Inconsistent condom use and other risky practices particularly common among women and those with limited HIV knowledge, highlighting the need for comprehensive sexual health education.
An analysis of the sexual behaviour of unmarried, sexually active young people (aged 15-24) in Nigeria over ten years suggests risky sexual behaviours are extremely common and increasing, especially among young women.
The findings come from an analysis of data relating to unmarried, sexually active young people who took part in the three most recent Nigeria Demographic and Health Surveys, conducted in 2008, 2013 and 2018.
In each survey, four-fifths of young people in this group said they had engaged in at least one of four key risk behaviours for HIV, sexually transmitted infections (STIs) and unwanted pregnancy. Of those surveyed, 63-77% reported using condoms inconsistently, 58-72% reported not using modern contraceptives, 53-55% reported having sex before they were 18, and 8-10% reported having multiple sex partners. This is despite the existence of several programmes between 2008 and 2018 that aimed to improve the sexual and reproductive health (SRH) of young Nigerians.
Between 2008 and 2013 the four risk behaviours appeared to be declining among young people. But from 2013-2018 these behaviours rose by 8-25%. This means that, overall, the proportion of young people engaging in at least one risk behaviour increased from 87% to 89% between 2008 and 2018. The highest increases were seen in non-use of modern contraception (10%) and inconsistent condom use (7%).
When analysed by sex, a significant trend emerged. In 2008, a similar level of young women (87%) and young men (86%) engaged in at least one risk behaviour. In 2018, risk behaviour among young men had fallen in three of the four categories (multiple sex partners being the exception) but increased among young women in each category. As a result in 2018, 94% of young women reported engaging in at least one risk behaviour, compared with 71% of young men.
Having comprehensive knowledge of HIV and AIDS was associated with being less likely to have sex early, and being more likely to use modern contraception and condoms. This underlines how important comprehensive sexual health education is in reducing young people’s risk behaviours.
The analysis also found differences between ages and locations. Youths (ages 20-24) were less likely to report inconsistent condom use, non-use of modern contraception and early sex than adolescents (ages 15-19), but more likely to report multiple sexual partners.
Young people in urban areas were more likely to use condoms than those in rural areas. By region, the highest level of consistent condom use among young people was in the South-West, while the North-East had the highest level of young people in multiple sexual partnerships.
Overall, being male, older (20-24), living in South-West Nigeria, living in an urban area, having a higher socio-economic status, having secondary level education or above, and having comprehensive knowledge of HIV and AIDS were all associated with a lower likelihood of risky sexual behaviour.
These findings show that young Nigerians are still struggling to access quality SRH services. Unfriendly or unsuitable services and weak supply systems are likely to be factors in this.
Age-appropriate, non-judgemental SRH services are needed to close this gap. To be effective, SRH services for young people should also take gender, age and location into account. Until this happens, young Nigerians will remain disproportionately affected by HIV, STIs, early and unplanned pregnancy and unsafe abortion.