Sexual risk behaviour and its correlates among adolescents in Indonesia, Laos, Thailand and Timor-Leste: results from national school surveys in 2015

The health and wellbeing of undergraduate students in Indonesia: descriptive results of a survey in three public universities

Around a quarter of the Indonesian population are adolescents and young adults (AYA), the future leaders of upcoming decades. Investing in AYA current health is important to secure their future health and ability to lead the development of Indonesia. There is a need to comprehensively assess the current health of Indonesia's future leaders. This study describes the health and wellbeing of AYA undergraduates, as well as their risk-taking behaviours, to inform the design of university based primary care services that meet student needs. A multicentre survey of undergraduate students was conducted in three Indonesian public universities from October 2022 to October 2023. The questionnaires were adapted from a similar study at the University of Melbourne and covered the domains of general health, academic outcome, risk-taking behaviours, mental health, social pressures-and-supports, perceived discrimination and awareness of the university health services. The data were analysed descriptively to demonstrate the number and percentages of students experiencing conditions in each domain. A total of 4365 students completed the survey, with an average of 2947 completing each section of the questionnaire. Most of the students perceived their general health as good or very good (n = 2,164; 73.7% from those filing in the section; 49.6% from overall participants) and have GPA > 3 (n = 2903;73.5%; 66.5%). However, high percentages had mild to severe depressive (n = 2,240; 74.7%; 51.3%), and anxiety symptoms (n = 1,696; 56.6%; 38.9%). Some expressed risk-taking behaviours, such as smoking cigarettes (n = 460; 16.6%; 10.5%), already engaged in sexual activities (n = 268, 12.9%; 6.1%). Most participants reported having a dysfunctional family (n = 2,755; 92.3%; 63.1%), gender and sexual discrimination (n = 304; 11.6%; 6.9%;), and only a third are involved in social clubs (n = 876; 33.5%; 20.1%). Half of the overall participants are aware of the university health service (n = 2,066; 79%; 47.3%). Despite having high academic achievement, the high proportion of Indonesian students experiencing mental ill health and risk factors for non-communicable diseases are alarming. Health risks are further exacerbated by low social support indicated by most having a dysfunctional family and few involved in social clubs. Further action is required to heighten student awareness of, and access to, university health services and to ensure these services can address their health and social issues.

Associations between socio-demographics, sexual knowledge and behaviour and sexually transmitted infections among reproductive-age women in Southeast Asia: Demographic Health Survey results

Sexually Transmitted Infections (STIs) seriously affect population morbidity, mortality, and are a major public health problem worldwide. A cross-sectional study was conducted using the latest Demographic and Health Survey (DHS) data published between 2005 and 2022 for five Southeast Asian countries. The study's focus was on STI risk factors in the DHS of Timor-Leste, Philippines, Indonesia, Myanmar, and Cambodia. The study included 139,062 women of reproductive age, aged 15 to 49 years, who reported whether they had experienced an STI or its symptoms and had comprehensive information on the variables of interest, including socio-demographics, sexual behaviour and knowledge. The report shows that the prevalence of STIs or symptoms of STIs in 5 Southeast Asian (SEA) countries included in the study is 11.6%, with the highest prevalence found in Cambodia, and the lowest in Philippines. Women aged 15-24 years in Indonesia (17.08%) and Philippines (9.81%), had a higher risk of STIs than those aged 25-49 years. In most studied countries of SEA (Cambodia, Indonesia and Myanmar), poorer women had higher risk of STIs. Also, in most SEA countries (Cambodia, Indonesia, and the Philippines), knowledge of STIs was significantly associated with having an STI in women aged 15-49 years. Sexual behaviour factors showed that acceptance of beating a wife for refusing to have sex with her husband was associated with STIs in all countries except Myanmar. The association between women's characteristics in reproductive age including socio-demography, sexual knowledge and behaviour, and STIs or symptoms of STIs is varied in countries of SEA. STIs interventions can be tailored to the specific characteristics of women in each of the 5 countries of SEA.

Condom non-use among adolescents: Prevalence and associated factors among school-going adolescents from 58 countries

OBJECTIVES

Studies in several resource-limited settings have investigated the prevalence and potential factors associated with condom non-use among adolescents, showing inconsistent and varied findings, owing to methodological inconsistencies. Thus, this study aimed to investigate the prevalence and associated factors of condom non-use among a global sample of adolescents and their differences based on sex and region.

METHODS

We conducted a cross-sectional study using the 2009-2018 Global School-based Health Survey data from 58 countries which included 183,100 adolescents aged 12-15 years. Random-effects meta-analysis was used to estimate the overall and regional pooled prevalence of condom non-use. Multilevel mixed-effect logistic regressions were used to investigate the correlates of condom non-use.

RESULTS

Overall, 26.2% of the total sample reported being sexually active and of these, 27.6% did not use condoms during last intercourse, with boys reporting higher than girls (27.9% vs. 25.6%). The prevalence of condom non-use was the highest in the African region (29.2%) and the lowest in the South-East Asia region (21.1%). There were variations in prevalence across countries, regions, and sex. Female gender, older age, loneliness, suicidal ideation, being bullied, parental support and supervision, truancy, smoking, illicit drug use, early sexual initiation, and having multiple sex partners were associated with condom non-use. There was evidence of heterogeneity of correlates across regions and sex.

CONCLUSIONS

In this analysis, we found variations in the prevalence and associated factors of condom non-use among adolescents by sex and region. These findings can shape effective sexual health initiatives and improve resource distribution across regions.

Sexual Behaviors Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Medical Students: A National Study of Thai Medical Schools

Objective

This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students.

Methods

In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks.

Results

Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity.

Conclusions

Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education.

Sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia: a secondary analysis of the 2017 Global school-based student health surveys

BACKGROUND

Sierra Leone and Liberia have experienced civil wars and, recently, Ebola outbreaks that led to profound economic hardship, psychopathologies and family disruptions. These factors are associated with sexual risk behaviours among youths. However, there is very little information on sexual risk behaviour among Sierra Leonean and Liberian school-going adolescents. The present study assessed the prevalence and determinants of sexual risk behaviours among school-going adolescents (10-19 years) in Sierra Leone and Liberia.  METHOD: We used publicly available nationally representative cross-sectional datasets of the 2017 Sierra Leone and Liberia Global school health survey. The sample consisted of 2798 and 2744 school-going adolescents from Sierra Leone and Liberia, respectively. Complex sample descriptive and regression analysis was used to analyse our data.

RESULTS

The majority of adolescents in the two countries were involved in multiple sexual risk behaviour (80.2%), with a higher prevalence observed in Sierra Leone (85.2%) than in Liberia (75.3%). Liberian adolescents showed lesser odds of indulging in multiple sexual risk behaviours than their Sierra Leonean counterparts (AOR = 0.572; 95%CI: 0.345-0.946). Male, compared to females, were more likely to engage in multiple sexual risk behaviour (AOR = 2.310;95%CI:1.543-3.458), with a similar pattern observed in both countries. Alcohol use was associated with multiple sexual risk behaviour (AOR = 3.064; 95%CI: 2.137-4.392). Also, in Sierra Leone and Liberia, adolescents with one and two or more forms of psychological distress were more likely to have ever had sex than those who did not show any form of psychological distress. Missing class/school was associated with multiple sexual risk behaviour (AOR = 1.655; 95%CI:1.133-2.418). Peer support was only found to be a protective factor against no condom use among Liberian adolescents (AOR = 0.608; 95%CI: 0.435-0.850). Less parental support was only associated with ever had sex among adolescents in Sierra Leone (AOR = 2.027; 95%CI: 1.322-3.107) but not in Liberia (AOR = 1.034; 95%CI: 0.650-1.644).

CONCLUSION

Our study found a high sexual risk behaviour among school-going adolescents in Sierra Leone and Liberia. Our finding highlights the need to strengthen sexual and reproductive health education in schools and communities that incorporate mental health promotion activities tailored to this group.

The use of condoms and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African countries

BACKGROUND

Adolescents in sub-Saharan Africa still face sexual and reproductive health challenges. Contraceptives have been used to address these challenges. Despite efforts at national and global levels, contraceptive uptake among young people in Africa remains a challenge due to personal, societal, and health systems-based barriers. We estimated the prevalence and correlates of condom use and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African (SSA) countries.

METHODS

We conducted a secondary analysis of the Global School-based Student Health Surveys (GSHS) datasets pooled from nine SSA countries. We included a sample of 27,504 school-going adolescents 11 years and younger and 18 years and older. We employed meta-analysis using a random-effects model to estimate the total prevalence of the use of condoms, other birth control methods other than a condom and any birth control method at last sexual intercourse. We conducted complex sample descriptive and logistic regression analyses to determine the characteristics and determinants of not using condoms and other birth control methods among sexually active school-going adolescents in nine sub-Saharan African countries, respectively.

RESULTS

More than half [n = 4430, 53.8% (43.9-63.8)], two-fifth [n = 3242, 39.5% (33.2-45.9) and two-thirds of adolescents [n = 4838, 65.6% (57.5-73.7)] of sexually active in school adolescents across the nine sub-Saharan African countries used condom, other birth control methods and any form birth control method during their last sexual intercourse, respectively. The non-use of condoms at last sex was associated with being younger (less than 16 years) [AOR = 1.48;95%CI: 1.12-1.94], early sexual debut [AOR = 1.81(1.47-2.22)], having two or more sexual partners [AOR = 1.30(1.06-1.58)] and no/minimal parental support [AOR = 1.54(1.17-2.03)]. The non-use of other birth control methods at last sex was associated with being male [AOR = 1.37 (1.09-1.73)], early sexual debut [AOR = 1.83(1.48-2.27) and having no parental support [AOR = 1.64(1.34-2.00)].

CONCLUSION

Contraceptive need among sexually active school adolescents in the nine sub-Saharan African countries is high. Such a need calls for the development of country-specific and or the review of existing school-based sexual health education and youth-friendly sexual and reproductive health interventions that target risky adolescents and promote adolescent-parent effective communication, connectedness and support.

Prevalence of Good Condom Usage and Its Association with Condom Use Self-Efficacy among Youth Attending HIV/STDs Clinics in Primary-Care Settings in Malaysia

The low prevalence of condom usage among youth with Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STDs) is a concern. Condom use self-efficacy has been identified as a significant predictor of condom usage. This cross-sectional study examines the prevalence of good condom usage and its association with condom use self-efficacy among Malaysian urban youth, aged between 18 to 24 years old attending HIV/STDs clinics in primary-care settings, Selangor. Utilising the Harmonised Malay version of Condom Use Self-Efficacy Scale (CUSES M-H) questionnaire, the data from 218 responders were analysed using univariate and multiple logistic regression. The prevalence of good condom usage was 61% (95% CI: 54%, 68%). The average mean score of condom use self-efficacy was 3.07. Condom use self-efficacy was divided into four subscales of mechanics, perceived barriers, assertiveness and intoxicants. The assertiveness subscale had the highest average mean score of 3.42, while the intoxicant subscale score had the lowest average mean score of 2.24. Good condom usage was significantly associated with condom use during first sexual intercourse (aOR = 5.81, 95% CI: 1.97, 17.14), duration diagnosis of HIV/STDs of more than 12 months (aOR = 6.40, 95% CI: 2.30, 17.86) and the high assertiveness subscale score (aOR = 1.19, 95% CI: 1.03, 1.36). A behavioural change campaign that targets high-risk youth in primary care settings could promote condom use self-efficacy particularly assertiveness to increase condom usage among the youth.

Prevalence and Correlates of Sexual Risk Behavior among School-Going Adolescents in Four Caribbean Countries

This study aimed to assess the prevalence and correlates of sexual risk behaviors among adolescents in the Caribbean. Nationally representative cross-sectional data were analyzed from 9143 adolescents (15 years = median age) that took part in the 2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS). The results indicate that 41.4% of the students had ever had sex, ranging from 26.4% in Trinidad and Tobago to 48.1% in Jamaica. Among the sexually active, 58.8% had had ≥2 sexual partners; 58.6% had had an early sexual debut (≤14 years); 41.9% had not used birth control the last time they had sex; 28.4% had not used a condom the last time they had sex; and, of the whole sample, 31.9% had engaged in two or more (multiple) sexual risk behaviors, ranging from 16.5% in Trinidad and Tobago to 40.3% in Jamaica. In an adjusted logistic regression analysis, substance use (tobacco, alcohol, and cannabis), psychological distress, frequent soft drink intake, participation in physical fighting, school truancy, older age, and male sex were associated with single and/or multiple sexual risk behaviors. A large number of adolescents in the Caribbean reported sexual risk behaviors, emphasizing the need for intervention.