Factors Associated With Condom Use Among High School Students of Natitingou Agricultural Technical School,Benin,in 2017

Abstract

Introduction

HIV/AIDS is one of the most dreaded diseases of this century. Condom use is probably the most effective way to combat the disease. Objective: To study the factors associated with condom use among high school students in Natitingou in 2017.

Methods

A descriptive cross-sectional analytical study involving 202 individuals, based on non-random sampling technique with exhaustive choice. Collected data were processed and analyzed with Epi-Data 3.1 and Epi-Info 7.

Results

128 male and 74 female students were included in the study. Mean age was 19.51 years. Prevalence of condom use was 40.63%. Factors associated with condom use were: level of education, injecting drug use, knowing one’s HIV status, ease access to condom, friends' point of view on voluntary testing.

Conclusions

There is still room for improving the prevalence of condom use among high school students, and this suggests the social gradient perspective that other more in-depth studies will be able to specify.

Keywords

HIV/AIDS condom use high school students associated factors Natitingou Benin

Background

AIDS is one of the most terrifying diseases in this century. World AIDS Day in 2017: 1.8 million [1.6 million-2.1 million] HIV-infected people in 2016 worldwide, and about 370000 [270000–490000] new HIV infections in West and Central Africa.¹ In this same region, 310000 [220000–400000] people died of AIDS-related diseases in 2016.¹ Despite significant progress made after more than 15 years in the fight against HIV/AIDS, new infections are occurring among key and vulnerable populations. As a result of the escalating number of young people in sub-Saharan Africa, there are today nearly 100 million young people aged 15–24 compared with 1990.² Young people are generally highly vulnerable to HIV/AIDS infection because of their risky behavior, their lack of access to information on HIV/AIDS and prevention services. “Condoms are the main effective way to fight HIV/AIDS and STIs”.³ However, it is clear that despite IEC campaigns, the problem posed by STIs/AIDS remains real in adolescents.

In Benin, 1.2% prevalence was recorded nationwide among people aged 15–49.^5,6 According to the 2016 follow-up report on Benin HIV/AIDS policy statement, 0.2% prevalence is recorded among young school adolescents aged 15–24, with a female predominance (0.4% vs. 0.1%).⁴ Despite this tendency towards stability in the general population (1.2%), there are pockets of concentration of high prevalence among some key populations more at risk of infection, especially sex workers, their partners, inmates, men who have sex with men (MSM) and injecting drug users (IDUs).⁴

The TRaC (Tracking Results Continuously) household survey on factors associated with routine condom use among adolescents aged 15–24 in the Atacora and Donga regions of Benin in 2010 reveals that systematic use of this means of prevention by these young people with occasional partners was 26.2%.⁵ Adolescents aged 15–19 were at higher risk: in this age group, the proportion of condom non-users is higher (45%) than that of users (32.3%).⁵ Several factors are associated with condom use. Education is a powerful protective factor against HIV infection that provides young people with aspirations for their future, increases their hopes for future income and their ability to process health-related information.⁶ Studies in Africa and elsewhere have shown that school remains a means of protecting children.^7,8 Metiegam in his students-based study found that sex and level of education were significantly associated with condom use.⁹

To date, no study has yet been conducted in Benin focusing on the factors associated with condom use among young people in high schools. Young people, who are real human capital, are concerned, and this jeopardizes the development efforts planned in our various countries since independence. Given their vulnerability to infection and the multiple interactions between STIs/AIDS, it is important to determine the prevalence and factors associated with condom use. We propose to study the prevalence and factors associated with condom use among high school students at the Agricultural Technical School (ATS) in Natitingou in 2017. More specifically, it will be necessary to determine the prevalence of condom use among high school students in ATS Natitingou in 2017; Describe their knowledge, attitudes and practices related to HIV/AIDS and; Determine the factors associated with their condom use.

Data Source and Methods

Data Source

The study took place at ATS Natitingou in Benin. Natitingou municipality is located in the central area of Atacora region. It covers an area of 3,045 km² or 12.8% of the total area of the region. It is limited to the North by Toucountouna municipality, to the South by Copargo municipality, to the East by Kouandé municipality and to the West by that of Boukombe. According to the fourth General Census of Population and Housing (GCPH4) conducted in 2013, the average population of Natitingou is currently about 103843 inhabitants.¹⁰

Methods

It was a descriptive and analytical cross-sectional study. The study population consisted of all ATS Natitingou high school students, both internal and external. Male and female high school students enrolled in 2016/17 academic year, and present during the survey period were included in the study. They all gave their informed consent to participate in the survey. Students unable to answer the interview questionnaire for one reason or the other were excluded. Given the lack of information on the exact number of registered students and regular attendance in each class, and the non-existence of studies providing us with the proportion of condom use in schools in Benin especially in Natitingou, it was impossible to estimate our sample size.

Thus, our sample size corresponded to the total number of individuals meeting the selection criteria. The sampling method was non-probabilistic with an exhaustive choice of subjects.

Semi-structured individual interview technique was used for data collection. We adopted a semi-structured individual interview guide leading to socio-demographic information and those related to HIV/AIDS knowledge, attitudes and practices as well as living and learning conditions. Data collection was conducted from 16th to 28th of October 2017 as the school was accessible during that period. The collection team consisted of four undergraduate students in Sociology and Epidemiology. They were briefed on the methodology for data collection and interview guide filling out.

The dependent variable was condom use and independent variables related to socio-demographic characteristics; predisposing factors; facilitating factors; and reinforcing factors.

A check of the completed forms had been carried out by the survey officers at the end of each day with correction of errors. Data were entered using Epi-Data 3.1 and analyzed with Epi-Info 7. Statistical inference tests (chi-square test and confidence intervals) were performed. The difference was statistically significant for p < 0.05 or when the confidence intervals of different groups do not coincide. The Prevalence Report (PR) was used as a measure of association to quantify associations with condom use.

In compliance with ethics and in accordance with Act n°2010–40 dated 8th December 2010 relating to the code of ethics and deontology for health research in Republic of Benin in its article 6,¹¹ the informed consent and favorable opinion of each subject submitted to our study were collected. We relied on their voluntary membership to provide them with the necessary information about the purpose, significance, and scope of our study before collecting the information. Also, the study population were reassured as to the anonymity and confidentiality of the information collected.

Results

Description of the Study Population

A total of 202 high school students, 128 male (63.37%) and 74 female (36.63%), a sex ratio of 1.7 in favor of boys, were included in the study. The interview was conducted entirely in French. High school students aged 15–20 were predominantly represented (68.81%). Mean age was 19.51 years, with 13 and 28 as extreme values. The mode was 18 years. Christian high school students were more represented (57.92%) as well as those of senior high school (67.33%), those residing outside the school (54.46%) and those coming from the urban area (58.42%).

Prevalence of Condom Use Among High School Students at ATS Natitingou

Of high school students who have ever had sex (n = 160), 33.75% reported having had sex in the last three weeks and 40.63% used a condom during their last sexual intercourse. Reasons for not using condom by ATS Natitingou high school students during the last sexual intercourse were: no possession (23.16%), partner refusal (28.42%), omission (22.11%), too stressed (26.32%) (n = 95).

HIV/AIDS Knowledge, Attitudes and Practices of ATS Natitingou Students

HIV/AIDS Knowledge

All respondents had already heard of AIDS and 99.01% had mentioned that we could protect ourselves from HIV/AIDS, 97.03% knew condom, 85.64% the existence of drugs allowing people living with HIV (PLHIV) to live a normal life. The main sources of information on HIV/AIDS for ATS Natitingou high school students were health center (81.19%) followed by radio (66.34%). Students' knowledge of HIV/AIDS transmission pathways was respectively sexual intercourse (89.60%), blood transfusion (79.21%) and the use of contaminated syringes (70.30%). Altogether, 59.41% of high school students had sufficient knowledge about HIV/STIs transmission pathways; that is, individuals who mentioned both the three correct answers. Of these, 62.50% were male and 37.50% female with the prevalence of 15–20 years.

Attitudes

Among the respondents, 59.41% were worried and concerned about HIV/AIDS and 61.88% were aware that anyone can be infected by HIV. In addition, 92.57% of them were willing to accept a voluntary HIV test and 79.21% rated the purchase or possession of condoms as good. Finally, 74.26% disagreed with PLHIV stigmatization while 64.85% declared being able to care for a PLHIV.

Practices

Altogether, 63.86% of respondents had already obtained a condom and 79.21% had had sex before, with 63.13% of males and 36.88% of females. In addition, 50.50% of them had never been tested and 61.88% had not attended a health center to have information on STIs/AIDS or to treat an STI. Of those who had already been tested, 90% had obtained the test results. For those who did not collect test results, the reasons were lack of time (60%) and fear of the result (40%) while the screening sites used by ATS Natitingou students were: health center (87.13%), “Love and Life” center (54.46%), NGOs (17.82%).

Living and Studying Conditions

ATS Natitingou does not have a voluntary counseling and testing center (VCT) while 63.37% have one in their area. Sexuality was not a taboo in the neighborhood of 55.45% of respondents and getting condoms in their area was easy for 70.30%. For 87.62%, religion did not forbid talking about sexuality. Getting condom was free (37.32%) and paid (62.68%) for high school students. Those who lived away from their parents accounted for 53.47%, 76.24% had parental support and 81.19% had friends to discuss sex with. Among those with parent/guardian support, this support was financial and monthly: US $5–20 (47.40%), US $21–30 (29.22%), US $31–50 (8.44%) and more than US $50 (8.44%). 79.27% and 84.76% of friends with whom to discuss sexuality recognized the influence of friends' views on condom use and voluntary testing, respectively.

Factors Associated With Condom Use

Socio-Demographic Characteristics

Table 1 shows that condom use was significantly associated with study level (p = 0.0019). Prevalence was high (48.65%) and low (22.45%) for senior high school (SHS) and junior high school (JHS) respectively. SHS students are 2.17 times more likely to use condoms than those in JHS.

Table 1.

Condom Use According to the Socio-Demographic Characteristics of ATS Natitingou High School Students (n = 160).

	Total	Condom use		PR	[95% CI PR]	p
	(N)	n	%	PR	[95% CI PR]	p
Sex						0.1786
Male	101	37	36.63	1.30	[0.89–1.88]
Female	59	28	47.46	1
Age (years)						0.4439
[10–15]	3	1	33.33	1
[15–20]	104	44	40.38	0.49	[0.05–4.89]
[20–25]	50	21	42.00	0.46	[0.04–4.74]
[25–30]	3	1	33.33	0.67	[0.02–18.06]
Religion						0.5959
Christians	92	40	43.48	0.72	[0.34–1.54]
Muslims	52	20	38.46	0.81	[0.36–1.82]
Others	16	5	31.25	1
Level						0.0019
Junior high	49	11	22.45	2.17	[1.24–3.77]
Senior high	111	54	48.65	1
Position						0.7529
Internal	69	29	42.03	0.94	[0.64–1.37]
External	91	36	39.56	1
Place of origin						0.7425
Urban	96	40	41.67	0.94	[0.64–1.38]
Rural	64	25	39.06	1

Level of Knowledge on HIV/AIDS

Regarding knowledge of HIV/AIDS transmission pathways at ATS Natitingou (n = 160), we noted a statistically significant association between condom use and the use of contaminated syringes (p = 0.0341).

Attitudes

We noted a statistically significant association between condom use and the point of view of PLHIV stigmatization (p = 0.0221). Students who disagreed with PLHIV stigmatization have a prevalence of 45.16% against 34.78% for those who think otherwise.

Behaviors/Practices

Students who have already obtained a condom, use 2.36 times condom than those who have not previously had access to a condom. Association between condom use and whether or not a condom has been previously obtained was significant (p = 0.0013). There was also a significant association between condom use and whether or not screening was carried out (p = 0.0266).

Living and Studying Conditions

Table 2 shows a statistically significant association between condom use and having parents/guardians support or not (p = 0.0397). Friends' views on voluntary testing were significantly associated with condom use (p = 0.0219).

Table 2.

Prevalence of Condom Use According to Living and Studying Conditions of ATS Natitingou High School Students (n = 160).

	Total	Condom use		PR	[95% CI PR]	p
	(N)	n	%	PR	[95% CI PR]	p
VSC* in School						0.2684
Yes	34	11	32.35	1.32	[0.78–2.24]
No	126	54	42.86	1
VSC in your area						0.1265
Yes	102	46	45.10	0.73	[0.47–1.11]
No	58	19	32.76	1
Somewhere to get a condom						0.499
Yes	116	49	42.24	0.86	[0.55–1.34]
No	44	16	36.36	1
If yes, free or paid						0.9005
Free	50	19	38.00	1.03	[0.66–1.60]
Paid	87	34	39.08	1
Sexuality taboo in neighborhood						0.8871
Yes	70	28	40.00	1.03	[0.70–1.50]
No	90	37	41.11	1
Religion forbids talking sexuality						0.5758
Yes	33	12	36.36	1.15	[0.70–1.88]
No	127	53	41.73	1
Culture forbids talking sexuality						0.6701
Yes	20	9	45.00	0.99	[0.53–1.50]
No	140	56	40.00	1
Living away from parents						0.2249
Yes	72	33	45.83	0.79	[0.55–1.15]
No	88	32	36.36	1
Support from parents/guardians						0.0397
Yes	122	55	45.08	0.58	[0.33–1.03]
No	38	10	26.32	1
Friends to discuss sex with						0.1201
Yes	134	58	43.28	0.62	[0.32–1.20]
No	26	7	26.92	1
Point of view on condom use						0.0923
Agree	108	51	47.22	0.64	[0.36–1.14]
Do not agree	30	9	30.00	1
Point of view on voluntary testing						0.0219
Agree	118	56	47.46	0.42	[0.17–1.03]
Do not agree	20	4	20.00	1

Abbreviation: VSC: Voluntary Screening Center.

Discussion

Limitations of the Study

The sampling method is non-probabilistic with an exhaustive choice of high school students. The lack of information on the exact number of registered and regular attendance in each class and the absence of any proportion on condom use in schools in general and high schools in particular explain this choice. The small size of our sample is explained by the fact that our sampling method is exhaustive and therefore all subjects that met the inclusion criteria were included. To limit information bias, a long explanation of each question in the interview guide was made to facilitate understanding.

Prevalence of Condom Use

The prevalence of condom use in our study (40.63%) was higher than that obtained by the TRaC study (26.2%) in households on the factors associated with the systematic condom use among adolescents and young people aged 15–24 in Atacora and Donga regions in Benin in 2010.⁵ This difference in prevalence can be explained by the fact that targets have different characteristics. The TRaC study focused on individuals who are probably less educated than those in our study and therefore less informed about HIV/AIDS and the importance of condom use. Also in this TRaC study, adolescents aged 15–19 had a lower prevalence (32.3%) than data recorded in our study (40.38%) for the same age group. Metiegam reports that more than half of the students (56.6%) declared having used condom during their last sexual encounter.⁹ This prevalence is higher than that observed in our study and could be explained by the higher level of education in the case of Metiegam.⁹

Socio-Demographic Characteristics

The prevalence of condom use did not vary significantly by sex (p = 0.1786). Metiegam contrasts with condom use, which varied significantly by sex (p = 0.012).⁹ This difference can be explained by the fact that Metiegam study was conducted in a university while ours was conducted in a high school. University students are probably more knowledgeable about the risk of being infected with the virus than high school students. In addition, condom use was significantly associated with study level (p = 0.0019). Prevalence was high (48.65%) and low (22.45%) for SHS and JHS respectively. The same finding was made by Metiegam in 2009 (p = 0.003). Second and third year medical and 2nd year pharmacy students reported the lowest condom use.⁹

HIV/AIDS Knowledge

All high school students had heard about HIV/AIDS. The same observations were made by Metiegam who found that 100% had heard about HIV/AIDS.⁹ In addition, Rwenge in Bamenda, Cameroon, reveals that 97.1% of young respondents have heard of AIDS.¹² This could be explained by the various methods allowing wide dissemination of information on HIV/AIDS. Regarding the main sources of information on STIs/HIV/AIDS, health center (81.19%) followed by radio (66.34%) were mostly cited by high school students. Talk with parents was the least cited source (29.21%), and in Metiegam (10.2%)⁹ and Traore (8.2%) studies¹³ it is even in lower proportion. The greater proportion recorded in our study could be explained by the fact that high school students are less independent than the students involved in the other two studies and deserve further exploration.

Attitudes

In our study, 64.85% of high school students had approved of taking care of a PLHIV. Metiegam reports 76.7% with students in Bamako⁹ and Nyiransabimana et al.¹⁴ in Rwanda report 80% among housekeeping girls. These differences could be explained by the diversity of targets and their levels of education. In addition, 59.41% of high school students were worried and concerned about HIV/AIDS. This proportion is lower than figures recorded by Metiegam, 91.3%⁹ and could be explained by the diversity of targets, university students having a greater chance of better awareness of HIV/AIDS severity than high school students. These same reasons could explain, in our opinion, the difference observed regarding the students willingness in Metiegam study⁹ to make a voluntary screening (82.4%) and that of the high school students in our study (92.57%).

Practices

In our study, 63.86% of high school students had already obtained a condom at least once and condom use during last intercourse was 40.63%. Metiegam reported 56.6% in her study with a statistically significant difference by sex (p = 0.012).⁹ The level of education of the targets could explain this difference. This same reason could explain the difference between our study and that of Metiegam⁹ with regard to the proportion of respondents who have already been screened (49.50% and 61.2%) and the rate of results non-withdrawal (10% and 5.2%).

Conclusions

The prevalence of condom use among ATS Natitingou students remains low. The typical profile of the high school student using condom is as follows: senior level, regardless of sex, with the support of their parents/guardians, friends who support voluntary testing, knowing their HIV status and that of their partner, with easier access to condom. These results suggest the idea that condom use by ATS Natitingou students is in the perspective of the social gradient that other more in-depth studies will be able to specify.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

David S. Houéto

Author Biographies

David S. Houéto, associate professor in Health Promotion, University of Parakou.

Eloi B. N’Koué N’Da, master degree student in Health Promotion, University of Parakou.

Emmanuel N. Sambiéni, associate professor in Medical Anthropology, University of Parakou.

References

UNAIDS. World AIDS day 2017. Right to health, www.unaids.org/en/resources/campaigns/right-to-health (accessed 2 November 2020).

The Global Fund. Results report 2017. Geneva: Author, 2017, 52 p.

ONUSIDA/OMS 2009. Le point sur l’épidémie de sida 2009. ONUSIDA/09.36F/JC1700F (version française, décembre 2009).

Comité National de Lutte contre le Sida (CNLS/Bénin). Rapport de suivi de la déclaration de politique sur le VIH/sida au bénin 2016. Rapport de Suivi, Mars 2016, 61 p.

Population Services International (PSI-Bénin). Etude TRaC dans les ménages sur les facteurs associes à l’utilisation systématique du condom chez les adolescents et jeunes de 15-24 ans des départements de l’Atacora et de la Donga au Bénin. Round 1. TRaC Summary Report PSI Dashboard, 2012, 14 p.

Manseau

Blais

Côté

, et al. Amour et sexualité chez l’adolescent, carnet de route: programme qualitatif d’éducation sexuelle pour jeunes hommes. Presse de l’Université de Quebec, 2007, 133 p.

Agha

Hutchinson

Kusanthan

The effects of religious affiliation on sexual initiation and condom use in Zambia. J Adolesc Health 2006; 38: 550–555.

Gupta

Mahy

Sexual initiation among adolescent girls and boys: trends and differentials in Sub-Saharan Africa. Arch Sex Behav 2003; 32: 41–53.

Metiegam

ATT.

Connaissances, attitudes et pratiques comportementales liées aux IST et au VIH/sida des étudiants de la FMPOS. Thèse de doctorat en médecine., Diplôme d'Etat, Université de Bamako, Mali, 2009, 85 p.

10.

Biaou

CF.

Monographie de la commune de Natitingou. Bénin: Afrique Conseil, 2006, 85 p.

11.

Ministère de la santé/Bénin. Loi n°2010-40 du 08 décembre 2010 portant code d’éthique et de déontologie pour la recherche en santé. Cotonou, République du Bénin, 2012, 13 p.

12.

Rwenge

Comportements sexuels à risques parmi les jeunes de bamenda, au cameroun. Perspectives internationales sur le planning familial. Numéro Spécial de 2000; 35: 13–18.

13.

Traore

Connaissances, attitudes et pratiques comportementales des jeunes de moins de vingt ans face aux IST/Sida. Thèse de Doctorat en médecine, Université de Bamako, 2006, 92 p.

14.

Nyiransabimana

Ntahobakulira

Nyirazinyoye

, et al. Etude de connaissances, attitudes et pratiques des filles de ménages en matière du VIH/sida/IST au Rwanda: cas de la ville de kigali. Rev Médicale Rwandaise 2012; 69: 23–26.