Risks that adolescent encounter and perception of the problem

Risky sexual behaviour is any behaviour that increases the probability of negative consequences associated with sexual contact, including HIV/AIDS, other STDs, abortion

and unplanned pregnancy. It also includes behaviours like having multiple partners, risky casual with unknown sexual partners, early sexual initiation and failure to discuss risk topics prior to intercourse as well as failure to take protective actions such as use of condoms and birth control (African Health Science 2013:498-506).

Unprotected sex, early sexual debut, alcohol or drug use before sexual intercourse, multiple sexual partners, forced or coerced sexual intercourse and sexual intercourse for reward are defined as sexual activities that may expose an individual to the risk of infection with HIV and other sexually transmitted diseases. In addition, lack of knowledge about HIV and AIDS and poverty has been identified as factors that increase the chances of young people engaging in risky sexual behaviour (Avert 2009:3).

Table 4.14: Summary of the main causes and consequences of risk sexual practices generated from the focus group discussions

Sn Possible causes of risk sexual practices suggested by FGD participants Consequences of risk sexual practices mentioned by the participants Remarks on the consequences of risk sexual practices

1 Lack of knowledge about safe sex due to information gaps and misinformation

STIs (such as HIV/AIDS, Gonorrhoea, and syphilis)

Suggested by the majority of the participants

2 Sex without proper use of condom Spread of STIs to others By most urban and rural participants

3 Absence of services (such as safe abortion, STI testing centres, contraceptive, condom and others)

Unintended pregnancy and unsafe abortion

Suggested by most of the participants

4 Substance abuse (such as alcohol consumption, khat chewing)

Death and disability Mentioned by some of the participants

5 Peer pressure and fell in love School dropout Suggested by majority of the participants 6 Economic problem especially for

female adolescents

Migration to other places Stated by some urban participants

7 Viewing romantic films Prostitution Mentioned by some of the urban discussants 8 Absence of free discussion on

sexual issues between

children/youths and their families

Having a child without plan Suggested by majority of the discussion participants 9 Dressing style of female

adolescents

Sterility and cancer Mentioned by few urban male participants

Sn Possible causes of risk sexual practices suggested by FGD participants Consequences of risk sexual practices mentioned by the participants Remarks on the consequences of risk sexual practices

10 Family/community in their areas believes that males should practice sexual activities before marriage

Rejection by the families and the community due to child birth without marriage for the female adolescents

Mentioned by majority of the rural and some of the urban

participants

11 Having many sexual partners Psychological problems Stated by some urban participants

12 Pre-marital sexual practices Financial problems due to many expenses related to the

consequences of sexual risk practices

Mentioned by some urban and rural participants

13 Forced sex and abduction especially in rural areas

Disposing baby anywhere after giving birth

By one female urban participant

Casual sexual involvement is often perceived as predisposing an individual toward having multiple sexual partners and making other risky sexual decisions (such as inconsistent condom use, infrequent STI testing). It is therefore, often assumed that adolescents who engage in these types of behaviour are at greater risk for negative physical outcomes, such as unintended pregnancies and STIs, than adolescents who practice sexual activity in the context of a committed relationship. In addition, adolescents’ involvement in casual sexual activity have been shown to contribute to psychosocial difficulties such as lowered self-esteem, increase in depressive symptoms, and inhibited interpersonal/relationship-building skills (Buysse 1998; Eisenberg et al 2009; Manning et al 2005; Manning et al 2006). These effects are enhanced by the traditional societal expectations which have maintained that sexual behaviour should take place within the context of a committed relationship. Similarly, the abstinence-only education policy in Ethiopia requires teaching that sexual activity outside the context of marriage is likely to have harmful physical and psychological consequences (Eisenberg et al 2009).

The participants generally agreed that there are many unprotected sex related risks that have been encountered by adolescents in their lives. The participants stated that: "STDs such as, HIV/AIDS, gonorrhoea and syphilis are some of the risks encountered by the youth. Unwanted pregnancies, leading to illegal abortion performed by local

abortionists are also common and are due to the risky sexual behaviours the youth engages in”.

According to the female participants, unwanted pregnancy is the main cause of high rate of school dropouts, migration, child abuse and engagement in commercial sex works. Participants also discussed the main causes of unwanted pregnancy. They identified adolescents’ poor knowledge of the use of modern contraceptives including condom, lack of access to modern contraceptives, negative attitude towards modern contraceptives and forced sex as being among the major causes of unwanted pregnancy especially in the rural setups.

Most participants admitted that it is very difficult to assess the actual prevalence of STDs including HIV/AIDS in their area due to the associated stigma. However, they pointed out that an estimate of the prevalence of STIs including HIV/AIDS can be made based on the increasing rate of ART and anti-tuberculosis drug utilisation in their area.

On abortion, urban female adolescents stated that even though illegal abortions are being done secretly, abortion is openly discussed among peers and many female adolescents visit local abortionists who often insert plastic tubes and other sharp materials in the cervix. Such practices could significantly contribute to high spread of HIV/AIDS and other blood-borne diseases among the peers and others. Both female and male discussants agreed that females visit local abortionist due to lack of knowledge, accessibility, and secrecy behind unwanted pregnancies, financial constraint and absence of safe abortion services in their locality.