Unsafe sexual practice and associated factors among adolescents in secondary schools in Gambella town, Ethiopia: a health belief model.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Adolescents’ perceptions of what is socially acceptable around abstinence and condom use were significantly associated with unsafe sexual practices. In particular, low perceived social support for consistent condom use was associated with greater likelihood of unsafe sexual behavior, underscoring the importance of strengthening social environments that support condom use. The discussion also suggests that gender norms encouraging sexual experimentation among boys while discouraging it among girls may contribute to gender differences in sexual risk-taking.
Objectives The study assessed the prevalence of unsafe sexual practices and factors associated with these practices among secondary school adolescents in Gambella town, Ethiopia, with attention to individual, social, psychological, and behavioral determinants.
Methods An institution-based cross-sectional study was conducted from May to June 2023 among 621 students from two secondary schools using a self-administered questionnaire and random sampling. Unsafe sexual practice was defined using indicators including sexual activity, multiple partners, and unprotected or inconsistent condom use. The study applied the Health Belief Model to assess perceived susceptibility and severity, benefits and barriers, self-efficacy, and social perceptions related to safer sexual behavior. Social norms measures included Likert-scale items assessing perceived peer norms about premarital sex, perceived social or religious acceptability of premarital sex, perceptions of sex as a sign of maturity, and perceived norms surrounding condom use, including whether condom requests signal mistrust or cause partner conflict. Multivariable logistic regression examined factors associated with unsafe sexual practices.
Results Overall, 36.6% of students engaged in unsafe sexual practices; 40.4% had ever had sexual intercourse, and among those sexually active in the previous year, 48.5% reported inconsistent condom use and 45.4% reported two or more partners. Perceived norms supporting consistent condom use were low among 56.7% of respondents. Low perceived norms for consistent condom use were associated with approximately twice the odds of unsafe sexual practice (adjusted odds ratio=2.05; 95% confidence interval: 1.39–3.03). Perceived norms regarding abstinence were also significantly associated with unsafe sexual practice (adjusted odds ratio=0.60; 95% confidence interval: 0.41–0.89). Sex, age, condom-use self-efficacy, pornography exposure, khat use, and alcohol consumption were also significant factors.
Conclusions Unsafe sexual practices were common among students and were associated with social perceptions alongside demographic, self-efficacy, and behavioral factors. The authors recommend age- and gender-responsive school health education and coordinated efforts by schools, education and health authorities to address behavioral and social influences on adolescent sexual risk-taking.
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