Social Determinants of Safe-Sex Behaviors Among Zambian Adolescents

Background and Purpose: In 2014, Sub-Saharan Africa accounted for over 80% of adolescents living with HIV worldwide. Studies conducted in some Sub-Saharan countries suggest that gender, poverty and orphan status (defined as a child under the age of 18 that has lost one or both parents) are associated with increased sexual risk behaviors and HIV infection. Despite being one of the Sub-Saharan African countries most affected by HIV and high rates of poverty, the link between socioeconomic conditions and adolescent HIV risk in Zambia remains an understudied area. Given Zambia’s very young population (66% under age 24 in 2014), identifying who is most likely to engage in safe sex practices among adolescents could assist in the overall decline in HIV prevalence. This study conducted multivariate analysis on secondary data from a sample of Zambian adolescents to identify predictors of safe sex practices.

Method: This study utilized cross-sectional survey data from the Zambia Demographic Health Survey (ZDHS) 2013-14. The sample included 1104 sexually active adolescents between the ages of 15-17. The outcome of interest was whether the adolescent used a condom at their last sexual encounter. Predictor variables included orphan status, gender, type of residence, household wealth, school attendance, educational attainment, relationship to head of household, and participant age. A logistic regression was used to examine predictors associated with condom use at last sexual encounter. 

Results: About 65% of participants reported not using a condom. Twenty six percent of the participants were orphans and 74% were non-orphans. The sample was almost equally divided between males and females. The highest percentage (40%) of adolescents in this data was from poor households. The logistic model showed that adolescents who did not attend school in the current school year had lower odds of condom use compared to those that were in school (OR = 0.63, p < .01). Additionally, adolescents from households with medium wealth (OR = 1.40, p < .05) and adolescents from rich households (OR = 1.80, p< .01) had greater odds of having used a condom compared to adolescents from poor households. There were no statistically significant differences in likelihood of condom use by orphan status, educational attainment, relationship to household head, age, gender and type of residence.

Conclusions and Implications: Results from this study contributes to prior research by identifying supportive evidence of the role of household wealth and school attendance on Zambian adolescents’ sexual behavior. Implications for social work research and practice include the need for increased support toward adolescent school attendance and household economic conditions in promoting safer sex. Further investigation is warranted to examine safe sex among adolescents from a longitudinal perspective to establish whether sexual risk maybe linked to changes in socio-economic conditions across the lifespan.