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Ethnicity, Gender and Risky Sexual Behaviour Among Nigerian Youth: an Alternative Explanation Clifford Odimegwu and Oluwaseyi Dolapo Somefun*

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Ethnicity, Gender and Risky Sexual Behaviour Among Nigerian Youth: an Alternative Explanation Clifford Odimegwu and Oluwaseyi Dolapo Somefun* Odimegwu and Somefun Reproductive Health (2017) 14:16 DOI 10.1186/s12978-017-0284-7 RESEARCH Open Access Ethnicity, gender and risky sexual behaviour among Nigerian youth: an alternative explanation Clifford Odimegwu and Oluwaseyi Dolapo Somefun* Abstract Background: While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations. Methods: The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15–24). Logistic regression was used to predict condom use at last sexual activity and MSP. Results: The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15–19 and elevated risk of first sex was higher among Yoruba males. Conclusion: This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs. Keywords: Youth, Condom use, Ethnicity, Multiple Partnership, Sexual debut Plain English Summary on the sexual behavior of youth can help them make Desired progress has not been made in the reduction of healthy transitions to adulthood. sexually transmitted infections and young people aged Cross-sectional data were analyzed separately for 15–24 are particularly at risk due to their high rates of males and females because we hypothesized that cultural risky sexual behavior. In this study, we examine the ef- characteristics of each ethnic origin that predict sexual fect of ethnic origin on three measures of risky sexual behavior among youth would differ by sex. behavior; age at first sex, condom use and multiple sex- Our results confirmed our hypothesis as ethnic origin ual partners among youth in Nigeria. We study youth in stood as a significant predictor of youth sexual behavior the Nigerian context because the country has a youthful among youth in Nigeria. We conclude that interventions population and understanding the influence of ethnicity that look beyond individual level should be considered in reducing the number of youth engaging in risky sex- ual behavior. Community based intervention programs should be developed in order to reduce risky sexual be- * Correspondence: [email protected] Demography and Population Studies, School of Public Health and Social havior among youth in Nigeria. Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg 2000, South Africa © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Odimegwu and Somefun Reproductive Health (2017) 14:16 Page 2 of 15 Background their ability to negotiate the timing of sex, conditions Young adults are at risk of negative health consequences under which it takes place, and condom usage. This associated with early and unsafe sexual activity. These plays a critical role in determining their respective vul- consequences may include infection with the human im- nerabilities to HIV. For example, femininity often re- munodeficiency virus (HIV), other sexually transmitted quires women to be passive in sexual interactions and infections (STIs) and unintended pregnancies. Nigeria, ignorant of sexual matters, limiting their ability to access with an estimated population of 160 million [1], is sec- information on the risks of sex or to negotiate condom ond only to South Africa in the number of people living usage [13]. Masculinity, on the other hand, requires that with HIV/AIDS worldwide, with 9% of the global bur- men be sexual risk takers and condones multiple part- den of the disease being in Nigeria [1, 2]. Although ners which, without adequate prevention, increases their efforts have been put into place by the international vulnerability to HIV [14, 15]. The unequal power bal- community and the Nigerian government to limit the ance between men and women results in their unequal spread of HIV/ADIS in the country, it still maintains access to HIV information, resources and services. an upward trajectory in certain states due to the risky Ethnicity is an important sociocultural factor mediat- sexual behaviours youth engage in. About 20,000 girls ing sexual behaviour in sub-Saharan Africa [16, 17] and under the age of 18 give birth daily in developing some studies have concluded that ethnicity may be more countries, with Nigeria no exception. Early childbear- important than socio-economic characteristics [18–20]. ing poses serious consequences to the health and de- Ethnicity has been described a social group that shares a velopment of young girls [3]. common and distinctive culture, religion and language. Risky sexual behaviour involves the number and types Gender, class and sexuality are the greatest sources of of partnerships, sexual acts, and sexual orientation. ethnic stability and instability, even though ethnic Other elements of risky sexual behaviour include early boundaries and identities are usually based on language age at first sexual intercourse, unprotected sexual inter- and religion [21]. course with ‘at risk’ sexual partners, and untreated sexu- The relationship between ethnic origin and health out- ally transmitted diseases [4]. These behaviours have comes has received scholarly attention [22–25]. For in- implications in the prevention of HIV and other STIs. stance, [26] studying the effect of internal migration and To ensure the decline of HIV and other STIs, further re- premarital sexual initiation in Nigeria found ethnicity to search on the determinants of youth sexual behaviour in be a key independent predictor of premarital sexual ini- Nigeria is important, especially in a country like Nigeria tiation. Ethnic origin per se does not influence health where 63% of the population is under 25 years old. It is outcomes, but rather the socioeconomic characteristics critical to understand the social and cultural mecha- of ethnic groups [27]. [26]. Ethnographic and epidemio- nisms underlying sexual behaviour that may be condu- logical studies have confirmed that adolescent sexual be- cive to unintended pregnancies and the spread of HIV/ haviour varies from prevention to liberalism across AIDS, so as to help these youth make healthy transitions different cultural groups [28]. Particular ethnic practices to adulthood. may increase the likelihood of HIV infections among There is a need to look beyond individual determi- young women, for instance, the practice of early mar- nants and include sociocultural contextual factors influ- riage in some ethnic groups increases likelihood of in- encing sexual behaviours of youth [5–7]. The danger of fections and obstetric fistula [29, 30]. Ethnicity may focusing on the individual psychological process alone is influence sexual behaviour through cultural beliefs that it overlooks the associations of behaviour to social, and practices. For example, the practice of levirate cultural, and economic dimensions, thereby missing the marriage, where a man’s widow is forced to remarry possibility to fully recognize essential determinants of to one of his brothers, is still being practised in some behaviour. This is because fundamental barriers that areas of sub-Saharan Africa despite the high preva- would hinder the promotion of youth protective sexual lence of HIV [31, 32]. behaviours are deep-rooted within the sociocultural con- Nigeria is home to about 374 ethnic groups and texts that shape the youth [7]. Societal norms and English is the official language. Three ethnic groups - gender-power relations influence behaviour, which may Yoruba, Igbo and Hausa - make up around 50% of allow positive or negative changes [8]. For instance, in the population. The other much smaller minority eth- different societies, norms and beliefs of suitable roles for nic groups, which include Kanuri, Edo, Ijaw, Ibibio, men and women are enforced by that society’s institu- Ebira, Nupe, and Tiv, make up the rest [33]. The tions and practices, such as marriage, polygamy, and fe- three major ethnic groups are differentiated
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