Epidemiology of Sexual Behaviour with Risk of Sexually Transmissible Infection ( STI ) among Students in Africa : The Case of the University of Ouagadougou

Objective: To study the sexual risk behaviors and their determining role in sexually transmissible infection (STI) and HIV among students of the University of Ouagadougou. Methodology: It was a descriptive and analytical single pass cross-sectional study from June 22 to July 21 2010 at the University of Ouagadougou. A cluster sampling in two stages was adopted to form a population of 762. Data were collected using a standardized written questionnaire completed by individual interview after informed consent. Results: The average age of students was 24.2 ± 2 years old for men and 23.7 ± 2 years old women. Singles represented 95.1% of students. The students were not scholarship grantees in 90.6% of the sample. Knowledge about STIs was average in 60.2% of cases. In total 33.65% of the students admitted to having had multiple sexual partners, 19.57% had sex with prostitutes, 34.62% had unprotected sex, 4% practiced sodomy without condoms and 3.1% of students had sex in group with one partner. In multivariate analysis, male gender was the determining factor associated with multiple sexual partner (OR = 3.30 95% CI = 2.19 to 4.95) and relations with prostitutes with an odds ratio of 16.13 (95 = 6.87% to 37.8%). The female gender was the determining factor associated with not using a condom with odds ratio of 1.5 (95% CI = 1.01 to 2.16). Conclusion: There are many risk behaviors for HIV transmission among students of the University of Ouagadougou. The urgent implementation of specific prevention programs to benefit this population is essential. Corresponding author. C. M. R. Ouedraogo et al. 220


Introduction
HIV infection is a disease that poses to humanity an unprecedented [1] [2] challenge.In Burkina Faso, the average prevalence of the pandemic in 2008 in the adult population was 1.6% and the number of HIV positive was estimated at 130,000, with a fatality rate of 19.7%.According to UNAIDS, sexual behavior plays a key role in the spread and persistence of the pandemic which mainly concerns young sexually active population [3]- [6].Promotion of safer sexual practices among youth and especially among students who are the future of the nation is more important than ever.In student environment, the situation of HIV infection is poorly understood due to insufficient given statistics [7].Also to provide relevant and local information for the implementation of health education programs, we conducted a survey on sexual risk behaviors among students at the University of Ouagadougou.

Patients and Methods
It was a descriptive and analytical single pass cross-sectional study which lasted from June 22, 2010 to July 21, 2010.It involved seven (07) units of training and research (UTR) and the Burkinabe arts and crafts Institute (IBAM) of the University of Ouagadougou.All the students of the 1st and 2nd cycle enrolled for the academic year 2009-2010 constituted our study population.The 3rd cycle students who performed practical training outside the University were not included in our sample.We conducted a two stages cluster sampling.The first level was made from a list of all classes by simple random sampling.The second level was made by a systematic sampling where the number of students selected was proportional to the size of the class.The sample size of 762 students was calculated from the prevalence in the general population and an accuracy of 95%.We used a standardized written questionnaire completed by individual interview after informed consent.We recorded 9 nonrespondents, the response rate was of 98.82%.Ten investigators were trained on technical approach, maintenance as well as the interest of the investigation.The administration of the questionnaire was made outside of school hours.Data were entered using EPI Data software version 3.1 and analyzed in SPSS 17.0.We used a chi 2 test to compare variables with a significance level of 5%.

• Sex
Considering a total of 753 students, 454 were males and 299 were females.The sex ratio was 1.52 in favor of males.

• Age
The average age of students was 23.8 ± 3 years old.Median was 24 years old.For males the average age was 24.2 ± 2 years old and 23.7 ± 2 years old for females.Extreme ages in our sample were 18 and 54 years old.

• Level of knowledge of STIs
In our series, 27.8% of students had low knowledge about HIV/STI, 60.20% had average knowledge and 12% of students had deep knowledge.

• Sexual Experience
In total 618 students, or 82.10% had sex, 60.20% were males and 39.80% females.It was noted that 81.93% of men and 82.27% of women had ever had a sexual experience (p > 0.05).

• Age at first sex
The average age at first intercourse was 19 ± 2 years old.It was 19.14 ± 2 years old for females and 18 9 ± 2 years old for males.Extreme age at first intercourse was 11 years old and 32 years old.

• Frequency of sex
The students had sex on average 2.61 times per week.Weekly frequency of sexual intercourse by gender is presented in Table 1.

• Details of last sexual intercourse
The last sex that students had was consenting in 88.1% and in 11.9% of cases was imposed by the partner.The condom was used in 45% of cases.

• Number of sexual partners
The number of sexual partners by gender was presented in Table 2.

• Having sex with sex workers
In our study, 121 students, or 19.57% (121/618) of sexually active students had sexual contact with prostitutes.In this group, 95% were male and 5% were women (p < 0.001].During the last twelve months prior to the survey, 54.78% of those who frequented prostitutes had only one sexual contact, and 45.22% had more than one sexual contact. • Sexual intercourse with a partner using drugs intravenously According to the survey, 10 students, or 1.61% (10/618) had had sex with a partner using drugs intravenously.

• Drunk sexual intercourse
In our study, 50 students or 8.1% (50/618) of sexually active students had already had sex while drunk.We noted 76% men and 24% women (p < 0.01).

• Fellation practice
At the time of the survey, forty-eight women, or 19.51% (48/246) of sexually active women practiced fellation.This practice was recurrent among women who maintained sex with multiple sexual partners (78%).At the time of the survey, 27 men, 7.25% (27/372) of sexually active men practiced cunnilingus.Also, it was found that 84% of men who practiced cunnilingus were in the age group of 15 -24 years old.But no statistically significant difference had been found.

• Cunnilingus practice
• Practice of sodomy Sodomy was practiced by 22 students, 6% (22/372) of sexually active men.In this population, 60% practiced without condoms and 40% with condom.Anal sex without a condom was mainly practiced by men (70%) who had multiple sexual partners.

• Practice of homosexuality
In our study, 4 statements about homosexuality were noted, 1.07% (4/372) of sexually active men.Students who had homosexual behavior were all male and in 50% of cases they had not used condoms.

• Concept of sexual assault
In our series, 04 students, or 1.62% of sexually active women reported having been sexually assaulted and 4 males students, representing 1.07% of sexually active men reported having committed a sexual assault.

• Unprotected sex
In our study, 203 students, or 32.84% of sexually active students had not used a condom during their last sexual intercourse.Among them, 48.06% were male and 51.94% were women (p < 0.01).Also, 31.94% of men who had multiple sexual partners have had unprotected sex during their last sexual intercourse.

• Sexual intercourse by simultaneous multiple partners
In our series, 20 students, or 3.23% (20/618) of sexually active students had sexual relations with several partners at once.It was noted that 75% were men and 15% women.

Study of Determinants of Sexual Risk Behavior
• Not using a condom The determinants of no condom use after multivariate analysis by logistic regression were shown in Table 3.

• Determinants of multiple sexual partnerships
Determinants of multi sexual partnership after multivariate analysis by logistic regression were shown in Table 4.

• Determinants of sex with prostitutes
The study of factors associated with having sex with prostitutes is presented in Table 5.
Table 3. Analysis of factors associated with not using a condom.

Discussion
The data collected were they sincere?The problem arises in all investigations, manipulating politics, sports practices or sexuality.Despite these limitations, the results we have achieved have allowed to make comments and lead a discussion.

Risk Sexual Behaviors
• Multiple sexual partners In our series, among sexually active students, 33.65% reported having multiple sexual partners.This frequency is lower than those of other African authors.Sepou Bangui [8] Yao in Abidjan [9] and Ditri in Togo [10] reported 41%, 63% and 58% respectively.Multiple partners is a major risk factor for the transmission of STIs and should be prohibited in youth.Awareness campaigns should help correct this behavior by assuming that prostitution is an significant risk factor for HIV infection spread [11] [12].

• Sexual intercourse with sex workers
In our series, 19.57% of students had sex with prostitutes in the past twelve months.Ditri in Togo [10] and Tiembré in Côte d'Ivoire [4] reported respectively 30.9% and 31.8% of students having sex with sex workers respectively.Since the adoption of the structural adjustment program by African leaders living conditions of African student became difficult.But this should not justify this behavior that exposes youth tremendously.

• No use of condoms
In our study, 34.95% of students had not used a condom during their last sexual intercourse.Yao in Abidjan [9] and Ditri in Togo [10] reported 31% and 26% of non-use of condom during last sexual intercourse respectively.Some bad beliefs among students according to which direct contact is essential during intercourse could be a barrier to condom use.One cannot imagine that condoms price subsidizing will constitute a barrier to its use.

• Homosexuality
Four students, representing 1.07% of sexually active men had sex with men.Ditri had reported a rate of 1.3% in Togo [10] Harding Nigeria 2% [13] Yao Côte d'Ivoire 2.95% [9].Our figures and those of the other series suggest that homosexuality is a reality in our societies and deserves to be taken into account in all programs of STI prevention [14].

• Oral sex
Oral sex was practiced by 19.27% of sexually active students.Similar results are reported by other African studies [9] [10].This practice is a potential source of contamination to STI and HIV and should be proscribed sexual practices of our students.It could also be practiced using the appropriate protective measures.

• Drunk sex
In our series, 8.1% of students had sex while drunk.According to Tiembre in Côte d'Ivoire, 20.4% of students reported having had sexual intercourse in the same conditions [4].Sex while drunk is a risk factor for infection with STIs and HIV.Alcohol abuse leads to a loss of control mechanisms of his own personality and allows involuntarily risk behaviors for STI [15].Burkina Faso is a crossroads where cheap adulterated liquor is easily accessible by students.Students who are mostly without scholarships should stay away from drinking that might in danger their future and impoverish them more.

Determinants of Risk Behavior
• No use of condoms Non-use of condom during sex is a risky behavior that persists among students.In multivariate analysis, only the female appeared to be the demographic factor significantly associated with not using a condom for sexual intercourse among students [OR = 1.5, 95% CI 1.01 to 2.16].In fact, the females are 1.5 times more likely than men of not using condom during sex.Our results are comparable to those reported by Mondieli in Niger [16].In fact, in his study on the determinants of risky sexual behavior of STI/HIV/AIDS among adolescents in Niger, female gender was significantly associated with not using a condom at their last sexual intercourse.These results show the vulnerability of the girl who should know how to negotiate condom use from her partner.

• Multi sexual partnership
In multivariate analysis, only male gender was associated with this practice and the men were 3.3 times more likely to have multiple sexual partners than women.Talman in Côte d'Ivoire [17] showed in his study of social inequality and risky sexual behaviors among young people in Ivorian urban area, male sex was a determinant of risk sexual behaviors associated with the acquisition of multiple partners among Ivorian youth from 15 to 24 years in urban areas.The fact that African societies are more permissive sexuality of males over females could explain these findings [18].

• Sex with prostitutes
In multivariate analysis, only gender was statistically associated with having sex with prostitutes and males were 16.3 times more likely to have sex with prostitutes than females.According to some African beliefs, the man would value its sexual experiences and attendance of sex professionals, there could find it as a way of selfexploration of unsuspected pleasures areas, to raise strong emotions [19].

Conclusion
There are many risk behaviors for HIV transmission among students of the University of Ouagadougou.The fight for the development of our society must go with the urgent implementation of specific prevention programs in this population.Further studies will explain more this subject which is a national interest.(Plusieurs réponses possibles) Enquêteur: ne pas suggérer les réponses.

Table 1 .
Distribution of weekly frequency of intercourse by sex.

Table 2 .
Distribution of the number of sexual partners by gender.

Table 4 .
Studies of factors associated with multiple sexual partnerships.

Table 5 .
Studies of factors associated with the maintaining of sex with prostitutes.