Sexual risk-taking in the era of HIV/AIDS : case study of adolescents resident in Ketu South, Upper Denkyira, and Offinso South electoral constituencies in Ghana

Objective Research on HIV/AIDS in sub Saharan adolescents has been limited to students in primary, secondary school, and college. There is a paucity of information on out-of school adolescents. This research, conducted from July 1998 through June 1999, sought to determine the predictors of HIV knowledge, condom use, and sexual risk taking in the era of HIV/AIDS in a population of in-school and out-of-school adolescents aged 10-19 and resident in Ketu South, Upper Denkyira, and Offinso South electoral constituencies in Ghana. Methods This cross sectional research incorporates in and out of school adolescents and utilizes the AIDS Risk Reduction Model (ARRM) and other supplementary variables to predict AIDS knowledge, condom use and sexual risk taking. Subjects were randomly selected (n = 1415) and assessed via questionnaire on their knowledge of AIDS and other STDs, attitude towards condoms and use, self-efficacy, peer norms, and sexual behaviour. Results While certain aspects of AIDS knowledge were well known by respondents, definite gaps in knowledge and misconceptions about infection through casual contact were common. Three multivariate logistic models for knowledge, condom use, and sexual risk taking, were developed after controlling for potential confounders such as age, gender, location, educational status (being in school or out of school) and constituency. In the HIV/AIDS-related knowledge model, independent associations for higher knowledge scores were being male (p = 0.006), being an older adolescent (p = 0.011), higher educational level (p = 0.005), not believing that one can get AIDS through witchcraft (p = 0.024), believing that AIDS is a problem in Ghana (p = 0.001), having ever had sexual intercourse (p - 0.023), having heard about syphilis (p < 0.001), knowing that nobody can cure AIDS (p = 0.001), having taken steps to avoid HIV (p < 0.001), and having discussed AIDS with friends and acquaintances (p = 0.010). Significant predictors for condom use were being out of school (p = 0.002), having discussed AIDS with regular sexual partner (p < 0.001), having discussed AIDS with friends and acquaintances (p = 0.004), self-efficacy (p < 0.001), reliance on the efficacy of condoms as protection against STDs including HIV (p = 0.019), and negative attitude towards condoms (p = 0.004). In the sexual risk-taking model, independent associations were found for being male (p = 0.040), being a residence of Upper Denkyira (p = 0.001) and Offinso South (p = 0.005), early age of first sexual intercourse (p = 0.001), having a relative or friend or acquaintance who has AIDS (p = 0.025), believing that somebody can cure AIDS (p < 0.001), self perceived risk of contracting HIV in the following year (p = 0.018), and having discussed HIV with family (p = 0.007). Conclusion Consistent with the literature, the results of the study demonstrate support that increasing HIV knowledge alone will not stem the spread of HIV among adolescents in Ghana. Rather, it appears that the solution lies in enhancing individual's appreciation of his or her own risk and enhancing self-efficacy for reducing that risk. There should also be policies that mitigate poverty and economic inequality, strict enforcement of sexual assault legislation laws, as well as adoption of an integrated health care delivery system that includes family planning, and the dissemination of correct and relevant materials on AIDS. At the same time the government and other stakeholders should seek to create the enabling environment which increases access to the means of prevention. This approach should form the basis for AIDS risk reduction strategies in Ghana.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat