Sex Education Literacy Among College Students in Sierra Leone

Background/Purpose: College students engage in risky sexual behaviors such as unintended pregnancies, early marriages, abortion, and having multiple relationships which expose them to sexually transmitted illnesses (STIs) including HIV/AIDS (Teferra, Erena, & Kebede, 2015). In Sierra Leone, 34% of adolescents ages 15-19 reported having children or currently pregnant (Doyle, Mavedzenge, Plummer, & Ross, 2012) and about 39% marry before the age 18, 13% before the age 15 (UNICEF, 2016). Despite their knowledge of career development and success, college students may lack sexual health knowledge and STI prevention skills (Mulwo & Chemai 2015). This can be very worrying in sub-Saharan Africa where college age students die at a rate of 300 deaths a day from AIDS-related deaths (UNAIDS, 2017). The current study tested the path coefficients of a health literacy model and shows the intersection between education and health-risky behaviors among college students in Sierra Leone.

Methods: A cross-sectional study was conducted with a sample of 338 university students in Sierra Leone between May and June 2017. Participants responded to a 27-item unidimensional Sexually Transmitted Infections Knowledge Questionnaire (STI-KQ) rated on a three-point scale, with higher values indicating a higher level of knowledge. All constructs had Cronbach α >7, with the exception of one with Cronbach α = .69. A Confirmatory factor analysis (CFA) was conducted to examine the relationships between three latent constructs of STI knowledge, sexual risk behavior and family status and parents’ education. Structural Equation Modeling (SEM) with a maximum likelihood estimation method was utilized to assess the fit of the hypothesized model.

Results: Most of the participants in the study were female (61.5%), with a mean age of 24.3 years (±5.63 years). Over a third of these college students reported that they did not know that being diagnosed with an STI was a risky factor for acquiring HIV. Further, 56.3% of this sample of college students reported that they did not know if a woman with genital herpes could pass the infection to her child. The SEM model achieved best fit with the composite factor scores with X ²(df=101) = 121.030, p=.085, RMSEA = 0.024, TLI = .961 and CFI = .971. All factor loadings were above .4 except for HIV testing (.102, p=.130), fear to say “no” to have sex (.195, p=.0001), and mother’s education (.356, p=.0001). The relationships between the latent constructs showed significant negative effect of education on sexual risk (β = -.128, p=.05) and STI knowledge on sexual risk (β = -.160, p=.05).

Conclusion/Implications: A significant proportion of college students in Sierra Leone surveyed did not demonstrate to have comprehensive and accurate sex education. Social determinants of health in Sierra Leone should reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. A diversified university system that reflects the geographical diversity of the country and trains young people in accessing information that accurately includes a range of social, economic and environmental factors is a future a good future orientation for the country.