A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa

Abstract

Background

Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks.

Methods

Data from a nationally representative sample of 1268 males and 2621 females aged 15–24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects.

Results

Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35–0.67), household size of 5 + members (AOR = 0.78, CI: 0.54–1.15), community education (AOR = 0.97, CI: 0.72–1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59–1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58–1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20–24 years (AOR = 12.6, CI: 9.93–16.00); secondary education attainment (AOR = 1.01, CI 0.58–1.77); family structure (AOR = 1.37, CI: 0.75–1.15); Gauteng province (AOR = 1.45 CI: 0.92–2.28); residential mobility (AOR = 1.25, CI: 1.02–1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09–1.76) were more likely to engage in risky sexual behaviour.

Conclusion

The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.

Plain language summary

Risky sexual behaviour is most common among young people aged 15–24 years and is associated with an increase in sexually transmitted infections, including HIV/AIDS among this young productive age category. However, no adequate progress has been made in the reduction of these infectious diseases at the community level in South Africa. In this study, we investigate the effect of neighbourhood and individual-level factors leading to two measures of risky sexual behaviour; unprotected sex (non-condom use) and multiple sexual partnerships among young people. In this study, the target for young people in the South African context was because the country has a youthful population. Understanding the influence of neighbourhood and individual-level factors on the sexual behaviour of young people can help them live healthy as they transition to adulthood. We utilized cross-sectional data from the most recent South Africa Demographic and Health Survey, which was analyzed separately for males and females respectively, due to the cultural differences in sexual practices observed in many communities in South Africa. Our results confirmed an association between the neighbourhood and individual-level factors with youth engagement in risky sexual behaviour in South Africa. These results, imply that there is a need to review policies regarding the community-based interventions for sexual and reproductive health in other to reduce risky sexual behaviour among young people in South Africa.