new FULL THESIS-1

Assessment of prevalence and contributing factors for risky sexual behavior among
Gondar town preparatory school students
University of Gondar
Faculty of Social Science and Humanities
Department of Psychology
By
Kassahun Ashagrie Zewdu
September,2012

By
Kassahun Ashagrie Zewdu
Advisors Riyadh Mohammed
Berhanu Mekonen
A thesis submitted to University of Gondar, Faculty of Social Science and the Humanities,
Department of Psychology in partial fulfillment of the requirement for the Degree of
Master of art in Social Psychology
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September, 2012
By Kassahun Ashagrie Zewdu
APPROVAL OF BOARD OF EXAMINERS
NAME SIGNATURE
______________________ ______________
Chairperson, department graduate committee
______________________ ______________
Advisors
_____________________ ________________
_____________________ _________________
Examiner, internal
________________ ________________
Examiner, external
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________________ ________________
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Acknowledgement
I would like to thank my advisors Ato Riyadh Mohammed and Ato Berhanu Mekonen for their
unreserved constructive comments, support and follow up. I would like to acknowledge my
brothers Ato Gizachew Ashagrie and Ato Mulufird Ashagrie, they are the back bone of for all
parts of my life and they have paid a great contribution on this paper by giving different
literature reviews and their own experiences on researchs.
I am also thankful to participants (Fasiledes, Angereb and Azezo preparatory school students) of
the study for lending me their precious time in filling out the questionnaires.
I would like to appreciate Gondar town Educational office, and staff members of Fasiledes,
Angereb and Azezo preparatory schools for their immediate response and facilitation made
during the data collection period.
At last but not least all staff members of Gondar University Psychology department will be
acknowledged for their cooperation.
Finally, I want to acknowledge my friends Ato Wondimu G/kiross ,Ato Daniel Birhanu and Ato
Berhanu Elfu for their valuable advice and suggestions provided to me that has contributed a lot
to go on the right way.
I

Table of contents
Acknowledgement .......................................................................................................................................I
Table of contents ........................................................................................................................................II
List of figures ............................................................................................................................................V
List of Annexes...........................................................................................................................................VI
Lists of Abbrevations.................................................................................................................................VII
I. Introduction..............................................................................................................................................1
1.1. Background.......................................................................................................................1
1.2. Statement of the problem..................................................................................................4
1.3. Research Questions..........................................................................................................5
1.4.1. General Objective.......................................................................................................6
1.4.2. Specific Objectives.....................................................................................................6
1.5. Significance of the study...................................................................................................6
1.6. Delimitation of the study.....................................................................................7
1.7 Limitation of the study ..........................................................................................7
1.8 Operational definition .............................................................................................7
Chapter two.................................................................................................................................................8
2.1 Review of related Literature.................................................................................................................8
2.1.1 Prevalence of risky sexual behavior....................................................................................................8
Methods....................................................................................................................................................20
3.1. Study design...................................................................................................................20
3.2. Study Area....................................................................................................................20
3.3. Study population .........................................................................................................21
3.4. Sample Size and sampling Techniques...........................................................................21
3.5. Data gathering instruments............................................................................................22
3.6 Data gathering procedure...............................................................................................22
3.7. Variables for the study....................................................................................................22
3.7.1. Independent Variables.............................................................................................22
3.7.2. Dependant Variable.................................................................................................23
3.8. Pilot study........................................................................................................................23
3.9. Ethical considerations: ...................................................................................................23
..........................................................................................................................................................23
II

Chapter four..............................................................................................................................................24
Results.......................................................................................................................................................24
4.1. Socio-demographic characteristics..................................................................................24
4.2 prevalence of risky sexual behavior.................................................................................28
4.3 .Contributing factors for risky sexual behavior .................................................................29
4.4 personal perceptions towards HIV/AIDS and its contributing factors for risky sexual
behavior ................................................................................................................................31
4.5 Estimates of knowledge on HIV/AIDS prevention and transmission.................................32
................................................................................................................................................................33
Chapter five......................................................................................................................................34
Discussion ......................................................................................................................................34
5.1. Summary, conclusion and recommendation....................................................................36
5.1.1. Summary ................................................................................................................36
5.1.2. Conclusion ...............................................................................................................37
5.1.3. RECOMMENDATION ..............................................................................................38
References ...............................................................................................................................................39
Annexes ....................................................................................................................................................48
ANNEX-1..............................................................................................................48
ANNEX- 2..............................................................................................................................62
Map of Ethiopia......................................................................................................................73
List of tables
III

Table 1 Socio-demographic data on age, educational level and ethnicity of Gondar town
preparatory school students in 2012. …. …………………………………………………….…25
Table 2 Socio-demographic data on religion and marital status of Gondar town preparatory
school students in 2012. ………………………………………...……………………………..26
Table 3. Socio-demographic data on number of family member, parent marital status and current
living condition of Gondar town preparatory school students in 2012. ..………………………..27
Table 4. Socio-demographic data on residence, father and mother educational status of Gondar
town preparatory school students in 2012. ……………………………………………………..28
Table 5. Data on risky sexual behavior and knowledge among Gondar town preparatory school
students in 2012. ………………………………………………………………………………..30
Table 6. Contributing factors for risky sexual behavior among Gondar town preparatory school
students in 2012 ………………………………………………………………………….….31
Table 7. Contributing factors for risky sexual behavior among Gondar town preparatory school
students in 2012 ……………………………………………………………………………….32
IV

List of figures
Figure 1. The frame of sampling of the sample ………………………………………….….…22
Figure 2. Number of sexual partners in the past among Gondar town preparatory school students
2012 …………………………………………………………………….. …...……………...…29
Figure.3. Reasons for initiation of first sexual intercourse among Gondar town preparatory
school students, in 2012. ……………………………………………………………………..33
Figure 4.Knowledge about the mode of HIV transmission among preparatory school
students in Gondar town in 2012. ………………………………………………….…34
V

List of Annexes
• Annex 1- Questionnaire (Amharic version)
• Annex 2- Questionnaire (English version)
• Annex 3- Map of Ethiopia and the study area(Gondar town)
VI

Lists of Abbrevations
AOR –Adjusted odds ratio
COR-crude odds ratio
CSA - Central Statistics Authority.
CSW-Commercial Sex Worker
Div/Wido/Sepa- Divorced/Widowed/Separated
FDRE- Federal Democratic Republic of Ethiopia.
FGAE- Family Guidance Association of Ethiopia.
FHI- Family Health International.
HAPCO- HIV/AIDS Prevention and Control Office.
NGOs- Non Governmental Organizations
PMTCT- Prevention of Mother to Child Transmission
STDs- Sexually Transmitted Diseases
UNAIDS- United Nations Program on HIH/AIDS
UNDP- United Nations Development Program.
UNFPA- United Nations Population Fund.
UNHCR-United Nations Higher Commission for Refugees.
VCT- Voluntary Counseling and Testing.
WHO- World Health Organization
VII

Abstract
Risky Sexual Behavior refers to Sexually active school adolescents who have sexual contact with
causal partner, or multiple sexual partners, or Commercial Sex Worker or experience unprotected
sex (not using or occasional use of condom), the sexual activity occurs when one of the partner
age is less than or equal to 18 years. The study focused on assessing the prevalence and
contributing factors for risky sexual behavior among Gondar town preparatory school students in
2012.Cross sectional survey study design was conducted among Gondar town preparatory school
students. A total of 303 respondents were participated to achieve the objectives. The data was
analyzed by descriptive statistics, bivariate and multi variate analysis to identify the contributing
factors for risky sexual behavior. A total of 297 respondents responded to the questioner giving a
response of 98%. The prevalence of risky sexual behavior was 19.2%. Risky sexual behavior
was associated with illiterate father (AOR 4.12: 95% CI 1.76, 9.68), living with mother and
father (AOR 0.31: 95% CI 0.51, 0.62), married student (AOR 3.99: 95% CI 1.66, 9.58) student
age between 15-18 years (AOR 2.09: 95% CI 1.06, 4.12), substance abuse (AOR 2.27: 95% CI
1.14, 4.51), high risk personal perception (AOR 2.74: 95CI 1.36, 5.56), peer pressure (AOR
6.54:95CI: 3.98, 9.42). High prevalence of risky sexual behavior was observed among Gondar
town preparatory school students. Risky sexual behavior was affected by age less than 19 years,
peer pressure, father educational status, marital status of the student, substance abuse, living
condition of the students and personal perception. The researcher recommended that Peer
educators should be established and strengthen in all schools so that they can provide education
in a friendly manner. schools main focus area should be for under age (under 19) to have good
awareness about sex education to avoid risky sexual behavior.Knowledge by itself is not enough,
so the schools adminstration and parents mainly focus on comitment on attitude and practice for
prevention of risky sexual behavior.
VIII

I. Introduction
1.1. Background
HIV/AIDS is one of the most urgent public health challenges facing both developing and
developed nations. Even though it affects all the social sectors of the population, the
epidemic among adolescents is the fastest growing partly because of young people’s
vulnerability and because of low use of preventive services. In spite of this, adolescents are
also seen as a ‘window of hope’ because they have great potential for positive change of
attitudes and behaviors(WHO,2004).
Focusing on young people is likely to be the most effective approach to confronting the
epidemic, particularly in high prevalence countries. This was recognized at a global level by
the 2001 UN General Assembly Special Session on HIV/AIDS who endorsed that “By 2003,
establish time-bound national targets to achieve the internationally agreed global prevention
goal to reduce by 2005 HIV prevalence among young men and women aged 15–24 in the
most affected countries by 25% and by 25% globally by 2010”. WWW.AIDS in Ethiopia
single point estimate.2010.
Research on adolescents’ sexual behavior carried out in other countries has shown that a
range of factors including lack of reproductive health and HIV/AIDS information and
services contribute to heightened risk of HIV among young people(Biglan
et.al,1990,Santelli,et al,2000). However, the single most important determinant of HIV
infection among young people in Africa is having unprotected sex with a person who is
infected. To quote the Measure Evaluation program, “Any number of other factors may
influence who has sex with whom and whether they use condoms, but the act that spreads the
virus, in the overwhelming majority of cases, is an act of unprotected sex”. (M&E Bulletin,
2001)
Many factors have been proposed to explain why adolescents do not use condoms. In spite
of efforts by national HIV prevention programs to reduce or eliminate the cost of condoms in
many African countries, adolescents still report affordability as a reason for non-use.
(Samuelsen,2006) Negotiation to use condoms is also difficult since suggesting the use of
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condoms is often seen as a sign of mistrust in a sexual relationship. Furthermore, the ability
by female adolescents to negotiate the use of condoms is made difficult if they have received
gifts or money.(Amuyunzu et.al,2005) Other reasons for non-use of condoms among
adolescents include dislike of condoms, and embarrassment to purchase or ask for condoms
from adult providers, which stems from disapproving attitudes from health
providers(MacPhail et.al,2001).
HIV programs that are designed to improve knowledge and awareness about HIV and
sexually transmitted infections (STIs) are often based on the premise that greater knowledge
among adolescents will lead to changes in their sexual behaviour. However, some studies
have reported the lack of association between HIV knowledge and sexual behavior
(Maswaya et.al, 1999, Akwara.et.al, 2003). On the other hand, social and cultural barriers,
attitudes and practices seem to be the major determinants of adolescents’ risky behavior
(Meekers, Klein, 2002, Marandu, Chamme, 2004).
Another premise is that use of protection will depend on the type of sexual partner, and
while this premise may hold among adults, it is not clear that adolescents act in this way.
World Health Organization/Global Programme on AIDS (WHO/GPA) data did not find
significant associations between levels of AIDS awareness and the number of partners and
self-perceived risk. Findings by Fapohunda & Rutenberg (1999) and Idele (2002) may
provide a possible explanation for the weak link between knowledge, perceived risk and
behavior. In their studies, respondents had a fatalistic attitude towards AIDS.
The expression ‘after all you have to die of something’ was cited to justify high-risk
behavior. This fatalism has been noted in other studies where participants are aware of modes
of transmission and prevention and yet continue to engage in risky sexual practices (Obbo,
1993).
Exposure to AIDS information through mass media may lead to high levels of awareness,
which can in turn influence self-assessed risk of HIV and behavior. It has been argued that
people’s assessment of risk may depend upon how much they trust the accuracy of the
information (Stallings, 1990). However Prohaska et al. (1990)
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According to the study of priscillaa.Akwara, Nyovanijanet madiseandrew hinde (2003), the
bivariate analysis of the association between risky sexual behavior and background and
intermediate socio demographic factors of residence, work status, education, ethnicity, age
and marital status were associated with reporting of risky sexual behavior for both women
and men at the 5% level of significance.
Religion was not significant for either females or males. The percentages of men and women
who reported risky sexual behavior but who perceived themselves to be at small or no risk of
HIV infection were analyzed. These men and women were singled out because they appear
to under-rate their risk of HIV in relation to their reported sexual behavior.
The results show clearly that young, Unmarried (or formerly married) persons appear to
under-rate their risk despite engaging in risky sexual behavior. According to CDC’s Youth
Risk Behavioral Survey (YRBS), many young people begin having sexual intercourse at
early ages: 47% of high school students have had sexual intercourse, and 7.4% of them
reported first sexual intercourse before age 13 (CDC,2003).
HIV/AIDS education needs to take place at correspondingly young ages, before young
people engage in sexual behaviors that put them at risk for HIV infection. A review of
quantitative and qualitative studies shows that individuals are more likely to underestimate
than to overestimate their risk of HIV infection regardless of the nature of their sexual
behavior (Nzioka, 2001; Aggleton et al., 1994; Ingham & van Zessen, 1997; Becker &
Joseph, 1988). People often rationalize risk-taking behavior using a range of socially
constructed criteria that could explain the apparent mismatch between objective risk and
perceived risk (Abrams et al., 1990).Using in-depth interviews to examine lay perceptions of
risk of HIV infection in one community in Kenya, Nzioka (1996, p. 576) found that people
constructed risk in ways ‘which were socially meaningful but which neither limit the spread
of the virus nor offer security to the individual from the virus’.
A qualitative study in Kenya found that although AIDS was perceived as a great threat in
focus group discussions, individuals did not necessarily perceive themselves to be at risk
(Idele, 2002). Uganda and Thailand used behavioral survey as an evidence to prove the
reduction of AIDS prevalence in the past couple of years as a result of change in high-risk
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human behaviors gained earlier (Kilian et al., 1999; Mills et al., 1997). For effective
prevention and handling of the epidemic, definitive and concrete knowledge on means of
viral transmission and rejecting prevalent misconception are critical (Mesfin et al., 2004).
Assessment of high risk behaviors in Ethiopia was initiated as early as 1990s. High score
especially in some mode of viral transmission was documented which showed some success
especially in raising awareness both in the general and sub-group of the population (Eshetu et
al., 1997). Adequate knowledge on transmission of HIV by itself is no use if individuals do
not know that they can get infection from asymptotic carriers who look well and healthy
(Mesfin et al., 2004).
Much research has been carried out on the determinants and consequences of sexual behavior
among adults, but until recently adolescents have received little attention in Ethiopia. Gaps in
knowledge regarding adolescents’ sexual behavior persist. For example, not much is known
about what motivates young people to initiate first sex, what factors contribute school
adolescents’ exposure to risk sexual behavior toward HIV/AIDS across religion, gender,
income, life condition and family educational status. This is the gap of many researches in
Ethiopia that this study attempts to fill.
1.2. Statement of the problem
HIV/AIDS is the most dramatic epidemic of the century that has claimed over two decade
more than 3 million deaths. Young people (15-24) are the most at risk segments of the
population affected by this epidemic (FDRE, HAPCO, 2010).
There are still a huge number of people infected and affected by HIV. In 2009, a total of
33.3 million (31.4 – 35.3 million) people were estimated to be living with HIV globally, of
which 2.6 million (2.3 – 2.8 million) people became newly infected and 1.8 million (1.6 – 2.1
million) people died of AIDS in the same year. The estimated 1.3 million [1.1 million–1.5
million] people died of HIV related illnesses in sub-Saharan Africa in 2009 comprised 72%
of the global total of 1.8 million [1.6 million–2.0 million] deaths attributable to the epidemic.
Sub-Saharan Africa accounts 22.5 million (20.9 -24.2 million) infections (UNAIDS, 2010).
There are more teenagers alive today than ever before and most of them living in developing
countries. Young people aged 15-24 account for more than 50 percent of all HIV infections
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worldwide. More than 7,000 young people are newly infected with HIV each day throughout
the world. It is heavily affected and accounts for nearly 70% of all cases. Ethiopia is one of
the sub Saharan countries highly affected by HIV/AIDS pandemic, where most of the burden
Africa alone, an estimated 1.7 million young people are infected annually. Sub Saharan
African occurring among the young age group (UNAIDS, 2007). The national HIV
prevalence is estimated to be 2.4% (urban 7.7%, rural 0.9%) (www.aids in Ethiopia,2010).
Preventing HIV among young people is particularly urgent in sub-Saharan Africa, where in
many countries young people comprise more than 30 percent of the population and general
HIV prevalence rates often exceed 10 percent. Promotion of VCT and other behavioral
change interventions is one of the main national strategies developed and implemented by
different stakeholders at national level to curb the epidemic.
Ethiopia has developed and implemented a Multisectoral Plan of Action for Universal Access
to HIV Prevention, Treatment, Care and Support (2007–2010). This process has been guided
by the HIV/AIDS Strategic Plan for Multisectoral Response (SPM), Ethiopia’s universal
access commitment, and the “Three Ones” principles. This harmonized SPM was prepared
with participation of regions, sector organizations,employee associations, the private sector,
development partners, the Network of HIV Positives in Ethiopia (NEP+), the Ethiopian Inter-
Faith Forum for Development, Dialogue and Action(EIFDDA) and others( FDRE,
HAPCO,2010)
In this study what Factors are that contribute to exposure of risk sexual behavior toward
HIV/AIDS among preparatory school students is the issue that the researcher needs to
understand. We know that because of globalization the world becomes one village and all
aspects of technologies are dramatic but still the world cannot solve the problem of HIV. It’s
among the top killer dieses.
1.3. Research Questions
The following are the research questions of this study:
 What is the prevalence of risky sexual behavior among Gondar town
preparatory school students?
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 What are the contributing factors for risky sexual behavior among Gondar
town preparatory school students?
 Is the preparatory school students’ knowledge can have effect on risky sexual
behavior prevention?
 Is personal perception towards HIV/AIDS having a contributing factor for
risky sexual behavior?
1.4. Objectives of the study
1.4.1. General Objective
The general objective is to assess the prevalence and contributing factors for risky
sexual behavior among Gondar town preparatory school students
1.4.2. Specific Objectives
The specific objective is ;-
 To estimate the prevalence of risky sexual behavior among Gondar town preparatory
school students.
 To assess the contributing factors for risky sexual behavior among Gondar town
preparatory school students.
 To assess preparatory school students knowledge on HIV transmission and prevention
 To assess perception of risks to HIV/AIDS among preparatory school students.
1.5. Significance of the study
The study will have the following significances:-
 The study will be mportant for Gondar town Education office to identify and take
measure about the prevalence and the factors that contribute to risky sexual behavior
toward preparatory school students.
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 The study will be useful to Gondar town HAPCO to fill their knowledge gap about
the prevalence and the factors that contribute to risky sexual behavior toward
HIV/AIDS among preparatory school students.
 The study will also serve as a spring board for other researchers to conduct their study
on this area.
1.6. Delimitation of the study
The study area was Gondar town preparatory schools (Fasiledes, Azezo and Angereb) and
the study target populations were Gondar town preparatory school students.
The delimit of this research was assessing the prevalence and the factors of risky sexual
behavior among Gondar town preparatory school students.
1.7 Limitation of the study
 The study participant may lack genuineness because it is the social sensitive issue
due to this student may bias to social desirability.
 There was budget and time constraint.
1.8 Operational definition
The following are words which the researcher operationally defined:-
Risky Sexual Behavior - Sexually active school adolescents who have sexual contact with
causal partner, or multiple sexual partners, or Commercial Sex Worker or experience
unprotected sex (not using or occasional use of condom), the sexual activity occurred when
one of the partner age is less than or equal to 18 years.
Students living condition –it’s the students current living environment for example students
lives together with their father and mother, students live only with their father and mother,
students live alone and students live with other persons(relative or other)
Knowledge – information and skills acquired through experience or education.
Knowledgeable—if the respondent correctly responds 8 of the 14 knowledge questions.
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Non knowledgeable - if the respondent fails to correctly respond 6 or more of the 14
knowledge questions.
Chapter two
2.1 Review of related Literature
2.1.1 Prevalence of risky sexual behavior
Risky sexual behavior is Early initiation of sexual intercourse, Unprotected intercourse,
Multiple sexual partners and Sex while under the influence of drugs or alcohol
(Nicholson,1999)
Theory that describes risky behaviors resulting from an interaction of four risk domains;
biological, personality, behavioural, and biological systems (Jessor 1991: 12).
Some determinants, such as age, sex, beliefs and attitudes, relate to the individual, while
others relate to peer, family, and community influences, and the broader socioeconomic
environment. The importance of factors external to young people is intrinsic to the
WHO/UNFPA/UNICEF framework for Programming for adolescent health and
Development ("Action for adolescent health: towards a common agenda,
http://www.who.int/child-adolescent-health.htm)
Premarital sexual activity is common in many parts of the world and is reported to be on the
rise in all regions (Green et.al, 2002). The sexual and reproductive experiences of young
people vary dramatically region by region, age and sex, but most people become sexually
active between the ages of 10 to 20 (UNFPA,2002).
Prevalence rates reveal that high percentages of teens engaged in sexual behavior.
Adolescents are the population at highest risk for acquiring sexually transmitted diseases,
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with risk factors that include having multiple sex partners, engaging in unprotected sex, and
having partners who are at high risk for having an STD (Division of STD Prevention, 2000).
Considering this fact risk related factors which have relevance to this study had been
reviewed.
A study done in Cambodia in 1,049 students surveyed, 12.7% reported sexual intercourse
during the past three months. Out of those sexually active students, 34.6% reported having
two or more sex partners over the same period, and 52.6% did not use a condom during their
last sexual intercourse. Siyan Yi et al 2010
A study done Nigeria in 1095 students showed that as many as twenty four percent of the
students have multiple sex partners, about 44 percent of who do not like using condom.
Having multiple sex partners was found to have significant effect on decision on infection
prevention technique adopted by the student. About 43.69 percent of those who have
multiple sex partners agree that they are engaging in risky sexual behavior(Ojikutu,2010).
In Ethiopia too, the two risk factors for the spread of STDs among youth are the practice of
having multiple sexual partners and the limited use of condoms. A study conducted in high
schools in Addis Ababa indicated that 54 percent of sexually active youth have experienced
sex with more than one partner (Kifelew, 1998).
In a study conducted among college students in Gondar, Ethiopia, 49% were engaged in
sexual intercourse and, only a third used condom (Teka, 1992). Similarly in other parts of the
country, adolescents were found practicing unsafe sexual activity (Mekonen, Mekides1995,
UNAIDS, 2001).
Another study done in Gondar showed that 25% of the study group had previous sexual
intercourse and exposed at least one risk behavior. About 34% of the respondents had
negative attitude towards AIDS and STDs(Shiferaw,2011).
2.1.2 Causes of risky sexual behaviors
Age: common sense dictates that older adolescents report more sexually active and having
more partners than younger teens (Miller, Forehand, and Kotchick, 2000); therefore, being an
older teen is a risk factor for risky sexual behaviors, as compared to younger teens. Blum and
Mmari (2005) found that the likelihood of experiencing first sex greatly increased by the age
9

of the respondent. The same is true for age and the number of sexual partners, as well as age
and the contraction of sexually transmitted diseases. The timing of first intercourse may be a
useful marker for risky sexual behavior and a history of STDs (Greenberg, Magder, and Aral,
1992)
In Bangladesh, 88 percent of unmarried boys and 35 percent un married girls living in urban
areas have had sex before the age of 18 (Mequanint,2000). In Ethiopia too, studies have
confirmed that school adolescents had commencement of sexual inter course before the age
of 18 (Kora, Mesfin, 1999,).
Residence: - place of residence is shown to be a significant factor in terms of sexual debut,
pregnancy, and abortion. Urban women are some what more likely to have become sexually
active, are significantly more likely to have ever become pregnant, and are somewhat more
likely to have under gone an abortion (Murray et al, 2006). Shabbir, Habteab and Kahs
(1997) had also revealed that, urban students had earliest sex and more sexual partners
compared to their rural counter parts
Educational Level: - a study conducted by Meekers and Ahmed (2000) revealed that
adolescents with secondary education were more likely sexually experienced than those with
lower level of education. In Ethiopia, Zubeida (1992) and Sileshi (2005) found that, with an
increase of educational level there is an increase in sexual experience.
Parental Education:-parent’s education levels have been found to be related to their
teenagers’ behavior. Teenagers who have educated parents tend to delay their first
intercourse. Even if sexual activity happens; there is a high probability that steps would be
taken to reduce the risk of pregnancy by educating adolescents about safe sex
(Bogenschneider et al, 1996). Koss(1985)found that children whose parents had less than a
12th grade education were 5.7 times more likely to have initiated sexual intercourse and
children whose parents had a high school education or equivalent were 7 times more likely to
have initiated sexual intercourse compared to those children whose parents had a college
level education. The reason for the connection between
parent education level and teens’ behaviors are unclear, but it is speculated that expectations
for the child’s future and parental modeling likely play a role (Brooks, 2007).
10

Economic: a family’s socio-economic status is strongly related to adolescent’s participation
in negative behaviors. Unfortunately, unsafe behaviors tend to compound the problems
associated with low socio-economic status. Adolescents in welfare-dependent families
exhibit the worst physical and mental health, and tend to engage in earlier onset of sexual
activity and violent behavior than teens from other socio-economic brackets (Bridgman and
Phillips,1998). Other studies have identified that youth from low income families experience
higher rates of poor physical and mental health, are more likely to engage in delinquent acts,
have early and unprotected sexual intercourse, and more likely to experience adolescent
pregnancy, be arrested, and drop out of school(Harris and Marmer,1996;Duncan and Brooks-
Gunn, 1997).
Peer Influence - Peers play a strong role in risk-taking among youth. Theoretical and
empirical evidence abounds to show that what their peers are doing or what they perceive
them to be doing influences youth behavior in a variety of settings (Babalola, 2004).
Weakening of economic, social and cultural bases of the family will push youth to become
norm less concerning their sexuality leading youth to seek knowledge and advice about
sexuality from inappropriate sources (peers) predisposing them often to undesirable end
results. Among key elements of HIV/AIDS education programs designed by US researches
one of it was to deal with
Peer pressure and other social pressures on young people to be sexually active. Changing
young people’s risk taking behavior requires going beyond providing information to helping
young people acquire the ability to refuse sex and to negotiate with sex partners (Population
Reports,2001).
Young people share values within the context of peer groups and these values influence
adolescent behavior. Young people whose peers engage in diverse risk behaviors are more
likely to engage in risky sexual behavior. The valuing and practice of drug use within peer
groups may increase sexual health risks among adolescents (Biglan et al., 1990).
Having sexually experienced friends was associated with a higher probability of ever having
had sex and having more lifetime sexual partners. Youth who engaged in high-risk activities
(attending parties, going to discos, drinking alcohol) with their first close friend were more
11

likely to ever have had sex, were to have a higher number of sexual partners over their life
time and were less likely to have used condom (Robert et al., 2000).
In many countries young women and men are under strong peer group pressure to engage in
premarital sex. Peer pressure easily influences them often in way that can increase their risk
(Goulnda, et. al, 2002).
Above all, the school environment where by students are sharing different experiences is a
convenient place to be influenced by friends’ idea and many of them are misguided by those
who think they know but don’t and as a result of this, increases their vulnerability to the
current devastating health problem. Adolescents who started having sex early are likely to
have sex with high-risk partners or multiple partners, and are less likely to use condoms
(Goulnda, et.al, 2002).
Substance abuse: - teens and young adults face many pressures and decisions involving
alcohol, drugs, chat and sexual activity decisions that often occur simultaneously. Substance
use increases the probability that an adolescent will initiate sexual activity, and relatively,
sexually experienced adolescents are more likely to initiate substance use (Mort FL and
Haurin RJ, 1988). Adolescents who use drugs were much more likely to be sexually
experienced than adolescents who did not use drugs (Blum and Mmari, 2005). Adolescents
who use drugs and alcohol are more likely to engage in high-risk sexual behavior (Bachanas
et al., 2002). Specifically, marijuana use has been found to be a strong predictor for risk of
pregnancy (Mcgill, 2000).
Several studies found similar findings, those teens that use marijuana and alcohol also tend to
engage in more STD-related risk behaviors, including earlier initiation of sexual intercourse
and inconsistent use of barrier contraceptives (Eng and Butler, 1997; Graves and Leigh,
1995; Lowry et al., 1994). Stueve and O’Donnell (2005) examined relations between early
alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents
(controlling for early sexual initiation) and found similar positive connections between
substance use and risky sexual behaviors. Results indicate that by tenth grade, females who
reported early alcohol use were about four times as likely as their alcohol-delaying
counterparts to report being recently drunk or high and almost twice as likely to initiate
12

sexual intercourse or engage in sexual intercourse. They conclude that prevention programs
need to begin earlier than seventh grade and must address the combined risks of early
drinking and sexual experimentation.
Risk-prone adolescents may use substances because the experience is novel and exciting and
because they focus on these aspects and ignore the possible negative consequences. In turn,
substance use can increase the risk of unprotected intercourse by reducing social inhibition,
impairing decision making and negotiation skills, and reducing inhibition control. Alcohol
use, in particular, is associated with cognitive impairments, which may increase the risk of
unprotected sex (Raffaelli and Yuh Ligshen, 2005).
The long-term effects of substance use on sexual behaviors can be serious. Graves and Leigh
(1995) examined the connection between acquiring HIV and substance use. Their results
indicated that the presence, frequency, and quantity of substance use over time is associated
with an increased likelihood of having sexual intercourse, having more than one sexual
partner, and not using a condom, thus increasing one’s risk for contracting. In short, it
appears that alcohol/drug use can impact sexual behaviors both at the time of sexual activity
(i.e. deciding whether to engage in sexual activities under substance influence) and over
long-term periods (i.e.drug) alcohol use increases one’s overall engagement in risky sexual
behaviors (Brooks, 2007).
Economic, social and political conditions in many developing countries create circumstances
that make young people vulnerable to HIV infection (Mequanint, 2000).
Poverty underlies much sexual behavior (Reverse, peter, 1999). Epidemiological studies
across the developing world show that young people are not equally affected by HIV/AIDS.
Rather, those who are most socially and economically disadvantaged are at highest risk
(population reference BUREAU, 2001).
In a society where poverty is deep rooted as practically existing in Ethiopia, school
adolescents also share the burden since they are found in poor living condition which leads
them to experience sex at an early age and may be particularly vulnerable to sexual
exploitation which as a consequence exposes them to reproductive health problem. Economic
deprivation leads many young women in sub-Saharan Africa and in to sexual relationships
with older men-sometimes known as “sugar daddies’- who provide money and other
13

necessities, such as clothing and school supplies and fees in exchange for sex (Green, et.al,
2002).
Sexual relationship involving exchange of money or gift may place adolescents at greater
risk of unintended pregnancies and STDs (Lemma, 2000). Unequal power relations between
women and men, for example may render young women especially vulnerable to coerced or
unwanted sex (population reference bureau, 2001).
Young women who initiate sex at very young ages may also have experienced some sort of
pressure-either physical or verbal- to have sex against their will (Lemma, 2000).
Studies also show that young people who have been victims of sexual abuse are more likely
to engage in high risk sexual behavior than who have not been abused (Green,et.al,2002).
A traditional society like ours, where by unequal social position of women exists and
masculinity of men is over emphasized, high school girls are highly exposed to coercion
which leads them to early sexual activity thereby increasing their vulnerability to STDs as a
result of engagement in sexual acts by the time they don’t appreciate the pros of the coitus.
For many adolescents experimenting with tobacco, alcohols and drugs are an indication for
reaching certain developmental stage. A tendency to take such risks also applies to all sorts
of risks including risky sexual behavior. In Tanzania, for example, youth ages 10 to 24 that
smoked and drank alcohol were four times likely than others to have multiple sexual
partners.
A Study by Lemma Eyob on sexual behavior of high school students in Jimma showed that
14.6% of the students reported having sex under the influence of alcohol (CSA, 2007-2008).
So, in a country where places to spend free time like libraries, playing grounds and
recreational facilities for young people are very few as obviously seen In Ethiopia,
preparatory school students will also be exposed to alcohol, Khat or tobacco that could
influence them to practice unsafe sexual activity.
A study by Lengwe (2009) found that desire to experiment with sex and drug abuse influence
students’ sexual risk behavior while Eleazar (2009: 120) argues that living with parents or
guardians with unregulated sexual attitudes encourage students to engage in sexual risk
behavior.
Knowledge on HIV/AIDS and Risk perception
14

The primary concern in the fight against the HIV/AIDS epidemic has to be enabling people
to know how HIV is being transmitted from one person to another. A good knowledge of
how HIV is transmitted and possible prevention methods has thus significant contributions to
reduce the spread of the epidemic infection to be low. Religion can also work to influence
community practices and national policies. The Kenyan national AIDS programmes faced
opposition from religious leaders at the onset, particularly on the issue of introducing sex
education in schools and on condom use, which were thought to encourage promiscuity
(Forsythe et al., 1996).
The conceptual framework assumes that the background factors operate through a range of
intermediate factors to influence perception of risk and sexual behavior. These intermediate
factors may be socio demographic (such as sexual initiation, marital status, and the level of
education and work status) or psychosocial (like access to information, knowledge, attitudes
and beliefs).
These two types of intermediate factors are described next. Unless the first intercourse is also
the start of a mutually monogamous relationship, early age at first sexual intercourse is
associated with a long period of exposure to sexual activity, a higher propensity to
accumulate sexual partners, and increased chances of contracting sexually transmitted
diseases (Dixon-Muller & Wasserheit, 1990; Konings et al., 1994).
Marital status influences perception of the risk of HIV infection and sexual behavior.
Whereas non-married women may have some ability to negotiate safer sex, married women
face extra challenges because of the fear of being suspected of promiscuity by their spouses,
which may lead to unwanted consequences such as separation or even divorce. Often,
married women acquiesce in unsafe sexual practices, even if they suspect or know of their
partner’s extramarital relations (Blanc et al., 1996).
Although HIV cannot be spread through sexual intercourse in stable monogamous
relationships between uninfected partners, among married women the presence and the
nature of their partners’ casual or extramarital sexual practices largely determines the risk of
HIV transmission (Ahlburg et al., 1997).
The level of formal schooling may influence perception of HIV risk and sexual behavior but
the evidence is rather conflicting. Caraël (1995) found increased casual sexual activity
15

among those with higher schooling but Meekers (1994) found that the association disappears
when age is controlled for Knowledge of AIDS has increased remarkably over the years and
is almost universal in most sub-Saharan African countries but the association between such
knowledge and sexual behavior is rather ambiguous. Cleland (1995), using the World Health
Organization/Global Programme on AIDS (WHO/GPA) data did not find significant
associations between levels of AIDS awareness and the number of partners and self-
perceived risk.
Findings by Fapohunda & Rutenberg (1999) and Idele (2002) may provide a possible
explanation for the weak link between knowledge, perceived risk and behavior. In their
studies, respondents had a fatalistic attitude towards AIDS. The expression ‘after all you
have to die of something’ was cited to justify high-risk behavior. This fatalism has been
noted in other studies where participants are aware of modes of transmission and prevention
and yet continue to engage in risky sexual practices (Obbo, 1993).
Exposure to AIDS information through mass media may lead to high levels of awareness,
which can in turn influence self-assessed risk of HIV and behavior. It has been argued that
people’s assessment of risk may depend upon how much they trust the accuracy of the
information (Stallings, 1990). However Prohaska et al. (1990)
School adolescents with inadequate knowledge about adolescents’ sexual behavior, due to
limited reproductive health education, are lacking information, which places them at the risk
of emotional damage as well as the obvious danger of pregnancy and HIV/AIDS. Lacking
the necessary knowledge and skills, younger adolescents are less likely to protect themselves
from HIV. In countries such as Cameroon, Central Africa Republic, Lesotho and Serraleone,
more than 80 percent of young women aged 15 to 24 do not have sufficient knowledge about
HIV (Goulnda, 2002).
A study done in Nigeria Only 54.63 percent of those who have heard about HIV/AIDS are
willing to use condom and 71.33 percent of the respondents are very concerned about the
alarming rate of spread of the disease and the prevalence of risky sexual behavior is 24%.
(Ojikutu,2010)
16

Although AIDS awareness is relatively high among youth in Ethiopia, nearly a third of
young women and a sixth of young men do not know a specific way to avoid contracting the
infection (Kifelew, 1998).
2.1.3 Consequences of risky sexual behaviors
HIV/AIDS
One of the current challenging tasks faced by health professionals and scientists worldwide is
the prevention and control of HIV/AIDS. This disease claims yearly a huge toll of deaths,
productivity and economic losses, especially in sub-Saharan Africa where the population is
already weakened by poverty, malaria and tuberculosis (Boswell, Baggaley, 2002).
Globally, 33.2 million people were estimated to be living with HIV and 2.5 million were
newly infected with HIV in 2007 [WHO, 2008]. As the HIV epidemic spreads younger age
groups are becoming exposed to the risk of infection [UNFPA, 2005]. Ten million youth
(ages 15-24) worldwide are living with HIV and every day, an estimated 6,000 youth are
infected with the virus
[http://www.who.int/mediacentre/factsheets/fs314/en/index.htmlAfrica disproportionately
bears the burden of the HIV/AIDS pandemic. Although only 11% of the world's population
lives in Africa, roughly 67% of those living with HIV/AIDS are in Africa. (UNAIDS, 2009)
In Africa, there were 22.4 million people living with HIV and 1.9 million new HIV infections
in 2008. An estimated 14 million children in Africa have been orphaned as a result of
HIV/AIDS. http://www.who.int/mediacentre/factsheets/fs314/en/index.html
Southern and eastern Africa have been the most severely aﬀected regions. Seven countries
have an estimated adult (15-49) HIV prevalence of 20percent or greater: Botswana, Lesotho,
Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. In these countries, all in
southern Africa, at least one adult in ﬁve is living with HIV. An additional six countries,
Burkina Faso, Cameroon, Central African Republic, Kenya, Malawi and Mozambique, have
adult HIV prevalence levels higher than ten percent (FMoH, 2008).
The 2008 HIV/Syphilis Sentinel Survey in Nigeria revealed that 3.3% of young people aged
15-19 are infected with the HIV virus [FMOH, 2008]. Ethiopia, one of the hardest hit
17

countries with HIV/AIDS in the world, is home to the third largest HIV/AIDS infected
population next to India and South Africa. It is estimated that 1.2 million Ethiopians are
living with HIV/AIDS including 79,871 children in the year 2010. The national adult HIV
prevalence rate is 2.4% for the same year, estimated prevalence for the urban and rural is
7.7% and 0.9% respectively.
The 2010 HIV prevalence is higher among women (2.9%) than men (1.9%) and is higher in
the urban (7.7%) than in the rural population (0.9%). There are an estimate of 137,494 new
infections and 28,073 AIDS deaths in the population in 2010. A total of 90,311 HIV positive
pregnancies and an estimated 14,276 HIV-positive births occurred.
Among children, in 2010, there are estimated 79,871 living HIV, 14,276 new HIV infections
and 3,537 AIDS deaths estimated. A total of 5.4 million children fewer than 17 in the country
are estimated to be orphans in the year 2010 for different reasons, of which 804,184 were due
to AIDS. In Amhara region adult prevalence of HIV is 2.9% (WWW.AIDS in Ethiopia,
2010), A study conducted among high school students of Gondar town revealed a prevalence
of 1.1% (population reference bureau, 2000).
Sexually Transmitted Diseases
Adolescent, the period in particular between 10 and 25 years involves sexual experimentation
that may lead to acquisition of sexually transmitted infections (STIs) and unplanned
pregnancies. The risky sexual practices in this age group may include early sexual debut,
having multiple sexual partners, engaging in unprotected sexual intercourse, engaging in sex
with older partners and consumption of alcohol and illicit drugs. (Eaton,2006)
Several studies done in sub Saharan Africa, including Tanzania, have shown a high
prevalence of STIs including HIV among youth, with females having higher prevalence
compared to males. (monasch,Jaspan,2006) Reasons for higher susceptibility of females have
been found to be multi factorial and include biological, economical and social demographic
factors; mixing patterns among sexual partners, the age difference between male and female
sexual partners, with males seeking sexual gratification from younger females and peer
pressure. (Kelly,Jaspan,2006) In contrast, most studies have indicated that male youth have a
higher number of sexual partners than females. (Kelly,Jaspan,2006).
18

Some common sexually transmitted infections are Chlamydia, Gonorrhea, Syphilis, Bacterial
vaginosis, Trichomoniasis, HIV, Herpes, Genital Warts (HPV), Hepatitis B, Molluscum
Contagiosum. (Planned Parenthood, 2000)
Unwanted pregnancy
Over 100 million acts of sexual intercourse take place each day in the world, resulting around
1 million conceptions, about 50 percent of which are unplanned and about 25 percent are
definitely unwanted (Akalework,2008; WHO, 2007).
The World Health Report (WHR, 2005) noted that unwanted, mistimed and unintended
pregnancies are the most common cause of maternal mortality in developing countries.
Risky sexual behaviors have grim consequences on adolescents especially girls. For young
women aged15-19 worldwide, pregnancy is the leading cause of death, most pregnancy
related deaths are attributable to complications of child birth or unsafe abortion
(UNFPA,2005).There is evidence that, in urban areas, unsafe abortion and abortion-related
deaths are rising among unmarried adolescent women (WHO,2004). Adolescents tend to
delay obtaining an abortion and often seek help from a non-medical provider, leading to
higher rates of complications. Self induced abortion is also common among adolescents in
many countries (Ipas, 2004).
2.1.4 Prevention for risky sexual behaviors
According to(Nicholson,1999) the following prevention practices regarding risk sexual
behavior should be considered when designing and targeting for the prevention of HIV, STD
and pregnancy :
 Religiosity
 Close parent-child relationship
 Positive parent communication
 Access to condoms and other contraceptives
 Perception of positive peer group attitudes towards delaying intercourse or
contraceptive use
 Access to prevention education
19

 Access to STI screening, treatment and counseling
 Increase involvement by parents in sexuality education
 Increase focus on prevention education, in addition to abstinence-focused education
 Increase access to reproductive health services for adolescents
 Focus on both reducing risk factors and strengthening protective factors
Chapter three
Methods
3.1. Study design
Cross sectional survey study was conducted from February to June 2012 among Gondar town
preparatory school students.Cross sectional studies are useful to identifying associations
between variables.
The study had questionnaires measure the prevalence and contributing factors for risky
sexual behaviors that expose to HIV/AIDS.
The study was also called cross-sectional because the information about the prevalence and
contributing factors for risky sexual behaviors that expose to HIV/AIDS was gathered at only
one point in time. The advantage of cross sectional survey is that in general it is quick and
cheap than longitudinal study.
3.2. Study Area
The study was conducted in 3 preparatory schools, namely Fasiledes, Angereb and Azezo
preparatory schools which are found in Gondar town. Gondar town is located 730km
Northwest of Addis Ababa, Ethiopia. Gondar is a town in Ethiopia, which was once the old
imperial capital and capital of the historic Begemder Province.
The town has a latitude and longitude of 12°36′N 37°28′E/ 12.6°N 37.467°E with an
elevation of 2133 meters above sea level (Gondar town –Wikipedia, the free encyclopedia).
20

Gondar town is the capital city of North Gondar zone Administration and there are about
206,987 people living in the town (FDRE CSA, 2007-2008).
The reason that the researcher selected Gondar town preparatory schools as study area was
there is inadequate researchs the researcher found on prevalence and contributing factors for
risky sexual behaviors that expose to HIV/AIDS on preparatory school students in Gondar
town.
3.3. Study population
All Gondar town preparatory school students are included in this research. The source
population for this study was all preparatory school students of Gondar town enrolled in the
academic year 2011/12. According to the statistics obtained from Gondar town education
office, in this academic year 3008(male: 1583 and female: 1425) students were enrolled in
Fasiledes, Angereb and Azezo preparatory schools with female students accounting for 47.3
%.
3.4. Sample Size and sampling Techniques
The sample size is calculated by using single population proportion formula. To determine
sample size, the study considered a prevalence of 25% obtained from a previous study among
school adolescents in Gondartown who do have one of the risky sexual behaviors, margin of
error of 5%, and confidence interval of 95%.
n = (Z α/2)2
P (1-P) Where, n = the sample size
w2
Z = Critical value= 1.96
P= Prevalence= 25%
w= Margin of error= 5%
With the 5% non- response rate, the final sample size was 303.
The sample size was distributed proportionally to each preparatory schools based on the
student population they have. Proportional distribution of sample was assigned to the
respective grade. Stratified Random Sampling was conducted to select participants of the
study.
Figure 1. The frame of the study area
21Gondar townGondar town

Stratified sampling
3.5. Data gathering instruments
A structured pre tested standaridized self administered questionnaire was utilized for data
collection. The questionnaire was developed through a review of related Ethiopian and
international literature. The data collection instrument was an anonymous structured
questionnaire, which was prepared in English. The English version of the questionnaire was
translated first to Amharic and back to English in order to ensure its consistency. The
researcher used structured questionnaire.
3.6 Data gathering procedure
The Six facilitators that completed 12th
grade were recruited. One day training was given
prior to the data collection time. In addition to the principal investigator, two supervisors
were assigned to lead the data collection, to check for completeness and consistency of a
questionnaire, and to assist data collectors. The questionnaire was distributed to the selected
students in the classroom and collected from May 12-13, 2012 when the instructors were
willing to allow the students to complete the questionnaire in the classroom, and then the
filled questionnaires were collected immediately
3.7. Variables for the study
3.7.1. Independent Variables
 Demographic characterstics
Sex, Religion, Parents Marital Status, living condition of the student, student marital status,
age
 Intermediate variables
22
Fasiledes
N=1993
n=201
Atse fasil (azezo)
N=725
n=73
Angereb
N=290
n=29

Peer pressure, Knowledge of HIV/AIDS, Risky perception towards HIV/AIDS and STIs and
substance abuse (Alcohol, Drugs, Khat and Cigarette)
3.7.2. Dependant Variable
Risky sexual behavior (condom use, multisexual partner and sex at the age of less than 18)
3.8. Pilot study
The instruments used in this study have been used by different research institutions and was
adopted and tested for their reliability and validity. The researcher randomly selected 20
participants from the entire population. To determine the reliability and validity of the items
the researcher used Crombach Alpha method, because it was best to measure internal
consistency.
After administering the instrument, the reliability and validity of the instrument seen and
their backward and forward translation was also checked by using individuals who were
skilled in language, such as English and Amharic teachers. The items that were added and/or
removed was determined based on the result
3.9. Ethical considerations:
Ethical clearance for the study was obtained from Institutional Review Board of faculty of
social science and humanity. Official letter were written from the department of Psychology,
Gondar town Education office, Fasiledes preparatory school, Angereb preparatory school,
and Azezo preparatory school to the concerned bodies to get permission and the first page of
the questionnaire was provided full information to the study participants regarding the
purpose and nature of the research. Written Consent was obtained from each participant.
Participation to the study was on voluntary basis, and participants were informed their right
not to participate in the study if they do not want to participate. Moreover, confidentiality of
the information was assured anonymous questionnaire.
23

Chapter four
Results
4.1. Socio-demographic characteristics
Two hundred ninety seven (98%) selected subjects responded to the prepared questionnaire and 6
selected subjects do not respond. Among the study subjects, 133 (44.8%) were males and
164(55.2%) were females making the male to female ratio of 1 to 0.81 Of the selected
subjects 209 (70.4%) were in the age group 15-18 years with mean age of years (17.49 +
1.7 for males and 16.71 + 1.5 for females). The ethnic composition of the students
indicates that 286 (96.3%) were Amhara and 11(3.7) were other (Tigrie, Oromo and guragie),
(Table 1).
Table 1. Socio-demographic data on age, educational level and ethnicity of Gondar
town preparatory school students in 2012. (n=297)
Variables Male (%) Female (%) Total (%)
297
Age
15-18 69(51.9) 140(85.4) 209(70.4)
19-24 64(48.1) 24(14.6) 88(29.6)
Educationallevel
11th
67(50.4) 104(63.4) 171(57.6%)
12th
66(49.6) 60 (36.6) 126(42.4%)
Ethnicity
Amhara 126 (94.7) 160(97.6) 286 (96.3)
Other 7 (5.3) 4(2.4) 11(3.7)
Of the study subjects 268 (90.2%) were unmarried. The religion composition of the students
24

indicates that 269 (90.6%), 22(7.4%), 3(1%) 1(.3%) 2(.7%) were Orthodox Christians,
Muslim, protestant, catholic and Jude, respectively. Of the study subjects 260 (87.5%) Were
unmarried, 35(11.8%) were married and 2(.7) were divorced (Table 2).
Table 2. Socio-demographic data on religion and marital status of Gondar town
preparatory school students in 2012.(n=297)
297
Religion
Orthodox
125(94.0) 144(87.8) 269(90.6)
Muslim 6(4.5) 16(9.8) 22(7.4)
Protesta
nt 0 3(1.8) 3(1.0)
Cath
olic 0 1(.6) 1(.3)
Ot
her 2(1.5) 0 2(.7)
Marital status
Sin
gle 112(84.2) 148(90.2) 260(87.5)
Marri
ed 21(15.8) 14(8.5) 35(11.8)
divorced/separated/widowed 0 2(1.2) 2(.7)
The respondents living situation shows that 151 (50.8%) of them live with both parents and
64 (21.5%) live with one parent Two hundred twenty two (74.7%) of the students
responded that their parents live together. Among the study subjects, 103(34.7%) came
from family size of 4-6 people and 151(50.8%) of the respondents came from family size
of above 7(table 3).
25

Table 3. Socio-demographic data on number of family member, parent marital status
and current living condition o f Gondar town preparatory school students in 2012.
(n=297)
297
No. of family member
1-3 23(17.3) 20(12.2) 43(14.5)
4-6 54(36.8) 49(32.9) 103(34.7)
>7 61(45.9) 90(54.9) 151( 50.8)
Parent marital status
Dad & mom live together 96(72.2) 126(76.8) 222(74.7)
Divorced 19(14.3) 19(11.6) 38(12.8)
Widow mom /dad died 15(11.3) 19(11.6) 17(5.7)
Separated 3(2.3) 17(10.4) 20(6.7)
Current living condition
with father & mother 58(43.6) 93(56.7) 151(50.8)
with father only 5(3.8) 3(1.8) 8(2.7)
with mother only 32(24.1) 24(14.6) 56(18.9)
with relatives 15(11.3) 20(12.2) 35(11.8)
with friends 4(3.0) 11(6.7) 15(5.1)
Alone 13(9.8) 9(5.5) 22(7.4)
With Others 6(4.5) 4(2.4) 10(3.4)
Among the respondants, eighty two (27.6%) of the study subjects came from rural area and
live in a rented house in towns. One hundred sixty seven (56.2%) of the respondents
responded that their fathers’ educational status was primary level, and 133 (44.8%) of them
mentioned that their mothers’ educational status of the same level respectively (Table
4 ).
Table 4. Socio-demographic data on residence,parents educational status o f Gondar
town preparatory school students in 2012.(n=297)
297
26

Residence
Urban 94(70.7) 116(70.7) 210(70.7)
urban only working days 5(3.8) 9(5.5) 14(4.7)
came from rural area and
live in a rented house in the
town
21(15.8) 26(15.9) 47(15.8)
urban till end of school
season
10(7.5) 11(6.7) 21(7.1)
Other 3(2.3) 2(1.2) 5(1.7)
Father’s educational status
Un able to read and write 13(9.8) 27(16.5) 40(13.5)
Read and write 55( 41.4) 34(20.7) 89(30)
Grade 1-4 14 (10.5) 20(12.2) 34(11.4)
Grade 5-8 11 (8.3) 33(20.1) 44(14.8)
Grade 9-12 10( 7.5) 16(9.8) 26(8.8)
Above grade 12 30(22.6) 34(20.7) 64(21.5)
Mother’s educational status
Unable to read & write 62(46.6) 43(26.2) 105(35.4)
Read and write 26( 19.5) 41(25.0) 67(22.6)
Grade 1-4 3( 2.3) 29(17.7) 32(10.8)
Grade 5-8 20( 15.0) 14(8.5) 34(11.4)
Grade 9-12 10( 7.5) 16(9.8) 26(8.8)
Above grade 12 12(9.0) 21(12.8) 33(11.1)
27

Figure 2: number of sexual partner in the past among Gondar town preparatory school
students in 2012(n=297).
The respondants number of sexual partner in the past were,45 students had only one
partner,14 had 2-5 partners,5 participants had more than 5 partners and 233 were have no
partner in the past .According to survey result almost 78percent of study participants not yet
started sexual intercourse.
4.2 prevalence of risky sexual behavior
Of the sexually active students, 57(19.2%) had risky sexual behavior operationalized
in the operational part. Forty five (15.2%) reported to have only one partner in the past
(figure 2). Among those who reported sexual relation with more than one partner, 19 (6.4%)
of them mentioned that the main reason to have sex with them was personal desire.
Table 5. Risky sexual behavior and knowledge among Gondar town preparatory school
students in 2012. (n=297)
28

297
Risk sexual behavior yes 22 (38.6) 35 (61.4) 57 (19.2)
No 111(46.2) 129 (53.8) 240(80.8)
Knowledgable yes 95 (32.0) 124(41.8) 219 (73.7)
No 38 (12.8) 40 (13.5) 78 (26.3)
4.3 .Contributing factors for risky sexual behavior
Generally adolescents (15-19years old) who practice sex are 2.09times more likely to engage
in risky sexual behavior than adolescents (19-24years old).
When we see the respondents’ fathers’ educational status and the risky sexual behavior,
students whose fathers are illiterate are highly vulnerable by4.12times than that of whose
fathers are educated.
Students who are living with their father and mother are protective for risky sexual behavior
and the risk is 69% lower than that of whose father and mother are not living together.
Students who are getting married are by 3.48 times higher risky than that of not married.
Respondents who use substance abuse are 1.64 times higher vulnerable for risky sexual
behavior rather than who are not use substance abuse.
Table 6. Contributing factors for risky sexual behavior among Gondar town
preparatory school students in 2012 (n=297)
Variables Risky sexual
behavior
COR WITH
95%CI
AOR WITH 95%
CI
29

YES NO
Father educational status
 Illiterate
 Other
14 26 2.68(1.29-5.55) 4.12(1.76-9.68)*
43 214 1 1
Living condition
 With mother &
mother
 Other
18 133 0.37(0.2-0.69) 0.31(0.51-0.62)*
39 107 1 1
Student marital status
 Married
 Others
13 22 2.928(1.37-6.3) 3.99(1.66-9.58)*
44 218 1 1
Student age
 15-18
 19-24
32 177 2.2(1.21-3.99) 2.09(1.06-4.12)*
25 65 1 1
* = statistically significant at 0.05 level
Table 7 contributing factors for risky sexual behavior among Gondar town preparatory
school students in 2012 (n=297)
Variables Risky sexual
behavior
COR WITH 95%CI AOR WITH 95% CI
YES NO
Substance abuse
30

 Yes 29 93 1.64(0.92-2.93) 2.27(1.14-4.51)*
 No 28 147 1 1
Personal perception
 High risk 22 48 2.51(1.35-4.67) 2.74(1.36-5.56)
 Low chance 35 192 1 1
Peer pressure
 Yes 43 14 12.95(6.54-25.66) 6.54(3.98-9.42)
 No 47 193 1 1
* = statistically significant at 0.05 level
The main reason for initiation of first sexual intercourse by the students were personal
desire (44%), peer pressure (33%), coersion (15%) and economic problem (8%) were the
major reasons reported by the students (Figure-3).
4.4 personal perceptions towards HIV/AIDS and its contributing factors for risky sexual
behavior
Respondents who perceive that as they are risky for HIV/AIDS by 2.74times higher than
that of not perceive themselves. The presence of peer pressure predisposes students to
practice risky sexual behavior. Keeping other variables constant students who have peer
pressure have 6.54 times higher chance of practicing unsafe sexual practice as compared to
students who have no peer pressure.
Figure.3. Reasons for initiation of first sexual intercourse among Gondar town preparatory
school students, 2012(n=297)
31

4.5 Estimates of knowledge on HIV/AIDS prevention and transmission
Having knowledge about risky sexual behavior has greater importance to protect them from
sexually transmitted disease and HIV/AIDS. Participants were asked some questions
regarding to their knowledge about HIV/AIDS.
Majority of the students 219 (73.7%) were aware of HIV or the disease AIDS and 297
(100%) of them had heard diseases that can be transmitted through sexual intercourse.
The main mode of transmission of HIV know by the students were sexual
intercourse 297 (100%) and contaminated injection needles 267 (90%) and mother to
child transmission 194 (65%) while mosquito bite 59(20%) was the major misconceptions
reported by the students (table 5) figure 4.
Figure 4.Knowledge about the mode of HIV transmission among preparatory school
students in Gondar town in 2012.(n=297)
32

Chapter five
Discussion
The prevalence of risky sexual behavior in the study area was 19.2%. This results was
inconsistence or lower than a study done in the same target group in South Africa
(Maluleke,2010)the prevalence was (27.65%),in Cambodia(Siyan,2010)(34.6%),
Nigeria(Ojikutu,2010) (24%) and Gondar town preparatory school (shiferaw Y. et al, 2009)
(25%) the possible reason might be the sample size was too small and school included in the
study was only one preparatory school (Fasiledes preparatory school) and also a lot of
intervention done by the stakeholders to avoid risky sexual behavior like health education,
distribution of condom was done and also the community norm may influence to tell franckly
since it is a social sensitive issue.
The presence of peer pressure predisposes students to practice risky sexual behavior.
Keeping other variables constant students who have peer pressure have 6.54 times higher
chance of practicing unsafe sexual practice as compared to students who have no peer
pressure. This result was the same as a study done in Bangladesh in 2000. Peer pressure
brings behavioral change that student may feel that practicing risky sexual behavior may be a
sign of development or modernity.
Respondents who use substance abuse are 1.64 times higher vulnerable for risky sexual
behavior than who are not substance abuses. Other studies also agree to this study for many
adolescents experimenting with tobacco, alcohols and drug a developmental stage. A
tendency to take such risks also applies to all sorts of risks including risky sexual behavior.
In Tanzania, for example, youth ages 10 to 24 that smoked and drank alcohol were four times
likely than others to have multiple sexual partners.
A Study by Lemma Eyob on sexual behavior of high school students in Jimma showed that
14.6% of the students reported having sex under the influence of alcohol (CSA, 2007-2008).
So, in a country where places to spend free time like libraries, playing grounds and
recreational facilities for young people are very few as obviously seen. In Ethiopia,
preparatory school students will also be exposed to alcohol, Khat or tobacco that could
influence them to practice unsafe sexual activity.
34

Age is one of the predictor variables that show significant contribution to the dependent
variable.
when we see the association of age and the sexually risky behavior, the students who
practice sex at the age of 18 and earlier are 2.09 times more vulnerable to risky sexual
behavior than those who practice sex when they are older this may be due to not matured of
students in physically, mentally, and psychologically and other Studies also show that
young people who have been victims of sexual abuse are more likely to engage in high risk
sexual behavior than who have not been abused (Green,et.al,2002).
A traditional society like ours, where by unequal social position of women exists and
masculinity of men is over emphasized, high school girls are highly exposed to coercion
which leads them to early sexual activity thereby increasing their vulnerability to STDs as a
result of engagement in sexual acts by the time they don’t appreciate the pros of the coitus.
Therefore the result of this study confirmed that early sexual intercourse (before 19years old)
becomes a risk factor to be sexually active.
When we see the respondents’ fathers’ educational status and the risky sexual behavior,
students whose fathers are illiterate are highly vulnerable by4.12times than illiterate, their is
also similar finding in Dessie town (Abdulhakim,2008)the reason for this finding is fathers
who are educated can treat and teach their families better than that of whose families are
illiterate and could be discussion with father about avoiding/delaying sex.
Students who are living with their father and mother are protective for risky sexual behavior
and the risk is 69% lower than that of whose father and mother are not living together.
There is also similar finding in Dessie (Abdulhakim, 2008) the possible reason is students
whose father and mother live together can get well treatment in socially and psychologically.
In addition to these, students who are live with both father and mothers can live a stagnant
life and they get a good treatment form their mother and father.
Students who are getting married earlier are by 3.48times higher risky than that of not
married. From the research that found students who are not married because these students
are not matured physically, psychologically, their sex organ is highly vulnerable to STDs
because the organ is lacerate easily but the research from Nigeria(Ojikutu,2010) was
35

inconsistence this may see the time that most students practice sex but in my finding any sex
started under 19year is risky because of the above reasons.
Majority of the students 219 (73.7%) were aware of HIV or the disease AIDS and 297
(100%) of them had heard diseases that can be transmitted through sexual intercourse. The
main mode of transmission of HIV know by the students were sexual intercourse
297 (100%) and contaminated injection needles 267 (90%) and mother to child
transmission 194 (65%) while mosquito bite 59(20%) was the major misconceptions
reported by the students this finding aline with the previous research from Gondar Fasiledes
preparatory school in 2009. But knowledge is not a predictor variable for risky sexual
behavior. There is also a similar finding a study done in Nigeria students (Ojikutu,et.
al,2010), but this is different from the previous researchs from Gondar in 2009 and Dessie in
2008 in the same target population.
5.1. Summary, conclusion and recommendation
5.1.1. Summary
Risky Sexual Behavior is Sexually active school adolescents who have sexual contact with
causal partner, or multiple sexual partners, or Commercial Sex Worker or experience
unprotected sex (not using or occasional use of condom), the sexual activity occurred when
one of the partner age is less than or equal to 18 years.
The study was focused on assessing the prevalence and contributing factors for risky sexual
behavior among Gondar town preparatory school students in 2012.
Cross sectional survey study design was conducted from February to June, 2012 among
Gondar town preparatory school students. A total of 303 respondents were included to
achieve the objectives. The data was analyzed by descriptive statistics, bivariate and multi
variate analysis to identify the contributing factors for risky sexual behavior.
The study was conducted in 3 preparatory schools, namely Fasiledes, Angereb and Azezo
preparatory schools which are found in Gondar town. Gondar town is located 730km
Northwest of Addis Ababa. Gondar town is the capital city of North Gondar zone
Administration.
36

Study population was all Gondar town preparatory school students included in this research.
The source population for this study was all preparatory school students of Gondar town
enrolled in the academic year 2011/12. According to the statistics obtained from Gondar city
education office, in this academic year 3008 students enrolled. The dependant variable for
this research was Risky sexual behavior.
A structured pre tested self administered questionnaire was utilized for data collection. The
questionnaire was developed through a review of related Ethiopian and international
literature. The data collection instrument was an anonymous structured questionnaire.
The result of the research described in different tables and figures. A total of 297 respondents
respond to the questioner giving a response rate 97%. The prevalence of risky sexual
behavior was 19.2%. Risky sexual behavior was associated with illiterate father (AOR 4.12:
95% CI 1.76, 9.68), living with mother and father (AOR 0.31: 95% CI 0.51, 0.62), married
student (AOR 3.99: 95CI 1.66, 9.58) student age between 15-18 years (AOR 2.09: 95% CI
1.06, 4.12), substance abuse (AOR 2.27: 95% CI 1.14, 4.51), high risk personal perception
(AOR 2.74: 95CI 1.36, 5.56), peer pressure (AOR 6.54:95CI: 3.98, 9.42).
Generally, High prevalence of risky sexual behavior was observed among Gondar town
preparatory school students. Risky sexual behavior was affected by age less than 19 years,
peer pressure, father educational status, marital status of the student, substance abuse, living
condition of the students and personal perception.
Finally, the researcher recommended that Peer educators should be established and
strengthen in all schools so that they can provide education in a friendly manner, schools
main focus area should be for under age (under 19) to have good awareness about sex
education to avoid risky sexual behavior. Knowledge by itself is not enough, so the schools
administration and parents mainly focus on commitment on attitude and practice for
prevention of risky sexual behavior.
5.1.2. Conclusion
High prevalence of risky sexual behavior was observed among Gondar town preparatory
school students. Risky sexual behavior was affected by age less than 19 years, peer pressure,
37

father educational status, and marital status of the student, substance abuse, living condition
of the students.
Risky sexual behavior was also affected by personal perception but donot affected by
knowledge.
5.1.3. RECOMMENDATION
The finding of this study indicate that preparatory school students practicing risky sexual
behavior that needs due attention. Therefore, based on the findings the following
recommendations were forwarded.
• To North Gondar zone HAPCCO and Gondar town HAPCCO
Reproductive health including HIV/AIDS prevention and controlling
should be actually incorporated in the school curriculum beginning from
the primary level so that to balance the gap between knowledge, Attitude
and practice students on sexual matters.
• The government and NGOs should strengthen the capacity of school anti
AIDS clubs in terms of material and trainings.
• Peer educators should be established and strengthen in all schools so that
they can provide education in a friendly manner.
• To North Gondar zone Health department and Gondar town Health office
-Reproductive health services (condom provision, treatment on STDs, and
VCT) should be made available nearby or in the schools.
• The schools main focus area should be for under age (under 19) to have
good awareness about sex education to avoid risky sexual behavior.
• Knowledge by itself is not enough, so the schools adminstration mainly
focus on comititment on attitude and practice for prevention of risky
sexual behavior.
38

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Annexes
ANNEX-1
በበበበበ በበበበበበ በበበበበበ በበበበበ በበበ በበበበ በበበበበበበ በበበበ በበ በበበበበ በበበ በበበበ
በበበበበ በበበበበ በበበበ በበበበበበ በበበ-በበበ በበበበበ በበበበበበ በበበበበበ በበበበበ በበበበበ በበበበ;
በበ በበበበ በበበበ በበበ በበበ በበበበበ በበበበበበ በበበበበበ በበበበበ በበበ በበበበ በበበበበ በበበበበ
በበበ በበበበበበ በበበ በበበ በበበበ
በበበበበ በበበበበ በበበበበ በበበበበበበ በበበበበ በበበበበ በ/በበ በበበበበበ በበበ-በበበ በበበበበበ
በበበበበበበ በበበበበ በበበበ በበበበ በበበ በበበ በበበ በበበበበ በበ/በ በበበበ በበበበበበ በበ በበ-
ወወወ ወወወወወወ ወወወወወወ ወወወወወወወ ወወወ ወወወወ
ወወወወወ ወወወ ወወወወ ወወወወ ወወወወወ ወወወ ወወወ
ወወወወወወ ወወወወወወ ወወወወ ወወወወወ ወወወወ ወወወወ
ወወወ ወወወወ ወወወ ወወወወ ወወወወወ ወወወወወወወ
ወወወወወ ወወወወወ ወወወወወወወ ወወወወ ወወወ ወወወወወ
ወወወ ወወወ ወወወ ወወወ ወወወወ ወወወ ወወወ ወወወ ወወወ
ወወወ ወወወወወ
ወወወወወወወወወ ወወወወ ወወወወወወወ ወወወወወ ወወወ
ወወወ ወወወወ ወወ ወወወወወ ወወወ
48

ወወወወወወወወወወወወወወወ ወወወወወወወ ወወወወ ወወ
ወወወወወ ወወወ ወወወ ወወወወወወ ወወወ ወወወወ ወወወወወ;;
ወወወ ወወወወ ወወወ ወወወወ ወወወወወወ ወወወወወ
ወወወወወወወወ ወወወ ወወወ ወወወወወወ ወወወ ወወወወወወ
ወወወወወ ወወወወወ ወወወወ
ወወወወ ወወወወወ ወወወወ ወወወወወወ ወወወወ ወወወወ
ወወወወወ ወወወ ወወወ ወወወ ወወወ ወወወ
ወወወወወወወ!
ወወወ 1ወ- ወወወወ ወወወ
ወወወወወ ወወወወወወወ ወወወ ወወወወወ ወወወወወ ወወወወወ ወወወወወወ ወወ ወወወ
ወወወወወወወወወ ወወወወወ ወወወወወወ ወወወወወወወወ
ወ ወወወ ወወወ ወወወወ
101
ወወ 1 ወወወ 2 ወወ
102
ወወወወ/ወ/
------------------------
103
ወወወወወ/ወ/ ወወወ 1. ወወወ/ወ/ 4. ወወወወወ/ወ
2. ወወወወ/ወ/ 5. ወወወወወ/ወወ/
3. ወወወወ/ወ
49

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