Risky sexual behavior and its determinants among secondary school students in the highly HIV/AIDS burdened setting of South Ethiopia: Implications for decision makers

Background Risky sexual behavior (RSB) among youth can lead to serious social, economic, and health problems, such as unwanted pregnancy and acquired immune deficiency syndrome (AIDS). Despite a high burden of AIDS in the South Omo zone, little is known about RSB among secondary school students, and numerous studies in Ethiopia have discordant RSB findings. Therefore, this study aimed to assess the magnitude of risky sexual behavior and its determinants among secondary school students in the South Omo zone. Methods An institution-based cross-sectional study was conducted in January 2023. A multistage sampling method was used to select 538 students. A validated and structured self-administered questionnaire was used to collect data after pretesting. The results of descriptive analysis were presented by texts, tables and figures. Variables found to be p<0.20 in the bivariate logistic regression analysis were candidates for multivariate analysis. The level of statistical significance was declared at a p value less than 0.05 in multivariate analysis. Odds ratios along with their 95% confidence intervals (CIs) were used to present the results of the logistic regressions. Results The prevalence of RSB among the study participants was 25.9% (95% CI= 22.3%-29.9%). It was significantly associated with having sexually active close friends [adjusted odds ratio (AOR) = 3.09; 95% CI: 1.90-5.02], attending night clubs (AOR=2.56; 95% CI: 1.35-4.86), drinking alcohol (AOR=1.90; 95% CI: 1.10-3.29), parental neglect (AOR=2.10; 95% CI: 1.35-3.29) and HIV/AIDS-related knowledge (AOR=1.76; 95% CI: 1.12-2.77). Conclusions Risky sexual behavior among secondary school students was very high. Having sexually active friends, attending night clubs, drinking alcohol, parental neglect and HIV/AIDS-related knowledge were determinants of RSB. Strengthening reproductive and sexual health services, close communication with youth in the family, measures to lessen alcohol consumption and night club attendance, and enhancing HIV/AIDS-related knowledge among secondary school students are needed. Plain English summary Young people, who are aged 10 to 24 years, face various reproductive health problems as they transition from childhood to adulthood, including risky sexual behavior. Risky sexual behavior includes having more than one sexual partner, having first sex before 18 years, not usually using condoms during sexual intercourse, or having sex with commercial sex workers. It could lead to health problems such as unwanted pregnancy and sexually transmitted diseases. This study was conducted to assess the amount of risky sexual behavior and related factors among secondary school students in the South Omo zone, South Ethiopia. By chance, we selected 538 students aged 15 to 24 years attending grades 9 to 12. Data were collected by using a questionnaire that selected students answered and returned. The data were processed and analyzed by a personal computer. Among all selected students, 97% participated in the study. The current study showed that approximately one out of four students were practicing risky sexual behavior. The occurrence of risky sexual behavior was high among students with sexually active close friends, night club attendance, alcohol consumption habits, parental neglect and low HIV/AIDS-related knowledge. In conclusion, the authors recommend decision makers intensify the availability and accessibility of reproductive and sexual health services for youths. Parents should be encouraged to openly and appropriately discuss reproductive and sexual health issues with their children. Additionally, it is crucial to decrease alcohol drinking habits and night club attendance of students, in addition to increasing HIV/AIDS-related knowledge.