2. Oral Presentation of Abstract Title “Association Between Risky Sexual Behaviors and HIV Risk Perception among In-School Adolescents in a Municipality in Ghana”
BY James Afriyie Maame Ewurama Essilfie [Department of Biomedical Sciences, School of Allied Health Sciences University of Cape Coast, Cape Coast, Ghana]

3. Outline of Presentation
Background to the Study
Aim of the Study
Research Methodology
Results and Discussion
Conclusion
Implications for Interventions
References

4. Background to the Study
AIDS/HIV) a serious global health issue.
AIDS-related illnesses - the 2nd leading cause of death for women (15 – 49 years) in Africa1
The national median HIV prevalence in Ghana has been increasing for and (from 1.6 in 2014; to 1.8% for 2015 and 2.4 for 2016)
Lowest HIV prevalence of 0.6% was recorded for people of 15 – 19 years
Extra efforts needed to bring down HIV prevalence among adolescents .

5. Background to the Study (cont’d)
Adolescents (people between 10 and 19 years) 3
Have high natural tendency for risk-taking behaviors , Vulnerable to STDs
More understanding of issues associated with HIV infection among adolescents needed
- perception on risk of HIV infection
- How risk perception influences sexual risk behaviors
Necessary for appropriate interventions to fight AIDS.

6. Background to the Study (cont’d)
According to the Heath Belief Model,
Likelihood for a preventive health action is influenced by perceived susceptibility to the disease.4
Perceiving one’s self to be at risk of getting HIV infection should influence the adolescent not to engage in risky sexual behaviors
Some studies have found different results

7. Background to the Study (cont’d)
On condom use
-From an earlier study in Ghana - perceived susceptibility to HIV infection was a predictor of condom use (condom ever used), but this did not directly influence condom use at last sexual intercourse In a recent study in South Africa- perceived risk for HIV infection had no impact on consistency in using condoms.6
On multiple sexual partners:
- In a study in Cameroun, low HIV/AIDS risk perception was associated with having multiple sexual partners In a study in Ethiopia, good (high) HIV risk perception was associated with having multiple sexual partnerships.8

8. Aim of the study
Scarcity of studies that consider the association between adolescents’ risky sexual behaviors and their HIV risk perception (how they perceive themselves to be at risk of getting HIV infection).
The aim of this study was to assess the association between HIV risk perception and risky sexual behaviors among in-school adolescents in a municipality in Ghana.
The sexual behaviors considered were:
- being sexually active (defined as “ever had sex within 1 year to the survey”), age at first sexual intercourse, condom use, number of sexual partners.

9. Methodology Study design, population and Sampling
A cross-sectional study design
Questionnaire for data collection
718 JHS students participated; Data 707 aged 11 – 19 years used
JH Schools in the Komenda-Edina-Egyafo-Abirem (KEEA) Municipal of Central Region, Ghana from March to May, 2017
Two schools randomly selected from the list of schools in Elmina educational circuit; one school randomly selected from each of the other 7 circuits. In selected schools, one class of JHS1, JHS 2, and JHS 3 selected. All students in selected classes were invited to voluntarily participate in the study (consent forms) by answering the questionnaire.

10. Methodology (cont’d) Variables and Measures
Socio-demographics - Age, School Class , Residential Location , Tribe, and Religion
HIV risk perception assessed by the:
Question - “How will you rate your risk or chances of getting the AIDS virus someday?”
Responses - “no risk at all”, “low risk”, “medium risk”, and “high risk”.
“No risk at all” was scored as “0” - having no HIV risk perception.
“low risk”, “medium risk”, or “high risk” were scored “1”, - having HIV risk perception.

11. Methodology (cont’d) Variables and Measures
Risky sexual behaviors:
- Being sexually active = “ever had sex within 1 year to survey” (yes or no)
- Age at first sexual intercourse (before 14 years or at 14 years and after),
- Condom Used at least sexual intercourse (no or yes)
- Number of sexual partners (1 or 2 or more),

12. Methodology Analyses and Ethical Considerations
SPSS version 22 used for analyses.
Descriptive statistics for frequencies and percentages
Bivariate and multivariate logistic regression analyses for assessment of association between HIV risk perception and risky sexual behaviors, at significant level of 0.05
The study was approved by the Institutional Review Board (IRB) of UCC.
Written permission was given by the Municipal Educational Office of KEEA,
Parents or wards gave consent for their children to participate in the study.

13. Results and Discussions Socio-demographic Characteristics of respondents
Of the 707 adolescents whose data were included for the analyses:
43.3% were males and 56.7% were females.
The mean age of the respondents was 14.8 ± 1.44 years.
Most of the respondents were of the Fanti tribe (91.5%)
Most were Christians (91.6%).
They were JHS 1, JSH 2 and JHS 3 Students; from Urban and Rural areas

14. Results and Discussions (cont’d) Risky Sexual Behaviors
Table 1. Risky Sexual Behaviors among adolescent respondents
Factors N %
Being Sexually Active (Had Sex within 1 year) (N=683) No
494
72.3
Yes
189
27.7
Age at first sexual intercourse (N = 139)
Below 14 years 72
51.8
At 14 years or after 67
48.2
Used Condom at last Sexual Intercourse (N = 179)
117
65.4 62
34.6
Number of Sexual Partners (N= 145)
2 or more 54
37.2 1 91
62.8

15. Results and Discussions (cont’d) Risky Sexual Behaviors
27.7 % have had sex within a year to the study; Among the sexually active: % had sexual intercourse below 14 years, % did not use condoms at their last sexual intercourse, and % had multiple sexual partners (Table 1).
The finding of this study agrees with a previous study among in-school young people in Accra, Ghana, which reported that 9 (Doku, 2012).
- 25% young people were sexually active; 31% had multiple sexual partners
A good number of the adolescents were involved in risky sexual behaviors.
The adolescents might be undertaking these sexual risk behaviors to learn more about themselves and to explore the world of sexuality.

16. Results and Discussions (cont’d) HIV Risk Perception
Table 2. Self-Assessed HIV Risk perception among subgroups of respondents
HIV Risk perception N %
Among all respondents (N=706)
No HIV risk perception
561
79.5
HIV risk perception
145
20.5
Among Sexually Active respondents (N=189)
140
74.1 49
25.9
Among Sexually Inactive respondents (N= 494 )
402
81.4 92
18.6

17. Results and Discussions (cont’d) HIV Risk Perception
Only a small proportion (20.5%) had HIV risk perception
An earlier study in Ghana reported a generally low risk perception [ only 15% of females and 16% of males perceiving themselves to be at risk of HIV infection].10 (Darteh et al., 2016)
Possible Reasons for low HIV risk perception:
Difficulties in correctly assessing their risk of getting the disease11.
- Youth in general think that they are not vulnerable to diseases12.
- The high stigma attached to HIV infection in Ghana

18. Having HIV Risk Perception
Results and Discussions (cont’d) Association between Risky Sexual Behaviors and HIV Risk Perception
Table 3. Bivariate and multivariate analyses of relationship between risky sexual behaviors and HIV risk perception among adolescent respondents.
Factor
Having HIV Risk Perception
Crude Odds Ratio
p-value
Adjusted Odds Ratio ¥ NO
YES
N (%)
OR (95% CI)
AOR (95% CI)
Being Sexually Active (Had sex in the last 1 year) (N=542)
Yes
140 (74.1)
49 (25.9)
1.539
( )
0.035
1.333
( )
0.188 No
402 (81.4)
92 (18.6)
Age at First Sexual Intercourse (N=106)
Below 14 years
54 (75.0)
18 (25.0)
0.865
( )
0.718
≥ 14 years
52 (77.6)
15 (22.4)
Used Condom at last sexual intercourse (N=134)
90 (76.9)
27 (23.1)
0.733
( )
0.382
44 (71.0)
18 (29.0)
Number of Sexual Partners (105)
2 or More
33 (61.1)
21 (38.9)
2.411
( )
0.019
2.393
( )
0.028 1
72 (79.1)
19 (20.9)
Abbreviation: CI, confidence interval; OR, odds ratio; AOR, adjusted odds ratio. ¥Adjusted for residential location, ethnicity, religion, and age

19. Results and Discussions (cont’d) Association between Risky Sexual Behavior and HIV Risk Perception
Being sexually active was independently associated with HIV risk perception
In a study in Uganda - ever had sex was a significant factor associated with perceived risk of contracting HIV.13 (Osingada et al., 2016)
Adolescents who were sexually active could more easily than those who were not sexually active to admit their susceptibility to HIV infection as most the adolescents reported that they did not use condom during their last sexual intercourse

20. Results and Discussions (cont’d) Association between Risky Sexual Behavior and HIV Risk Perception
Number of sexual partners was associated with HIV risk perception
38.9% among those with multiple sexual partners versus 20.9% among those with 1 sexual partner, p =
Association persisted even after considering the effects of age, religion, ethnicity, and residential location.

21. Results and Discussions (cont’d) Association between Risky Sexual Behavior and HIV Risk Perception
Sexually active adolescents with multiple sexual partners were 2.39 times more likely than those with single sexual partner to assess themselves to be at risk for HIV infection.
The study established a strong association between multiple sexual partnership and HIV risk perception among adolescents
It agrees with a study in Ethiopia which found that youth having two or more sexual partners perceived themselves to be at high risk of getting HIV infection than their counterparts with one sexual partner.14 (Negeri, 2014)
The acceptance of their risk of HIV infection by adolescents with multiple sexual partners could be attributed to their knowledge and information about how HIV is transmitted.

22. Results and Discussions (cont’d) Association between Risky Sexual Behavior and HIV Risk Perception
The study is suggesting absence of association between HIV risk perception and: - age at first sexual intercourse condom at last sexual intercourse. (More studies needed)
Absence of association between condom use at least sexual intercourse and HIV risk perception among adolescents appears to agree with a recent study in South Africa 6 (Muchiri, et al., 2017)
Probably other factors such as parental approval, social norms, and accessibility of condoms in the community overshadowed the individual adolescent’s perceived risks of HIV infection in influencing condom use at least sexual intercourse.

23. Conclusion
Only few of the adolescents in the study perceived themselves to be at risk of HIV infection.
Those who had some HIV risk perception were more likely to be sexually active than those who were not sexually active.
A risky sexual behavior (multiple sexual partners) was found to be associated with HIV risk perception.
Adolescents with multiple sexual partners were more likely to have HIV risk perception than adolescents with single sexual partner.

24. Implications for Interventions
Need to sustain efforts to reduce HIV infection among young people in Ghana and focusing on behavioural change.
Need for interventions that help adolescents to correctly assess their HIV risk perception.
Development of HIV interventions that are built on the adolescents’ belief that having multiple sexual partners puts one at risk for HIV infection.

25. References
1. Joint United Nations Programme on HIV/AIDS. Data UNAIDS; Retrieved from ook_2017_en.pdf
2. Ghana AIDS Commission. Summary of the 2016 HIV Sentinel Survey Report. Ghana AIDS Commission; Accessed March 29, 2018, from
3. World Health Organization. Health Topics. Adolescent Health. World Health Organisation; Accessed April 5, 2018 from
4. Rosenstock IM. Historical Origins of the Health Belief Model. HEB. 1974: 2(4): 328–335.

26. References (cont’d)
5. Adih WK AC. Determinant of Condom Use to Prevent HIV infection among Youth in Gana. J. Adolesc. Health. 1999: 24(1): 63–72.
6. Muchiri E, Odimegwu C, De Wet N. HIV risk perception and consistency in condom use among adolescents and young adults in urban Cape Town, South Africa: a cumulative risk analysis. South Afr J Infect Dis. 2017: 32(3):
7. Tarkang EE. Multiple sexual partnership and perception of risk of HIV infection among out-of-school youths aged in Cameroon: A short communication. CAJPH. 2015: 1(1): 9–13.

27. References (Cont’d)
8. Shiferaw Y, Alemu A, Assefa A, Tesfaye B, Gibermedhin E, Amare M. Perception of risk of HIV and sexual risk behaviors among University students: Implication for planning interventions. BMC Research Notes : 7(1): 1–8.
9. Doku D. Substance use and risky sexual behaviours among sexually experienced Ghanaian youth. BMC Public Health. 2012: 12(1):
10. Darteh EKM, Kumi-Kyereme A, Awusabo-Asare K. Perception of Risk of HIV among Adolescents’ Living in an Urban Slum in Ghana. Afr J Repr Health. 2016: 20(1): 62–70.
11. Prata N, Morris L, Mazive E, Vahidnia F, Stehr M.. Relationship between HIV risk perception and condom use: Evidence from a population-based survey in Mozambique. Int Fam Plan Perspect. 2006: 32(4): 192–

28. References (Cont’d)
12. Yawson AE, Appiah LK, Yawson AO, Bonsu G, Aluze-Ele S, Owusu Amanhyia NAK, … Flanigan T. Sex differences in perceived risk and testing experience of HIV in an urban fishing setting in Ghana. International Journal for Equity in Health. 2014; 13(1): 1–8.
13. Osingada CP, Nabasirye C, Groves S, Ngabirano TD. Perceived Risk of HIV Infection and Associated Factors among Secondary School Students in Wakiso District , Uganda. Advances in Public Health : 2016:
14. Negeri E. Assessment of risky sexual behaviors and risk perception among youths in Western Ethiopia: The influences of family and peers: A comparative cross-sectional study. BMC Public Health. 2014: 14(1):

29. THANK YOU