Factors Associated with Early Sexual Debut and HIV Testing among Adolescents and Youth in The Gambia

Background: Adolescent sexual risk behavior has become a major public health challenge, globally. The impact of rural adolescent engagement in sexual risk behavior has been well documented in the developed world such as the United States however; evidence from developing countries is inadequate, particularly in sub-Saharan African. Globally, an estimated 38.0 million people lived with HIV in 2019. An estimated 3.4 million young people aged 15~24 years were living with HIV and sub-Saharan Africa is the region that carries a significant HIV burden. HIV testing is a critical entry point for prevention, care, and treatment, as it facilitates early diagnosis and enhances prompt treatment to reduce new infections among vulnerable youth populations.
Objective: The main purpose of this dissertation was to identify and analyze factors associated with early sexual debut and HIV testing among adolescents and youth in The Gambia.
The aim of the study 1 was to assess sexual risk-taking behaviors, especially on early sexual debut influenced by factors such as health literacy and media use among rural adolescents in The Gambia.
The aim of the study 2 was to assess factors that influence the uptake of HIV testing among adolescents and youth aged 15~24 years in The Gambia.
Methods: Study 1 was a cross-sectional, descriptive correlational study design. Participants were 663 secondary school students recruited among adolescent students in secondary schools of the rural Gambia. The instruments used in this study include health literacy for adolescents (RELM-TeenS), media use, and Youth Risk Behavior Survey and the statistical analysis performed include Chi-squared tests and hierarchical logistic regression.
Study 2, a cross-sectional study design was used for analysis among 6194 participants. The 2013 Gambia demographic and health survey data was used to select variable for the analysis. The analysis employed Chi-squared tests and hierarchical logistic regression.
Results: The mean age of 16.21±1.69, of whom, 191 (28.8%) reported to be sexually active and 150 (22.6%) initiated sex at age of 15 and below. In the multivariate analysis, only gender was significantly associated with ever had sex, while school level, media use (total screen time), and health literacy significantly predict early sexual debut. Ever had sex was more prominent among male adolescent than female. Females compared to males, were 0.21 times less likely to engage in sexual activities, p-value < 0.001. Regarding early sexual debut, adolescent students in the junior secondary schools had lower odds of engaging early sexual debut compared to those senior students (aOR = 0.02; p-value < 0.001). Being heavy screen time media users had higher odds of engaging in early sexual debut (aOR = 5.63; p-value < 0.05). Adolescents who had adequate health literacy were 0.73 times less likely to be associated with early sexual debut, p-value < 0.05.
For study 2, the finding showed that less than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex.
Conclusion: The results of study 1 divulged that gender was significantly associated with ever had sex among adolescent students. Among sexually active adolescents, those who were in junior schools, heavy screen time users, and who had low health literacy had higher odds of being early sexual debutante. Adolescent students deserve age-appropriate comprehensive sex education, screen time media use, and health literacy programs in the existing school curriculum; provide adequate health services, with supportive environments to foster positive sexual and reproductive health services in The Gambia.
For study 2, the second study underscores the low level of HIV testing among youth (15~24 years) in The Gambia. Higher HIV testing was demonstrated among youth (20~24 years), married, with a higher education, those from the Jola/Karoninka tribe, with adequate HIV knowledge, and sexually active and had aged at first sex ≥15 years. Tailored HIV testing services and programs should be implemented to enhance youth HIV testing utilization and the findings can inform the development of worthwhile interventions for this multiplex and relevant population.
Implication: Our findings are relevant in clinical practices and education program to implement best behavioral practices and to strengthen health promotion in schools and in the communities towards preventing sexual risk taking behavior and increase HIV testing among adolescents and youth. Our findings will interest policy makers in formulating policies that will enhance access to and utilization of HIV testing and services among adolescents and youth especially those single youth, with low education who are sexually active. Future studies are required that use more variables for assessing HIV knowledge and behavior variables.