Youths in Sub-Saharan Africa are prone to risky sexual activities, unwanted pregnancy, and sexual violence[1, 2]. Having unprotected sexual intercourse; having multiple sexual partners over one's lifetime; having intercourse with a casual partner; sexual initiation at a young age; sexual intercourse with commercial sex workers; bartering sex for money, goods, or other favours; engaging in sexual activity while under the influence of alcohol/drugs; and sexualism are all examples of risky sexual behaviours.
Adolescence is characterised by greater autonomy, peer influence, risk-taking behaviours such as initiation of sex and alcohol/drug usage, [1, 4]. Compared to adults, adolescents are more likely to have several sexual relationships, participate in unprotected sexual intercourse, and choose high-risk partners. The study of teenage sexual behaviour is crucial because 60% of youths globally are afflicted with sexually transmitted infections (STIs), including HIV.
Earlier studies in Liberia reported a significant prevalence of risky sexual practices among in-school children and young adults. 78% of kids were found to be sexually active; 24.9% of those sexually active said they had sex for money, and 20.9% said they had never used a condom . In the same study, males were also shown to have more sex, have many sexual partners, and start sex earlier than females. Another study among Liberian youths found that 34% of those who were sexually active did so before the age of 15 (early sexual debut), and 21% of those who were sexually active had several sexual partners, and 26% of sexually active teenagers had never used a condom, 11% had gotten pregnant or helped someone become pregnant one or more times, and 11% had been sexually assaulted .A recent study reported that majority of sexually active Sierra Leone youths had condomless sex in their last sexual encounter . A United Nations Population Fund report on the impact of Ebola on adolescent pregnancy in Sierra Leone found that close to half had their first pregnancy during the Ebola outbreak period and close to a third had used ever use of any kind of family planning.
Various sexually related risk behaviours have been observed among adolescents in African countries. In Ghana, 33.5% of adolescents ever had sex, 73.8% had not used a condom at last sex, and 32.5% had multiple sexual partners; in Namibia in 2004, 33.2% ever had sex, and 17.1% had multiple sexual partners[12, 13]. Between 2015 and 2017, a community survey of adolescents (15–19 years) in Uganda, Tanzania, Nigeria, Ghana, Eswatini, Ethiopia, and Burkina Faso found that 25.9% had ever had sex. Among sexually active adolescents, the early sexual debut was 21% for girls and 28% for boys, unprotected last sex was 46% for girls and 40% for boys, and 37% for girls and 8% for boys had made someone pregnant.
In a study of 15-year-olds in 30 European countries, Israel, and Canada, 27% had had sexual intercourse, and 14% had not used the contraceptive pill or condoms at their most recent sex, and in a study of 15-year-olds in 10 European countries, the prevalence of sexual initiation was 18.8%, and among sexually active, 52.4% had >1 sexual partner.
Although the commonness of sexual behaviour varies by country and culture, the relationships between sexual and non-sexual risk behaviours and the function of psychosocial modulators may follow similar patterns. A previous study has identified factors associated with sexual risk behaviour among adolescents (ever had sex, early sexual debut, no condom use, and no contraceptive use), and they include male sex, older age, substance use, psychological distress, school truancy, and a lack of parental and peer support. Substance abuse has been connected to a higher chance of youths participating in unsafe sexual practices. When comparing youths who use substances to those who do not, studies show that those who use substances are more likely to engage in early sexual intercourse, have many sexual partners, and use condoms at a lesser rate[17, 18]. Few studies have been undertaken among Liberian youths to investigate the link between risky sexual behaviours and substance abuse. One study revealed no link between alcohol consumption and transactional sex,while another identified a link between alcohol consumption and having several sexual partners-but no other substances were investigated. Other drugs, such as marijuana, cocaine, stimulants such as methamphetamines, have been linked to risky sexual behaviours in adolescence[7, 20, 21].
Sierra Leone and Liberia are neighbouring countries that have shared unique history. Both countries populations have experienced civil war and, most recently, an Ebola disease outbreak leading to profound economic hardship, psychopathologies such as posttraumatic stress disorder, depression, and psychosis as well family disruption [20, 22–24]. These mental health morbidities and family disruption were more profound among adolescents and young people, making them vulnerable to indulge in at risk behaviours such as sexual risk behaviours like early sexual debut, having multiple sexual partners, and not using condoms[10, 25, 26]. Also, the adolescent birth rate in these countries is reported to be high and above the average sub-Saharan Africa . Given such a unique background of these two countries, it is important to examine how personal, psychosocial, and protective factors influence sexual risk behaviour, especially among adolescents. Currently, there is limited national data on sexual risk behaviour and related risk factors among only adolescents. Most studies conducted in these countries are either community based or are among adolescents and adults combined [7, 19, 28, 29]. Knowing the prevalence of sexual behaviour and the risk factors associated with it among teenagers in Sierra Leone and Liberia can aid in developing intervention programs aimed at delaying sexual initiation and encouraging "safer sex." As a result, the goal of this study was to assess the prevalence and determinants of sexual risk behaviours among school-aged adolescents in Sierra Leone and Liberia using their 2017 Sierra Leone and Liberia Global school health survey (GSHS).