Evaluation of Condom Use among University Undergraduates in Port Harcourt, Nigeria

Background: Barrier contraception has the beauty of dual protection—against pregnancy and sexually transmitted infections. Following the persisting burden of unsafe abortion and human immunodeficiency virus (HIV), much sensiti-zation/campaign has been ongoing in the past few decades by government and non-governmental organisations (NGOs) in Nigeria against unprotected sexual intercourse. The youth are generally assumed to have high risk sexual behaviour, hence this study on Port Harcourt university undergraduates. Objectives: To determine the awareness and use of condom among University undergraduates in Port Harcourt. Methods: The study was a prospective descriptive cross-sectional study of 636 undergraduate students of the University of Port Harcourt and Rivers state University, South-south Nigeria. The multistage sampling technique was used to randomly select participants and data collected using a pretested structured self administered questionnaire. Data was analyzed using version 23.0 SPSS and reported in means, frequencies and percentages. Probability value was set at 5% (p < 0.05) at a confidence interval of 95%. Result: Majority of the undergraduates (58.4%) had their first sexual intercourse at ≤19 years. A total of 580 (97.8%) and 467 (78.9%) were aware of male and female condoms respectively. However, a statistically significant number of sexually active undergraduates had unprotected sexual intercourse (p < 0.001; χ 2 = 200.602). Only 5.5% of the respondents in this study were willing to know their HIV status. Conclusion: There is a high level of condom awareness among Port Harcourt University undergraduates. Surpri-singly, their practice of unprotected sexual intercourse is still high.


Introduction
Nigeria has the second highest burden of Human Immunodeficiency Virus (HIV) worldwide with about 3.6 million people living with the virus [1]. Young people contribute 35% of new infections each year [2] [3]. This higher prevalence of HIV infection among Nigerian undergraduates has been attributed to their high level unprotected sexual intercourse with multiple sexual partners [4] [5] [6].
This sexual behaviour is also responsible for the rising incidence of sexually transmitted diseases, unwanted pregnancy, induced miscarriages, and post abortal complications seen among Nigerian undergraduates [7] [8].
Majority of Nigerian undergraduates have the knowledge that the use of condom during sexual intercourse can be effective in preventing sexually transmitted disease and unwanted pregnancy [7]. However, a significant percentage does not consistently use condom during sexual intercourse [9]. Barriers to male condom use identified among Nigerian undergraduates are reduced pleasure during sex, partners' decision, not protective for pregnancy, difficult to use, not affordable, allergy to latex, not readily available, and religion [10] [11]. There is also a very poor knowledge and use of female condom among the Nigerian Undergraduates [12], which primarily has been attributed to unavailability and difficulty in using it [13] [14] [15].
Studies have shown that 68% of undergraduates in South-eastern Nigeria are sexually active, 17.9% of these undergraduates have more than two sexual partners per year and 13.7% have more than five sexual partners per year [15]. Similar reports of high level of unprotected sexual intercourse with multiple sexual partners among University undergraduates have been reported in Southern Nigeria [11], North central Nigerian [10], Ethiopia [16] and China [17]. The factors responsible for this multiple sexual partners are satisfying sexual urge, peer pressure, ignorance, promiscuity, and sexual addiction [18]. About 73.7% of undergraduates in south eastern Nigeria have sex for pleasure [5] and 15.2% of undergraduates have been reported to have sexual addiction [19].
Majority of Nigerian undergraduates have the knowledge that the use of condom during sexual intercourse can be effective in preventing sexually transmitted disease and unwanted pregnancy [7]. However, a significant percentage does not consistently use condom during sexual intercourse [9]. In south eastern Nigeria, 96.4% of undergraduate know how to use the male condom and only 68.8% undergraduates have ever used it before [20]. Another study reported that only 47.3% of undergraduates in southern Nigeria use male condom consistently [21]. A study among students in south-south Nigeria reported a low practice of condom use and is barely boarded about sexually transmitted diseases and unwanted pregnancies [9]. Studies have also reported that only 33.2% of students in Ethiopia [22] and 30% of students in China [17]  sexual satisfaction and hinders sexual interest [11] Another study among undergraduates in south eastern Nigeria showed that religious belief (33.3%) was the commonest reason why most undergraduates don't use condom [20].
A study among undergraduates in south eastern Nigeria reported that 62% of the students were aware of female condom however only 5.1% of students have ever used a female condom [20]. Another study among undergraduates however reported that 64.3% of undergraduates had knowledge of female condom, however only 32.9% of respondents agreed that female condom can protect against STDs, HIV [23]. In a study to investigate the perceived confidence to use the female condoms amongst undergraduate female students from selected tertiary institutions in south western Nigeria, only 10.8% of respondent had confidence to use a female condom [13]. However, in southern Nigeria, a study among undergraduates reported that 89.3% were aware of female condom, only 8.9% had ever used one due to unavailability, high cost, and difficulty with its insertion [14]. In a Camerounian study, 67.3% of respondents were aware of female condom, however only 8.0% have ever used it before [12]. In view of the high rates of risky sexual practices and higher HIV prevalence rate among undergraduates, and the effectiveness of condom in the prevention of sexually transmitted diseases and unwanted pregnancies, it has become important to review the current knowledge and actual practice of condom usage among University undergraduates in Port Harcourt, south-south Nigeria.

Results
A total of 636 questionnaires were distributed to undergraduate students of the two universities. Five hundred and ninety-three (593) Table 2).
In  Table 4 showed that 60.9% of the respondents feel that the use of condom can prevent pregnancy and sexually transmitted diseases. While in Table 5, the major complaints of those who did not use condom regularly were reduced pleasure (57.1%), not reliable to prevent pregnancy (44.2%) or partner dislike (43.2%).
Four hundred and sixty-seven (78.8%) of the respondents had heard about the female condom, but only 116 (19.6%) had used it (Table 6).
Two hundred and thirty eight respondents (40.1%) do not know their HIV status and only 13 respondents (5.5%) were willing to get tested for HIV (Table 7).   Table 8 shows that condom use was significantly higher among respondents older than 25 years (91.2%), and least among those who were 19 years or less (59.2%) (p < 0.001; χ 2 = 48.582). It was also found that condom use was significantly higher among married men (96.1%) than among single men (77.7) (p = 0.002; χ 2 = 9.581). Among the respondents who reported that they had had sex before, about 72 (13.5%) of them had sex without condom as compared to those who had sex with condom (86.5%), and this difference was statistically significant (p < 0.001; χ 2 = 200.602).

Discussion
More than half (58.4%) of the undergraduates in this study had their first sexual intercourse at ≤19 years, which means they already have sexual exposure as teenagers probably before getting admission into the University. It had also been reported that majority of these teenager who engage in sex just for pleasure, have poor sex education [5]. This is not surprising as in most African tradition, it is considered inappropriate for a young person to discuss sex related matters before marriage, therefore teenagers have little or no sex education at home. Our educational system is also contributory, as most of our primary and secondary schools and even the Universities do not include sex education as part of its curriculum. The teenager is then left with the social media and friends for sex education leading to misinformation and early sexual adventures [20]. Early sexual exposure is usually associated with unprotected sexual intercourse with multiple sexual partners [11]. This was reflected in this study were 38.6% of undergraduates had multiple sexual partners and almost half (40.8%) of teenage undergraduates had unprotected sexual intercourse. This is higher than findings in South-eastern Nigeria, were 17.9% of undergraduates have more than two sexual partners per year and 13.7% have more than five sexual partners per year [5]. It then means that this deplorable situation is getting worse.  [21]. The low use of condom is probably due to the source of the information. In this study, majority of the undergraduates got the awareness of condom use from either friends (74.0%) or the social media (19.5%). A study in South-east Nigeria also noted that friends and social media were the commonest sources on information on condom use [20]. These sources may give incomplete or totally false information. Other major limitations to condom use among these undergraduates in this study were reduced pleasure (57.1), not reliable to prevent pregnancy or infection (44.2), and partner's dislike (43.2).
These similar limitations were reported by Brian et al. [5].
Unprotected sexual intercourse with multiple sexual partners explains the higher prevalence of 3.69% [4] of HIV among undergraduates compared to the national average of 3.6% [1]. A more worrisome issue is that only 5.5% of respondents in this study were willing to know their HIV status despite the fact that HIV counselling and testing is free in most government hospital. This is  [24]. If not stopped, this current trend will lead to an increase in HIV, STI, unwanted pregnancy and their associated complications, limiting the possibility of achieving the sustainable developing goals.

Conclusion
Though the awareness of condom use is high among undergraduates in this study, consistent use of condom during sexual intercourse was worrisomely poor.

Recommendation
There is a dare need to step up ongoing sensitization/counselling efforts on the benefits of the use of condom during sexual intercourse and particularly re-echoing the consequences of unprotected sexual intercourse among our youth and the society at large.

Limitation
The limitation to this study included the fact that the data is not large enough.
Hence the study remain preliminary, hence further enlarged study is needed.