Food Insecurity, Sexual Risk Taking, and Sexual Victimization in Adolescents and Young Adults: Evidence from Ghana and South Africa

Background and Purpose: Food insecurity is associated with adverse health outcomes in young people.
Adolescents and young adults, particularly young women, are vulnerable to sexual victimization and risk taking, which are associated with elevated risk of sexually transmitted infections and sexual violence. Yet, limited research exists on the relationship between food insecurity and sexual risk taking and victimization among young people in low- and middle-income countries. The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people; and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender.

Methods: Cross-sectional data were obtained from a sample of Ghanaian adolescents (n = 602) and young South African adults (n = 823). All respondents reported being sexually experienced. Food insecurity was measured using the Household Food Insecurity Access Scale. Sexual risk-taking and victimization behaviors included: transactional sex, age-disparate sex, sex while under the influence of drugs or alcohol, unwanted sexual contact, and condom use at last sexual intercourse. We used multivariable logistic regression with clustered-robust standard errors given binary outcome and clustered data. Moderation tests were performed by including an interaction between food insecurity and gender.

Results: Food insecurity was highly prevalent in both settings. Compared with young men, a higher proportion of young women reported engaging in risky sexual behaviors and experiencing unwanted sexual contacts. Food insecurity was also significantly associated with sexual victimization (Ghana) and age-disparate sex (South Africa). However, results indicated that gender did not moderate the association between food insecurity and sexual risk taking and victimization.

Conclusions: Our findings underscore the importance of food access on young people’s sexual health, regardless of gender. Health prevention efforts may be more appropriate when integrated with food access components that target vulnerable adolescents and young adults, irrespective of gender. However, our results also indicate that young women remain at higher risk of poor sexual health outcomes compared to young men. This finding suggests that prevention programs for young women may need to target other non-food drivers of sexual risk taking and victimization.