Risky sexual behaviour among students of a Nigerian tertiary institution

Background While initiation of sexual activity is a part of a normal behaviour and development, it may also be associated with negative outcomes when sexual activity is initiated at too early an age, or without due attention to involved risks. These risky behaviours expose to different kinds of sexuality and reproductive health problems like STIs, HIV, unwanted and unplanned pregnancy, abortion and psychological distress. Objectives to assess sexual risk behaviours among medical students of University of Nigeria. Methods A descriptive cross-sectional study of sexual risk behavior of the tertiary institution students. Results a statistical significance existed between certain socio-demographic characteristics and sexual intercourse; these characteristics are age, level of study and place of residence (p <0.05). Major reasons for sexual abstinence include ‘against my faith’, 66(37.9%), ‘waiting till marriage’, 56(32.2%), ‘not emotionally ready’, 54(31.0%) and fear of pregnancy, 10(5.7%). Conclusion Risky sexual behaviour exist among the respondents though with varying patterns.


Introduction
There are about 2 billion people aged 10-24 years old in the world.The youth in Nigeria account for 32% of Nigerian's 140 million people and nearly half of adolescents aged 15-19 years are sexually active. 1 This significant percentage which is enough to make an impact to the social, health and economy of the society and country at large.Human sexual behavior is any activity which could be solitary, between two persons, or in a group that induces sexual arousal. 2 It is the manner in which humans experience and express their sexuality. 3hile initiation of sexual activity is a part of a normal behaviour and development, it may also be associated with negative outcomes when sexual activity is initiated at too early an age, or without due attention to involved risks. 3exual risk behaviours include but not limited to sex without condom use, oral sex, anal sex, having multiple sexual partners, having a high-risk partner, 2 early sexual debut, sex with a social sex worker.Every minute, five young people worldwide become infected with HIV/AIDS. 4In 12 countries of sub-Saharan Africa, at least 10 percent of those aged 15 to 49 are estimated to be infected with HIV. 5 The majority of new infections in this region are among young people aged 15 to 24.Nigeria accounted for 59% of all new HIV infections in West and Central Africa in 2016. 6t is known that young people often engage in high-risk behaviour like cigarette smoking, drinking of alcohol, drug use, as well as gender-based violence.These behaviours in turn lead to engagement in sexual risk behaviours. 7These risky behaviours expose to different kinds of sexuality and reproductive health problems like STIs, HIV, unwanted and unplanned pregnancy, abortion and psychological distress. 8,9stification for the study Sexual behavior is a complex activity affecting all aspects of human's life.The period of adolescence is characterized by periods of rapid growth, both physical and mental.Adolescents experience specific vulnerabilities that are both psychological and biological and at this period are prone to make unhealthy lifestyle choices.Among Medical Students, the demands of medical school eating into timing, psychology, social life and general indulgence of the students on all spheres indeed makes them an interesting set to study especially as regards risky sexual behaviour especially as most studies done in this respect in our environment have been mostly of the general population.Sufficing, it cannot be over-emphasized that developing valid reliable tools for assessing risky sexual behaviours and its elements especially of the study group in perspective is of paramount consideration for putting an end to increasing sexual health problems. 3is study aims to reflect associations of certain factors such as sociodemographic, religion, curiosity etc. to risky sexual behaviors.As a result of unsatisfactory record keeping and data available in the country, adequate data does not exist on the sexual risk behaviours of adolescents.This aim of this study is to fill this gap and encourage further study in this area.
The Research questions include but not limited to the pattern of sexual risk behaviours among medical students of University of Nigeria? factors associated with sexual risk behaviours among medical students of University of Nigeria, Enugu Campus? while the objective was to assess sexual risk behaviours among medical students of University of Nigeria, Enugu Campus with specific objectives being to identify pattern of sexual risk behaviours as well as identify factors associated with sexual risk behavior among medical students of University of Nigeria, Enugu Campus.

Study area
The study was carried out in the University of Nigeria, Enugu campus, Enugu state.Enugu state in the South Eastern part of Nigeria is dominated by Igbo speaking ethnic groups with other minorities

Study design
The study was a descriptive cross-sectional study of sexual risk behaviours among medical students of University of Nigeria Enugu campus, Enugu State.

Study population
The study population consisted of 200 level to 600 level medical students of the University of Nigeria Enugu campus, Enugu State.

Inclusion criteria
200 level to 600 level medical students of the University of Nigeria Enugu campus who were present at the time of sampling and provided consent to participate in the study.

Exclusion criteria
The exclusion criteria were First year medical students of the University of Nigeria who are based in Nsukka campus, non-consenting medical students and students who declined to participate in the study, medical students absent on the day of survey and acutely ill medical students who cannot participate in the study.

Sample size determination
The sample size was calculated using the statistical formula: 11 N = [ Z 2 P (1-P)] D 2 Where: N = minimum sample size Z = standard score at 95% confidence level which is 1.96 P = prevalence rate from previous studies which is 17.9%. 12D = margin of error tolerated 5%.The sample size was calculated using the prevalence of sexual risk behavior accessed by the number sexual partners in a study done among undergraduate students in Southeast Nigeria in which a prevalence of 17.9% was obtained.
N = (1.96)Sampling Method of the Probability Sampling technique by dividing the faculty into strata of class levels.Medical student respondents were then randomly selected from these 5 class levels.

Data collection
The data collection tool was a pretested, structured and self-administered questionnaire.

Data analysis
The data was analysed using the Statistical Package for Social Science Software (SPSS) program version 25.Data was summarized using frequency tables and charts, means and standard deviations.Statistical associations were tested using Pearson's chi-square.A p-value of <0.05 was set as a criterion for establishing statistical significance.Chisquare test was used to determine the relationship among factors that affect sexual risk behaviors.

Ethical consideration
Ethical clearance was obtained from Health Research and Ethics Committee, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State.Participation was voluntary employing informed verbal consent.Confidentiality and anonymity of the respondent was ensured even as participants were at liberty to pull out at any point of the study at no consequence.

Results
Table 1 shows a statistical significance with certain socio-demographic characteristics and sexual intercourse.these characteristics are age, level of study and place of residence (p <0.05).In relation to the socio-demographic factors studied, the level of study was found to be statistically significant in association with sexual risk behaviours, reporting higher sexual risk behaviours in 200/300 level students (18.8%)   with commercial sex workers respectively.Table 5 reflects 24(32%) of the respondents who use contraceptives all the time during sexual intercourse while 14(18.7%) of respondents had never used contraceptives.
Table 6 presents respondents' choices on the consequences of risky sexual behaviours.124 (49.8%) of the respondents agreed to the option of transmission of STIs and 121 (48.6%) of the respondents agreed to the option of

Discussion
The significant associations between socio-demographic characteristics and first sexual intercourse were in age, level of study and place of residence.More respondents above the age of 23 reported ever had sex compared to those below this age.First sexual intercourse was more reported by respondents in 600 level and in those who lived off campus alone.This finding may be due to the reduced restrictions experienced by these groups of respondents.
In relation to the socio-demographic factors studied, the level of study was found to be statistically significant in association with sexual risk behaviours, reporting higher sexual risk behaviours in 200/300 level students (18.8%) and 600 level students (17.1%).Other socio-demographic characteristics studied but were noted to be insignificant probably because they may have happened by chance are the student's age, sex and place of residence.
The study observed that 70% of respondents had never had sex, which was close to the findings by Ochieng who showed that the vast majority (78%) of undergraduates had not had sexual intercourse. 13It was observed that belief was the reason why the majority (37.9%) had not had sex emphasizing religion has a role to play in an individual's sexual behaviour.
Majority of students (48%) agreed that curiosity was the driving force for their sexual initiation.This finding is concurrent with a study carried out among school female students in Lagos which reported that the major reason for sexual initiation was curiosity. 14 Students in University of Nigeria, Enugu campus which found majority of the respondents not using contraceptives due to its unavailability. 18 concern of consequences of risky sexual behaviours, 49.8% and 48.6% of respondents agreed to the concern of STDS/HIV/AIDS and unwanted pregnancy respectively.44.2% of respondents to reduced academic performance.This finding is contrary to the study done in where it was reported that all respondents, 478(100%), agreed to all the concerns such STD/HIV/AIDS, unwanted pregnancy leading to dropout from school, parental abandonment and abortion. 19,20

Conclusion
Risky sexual behaviour exists among the respondents though with varying patterns.Quite a number of sexually active respondents engaged in oral sex while about half of the respondents engaged in sex without contraceptives.Factors found to be associated with risky sexual behaviours include level of study, age at first sexual intercourse, substance/drug use, pornography viewing, masturbation as well as sexual abuse.

Recommendations
This study advocates for promotion of sexual and reproductive health education among students by a diversity of avenues, including religious institutions with emphasis on the consequences of risky sexual behaviours.

Financial disclosure
The Authors of this paper reported no financial disclosures Two stages of Sampling were used.These were Simple Random Sampling and Stratified Probability Sampling technique.In effect, Faculty of Medicine was chosen by Simple Random Sampling.The Faculty of Medicine was further divided into levels employing the Stratified 426 African Health Sciences, Vol 23 Issue 4, December, 2023

Table 1 :
Relationship between Respondents who have/ not had sex and sociodemographic factors using cross-tabulations and chi-square

Table 2 :
Respondents reasons for abstaining from sex and factors which prompted sex

Table 3 :
Respondents reasons for first sexual intercourse

Table 4 :
Frequency pattern of sexual risk behaviors

Table 5 :
Frequency of contraceptive use amongst respondents

Table 6 :
Respondents view on consequences of sexual behaviors 16,17er study carried out in Malaysia reported a similar finding.15Vol23Issue4, December, 2023 than 2 sexual partners with 45.3% having had one sexual partner in the past 12 months.18.1% of the respondents have had oral sex, 2.4% engage in anal sex and 3.2% has had sex with a commercial worker.This percentage is not in tandem with results of a study done in Southwestern Nigeria where 16.4%, 4.5% and 14% practiced oral sex, anal sex and sex with commercial workers respectively.16,1744% of the sexually active respondents did not use contraceptives during their last sexual intercourse.This percentage is quite large; when asked reason, majority opinionated contraceptives decreased sexual pleasure, in contrast to study done in South Eastern Nigeria on the Opinion and Use of Contraceptives among Medical