Psychological factors associated with sexual initiation and sexual intention among school adolescents aged 12-14 in Dar es Salaam, Tanzania

Abstract

Introduction: There are about 3.4 million adolescents below 15 years reported to have HIV globally and approximately 90% are in sub-Saharan African countries. Studies have shown that adolescents engage into sexual risk behaviors such as early age of sex initiation, multiple partners and unprotected sex at an early age. Psychological wellbeing impacts highly on a person‟s decision-making process. Several studies have highlighted a relationship between sexual risk behaviors and psychological factors. Low self-esteem, low self-efficacy and high depression have been seen to play a role in adolescent‟s engagement of risky sexual practice. No retrievalbe studies on psychological factors and sexual risk behaviors have been conducted in Tanzania. The current study provides more insight on how psychological factors can influence engagement in sexual initiation and future sexual intentions that put adolescents at risk of HIV transmission in the Tanzanian context. Objectives: To assess the levels of psychological factors (self-esteem, depression, self-efficacy) and their association with sexual risk behaviors (sexual initiation and sexual intention) in a school-based adolescents aged 12-14 years Study design: This was a cross section study design nested within a cluster randomized control trial of school aged adolescents in Kinondoni District of Dar es Salaam city. Methods: Employing a multistage random cluster sampling procedure six schools were randomly selected from a pool of 12 schools that are involved in a large cluster randomized intervention trial in the city. Participants from each of the 6 selected schools that met the study criteria had an equal chance to be in the study. A total of 250 participants willingly took part in this study. A self-administered structured questionnaire was used for data collection and included information on socio-demographic characteristics and sexual behaviors. Four standardized scales were used to collect measures for depression, self-esteem, vi HIV preventive self-efficacy and intentions to engage in sexual behaviors in the next six months. Results: A total of 250 participants were included in the study, 128 (51.2) Male and 121 (48.8%) female adolescents. The mean age (SD) of the participants was 12.6 years (0.7). The proportion of adolescents with high self-esteem was found to be 35.6% (89) with almost similar proportion having low self-esteem. A little more than a third 36.5% (89) of participating adolescents had high HIV self-efficacy. While with regards to depression symptomatology score, the overall proportion of adolescents who had high depression symptomatology scores was found to be 35.2%. The proportion of adolescents who had initiated sex was 35.6%. Adolescents who had high depressive scores were 3.6 times more likely to have initiated sexual activity as compared to those with low depressive score (OR, 3.62, 95% confidence interval 2.22, 9.06; p=0.001). Adolescents with low self-esteem were two and a half times more likely to have high risky sexual intentions compared to those with high self esteem (OR, 2.62 95% confidence interval 1.00, 6.92; p=0.04). Low HIV preventive self-efficacy was associated with almost three times the odds of high risky sexual intentions compared to adolescents with high HIV perceived self-efficacy, (OR, 2.72, 95% confidence interval 1.03, 7.32; p=0.04). Current depressive symptomatology did not significantly predict responses to future sexual intentions amongst participants. Conclusion and recommendations: There is an increased prevalence of early sexual initiation among young adolescents in Dar es Salaam. This study showed that depression is associated with sexual initiation but not with future intention to engage in sex. HIV preventive self-efficacy and self-esteem are associated with future intentions to engage in sex but not with sexual initiation. It is therefore recommended that School based interventions that aim at increasing psychological wellbeing of young adolescents are needed. Reproductive health interventions should focus on the emotional aspect of engaging in sexual risk behaviors.