1. Condom Use among Unmarried Male Youths in Nigeria: Modelling Socio-demographic Predictors

2. Adebowale Stephen Ayo Department of Epidemiology, Medical Statistics and Environmental Health, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria

3. Background  The HIV prevalence in Nigeria is becoming worrisome, particularly among youths.  Realization of the 6 th theme of the Millennium Development Goal (combat HIV/AIDS, malaria and other diseases) in Nigeria will be a hallucination, if research on underlying factors influencing the use of condom among youths is neglected.

4.  Nigeria: Most Populous African country  Population pyramid: Broad base  Life Expectancy at Birth 47 years (PRB, 2010).  The population figures over years: 158.3Million, 2010; projected 217.4Million, 2025 (PRB, 2010).  Population growth rate (2.4)  Population doubling time (28.9 years)

5.  approximately two-third of the population live in rural areas, which are characterized with poor modern social and health facilities (NPC, 2006).  The total population of male youths is 13,774,081 which constituted 9.81% of the population, while 12,399,007 are unmarried male youths (NPC, 2006).  HIV prevalence is 3.6% (UNAIDS, 2010)

6.  Knowledge of condom as a method of protecting STDs is high in Nigeria, but the utilization is low, particularly among unmarried male youths who are more sexually active than other segments of the males’ population (NDHS, 2003; NDHS, 2008).

7.  Engaging in sexual intercourse with someone other than a faithful spouse or partner is considered high-risk sex in terms of contacting STDs.  There are evidences that the risk of contracting STDs could be reduced by using condom (CDC, 1999; de Vincenzi, 1994; Prata et al., 2005)

8.  Constant use of condom remains an important public health prevention strategy against the spread of STDs and HIV.  However, there are diverse challenges in condom utilization in terms of affordability, accessibility and acceptability.  A handful of studies have examined that condom use is influenced by numerous socio- demographic factors (Kiragu and Zabin, 1995; Gueye et al., 2001; Akinwande and Brieger, 2007).

9.  Findings from sub-Saharan Africa countries indicate that a considerable proportion of youth belief that requesting condom use communicates distrust between spouses or sexual partners, believing that contacting STDs is inevitable and express concern that condom might break and cause injury when in use (Van Rossem et al, 2001).

10. In Nigeria:  There are unmet needs for condom use among male youths.  The cost of condom and poverty.  Availability, accessibility and acceptability

11.  The adverse consequences of not using condom among unmarried male youths are numerous, among which are;  Unwanted pregnancies, abortion, high risk abortion, high risk pregnancies, STDs, negative influence on female partner’s education e.t.c  None or partial utilization of condom can predispose sexually active young men to morbidity, poor health and mortality as a result of contacting STDs including HIV/AIDS.

12.  Improving the sexual health of male youths and their female sexual partners would be accomplished easily if condom is used constantly during sexual intercourse.  Unmarried male youths are a critical target group for sexual behavioral change programs.

13.  Realization of the efforts of achieving good reproductive health outcome will not materialize in a setting where the prevalence of condom use is low, particularly among sexually active male youths.  Few studies have focused on; modeling socio-demographic predictors of condom use among unmarried male youths in Nigeria.  These insights informed the motivation for this study.

14. Method  The study was retrospective cross- sectional in design and utilized NDHS, 2008 data.  During the survey, men aged 15-59 were interviewed.  The current study focuses on male youths aged 15-24 years (n=1629) who ever had sexual intercourse (vaginal, oral and anal).

15. Method (contd.)  Ever use and currently using of condom were used as dependent variables; while socio-demographic characteristics were the independent variables.

16. Method (contd.)  In the original questionnaire designed for the survey, a question was asked from the respondents on the “currently using contraceptive method”. Here, the respondents were to choose from the list of contraceptives both natural and modern methods.  The variable was therefore recoded into two categories; Condom = 1 and Otherwise = 0. This is the first dependent variable. The other dependent variable was obtained from similar question, but on “ever used of contraceptive”.

17. Method (contd.)  Analysis was done using Chi-square and logistic regression models.  Different Models were generated based on the Chi-square statistic.

18. Method (Contd.) Study Limitations  The use of secondary data, because the data was not specifically collected for the actualization of the objectives of this study.  Some youths who are sexually active could claim otherwise because of shame.

19. Findings  The data show that;  61.7% of the respondents had ever used condom.  Significant difference existed between the mean age of those who never used condom (19.60±2.5) and ever users (21.08±2.2).  Demographic factors such as age, region, residence, education and wealth index were found to be significantly associated with condom use (p<0.05).  Religion was not significantly associated with condom use (p=0.05).

20. Findings (contd.)  The percentage of male youths who ever used condom in the south (68.2%) was more than that of the North (44.5%).  Male youths residing in urban, ever used condom (70.8%) more than their rural counterparts (54.9%).  Ever used of condom increases consistently with increasing level of education. For instance, 50.4%, 60.2% and 84.7% of male youths with primary, secondary and higher level of education ever used condom respectively, while 28.3% of those with no formal education ever used condom.  Ever used of condom ranges between 30.5% among youths from poorest wealth index category through 73.4% for those in richest wealth index.

21. Findings (contd.)  Among all the socioeconomic variables considered in the analysis, smoking status, recent sexual activity, knowledge of STDs, ever tested for HIV and the total life-time number of sexual partners were significantly associated with ever use of condom status.  But, health insurance status (p=0.190), work status (p=0.435), had STD in the last 12 months before the survey (p=0.304) and paid for sex in the last 12 months (p=0.207) were not significantly associated with ever use of condom.  Those who ever smoked cigarette ever used condom (76.8%) than never smokers (60.7%).  Male youths who were sexually active in the last 1month before the survey (74.3%), ever used condom than those who were not sexually active (56.0%).

22. Findings (contd.)  The percentage of those who ever used condom was higher among those who ever heard of STDs (62.1%) than those who never heard of STDs (31.8%).  Those who have undergone HIV test (77.7%) were more likely to ever used condom than those who never went for such test (58.9%).  The proportion of condom users was more among respondents who have more than one life-time number of sexual partners (71.3%) than those who had only one (42.0%).

23. Findings (contd.)  Demographic characteristics and current condom use status among sexually active unmarried male youths.  49.5% are currently using condom  There was significant association between current use of condom and demographic characteristics such as; age (p = 0.004), region (p<0.001), residence (p<0.001), education (p<0.001) and wealth index (p<0.001).

24. Findings (contd.)  The percentage of male youths aged 20-24 years who are currently using condom (53.7%) was higher than that of younger male youths (39.7%).  Sexually active male youths living in Southern Nigeria (54.7%) are currently using condom than their counterparts residing in the North (36.1%).  The urban male youth residents were currently using condom (61.9%) than those residing in the rural areas (41.1%).  The proportion of current condom users among sexually active male youth increases with increasing level education, it ranges from 8.3% among illiterates through 70.4% among those who had higher education.  The higher the wealth index, the higher the percentage of male youths who are currently using condom. Approximately 64.0% of male youths that belong to richest wealth index categories are currently using condom as against 11.9% from the poorest.

25. Findings (contd.)  Higher prevalence of condom use was observed among those who ever tested than never tested for HIV (68.8% vs 45.7%) (p<0.001)..  Those who have more than one total life-time sexual partner (52.3%) were currently using condom than those with only one sexual partner (36.3%) (p<0.01).  Variables such as; smoking status, covered with health insurance, work status, ever heard about STDs, had STD in the last 12 months and paid for sex in the last 12 months prior the survey were not significantly associated with current use of condom.

26. Findings (contd.)  The multiple logistic regression analysis of current use of condom by demographic and socio-economic characteristics combined.  Male youths who were 20 years and older were 2.19 (p = 0.001) times more likely to ever use condom than younger youths.  Living in southern region predisposes male youths to the use of condom (AOR=2.05; C.I=1.55-2.72). Than their counterparts in the North.  The odd of ever use of condom was higher among male youth who were in the middle (AOR=2.45; C.I=1.48-4.07), richer (AOR=2.59; C.I=1.56-4.29) and richest (AOR=3.13; C.I=1.80-5.42) wealth indices than poorest.

27. Findings (contd.)  Male youths who were not sexually active in the last one month were less likely (AOR=0.40; C.I=0.38-0.64) to ever used condom than their counterparts who were sexually active.  Those who ever had an HIV test were 1.52 (p<0.018) times more likely to ever used condom than those who have not undergone the test.  Having multiple sexual partners increases the chances of using condom (AOR=2.59; C.I=2.01-3.32).

28. Findings (contd.)  Multiple logistic regression model of current use of condom among sexually active male youths by demographic and socio-economic characteristics.  Only wealth index and those who ever had HIV test show evidence of significant relationship with current use of condom.  Male youths who belong to richer and richest wealth index were 4.9 (C.I=1.76-13.68) and 4.4 (C.I=1.47-13.03) more likely to currently using condom than those in poorest wealth index category.  Currently using condom behaviour was higher among those who ever undergone HIV test (AOR=1.88, C.I=1.10-3.22) than those who never tested for the disease.

29. Findings (contd.)  The TABLE below shows the Adjusted Multiple logistic regression models of predicting the strength of Relationship between Ever Used of Condom, currently using condom among sexually active male youths and Socio-demographic Characteristics in Nigeria (NDHS, 2008). *Significant at 0.1% **Significant at 1% ***Significant at 5%

30. Ever Used CondomCurrently Using Condom BackgroundModel 1Model 2Model 3Model 4Model 1Model 2Model 3Model 4 CharacteristicsN=1557 N=1520 N=510 N=504N=503 Exp(β) Total life-time number of sexual partners OneR.C Two and above2.862*2.993*2.601*2.586*1.340 Age 15-19R.C 20-242.564*2.220*2.198*2.191*1.266 Wealth Index PoorestR.C Poorer1.6361.6771.6843.970**3.416***2.8332.598 Middle2.322**2.447**2.454*4.340**3.416***2.7512.700 Richer2.682*2.556*2.587*9.429*6.396*5.198**4.903* Richest3.362*3.091*3.126*12.427*6.957*4.620**4.369* Education NoneR.C Primary1.5861.1361.0781.8571.6911.580 Secondary1.8861.3041.2343.0872.7622.693 Higher3.839**2.483***2.3375.6663.9743.562 Region NorthR.C South2.025*2.113*2.052*1.4831.472 Recent sexual activity ActiveR.C Not Active0.490*0.491* Place of residence UrbanR.C Rural0.8080.7930.7610.6950.711 Ever been tested for HIV NoR.C Yes1.539***1.523***1.930***1.883*** Cigarette smoking NoR.C Yes1.230 Religion ChristianR.C Islam0.861 Traditional1.215 Others0.492 Constant0.438*0.061*0.172*0.192*0.145*0.077***0.082***0.059** -2 LogL1906.341774.9821688.7341686.115648.238637.317620.942618.002 Nagelkerke R 2 0.1540.2510.2750.2770.1320.1570.1710.178

31. 1.Population of People having STDs reduces and the contacting rate closes to 0 2.Population of People having STDs slightly increases above the initial value and the contacting rate closes to 0 3.Population of People having STDs and the contacting rate amplify. STDs Excluding HIV/AIDs Constantly using condom but STDs not Treated Constantly using condom with STDs Treated Not/irregularly using condom with/without STDs 3 2 2 3 1

32. Conclusion  The prevalence of current use of condom among sexually active unmarried male youths in Nigeria is low and must be improved.  Undergoing HIV test and Free access to condom are good measures for increasing utilization of condom among unmarried male youths in Nigeria.  These will reduce the chances of contacting STDs including HIV and unwanted pregnancies among youths (male and female) in Nigeria.

33. Acknowledgements  The author is grateful to Macro- International U.S.A and National Population Commission for allowing us to use their data (NDHS, 2008) for this study.

34. Thank you for listening