Sexual Risk Behaviors Among Youth in Soweto, South Africa During the COVID-19 National Lockdown

Mamakiri Mulaudzi; Peace Kiguwa; Campion Zharima; Kennedy Otwombe; Khuthadzo Hlongwane; Janan J Dietrich

doi:10.1016/j.esxm.2021.100487

Sexual Risk Behaviors Among Youth in Soweto, South Africa During the COVID-19 National Lockdown

Sex Med. 2022 Apr;10(2):100487. doi: 10.1016/j.esxm.2021.100487. Epub 2022 Feb 5.

Authors

Mamakiri Mulaudzi¹, Peace Kiguwa², Campion Zharima³, Kennedy Otwombe³, Khuthadzo Hlongwane⁴, Janan J Dietrich⁵

Affiliations

¹ Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Community and Health Development, Faculty of Humanities, Psychology Department, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: mulaudzim@phru.co.za.
² School of Community and Health Development, Faculty of Humanities, Psychology Department, University of the Witwatersrand, Johannesburg, South Africa.
³ Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; African Social Sciences Unit of Research and Evaluation (ASSURE), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Assessment of sexual risk behavior among youths is crucial for HIV prevention strategies. However, the literature on sexual behavior in youth during the COVID-19 pandemic is sparse.

Aim: This study surveyed sexual risk behavior among youth in Soweto, South Africa during the COVID-19 pandemic national lockdown in 2020.

Methods: We conducted a cross-sectional telephonic survey on socio-demographics and HIV risk behaviors among youth aged 18-24 years during level 3 of the lockdown. Frequencies and their respective percentages were determined for categorical variables and stratified by biological sex. Chi-square analysis was used to compare categorical variables. All data were analyzed using SAS software.

Outcomes: A risk assessment for HIV questionnaire was used to assess sexual risk behaviors. Also, substance use was assessed through a developed yes/no questionnaire.

Results: Of the 129 participants, 83.0% (n = 107) had a sexual partner; 52% of those who had a sexual partner were females, 60.7% (65/107) had one current sexual partner and 39.2% (42/107) had more than 1 sexual partner. Most reported sex within 1 week (54.2%, n = 58/107) and 30.8% within a month (30.8%, n = 33/107). Sex was with a dating partner (86.0%, n = 92/107) and 63% used a condom during last sexual contact. Males were more likely than females to have one-night stand sexual partners (23.5% vs 7.1%; P = .0176), make weekly changes in partners (17.7% vs 5.4%; P = .0442) and used condoms with their partners (92.2% vs 53.6%; P < .0001) during last sexual contact. The majority reported alcohol use (69.0%, n = 89/129). Males were more likely than females to use alcohol on a weekly basis (21.4% vs 6.4%; P = .0380). About 55.9% had penetrative sex under the influence of substances.

Clinical translation: This study gives an insight to the sexual risk behaviors among young people which is crucial for HIV prevention interventions.

Strength & limitations: This was the first study investigating sexual behavior in youth during the COVID-19 pandemic. The main limitations of this study relate to the sample size and sampling strategy. As the sample was not representative of the population of young people in Soweto and South Africa, the results cannot be generalized. However, the findings have relevance for future research in HIV prevention for young people in other settings in South Africa.

Conclusions: Interventions on promoting sexual health and reducing HIV risk behavior such as sex following alcohol consumption in young people are needed, especially during a pandemic such as COVID-19. Mulaudzi M, Kiguwa P, Zharima C, et al., Sexual Risk Behaviors Among Youth in Soweto, South Africa During the COVID-19 National Lockdown. Sex Med 2021;10:100487.

Keywords: COVID-19; Sexual Risk Behavior; South Africa; Substance Use; Young People.