VULNERABILITY OF NEPALESE YOUTH IN CONTRACTING HIV/AIDS FROM UNSAFE SEX

Abstract

This study examines the factors associated with vulnerability of Nepalese youth in contracting HIV/AIDS from unsafe sex. The study has defined vulnerability as a set of activities, behaviors and knowledge of youth which might put them at risk of contracting the disease through their risky sexual practices and lack of knowledge about modes of safer sex. It has also explored youths' correct knowledge on HIV/AIDS and condom according to various selected characteristics related to like education, occupation, place of residence, migration status, and activities like exposure to mass media and travelling away from home. Use of condom at first sex with any partner and other than spouse or non-live-in partner; use of condom at last sex in last 12 months with any partner and other than spouse or non-live-in partner; and use of condom every time had sex with partner other than wife or non-live-in partner are considered as dependent variables of vulnerability in the study. Likewise, knowledge of condom, knowledge about its source, one’s ability to get it oneself if wanted, heard about STIs/HIV/AIDS; various correct knowledge associated with HIV/AIDS; attitudes and perceptions towards HIV infected and justification to wife for not having sex with husband if she knew that he had STI and/or other women; sexual behaviors like pre-marital sex, last sex partner other wife or non-live-in partner; and multiple sex partners in last 12 months are regarded as intermediate factors of vulnerability. The selected socio-economic, demographic, cultural and spatial factors are taken as independent variables of the study. Data files of Nepal Demographic and Health Survey (NDHS), 2006 is used as the main source of data for the study. It was a nationally representative survey carried out using systematic sampling with probability proportional to size (PPS). The respondents selected were youth aged 15-24 years that included 4,431 females and 1,573 males of 15-24 years age group from a total of 8,707 households (not every household belonged to youth population). Among them, 2,427 youth females and 643 youth males had ever had the experience of sexual intercourse. Wherever possible, the cross tabulation data of 2006 NDHS were compared with that of 2001 NDHS also. vi Primary source of data used in this study also included some case studies related to HIV infected people. As dependent and intermediate variables of the study are dichotomous in nature, binary logistic regression models are used for predicting a dichotomous discrete outcome from a set of independent variables that are continuous, discrete, categorical, or a mix of any type; and from a set of intermediate variables as well as combined set of independent and intermediate variables in multivariate analyses. Statistical Product and Service Solution (SPSS) previously known as Statistical Package for Social Sciences of versions 10 and 18 (PASW Statistics 18) are used to perform the task from the weighted data of NDHS Data Files. The outcomes of logistic regression are interpreted with the help of indicators like odds ratio, model 2, -2 log likelihood, Cox and Snell R2, Nagelkerke R2, and Hosmer and Lemeshow's 2 goodness of fit along with levels of significance and 95 percent confidence interval in the case of odds ratio. Majority of the youth respondents (84% females and 79% males) were living in rural areas. Ninety-four percent males and 72 percent females are literate. Higher percentage of both females (64%) and males (41%) were engaged in agriculture as their major occupation. More than half females (55%) and 28 percent males were migrants. Eighty-five percent respondents were Hindu followed by 8 percent Buddhist and 7 percent other religious group. Thirty-one percent respondents were Brahmin/Chhetri followed by Janajati (24%), Tharu et al. (15%), other Tarai origin ethnic group (13%), occupational castes (12%), and other hill origin ethnic group (5%). One-half of respondents lived in Tarai, 43 percent in hills and 7 percent in mountain. Fifty-five percent youth females and 41 percent males had sexual experience. The hypotheses set in this study are that education helps to lessen the vulnerability, exposure to mass media is negatively associated with vulnerability, migrants than non-migrants are more vulnerable, knowledge of condom and HIV/AIDS is inversely related with vulnerability, knowledge about the source of condom would reduce the vii vulnerability, status of being able to get condom oneself would reduce the vulnerability, correct knowledge of HIV/AIDS would reduce the vulnerability, travelling away from home is positively associated with vulnerability, persons having multiple sex partners than those with a single partner are more vulnerable in contracting HIV/AIDS, and higher the frequency of sexual relation with sex workers, the greater is the risk of contracting HIV/AIDS. The hypotheses are tested statistically using multivariate logistic regression analysis and found true with significant (p<.05) for six of them and not true for one, while three could not be tested because of very few cases in one of the only two categories of the corresponding variables. From the examination of data between independent, intermediate and dependent variables, it can be concluded that youth with lower level no education, living in urban area, ever married, migrants, caste/ethnic groups of Tharu et al., other Tarai origin, and occupational caste, and less exposed to mass media are the most at risk youth population in contracting STIs including HIV/AIDS as these groups of youth populations are negatively associated both with dependent variables of condom uses and positive aspects of many intermediate variables, which in turn, could protect them from contracting STIs/HIV/AIDS. Similarly, lack of knowledge about STIs/HIV/AIDS, misconceptions about HIV/AIDS and the number of life-time sex partners in the case of youth males are the most important factors of intermediate variables that could put youth at greater risk in contracting STIs including HIV/AIDS. Vulnerability of urban and migrant youth males and uninfected wife becoming infected from husband were also observed from the case studies of qualitative information as well. Youth females with lack of knowledge about condom and its source, and their higher inability to get condom oneself even if they wanted, could make them vulnerable in contracting STIs including HIV/AIDS. Similarly, youth of both the sexes especially females, who had neither heard of any STIs nor HIV/AIDS are also equally vulnerable in this respect. Youth who lacked correct knowledge about HIV/AIDS such as having only one uninfected sex partner who had no other partners, always using condom during sex, and not having sex at all would reduce the chance of getting HIV virus; and a healthy looking person could also have HIV virus, might be vulnerable. Sexually not experienced youth who said that they would not intend for viii postponing sexual experience until marriage could be most at risk population due to their attitudes towards it. More youth males were involved in pre-marital sex and if they practice unsafely, they would be vulnerable in contracting HIV virus. Youth males who had last sex partner other than wife or non-live-in partner are vulnerable as well. Youth females who had not used condom at first sex due to any reasons could also be at risk in contracting STIs, if their partner/spouse whose it was not the first sex and were already infected with the ones. Youth males who started sexual intercourse at lower ages with partner other than spouse or non-live-in partner had used condom less at first sex and this act can make them most vulnerable in contracting HIV/AIDS. Youth males living in urban area, migrants, less exposed to mass media, castes of Tarai origin, those who lack correct knowledge about HIV/AIDS and higher number of life-time sex partners had also used condom less at last sex with both type of partners, wife and other than wife or non-live-in partner. This can make them and their spouse as well more vulnerable in contracting STIs including HIV/AIDS from unprotected sex. The same is true for female youth migrants. Youth males who did not use condom every time had sex with last sex partner other than wife or non-live-in partner are at the most risk than all of others in contracting STIs/HIV/AIDS.