Condom use lowest among East African students

Are sexual relationships with older partners, who are more likely to insist on having sex without the use of condoms, one of the high-risk drivers that promote and encourage the transmission of HIV, among university students across Sub-Saharan Africa?

This was one of the questions raised by public health researchers in a study, ‘Low condom use at the last sexual intercourse among university students in Sub-Saharan Africa: Evidence from a systematic review and meta-analysis’, that looked into the persistent low and inconsistent use of condoms by university students in the sub-region during the past two decades.

According to Dr Jonathan Izudi, a research fellow in global health at the University of California, and his associates from Uganda’s Makerere University and Mbarara University of Science and Technology, condom use by university students in the region stands at 52.9%.

The researchers found that, although knowledge and awareness of HIV was extremely high at about 97% among university students, there was significant prevalence of risky sexual behaviours that included low condom use, multiple sexual partnerships and high use of alcohol.

“We found condom use among sexually active university students to be lowest in Eastern Africa at 40.5%, and central Africa at 43.9%, and highest in Western and Southern Africa at 58.6% and 50.5% respectively,” said Izudi.

Researchers analysed studies on condom use among university students that were included in the Web of Science, Google Scholar and other public health platforms for the period between 2000 and 2019.

Admitting that there was little data to explain the regional differences in condom use in Sub-Saharan Africa, Izudi implied the differences could be explained by socio-cultural, religious and differences in HIV/Aids control and prevention approaches in each country. He explained that findings of higher use of condoms in Western and Southern Africa, in comparison with Eastern and Central Africa, might have been due to differences in HIV prevalence.

“Our submission is that, in high HIV-prevalence settings, the majority of students are potentially influenced to use condoms due to the increased risk of HIV acquisition.”

The study noted that what was not in doubt was that the university environment in Sub-Saharan Africa was creating a setting for high-risk sexual behaviours through condomless sexual intercourse and multiple sexual partnerships.

Izudi said countries with low condom use of less than 20% among university students included Madagascar, Ethiopia and Rwanda.

Most researchers appear to be in agreement that persons aged between 15 and 29, an age bracket that includes most university students, bear the burden of most of the new HIV infections in Sub-Saharan Africa as a result of high-risk sexual behaviours that include transactional sex, concurrent sexual partnering and inconsistent use of condoms.

According to Dr Ayesha Kharsany, a senior scientist at the Centre for the Aids Programme of Research in South Africa, of the estimated 6,000 new infections that occur globally each day, two out of three are in Sub-Saharan Africa, with young women continuing to bear the greater burden. But, beyond university students being engaged in age-disparate relationships, researchers have identified a wide range of factors that are contributing to risky sexual behaviours.

Researchers have identified poverty, the use of illicit drugs and excessive drinking of alcohol as well as the watching of pornographic content as some of the factors contributing to risky sexual behaviours in most countries globally.

But, even more critical for university students in Sub-Saharan Africa, peer pressure, living alone in urban settings, lack of parental control, low family connectedness, poor academic performance and having multiple concurrent sexual partners have become new pathways for HIV and other sexually transmitted infections (STI) in student communities.

According to Winnie Byanyima, executive director of the Joint United Nations Programme on HIV/Aids economic shocks in most countries in Sub-Saharan Africa are fuelling transactional sexual relationships that are driven by a need for support.

What this means is that, with the expansion of university education in the sub-region through the adoption of marketisation policies, many poor students who have not been sponsored by governments or just get meagre public higher education subsidies might have been cast into a web of dependency and forced into trading sex in their quest to acquire a degree or a diploma.