Awareness and utilization of female condoms among street youths in Ibadan, an urban setting in South-West Nigeria

Awareness and utilization of female condoms among street youths in Ibadan, an urban setting in South-West Nigeria

Obioma Chukwudi Uchendu^1,&, Oluwapelumi Adeyera¹, Eme Theodora Owoaje¹

 

¹Department of Community Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria

 

 

^&Corresponding author
Obioma Chukwudi Uchendu, Department of Community Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria

 

 

 

 

Condoms are the only method available technologically that prevents against several STIs including HIV and unwanted pregnancies [1]. It has been found to be very effective compared to other forms of contraception. There are male and female condoms, however, knowledge and use of male condoms is higher than female condoms [2]. Both female and male condoms need co-operation between both partners, however, the female condom can be used in situations of male refusal to use condom [3]. The consequence of unsafe sex affects women more causing a higher prevalence HIV among women than men and unwanted pregnancy [4]. Hence, the need for a female-oriented and female-owned preventive mechanism-the female condom [4]. The female condom is currently the only effective, female-controlled (or initiated) barrier method available to prevent sexually transmitted infections (STI) including HIV and unplanned pregnancy [1, 5]. It also gives the protection and effectiveness that a male condom gives [5]. Men exert greater control over the decision to use condom, hence the advent of female condoms to give women a perceived sense of being in control [4]. It has been documented to be the best female owned prophylaxis against STIs and pregnancy [6]. Documented reasons for female condom use intention by women include: their perception of increased exposure to STI, inability to communicate their sexual and reproductive health (SRH) needs to their spouses, experiencing negative reactions after expressing their desire to uptake condom to prevent STI or pregnancy and restrained decision making concerning SRH needs [5]. According to inter-NGOs in Switzerland in 1983, street child or youth is "any girl or boy who has not reached adulthood, for whom the street (in the broadest sense of the word, including unoccupied dwellings, wasteland, etc.) has become her or his habitual abode and/or sources of livelihood, and who is inadequately protected, supervised or directed by responsible adults" [7]. Street youths are exposed to circumstances and conditions on the street which makes them susceptible to health risks and prone to developmental and emotional problems [8]. They also engage in deleterious health activities like sexual risk behaviors and substance abuse [9, 10]. Commonly reported risky sexual behaviors among street youths include non-condom use, multiple sexual partners and transactional sex [10]. They are therefore at higher risk for STIs including HIV and unwanted pregnancies [11]. Street youths have been found to initiate sex earlier and are vulnerable to sexual exploitation and abuse [8]. Furthermore, they lack information on health risk behaviors its consequences and preventive methods. They also lack access to healthcare services which predisposes them to complications of unsafe sexual behavior is also more among this set of people [9, 12] and risky behavior has also been reported among them [9, 10, 12]. Despite the peculiarities of street youths to risky sexual behaviors, most studies conducted have been focused on in-school adolescents' sexual practices and STI prevention including the knowledge and utilization of condoms in general [10], Since street youths are sexually active and indulge in unsafe sex, the female condom which is a female-initiated method of prevention enables them take decisions regarding safer sex whether consensual or not. This study therefore documented the awareness and utilization of female condoms among street youths in Ibadan, Nigeria.

 

 

Study Area: this study was conducted in two local governments within Ibadan metropolis in South-West Nigeria, 90 miles north of Lagos. Ibadan is the capital of Oyo state, the largest traditional urban center in Africa and has a population of 6,393,927 as at 2011 [13]. Ibadan Municipality is made up of five Local Government Areas (LGAs) which include Ibadan North, Ibadan North East, Ibadan North West, Ibadan South East and Ibadan South West. The majority of the population are of Yoruba ethnicity, and about one-quarter of the population are youths [13]. Ibadan is a major commercial city in Nigeria that with several large markets where foodstuff and other products are brought in from or taken to other parts of the country. These markets have adjoining motor parks where passengers and goods are boarded unto or from the vehicles. These areas are a beehive of activity where young people are often found till late in the night [14].

 

Study design, population and sampling: the study was a cross sectional study conducted among 964 street youths between 15 and 24 years old involved in daily street-based activities either as economical, recreational or social activities. The study participants in the study areas were identified and recruited in clusters based on the activity they were engaged in with the assistance of the community mobilisation officers in the two local government areas. These street youths were engaged in employments such as street hawking, commercial transportation, docking of goods, cart pushing, garbage scavengers and artisans [15]. A two-staged cluster sampling technique was used to select two LGA; Ibadan North (IbN LGA) and Ibadan South East (IbSE LGA). Thereafter, two market areas high in commercial and transportation activities were selected then selected from IbN LGA (Bodija and Gate) and IbSE LGA (Oranyan-Bere and Mapo). All identified areas where street youths were found were visited and consenting youths were then recruited.

 

Data collection: a semi-structured interviewer administered questionnaire was used to obtain information on socio-demographic characteristics, sexual history and awareness and utilization of female condom. Questions were adapted from the Behavioral Surveillance Surveys (BSS) [16] and existing literature [17, 18]. The instrument was translated to the local language (Yoruba) and back translated to ensure the original meanings of the questions were retained. Sixteen research assistants with secondary education were trained for two days on respecting clients' confidentiality and responses; refusal to participate in the study, not being judgmental and maintaining a neutral composure at all times. Data collection was cultural sensitive and data collectors were gender-matched.

 

Data management and analysis: each completed questionnaire was cross-checked on the spot for completeness and appropriate filling before it was further cross-checked by the two of the authors. Data was thereafter entered and analyzed using SPSS version 22 software package [19]. Descriptive statistics was presented using frequencies and percentages. Logistic regression was used to determine predictors of female condom awareness and utilization.

 

Ethical considerations: prior to the commencement of the research, ethical approval to conduct the research was obtained from the Oyo State Ethical Review Committee after an in-depth review of the proposal for compliance with ethical guidelines. Also, permission was obtained from the leaders of the identified groups where necessary. The criteria for selection of samples included voluntary declaration for participation in the study and the ability for transmission of information.

 

 

Socio-demographics and sexual history: there was a total of 964 street youths interviewed. More than half (69.9%) were males and between 20-25 years of age (61.2%). Few were married (13.2%) and had less than secondary school education (16.6%). Majority (85.5%) worked to earn a living but only 37.3% were currently enrolled in a school (Table 1).

 

Awareness and utilization of female condoms: more than three-quarter (81.0%) had initiated sexual activity, of these, 86.8% had sex in one year preceding the survey. Almost half (47.9%) of the respondents have heard about female condoms however only 16.8% have ever seen while 4.3% have actually ever used a female condom (Table 2).

 

Predictors of female condom awareness and utilization: Table 3 shows the predictors of condom awareness and utilization. Age, education, current sexual activity and experience of rape attempt were predictors of female condom awareness. Street youths between 20-25 years and attained secondary school education or above were about 2.4 times (OR-2.365 95%CI-1.680-3.330) and 1.5 times (OR-1.509 95%CI-1.009-2.279) more likely to be aware of female condoms than their counterparts. Awareness of female condom was a significant predictor of utilization of female condom.

 

 

This study assessed awareness and utilization of female condoms among street youths involved in economical, recreational or social activities in market areas high in commercial and transportation activities located in Ibadan, Oyo State in Southwest Nigeria. Street youths from this study were sexually active and this is similar to findings from studies conducted in developed and developing countries as a result of lack of access to information, vulnerability to exploitation, idleness, poverty and lack of supervision or guidance [8-10, 12, 20, 21]. Awareness of condoms (47.9%) among street youths in this study was lower than what was reported among undergraduates in Edo (93.7%) and Oyo (80%) States in Nigeria but higher compared to rural dwelling women (5.2%) in Edo State [2, 18]. Undergraduate students are more likely to have access to information on prevention of STI and pregnancy including condom use either formally through their lectures or informally from their peers or internet. It is also expected that risky sexual behavior will also be reduced among them since there is some level of monitoring of their activities from their family and school authority [2]. In Cameroun, in-school young females (67.3% ) reported a higher awareness of condom [22], while up to 90% of women of inner-city Denver in the United States were aware of both male and female condoms [23]. Street youths in addition to low awareness have also been reported to have low knowledge of STIs and HIV/AIDS prevention which includes condom use [10, 12]. Although utilization of female condoms in this study among street youths was low, it is not peculiar to this group alone because low utilization of female condoms have been reported in the general population. While a higher proportion of undergraduates in Oyo State reported ever using a female condom [18] compared to this study, a study in Edo State conducted among undergraduates and rural women revealed that 1.9% of undergraduate students while none of the rural dwelling women had ever used female condoms. This low female condom utilization has also been reported in Cameroon (8%) [22], Turkey (3%) [3] and U.S (5%).

 

Low utilization of female condoms can be attributed to; its being less well known unlike the male condom, not being readily available and accessible especially in resource poor settings [24]. Other reasons are the male -dominated cultural norms that makes it difficult for women to initiate use female (or any) condoms, the misconception of poor sexual satisfaction with the use of female or male condoms during sex preference for male condoms, partner disapproval, insertion difficulties, use of hormonal pills to prevent pregnancy, stigma and shame associated with the purchase of female condoms [2, 24, 25]. Level of education has been found to be a predictor for use of female condoms with more educated individuals utilizing it more than the less educated. This was shown in the study that compared knowledge and use of female condoms between undergraduate female students and rural dwelling women [2]. While this study reported a higher proportion of respondents with secondary education and above being aware of female condoms compared to those with primary or no education, this relationship was however significant following logistic regression. The school curriculum especially at secondary (high) school includes sexuality education and prevention of pregnancy, STIs including HIV through consistent and correct use of male and female condoms. An interesting finding from this study was that males were both more aware of and were more likely to utilize female condoms. This may not be unusual because males are more aware of condoms generally among this population group since it is easier for them to discuss prevention methods among themselves [26]. Males are more likely find it easier to buy condoms more than females because of social stigma [27]. Moreover, males would prefer sex without use of male condoms [28]. In this study however, a significant predictor for utilization of female condoms among street youths was awareness of female condoms. Street youths generally have less access to health information and sexual and reproductive health services compared to other youths [10, 21]. It is therefore necessary to make information on female condoms available to street youths and improve access to it especially among female street youths. Enhancing females' access to female condoms will reduce unequal distribution of sexual power so that women can exercise control over decision-making on safe sex. Use of appropriate social marking and promotion will enhance awareness and utilization [2, 3, 18, 25, 29].

 

 

Awareness and utilization of female condoms among street youths is low. In order to achieve good sexual health outcomes for this group of people, there is a need for proper awareness and education on the effectiveness of female condoms.

 

 

The authors declare no competing interests.

 

 

The three authors; made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafted the article or revising it critically for important intellectual content; and gave final approval of the version to be published.

 

 

This study was sponsored by the Gates Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA through the Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Nigeria.

 

 

Table 1: socio-demographic characteristics

Table 2: sexual history, awareness and utilization of female condoms

Table 3: predictors of female condom awareness and utilization

 

 

1. Galvão LW, Oliveira LC, Díaz J, Kim DJ, Marchi N, Van Dam J et al. Effectiveness of female and male condoms in preventing exposure to semen during vaginal intercourse: a randomized trial. Contraception. 2005; 71(2): 130-6. PubMed | Google Scholar


2. Oladeinde BH, Omoregie R, Abdulfatai A, Olley M, Anunibe JA, Babatunde O. Awareness and use of female condoms among young Nigerian women. Centrepoint J Sci Ed. 2011; 17(2): 157-63. PubMed | Google Scholar


3. Çaliskan D. The awareness and use of the female condom among women at low and high risk for sexually transmitted infections in Ankara, Turkey. Dicle Med J Dicle Tip Derg. 2012; 39(1): 9-15. PubMed | Google Scholar


4. Gollub EL, Stein ZA. Commentary: the new female condom-item 1 on a women's AIDS prevention agenda. American Journal of Public Health. 1993; 83: 498-500. PubMed | Google Scholar


5. Macaluso M, Demand M, Artz L, Fleenor M, Robey L, Kelaghan J et al. Female condom use among women at high risk of sexually transmitted disease. Fam Plann Perspect. 2000; 32(3): 138-44. PubMed | Google Scholar


6. Kelvin EA, Smith RA, Mantell JE, Stein ZA. Adding the female condom to the public health agenda on prevention of HIV and other sexually transmitted infections among men and women during anal intercourse. American Journal of Public Health. 2009; 99: 985-7. PubMed | Google Scholar


7. Inter-NGO Programme on Street Children and Street Youth, Sub-regional seminar for the Mediterranean, Marseilles. Summary of proceedings. In.. Google Scholar


8. Solomon S, Tesfaye K, Lopiso E. Health Problems of street children and women in Awassa, Southern Ethiopia. Ethiop J Health Dev. 2002; 16(2): 129-37. PubMed | Google Scholar


9. Jean-Francois B, Elise R, Nancy H, Guillaume GDF. The Health of Street Youth in Canada: a review of the literature, in: Finding Home: policy options for adressing homelessness in Canada. Cities Centre, University of Toronto. 2009; 1-16. PubMed | Google Scholar


10. Brhane T, Assefa B, Birhan N. Reproductive health behaviour of street youth and associated factors in Gondar city, Northwest Ethiopia. Int J Med Biomed Res. 2014; 3(1): 28-37. PubMed | Google Scholar


11. Oppong Asante K, Meyer-Weitz A, Petersen I. Substance use and risky sexual behaviours among street connected children and youth in Accra, Ghana. Subst Abuse Treat Prev Policy. 2014; 9(1): 45. PubMed | Google Scholar


12. Albert M, Prosper L, Bavon M. HIV knowledge and sexual risk behavior among street adolescents in rehabilitation centres in Kinshasa; DRC: gender differences Albert. PanAfrican Med J. 2011; 10(23): 1-17. PubMed | Google Scholar


13. National Population Commission. Federal Republic of Nigeria 2006 Population and Housing census. 2010. Google Scholar


14. Omiyinka FO. Social networks and livelihood of street children in Ibadan, Nigeria. Int J Sociol Anthropol. 2009; 1(5): 82-9. PubMed | Google Scholar


15. National Bureau of Statisitics. Oyo State Information. State Information. 2014. PubMed | Google Scholar


16. Amon J, Brown T, Hogle J, MacNeil J, Magnani R, Mills S et al. Behavioral Surveillance Surveys BSS: Guidelines for repeated behavioral surveys in populations at risk of HIV. Behavioral Surveillance Surveys (BSS). 2000. PubMed | Google Scholar


17. Tobin-West CI, Maduka O, Onyekwere VN, Tella AO. Awareness, acceptability, and use of female condoms among university students in Nigeria: Implications for STI/HIV prevention. Int J Adolesc Med Health. 2014; 26(2): 259-65. PubMed | Google Scholar


18. Okunlola MA, Morhason-Bello IO, Owonikoko KM, Adekunle AO. Female condom awareness, use and concerns among Nigerian female undergraduates. J Obstet Gynaecol J Inst Obstet Gynaecol. 2006; 26(4): 353-6. PubMed | Google Scholar


19. IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Google Scholar


20. Cumber SN, Tsoka-gwegweni JM. The health profile of street children in Africa: a literature review. J Public Health Afr. 2015; 6(566): 85-90. PubMed | Google Scholar


21. Habtamu D, Adamu A. Assessment of Sexual and Reproductive Health Status of Street Children in Addis Ababa. J Sex Transimitted Dis. 2013; (Article ID 524076): 20. PubMed | Google Scholar


22. Tarkang E, Bain L. Knowledge, Attitudes and Utilisation of the Female Condom among High School Female Students in Kumba, Cameroon. Br J Educ Soc Behav Sci. 2015; 5(2): 169-80. PubMed | Google Scholar


23. Bull SS, Posner SF, Ortiz C, Evans T. Knowledge of, Attitudes Toward, and Stage of Change for Female and Male Condoms among Denver Inner-City Women. J Urban Health. 2003; 80(4): 658-66. PubMed | Google Scholar


24. Phiri SS, Rikhotso R, Moagi MM, Bhana VM, Jiyane PM. Accessibility and availability of the Female Condom2: Healthcare provider's perspective'. Curationis. 2015; 38(2): 9. PubMed | Google Scholar


25. Mahlalela NB. A qualitative exploration of female condom use among female university students in Durban, South Africa. University of Kwazulu-Natal. 2014. PubMed | Google Scholar


26. Gezahegn T, Birhanu Z, Aman M, Dessalegn M, Abera A, Nyagero J. Supplement article Peer communication on sex and sexual health among youths: a case of Debre Berhan university, Ethiopia. PanAfrican Med J. 2016; 25(Supp 2): 1-7. PubMed | Google Scholar


27. Katikiro E, Njau B. Motivating Factors and Psychosocial Barriers to Condom Use among out-of-School Youths in Dar es Salaam, Tanzania: A Cross Sectional Survey Using the Health Belief Model. Isrn Aids. 2012; 170739. PubMed | Google Scholar


28. Geter A, Crosby R. Condom refusal and young black men: The influence of pleasure, sexual partners, and friends. J Urban Health. 2014; 91(3): 541-6. PubMed | Google Scholar


29. PATH, UNFPA. Female Condom: A Powerful Tool For Prevention. Program for Appropriate Technology in Health (PATH) and United Nations Population Fund (UNFPA). 2006. PubMed | Google Scholar