1. What Factors Influence Early Sexual Debut amongst Youth: Comparative Evidence from Nigeria and India ICASA 2011 Babatunde.O, Temitope.F, Imoisili.A, Alabi.F

2. Outline Background Countries in focus (Nigeria and India) Fact files on Youth and Sexuality Study objectives Methodology Data analysis Results Conclusion

3. Study Background About half of the world’s population of 7 billion are under the age of 25. (UNFPA) No other age group suffers greater adverse consequences of poor reproductive health decisions as the youth. Highest rates of HIV transmissions worldwide and highest burden of sexually transmitted infections (CDC) Maternal deaths due to abortion related causes are utmost amongst youth

4. Why is Early Sexual Debut Important? Studies have shown that early sexual debut is directly associated with high risk sexual practices like multiple sexual partnering and low uptake of condom use (Fatusi et al, 2008). HPV infection and thus cervical cancer rate is higher amongst females who initiate sex early. (Ludick et al, 2006) It is also directly associated with increased lifetime prevalence of sexual partners. In addition to being at increased risk of HIV transmission, a higher STI incidence has been reported amongst youth who initiate sex early.

5. Study Location: Nigeria and India Why these 2 countries: – Availability of Data – High population countries

6. Youth in Nigeria and India Youth account for a third of Nigeria’s population of 150 million (National Population Census 2006) HIV infection rates amongst young people aged 15-19 is put at 3.3% and those aged 20-24, it is 4.6% (UNFPA Nigeria) Factors contributing to high reproductive health burden include lack of sexual and reproductive health services, high poverty rates and selected cultural norms. Cultural norms are exemplified in Northern Nigeria were maternal related deaths are high as a direct result of early girl child marriages. 73% of females in Northern Nigeria are married by age 18. (NDHS 2008)

7. Youth in Nigeria and India Globally, India has the highest number of youth numbering 358 million, about 5.1% of the world population (Office of the Registrar General of India, 2001) HIV prevalence rate is 0.04% amongst youth aged 15-19 and 0.18% amongst those aged 20-24 (NHFS 3). According to the Youth India Study (2006), there was a general paucity of knowledge on reproductive health issues amongst youth Comprehensive knowledge of HIV was lower amongst younger and unmarried young people.

8. STUDY OBJECTIVES

9. Study Objectives Determine the prevalence of sexual exposure amongst respondents Compare pattern of sexual debut across Nigeria and India by gender. Identify factors which are associated with early sexual debut amongst respondents Examine the effect of nationality on the association between early sexual debut taking into account other associated factors.

10. Methodology Data for this study were pooled from the National Demographic and Health Survey of Nigeria (NDHS 2008) and the National Family and Health Survey of India (NHFS 3). Inclusion Criteria – Young people aged 15 -24 – Never Married Exclusion Criteria – Non response to question on age at sexual initiation

11. Methodology(cont) Dependent variable: – Age at first sexual intercourse Independent variable: – Socio-demographic factors i.e. age, gender, education e.t.c – Community factors i.e. Urban/Rural – Psychosocial factors i.e. alcohol use, prior HCT experience.

12. Data Analysis Data were analyzed using SPSS 19 and STATA 9 software. Univariate analysis was used to generate frequency distributions. Bivariate analysis for associations between categorical variables using chi squared tests. Binary Logistic Regression was used for multivariate analysis. Adjusted odds ratios (OR), 95% confidence intervals (CI) and p-values were obtained. Statistical significance was determined at alpha level of 5% using two-sided tests. Appropriate sampling weights were applied.

13. RESULTS

14. Table 1: Selected Socio-demographic Characteristics Variables(N=55764)(%) Nationality India4430979.2 Nigeria1145520.5 Gender Male2523645.3 Female3052754.7 Age 15-193769867.6 20-241806632.4 Type of Location Urban2272740.8 Rural3303759.2

15. Table 1: Selected Socio-demographic Characteristics Variables(N=55764)(%) Educational Status None52499.4 Primary663611.9 Secondary3791468.0 Tertiary595610.7 Wealth Index Poorest642511.5 Poor871015.6 Middle1159620.8 Rich1373024.6 Richest1530227.4

16. Table 2: Sexual characteristics of respondents Variable(N)(%) Sexual Exposure Never4890287.8 Yes680212.2 Total55764 Age at first Sex <15 years97114.3 >= 15 years582985.7 Total6799

17. Table 3: Relationship between age at first exposure and selected variables Age at first sex <15 yearsAge at first sex >=15 years VariablesN%N% Nationality Nigeria59060.8358861.6 India38139.2224138.4 9711005829100 p value= 0.063 Gender Male60262.0348259.7 Female36938.0234740.3 9711005829100 p value= 0.032

18. Table 3: Relationship between age at first exposure and selected variables Age at first sex <15 yearsAge at first sex >=15 years VariablesN%N% Type of Location Urban26327.1243941.8 Rural70872.9339058.2 Total9711005829100 P<0.001 Level of Education None727.43135.4 Primary15616.262910.8 Secondary71273.5410270.4 Tertiary293.078413.5 Total9691005828100 P<0.001

19. Other factors significantly associated with early sexual exposure included socioeconomic status, alcohol use and previous HCT experience.

20. Figure 1: Percentage of males and females who had sex before age 15(married and unmarried)

21. Figure 2: Percentage of males and females who initiated sex before age 15 (unmarried)

22. Table 4: Early Sexual Debut and Selected Associated Factors Odds Ratio95% CIP-Value Nationality Nigeria2.442.24-2.66 0.18 India1.00 Gender Male1.161.05-1.280.044 Female1.00 Location Urban1.201.12-1.39<0.001 Rural1.00 Education None3.622.98-4.04<0.001 Primary2.222.11-2.48<0.001 Secondary1.241.1.14-1.32<0.001 Tertiary1.00 NB: Other factors controlled for include Wealth Index, Alcohol Use and HCT experience

23. Conclusions Delaying age of first sex still remains an effective way of reducing reproductive health burden amongst youth Irrespective of nationality, factors associated with early sexual debut amongst youth in Nigeria and India include male sex, urban location, alcohol use, poor socioeconomic status and low levels of education.

24. What can be done? It is imperative to promote better reproductive health services amongst youth. While improving the socioeconomic status of youth may be long term, immediate short term results can be sought by intensifying behavioral change programs amongst youth, keeping in view urban dwellers as well as the male gender.

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