infection with some of these agents can lead to infertility (e.g. C. trachomatis) or cancer (HPV), and an acute STI may enhance the transmission of and susceptibility to HIV. Human behavior including unsafe sexual attitudes and practices could occur in patterns.
According to Hornby (2007) pattern is a regular way in which something happens or is done. Cowie (1990) refers to patterns as the various forms that something may take. Similarly, Farlex (2008) stated that patterns have to do with any act of conventional principles and expectations that are binding on any person who is a member of a particular group. There are several types of patterns. Pridemore, Andrew and Spivak (2003) classified patterns into three demographic, temporal and spatial patterns. Demographic pattern is a cogent parameter to understand human activity and behavior including unsafe sexual attitudes and practices. According to Maris (1981) and Stillion (1985) demographic variation refer to the pattern that is concerned with variables of age, gender level of education, marital status, occupation, socio-economic and health status. In the present study demographic variables of gender, age and location on unsafe sexual attitudes and practices among students of Nasarawa state tertiary institutions shall be examined. Gender and age and location may have some temporal variation.
Magnusson (2000) opined that temporal patterns provide significant advantage over traditional analysis by incorporating time. Temporal variations relates to variables such as seasons, semesters, days of the week, public holidays, social gathering, weekends, and so on. In the context of this present study the time window shall be 12 months, which constitute an academic session in most Nigeria public tertiary institutions. Thus temporal variations of school session are holiday period that students of Nasarawa State institution engage in unsafe sexual attitudes and practices. Pridemore et al (2003) described spatial pattern based on geographical regions, or a particular country could be divided into economic and administrative regions or a result of the mixture of structural and cultural forces. Spatial pattern refers to location where students have access or live like hostels, off campus (students villages) hotels and homes. In this study, spartial pattern of campus and off campus will be adopted to refer to geographical location of exhibition or indulgence in unsafe sexual attitudes and practices by students. It is pertinent to highlight that substantial proportion of students’ population of Nigerian tertiary institutions (universities, colleges of education, polytechnics, technical colleges, health and medical institutions) falls within the age bracket of 15-24 years. This age bracket falls within WHO’s (1996) and United Nations’ (2007) definitions of age bracket (15 to 24 years) for youths. This age bracket is also stipulated in Joint Admission Matriculation Board-JAMB’s (2010) brochure as a requirement for admission into any Nigerian tertiary institution for a course of study ( must have attained the age of 16 before the applicant can be admitted).
STIs and HIV and AIDS, which are mostly caused by unsafe sexual attitudes and practices are most prevalent among 20-24 year olds (age bracket of most students in tertiary institutions) and closely followed by the 15-19 years cohort (WHO, 2002). Mba’s (2003) revealed that the most affected age group by the dreaded STIs/HIV epidemic are youths within the age bracket 15-30 years.
Ebere (2006) asserted that at the age of 18, most Nigerian youths still engage in unsafe sexual attitudes and practices with attendant substantial health, economic and psychological consequences, despite increased sexual knowledge. The assertion by the aforementioned researcher is a pointer to the need to determine whether or not similar patterns of sexual attitudes and practices currently exist among students of tertiary institutions in Nasarawa State who are the target population of this present study. Furthermore, Musbau (2010) opined that most studies carried out on sexual behaviours and practices among Nigerian students appear to have focused more on universities students leaving out a substantial category of students in the polytechnics and other tertiary institutions. This bizarre situation justifies the selection of other tertiary institutions including one university for comparism.
Nasarawa State has (6) tertiary institutions that are controlled by the state. These institutions are mostly located in the semi-urban and urban areas; they are College of Education, Akwanga; College of Agriculture, Lafia; Nasarawa State Polytechnic, Lafia; School of Nursing and Midwifery, Lafia; School of Health Technology, Keffi and Nasarawa State University, Keffi.
The study was anchored on three theories viz: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT) and Problem Behaviour Theory (PBT). The theory of planned behaviour based it premises that individual have the ability to control behaviour based on moral justification and outcome of behaviour despite social pressure. Problem Behaviour Theory involves risk taking by youths both negatively and positively (youths as agents of social and political change, exploring, innovators and creativity). The social cognitive theory is a bidirectional process between an individual and the environment. One construct of SCT is self efficacy an individual can influence the environment or be influenced by environment encourage by others family, cliques, peer group, friends and the social environment. A sexually permissive society encourages unsafe sexual attitudes and practices which may be the case of students of Nasarawa State tertiary institutions who are the focus of this study. Following from the above, the social environment, which influences students, may be characterized with various age grades.
Age is a crucial determinant in unsafe sexual attitudes and practices. revealed that the mean age of sexual initiation for female adolescents is 13.7 years, and males 15 years. Those with more than one sexual partner were 22.6 percent (Etuk and Etuk, 2004). They asserted that 78.8 percent of total female respondents initiated intercourse at the age of 12 years, those that have more than one partner were 51 percent of total respondents and for those of more than 5 sexual partners, 6 percent. The early age indulgence in sexual activities can account for high incidences of unplanned sex, unplanned pregnancies and even sexually transmitted infections and HIV among adolescents in Nigeria. The aforementioned implicated various age groups in different places may be same with students of tertiary institution in Nasarawa State which this study is set to find out. Although early age groups have been implicated thus unsafe sexual attitudes and practices may have gender variations.
Most men and women become sexually active during adolescence (Glasier, 2006), and that physical maturation occurs earlier in young men, but psychological and emotional readiness for potential consequences of sexual activity occurs much later than menarche. In some settings, young men have sex before reaching physical maturity; doing so is often related to engaging in high-risk or harmful behaviour (Dixon-Mueller, 2008). Odimegwu (2005) reported that male students were more likely to have sex much earlier and to engage in unsafe sex. Also, there were no obvious differences between the genders in numbers of same sex partners and also that male student display more liberal sexual attitudes than female students. The above evidences may also be found among students of tertiary institutions will be verified in this study.
In a study by Adaramaja et al (2010) they reported that environment a very prominent role in the life style of student especially where the live. In their research they discovered that off-campus students were more involved in the unhealthy lifestyles than the on-campus students. Early on Olley (2008) reported that anecdotal evidence showed that most sexual risk behaviours among university and college students may have been acquired through period of campus life. Shumba et al (2011) in their studies added factors like Lax supervision of students and sexual experimentation influence by alcohol and drugs in university and college campus.