Influence of household wealth status on transactional sex and condom use among Nigerian youth: A cross-sectional analysis of the 2018 Demographic and Health Survey

Abstract

Globally, despite the increasing social and economic interventions to achieve better health behavior outcomes for the younger generation, the rising rate of engagement in risky sexual behaviors (RSBs) among young people is alarming, particularly in developing countries. This could be attributed to households’ wealth conditions that contribute to poor access to sexual and reproductive health services. This study investigates the influence of household wealth status on RSBs (transactional sex and non-condom use) among unmarried youth aged 15-24 years in Nigeria. Survey data from the 2018 Nigeria Demographic and Health Survey were used to better understand RSBs among a weighted sample of 12,664 unmarried adolescents and young adults in Nigeria. Descriptive statistics were presented using frequency tables, while analytical methods included Pearson’s Chi-square test and multivariate logistic analysis. The study found that individuals aged 20-24 were significantly more likely to engage in RSBs, particularly among those from households in the poorest wealth quintile (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.04-2.76), living in communities with average poverty levels (OR: 1.34, 95% CI: 0.69-2.59), with higher education (OR: 3.22, 95% CI: 1.20-8.66), with community media access (OR: 2.04, 95% CI: 1.27-3.26), and residing in high-poverty communities (OR: 1.54, 95% CI: 0.94-2.54). To mitigate the negative effects of RSBs and their consequences, youth support initiatives should be prioritized by governments and non-governmental organizations through adaptation and mitigation strategies, particularly for those residing in low-wealth households, to discourage them from engaging in RSBs.

Keywords

Household wealth status / Risky sexual behavior / Transactional sex / Unprotected sex / Young people / Nigeria

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

References

[1] Adu C., Mohammed A., Budu E., Frimpong J.B., Tetteh J.K., Ahinkorah B.O., et al. (2022). Sexual autonomy and self-reported sexually transmitted infections among women in sexual unions. Archives of Public Health, 80(1):40. https://doi.org/10.1186/s13690-022-00796-4

[2] Ajayi A.I., & Okeke S.R. (2019a). Protective sexual behaviours among young adults in Nigeria: Influence of family support and living with both parents. BMC Public Health, 19:983. https://doi.org/10.1186/s12889-019-7310-3

[3] Anyanwu F.C., Akinsola H.A., Tugli A.K., & Obisie-Nmehielle N. (2020). A qualitative assessment of the influence of family dynamics on adolescents’ sexual risk behaviour in a migration-affected community. International Journal of Qualitative Studies on Health and Well-Being, 15(1):1717322. https://doi.org/10.1080/17482631.2020.1717322

[4] Bobo F.T., Asante A., Woldie M., Dawson A., & Hayen A. (2023). Evaluating equity across the continuum of care for maternal health services: Analysis of national health surveys from 25 Sub-Saharan African countries. International Journal for Equity in Health, 22(1):239. https://doi.org/10.1186/s12939-023-02047-6

[5] Bronfenbrenner U. (1994). Ecological models of human development. In: International Encyclopedia of Education. 2^nd ed., Vol. 3. Oxford:Elsevier.

[6] CDC. (2022). Prevention and Control of Infectious Diseases. Available from: https://www.cdc.gov/earlycare/infections-disease/index.html [Last accessed on 2025 Feb 02].

[7] National Population Commission. (2019). Nigeria Demographic and Health Survey 2018. Nigeria: NPC, ICF.

[8] Curtis T.J., Rodger A.J., Burns F., Nardone A., Copas A., & Wayal S. (2020). Patterns of sexualised recreational drug use and its association with risk behaviours and sexual health outcomes in men who have sex with men in London, UK: A comparison of cross-sectional studies conducted in 2013 and 2016. Sexually Transmitted Infections, 96(3):197-203. https://doi.org/10.1136/sextrans-2019-054139

[9] Dadzie L.K., Agbaglo E., Okyere J., Aboagye R.G., Arthur-Holmes F., Seidu A.A., et al. (2022). Self-reported sexually transmitted infections among adolescent girls and young women in sub-Saharan Africa. International Health, 14(6):545-553. https://doi.org/10.1093/inthealth/ihab088

[10] Dana L.M., Adinew Y.M., & Sisay M.M. (2019). Transactional sex and HIV risk among adolescent school girls in Ethiopia: Mixed method study. BioMed Research International, 2019:4523475. https://doi.org/10.1155/2019/4523475

[11] Decker M.R., Wood S.N., Byrne M.E., Yao-N’dry N., Thiongo M., Gichangi P., et al. (2021). Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings. PLoS One, 16(11):e0257009. https://doi.org/10.1371/journal.pone.0257009

[12] Dirisu O., Adediran M., Omole A., Akinola A., Ebenso B., Shoyemi E., et al. (2022). The syndemic of substance use, high-risk sexual behavior, and violence: A qualitative exploration of the intersections and implications for HIV/STI prevention among key populations in Lagos, Nigeria. Frontiers in Tropical Diseases, 3:822566. https://doi.org/10.3389/fitd.2022.822566

[13] Enane L.A., Vreeman R.C., & Foster C. (2018). Retention and adherence: Global challenges for the long-term care of adolescents and young adults living with HIV. Current Opinion in HIV and AIDS, 13(3):212-219. https://doi.org/10.1097/COH.0000000000000459

[14] Envuladu E.A., Massar K., & De Wit J. (2021). Adolescent sexual and reproductive health care service availability and delivery in public health facilities of plateau state Nigeria. International Journal of Environmental Research and Public Health, 18(4):1369. https://doi.org/10.3390/ijerph18041369

[15] Folayan M.O., Sam-Agudu N.A., & Harrison A. (2022). Exploring the why: Risk factors for HIV and barriers to sexual and reproductive health service access among adolescents in Nigeria. BMC Health Services Research, 22(1):1198. https://doi.org/10.1186/s12913-022-08551-9

[16] Hill R. (1949). Families Under Stress:Adjustment to the Crises of War Separation and Reunion. New York: Harper.

[17] Melesse D.Y., Mutua M.K., Choudhury A., Wado Y.D., Faye C.M., Neal S., et al. (2020). Adolescent sexual and reproductive health in sub-Saharan Africa: Who is left behind? BMJ Global Health, 5(1):e002231. https://doi.org/10.9734/isrr/2016/25462

[18] Menon J.A., Mwaba S.O., Thankian K., & Lwatula C. (2016). Risky sexual behavior among university students. International STD Research and Reviews, 4(1):1-7. https://doi.org/10.9734/ISRR/2016/25462

[19] Mensah E.O. (2020). When you open your legs, you eat: The discourse of transactional sex among female youth in Nigeria. Sexuality and Culture, 24(3):543-560. https://doi.org/10.1007/s12119-019-09648-w

[20] National Agency for the Control of AIDS. (2019). National Symposium on HIV Prevention Models for Adolescents and Young People in Nigeria:Call for Submissions - NACA Nigeria. Available from:Available from: https://naca.gov.ng/national-symposium-on-hiv-prevention-models-for-adolescents-and-young-people-in-nigeria [Last accessed on 2025 Feb 03].

[21] Nzoputam C., Adam V.Y., & Nzoputam O. (2022). Knowledge, prevalence and factors associated with sexually transmitted diseases among female students of a Federal University in Southern Nigeria. Venereology, 1(1):81-97. https://doi.org/10.3390/venereology1010006

[22] Odii A., Atama C.S., Igwe I., Idemili-Aronu N.J., & Onyeneho N.G. (2020). Risky sexual behaviours among adolescent undergraduate students in Nigeria: Does social context of early adolescence matter? The Pan African Medical Journal, 37:188. https://doi.org/10.11604/pamj.2020.37.188.22968

[23] Odimegwu C., & Somefun O.D. (2017). Ethnicity, gender and risky sexual behaviour among Nigerian youth: An alternative explanation. Reproductive Health, 14:16. https://doi.org/10.1186/s12978-017-0284-7

[24] Odimegwu C., Somefun O.D., & Chisumpa V.H. (2019). Regional differences in positive sexual behaviour among youth in sub-Saharan Africa. Journal of Biosocial Science, 51(2):254-272. https://doi.org/10.1017/S002193201800010X

[25] Odimegwu C.O., & Ugwu N.H. (2022). A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa. Reproductive Health, 19(1):119. https://doi.org/10.1186/s12978-022-01407-9

[26] Oladunmoye E.O., Rasaq T.A., Adegunle S.O., Onyema C.E., & Lawal B.F. (2022). Mediation analysis of pre-marital sexual behaviour in Nigeria: The direct and indirect effects of peer pressure, socioeconomic status, and parent-child relationship. International Journal of Humanities Social Science and Management, 2(4):140-148.

[27] Popoola J. (2020). Globalization and Nigeria’s economic development-a study of the interconnectedness. Open Journal of Political Science, 10(3):460. https://doi.org/10.4236/ojps.2020.103028

[28] Putra I.G.N.E., Dendup T., & Januraga P.P. (2021). The roles of women empowerment on attitude for safer sex negotiation among Indonesian married women. Women and Health, 61(1):95-108. https://doi.org/10.1080/03630242.2020.1831685

[29] Sano Y., Sedziafa A.P., Vercillo S., Antabe R., & Luginaah I. (2018). Women’s household decision-making autonomy and safer sex negotiation in Nigeria: An analysis of the Nigeria demographic and health survey. AIDS Care, 30(2):240-245. https://doi.org/10.1080/09540121.2017.1363363

[30] Shittu H.I., Onasoga O.A., Gommaa H.I., Ayuba A.U., & Shittu M.B. (2022). Knowledge and attitude of parents towards sexuality education in ilorin metropolis Kwara State, Nigeria. African Journal for the Psychological Studies of Social Issues, 25(3):31-32.

[31] Shu V.M. (2024). Sexuality Communication in African Families: The Dynamics of Openness and Closedness [Doctoral Dissertation, University of the Free State].

[32] Somefun O.D. (2019). Religiosity and sexual abstinence among Nigerian youths: Does parent religion matter? BMC Public Health, 19:416. https://doi.org/10.1186/s12889-019-6732-2

[33] Ssewanyana D., Abubakar A., Newton C.R., Otiende M., Mochamah G., Nyundo C., et al. (2020). Clustering of health risk behaviors among adolescents in Kilifi, Kenya, a rural Sub-Saharan African setting. PLoS One, 15(11):e0242186. https://doi.org/10.1371/journal.pone.0242186

[34] Stiglic N., & Viner R.M. (2019). Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews. BMJ Open, 9(1):e023191. https://doi.org/10.1136/bmjopen-2018-023191

[35] Tende F. (2020). Socio-Economic Determinants of Risky Sexual Behavior in Sub-Saharan Africa. Minnesota: Walden University.

[36] Ugwu N.H. (2022). outh sexual behaviour in South Africa: Social disorganisation as an alternative explanation. Available from https://wiredspace.wits.ac.za/items/114a7d84-c8b3-401e-ad81-753482701bd%203 [Last accessed on 2025 Feb 03].

[37] Ugwu N.H., Igwe I., Nwokeoma B.N., Ajuzie H.D., Iwuamadi K.C., Ezike S.C., et al. (2022). Adolescents’ knowledge and use of sexual and reproductive health services in the Federal Capital Territory, Nigeria. African Journal of Reproductive Health, 26(6):80-88.

[38] United Nations Department of Economic and Social Affairs, & Population Division. (2022). World Family Planning 2022: Meeting the Changing Needs for Family Planning:Contraceptive Use by Age and Method. UN DESA/ POP/2022/TR/NO 4. United Nations. Available from: https://www.un.org [Last accessed on 2025 Feb 02].