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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Mental health, childhood abuse and HIV sexual risk behaviour among university students in Ivory Coast</title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="I1">HIV/AIDS, STI and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I2">Department of Psychology, University of Limpopo, Turfloop, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I3">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Pengpid, Supa" sort="Pengpid, Supa" uniqKey="Pengpid S" first="Supa" last="Pengpid">Supa Pengpid</name><affiliation><nlm:aff id="I2">Department of Psychology, University of Limpopo, Turfloop, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I3">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Tiembre, Issaka" sort="Tiembre, Issaka" uniqKey="Tiembre I" first="Issaka" last="Tiembre">Issaka Tiembre</name><affiliation><nlm:aff id="I4">Institut National d'Hygiène Publique, Université Félix Houphouët Boigny de Cocody, Abidjan, Bp V 14, Ivory Coast</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23758850</idno><idno type="pmc">3682872</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682872</idno><idno type="RBID">PMC:3682872</idno><idno type="doi">10.1186/1744-859X-12-18</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">001224</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001224</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mental health, childhood abuse and HIV sexual risk behaviour among university students in Ivory Coast</title><author><name sortKey="Peltzer, Karl" sort="Peltzer, Karl" uniqKey="Peltzer K" first="Karl" last="Peltzer">Karl Peltzer</name><affiliation><nlm:aff id="I1">HIV/AIDS, STI and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I2">Department of Psychology, University of Limpopo, Turfloop, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I3">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Pengpid, Supa" sort="Pengpid, Supa" uniqKey="Pengpid S" first="Supa" last="Pengpid">Supa Pengpid</name><affiliation><nlm:aff id="I2">Department of Psychology, University of Limpopo, Turfloop, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="I3">ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</nlm:aff></affiliation></author><author><name sortKey="Tiembre, Issaka" sort="Tiembre, Issaka" uniqKey="Tiembre I" first="Issaka" last="Tiembre">Issaka Tiembre</name><affiliation><nlm:aff id="I4">Institut National d'Hygiène Publique, Université Félix Houphouët Boigny de Cocody, Abidjan, Bp V 14, Ivory Coast</nlm:aff></affiliation></author></analytic><series><title level="j">Annals of General Psychiatry</title><idno type="eISSN">1744-859X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Little focus has been paid to the role of poor mental health and childhood abuse among young people with regard to human immunodeficiency virus (HIV) risk behaviour and HIV prevention in Africa. The aim of this study was to determine the association between mental health, childhood abuse and HIV sexual risk behaviour among a sample of university students in Ivory Coast.</p></sec><sec><title>Methods</title><p>A cross-sectional survey was conducted with undergraduate students that were recruited randomly from classes at the Félix Houphouët Boigny University of Cocody. The sample included 824 university students (50% men and 50% women), with a mean age of 23.7 years (SD = 2.7).</p></sec><sec><title>Results</title><p>Of the 824 university students who completed the survey, 17.6% reported depression, 10.8% screened positive for post-traumatic stress disorder, 8.3% reported at least monthly heavy episodic drinking, 13.5% reported childhood physical abuse and 4.7% sexual abuse, 33.9% had two or more sexual partners in the past 12 months, 66.3% had inconsistent condom use, 23.6% had alcohol use in the context of sex and 16.7% had a history of a sexually transmitted infection In multivariable analysis among men, lack of religiousness and alcohol use in the context of sex were associated with HIV risk behaviour, and among women, poorer family background, experience of sexual and physical partner violence, alcohol use in the context of sex and depression were associated with HIV risk behaviour.</p></sec><sec><title>Conclusions</title><p>Poor mental health (depression) including alcohol use and partner violence was found to be associated with HIV risk behaviour. Coordinated mental health and sexual and reproductive health services to meet the needs of university students would be desirable.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Toure, B" uniqKey="Toure B">B Toure</name></author><author><name sortKey="Koffi, K" uniqKey="Koffi K">K Koffi</name></author><author><name sortKey="Kouassi Gohou, V" uniqKey="Kouassi Gohou V">V Kouassi-Gohou</name></author><author><name sortKey="Kokoun, E" uniqKey="Kokoun E">E Kokoun</name></author><author><name sortKey="Angbo Effi, O" uniqKey="Angbo Effi O">O Angbo-Effi</name></author><author><name sortKey="Koffi, Nm" uniqKey="Koffi N">NM Koffi</name></author><author><name sortKey="Diarra Nam, Aj" uniqKey="Diarra Nam A">AJ Diarra-Nam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patel, V" uniqKey="Patel V">V 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Gen Psychiatry</journal-id><journal-id journal-id-type="iso-abbrev">Ann Gen Psychiatry</journal-id><journal-title-group><journal-title>Annals of General Psychiatry</journal-title></journal-title-group><issn pub-type="epub">1744-859X</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23758850</article-id><article-id pub-id-type="pmc">3682872</article-id><article-id pub-id-type="publisher-id">1744-859X-12-18</article-id><article-id pub-id-type="doi">10.1186/1744-859X-12-18</article-id><article-categories><subj-group subj-group-type="heading"><subject>Primary Research</subject></subj-group></article-categories><title-group><article-title>Mental health, childhood abuse and HIV sexual risk behaviour among university students in Ivory Coast</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Peltzer</surname><given-names>Karl</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><xref ref-type="aff" rid="I3">3</xref><email>kpeltzer@hrsc.ac.za</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Pengpid</surname><given-names>Supa</given-names></name><xref ref-type="aff" rid="I2">2</xref><xref ref-type="aff" rid="I3">3</xref><email>supaprom@yahoo.com</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Tiembre</surname><given-names>Issaka</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>itiembre@yahoo.fr</email></contrib></contrib-group><aff id="I1"><label>1</label>HIV/AIDS, STI and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, South Africa</aff><aff id="I2"><label>2</label>Department of Psychology, University of Limpopo, Turfloop, South Africa</aff><aff id="I3"><label>3</label>ASEAN Institute for Health Development, Madidol University, Salaya, Phutthamonthon, Nakhonpathom 73170, Thailand</aff><aff id="I4"><label>4</label>Institut National d'Hygiène Publique, Université Félix Houphouët Boigny de Cocody, Abidjan, Bp V 14, Ivory Coast</aff><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>11</day><month>6</month><year>2013</year></pub-date><volume>12</volume><fpage>18</fpage><lpage>18</lpage><history><date date-type="received"><day>9</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>24</day><month>5</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 Peltzer et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Peltzer et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.annals-general-psychiatry.com/content/12/1/18"></self-uri><abstract><sec><title>Background</title><p>Little focus has been paid to the role of poor mental health and childhood abuse among young people with regard to human immunodeficiency virus (HIV) risk behaviour and HIV prevention in Africa. The aim of this study was to determine the association between mental health, childhood abuse and HIV sexual risk behaviour among a sample of university students in Ivory Coast.</p></sec><sec><title>Methods</title><p>A cross-sectional survey was conducted with undergraduate students that were recruited randomly from classes at the Félix Houphouët Boigny University of Cocody. The sample included 824 university students (50% men and 50% women), with a mean age of 23.7 years (SD = 2.7).</p></sec><sec><title>Results</title><p>Of the 824 university students who completed the survey, 17.6% reported depression, 10.8% screened positive for post-traumatic stress disorder, 8.3% reported at least monthly heavy episodic drinking, 13.5% reported childhood physical abuse and 4.7% sexual abuse, 33.9% had two or more sexual partners in the past 12 months, 66.3% had inconsistent condom use, 23.6% had alcohol use in the context of sex and 16.7% had a history of a sexually transmitted infection In multivariable analysis among men, lack of religiousness and alcohol use in the context of sex were associated with HIV risk behaviour, and among women, poorer family background, experience of sexual and physical partner violence, alcohol use in the context of sex and depression were associated with HIV risk behaviour.</p></sec><sec><title>Conclusions</title><p>Poor mental health (depression) including alcohol use and partner violence was found to be associated with HIV risk behaviour. Coordinated mental health and sexual and reproductive health services to meet the needs of university students would be desirable.</p></sec></abstract></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>The infection rate of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in Ivory Coast is estimated at 7.1% in adults ages 15–49. Ivory Coast has a generalised HIV epidemic with the highest prevalence rate in the West African region. Populations at comparatively high risk for HIV infection include women ages 20–24 and youth
[<xref ref-type="bibr" rid="B1">1</xref>]. High HIV risk behaviour has been reported among youth in Abidjan, Ivory Coast
[<xref ref-type="bibr" rid="B2">2</xref>].</p><p>Poor mental health is a major cause of morbidity in middle-income countries, with depression constituting the heaviest disease burden
[<xref ref-type="bibr" rid="B3">3</xref>]. The HIV epidemic contributes to increased depression rates both in persons who live with HIV
[<xref ref-type="bibr" rid="B4">4</xref>] and in those who are indirectly affected by HIV/AIDS
[<xref ref-type="bibr" rid="B5">5</xref>]. Several reviews in the general population indicate that there may be a relationship between poor mental health including substance use and childhood abuse and HIV risk behaviour such as multiple sexual partners and unprotected sex
[<xref ref-type="bibr" rid="B6">6</xref>-<xref ref-type="bibr" rid="B15">15</xref>].</p><p>Studies with university students found that anxiety
[<xref ref-type="bibr" rid="B16">16</xref>], depression
[<xref ref-type="bibr" rid="B16">16</xref>,<xref ref-type="bibr" rid="B17">17</xref>], psychological distress
[<xref ref-type="bibr" rid="B17">17</xref>], alcohol use
[<xref ref-type="bibr" rid="B17">17</xref>-<xref ref-type="bibr" rid="B22">22</xref>], drug use
[<xref ref-type="bibr" rid="B21">21</xref>,<xref ref-type="bibr" rid="B22">22</xref>] and traumatic experiences
[<xref ref-type="bibr" rid="B23">23</xref>], in particular childhood abuse, physical abuse and especially sexual abuse
[<xref ref-type="bibr" rid="B24">24</xref>], were associated with various forms of HIV risk behaviour. Currently, there is no sufficient data on university students regarding the association between mental disorders, childhood abuse and HIV sexual risk behaviour within the West African context. Therefore, the aim of this study was to determine the association between mental health, childhood abuse and HIV sexual risk behaviour among Félix Houphouët Boigny University undergraduate students in Ivory Coast.</p></sec><sec sec-type="methods"><title>Methods</title><sec><title>Sample and procedure</title><p>A cross-sectional survey design was used. An anonymous, self-administered questionnaire was used to collect data. Concerning the sampling procedure, we conducted a simple random sampling, stratified and weighted on the size of units of training and research (UTR) of Félix Houphouët Boigny University. Indeed, from the size of the different units of training and research (faculties), we determined the percentage weight of each unit training and research (faculty) compared to the total number of students at the Félix Houphouët Boigny University. Then, we assigned this percentage to 800 students in question, which gave us the number of student per unit training and research or faculty. In each UTR, we conducted a simple random sample rate. Permission to carry out the study was obtained from the President of Félix Houphouët Boigny University and ethical clearance was also taken. The cover pages of the questionnaires briefly explained about the study and provided instructions to the respondents on how to fill it up. It also provided information about the researchers. It also mentioned that anonymity and confidentiality would be maintained and that the participation of students was voluntary. It specified that data would be used only for research purposes. Written informed consent was taken from participating students, and the study was conducted from 7 January to 8 February 2013.</p></sec><sec><title>Measures</title><sec><title>Traumatic experiences</title><p>Participants were asked if they had ever been hit by a sex partner, forced to have sex, physically abused as a child, sexually abused as a child and diagnosed as HIV positive. Traumatic experience items were coded as yes/no
[<xref ref-type="bibr" rid="B25">25</xref>].</p></sec><sec><title>Post-traumatic stress disorder</title><p>A seven-item screener (<italic>α</italic> = 0.77) was used to identify post-traumatic stress disorder (PTSD) symptoms in the past month
[<xref ref-type="bibr" rid="B25">25</xref>,<xref ref-type="bibr" rid="B26">26</xref>]. Items asked whether the respondent had experienced difficulties related to a traumatic experience (e.g., ‘Did you begin to feel more isolated and distant from other people?’ and ‘Did you become jumpy or get easily startled by ordinary noises or movements?’). Consistent with epidemiological evidence, participants who answered affirmatively to at least four of the questions were considered to have a positive screen for PTSD
[<xref ref-type="bibr" rid="B25">25</xref>,<xref ref-type="bibr" rid="B26">26</xref>].</p></sec><sec><title>Depressive symptoms</title><p>We assessed <italic>depressive symptoms</italic> using the ten-item version of the Center for Epidemiologic Studies Depression (CES-D) scale
[<xref ref-type="bibr" rid="B27">27</xref>]. While the CES-D ten-item survey has not been directly compared to clinical diagnosis of major depression, the sensitivity and specificity of the CES-D 20-item survey has been reported to average 80% and 70%, respectively, compared to formal diagnostic interview
[<xref ref-type="bibr" rid="B28">28</xref>]. Scoring is classified from 0 to 9 as having mild level of depressive symptoms, 10 to 14 as moderate depressive symptoms, and ≥15 representing severe depressive symptoms
[<xref ref-type="bibr" rid="B29">29</xref>]. The Cronbach <italic>α</italic> reliability coefficient of this ten-item scale was 0.72 in this study.</p></sec><sec><title>Alcohol consumption</title><p><italic>Alcohol</italic> consumption was measured by asking participants which of the following terms best described them: non-drinker, special occasion drinker, occasional and regular drinker. Occasional and regular drinkers were asked, ‘how often do you have (for men) five or more and (for women) four or more drinks on one occasion?’ Response options ranged from 1 = never to 5 = daily or almost daily.</p><p>HIV risk behaviour items were developed based on literature review
[<xref ref-type="bibr" rid="B25">25</xref>,<xref ref-type="bibr" rid="B30">30</xref>,<xref ref-type="bibr" rid="B31">31</xref>] and assessed four components of HIV risk, number of sexual partners, protected or unprotected sexual intercourse, alcohol use in the context of sex and history of a sexually transmitted infection (STI). HIV risk behaviour, therefore, was assessed with four items, number of sexual partners in the past 12 months, condom use consistency in the past 3 months with primary partner, alcohol use in the context of sex in the past 3 months and ever having been diagnosed with an STI.</p><p>Socioeconomic background was assessed by having students rate their family background as wealthy (within the highest 25% in Ivory Coast, in terms of wealth), quite well off (within the 50% to 75% range for their country), not very well off (within the 25% to 50% range from Ivory Coast) or quite poor (within the lowest 25% in their country, in terms of wealth). We subsequently divided the students into poorer (not very well off and quite poor) and wealthier (wealthy, quite well off) categories.</p></sec><sec><title>Religiousness</title><p><italic>Religiousness</italic> was assessed with the five-item Duke University Religion Index (DUREL)
[<xref ref-type="bibr" rid="B32">32</xref>]. The instrument assesses the three major dimensions of religiosity: organizational religious activity, non-organizational religious activity, and intrinsic religiosity (or subjective religiosity)
[<xref ref-type="bibr" rid="B33">33</xref>]. The DUREL measures each of these dimensions by a ‘separate subscale’ , and correlations with health outcomes are analysed by subscale in separate models
[<xref ref-type="bibr" rid="B33">33</xref>]. Cronbach alpha for the intrinsic religiosity scale was 0.60 for this sample.</p></sec></sec><sec><title>Data analysis</title><p>The data were analysed using IBM SPSS (version 20.0). First, gender differences were analysed for all variables using chi-square tests. Since there were significant gender differences on a number of variables, subsequent models were analysed separately for men and women. Second, logistic regression analyses were done to identify traumatic experiences that were in bivariate analysis associated with a positive screen for PTSD and a positive screen for depression
[<xref ref-type="bibr" rid="B25">25</xref>]. Third, logistic regression was used to identify factors that were associated with HIV risk behaviour. Predictor variables were entered in a single step.</p></sec></sec><sec sec-type="results"><title>Results</title><sec><title>Sample characteristics</title><p>Of the 860 students approached for the study, 824 agreed to participate in the survey (96% response rate). The sample included 824 university students (50% men and 50% women), with a mean age of 23.7 years (SD = 2.7), 43.2% studying in their first year, 22.8% second year, 21.6% third year and 12.4% fourth year, and 82.9% were from a poorer family background. Most students were, by religious affiliation, Christians (77.6%) and Muslims (17.5%). Regarding mental health, 17.6% reported depression, 10.8% screened positive for PTSD and 8.3% reported at least monthly heavy episodic drinking. Childhood physical abuse was 13.5% and sexual abuse 4.7%. High HIV risk behaviour was reported: 33.9% had two or more sexual partners in the past 12 months, 66.3% had inconsistent condom use, 23.6% had alcohol use in the context of sex and 16.7% had a history of a STI. Both women and men indicated that they were subjected to partner violence, with 21.2% of women reporting sexual violence. Few (1.1%) indicated that they were HIV positive (see Table
<xref ref-type="table" rid="T1">1</xref>).</p><table-wrap position="float" id="T1"><label>Table 1</label><caption><p>Sample characteristics</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col><col align="right"></col></colgroup><thead valign="top"><tr><th align="left" valign="bottom"><bold>Variable</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Total (</bold><bold><italic>n</italic></bold><bold>= 824)</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Men (</bold><bold><italic>n</italic></bold><bold>= 412)</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Women (</bold><bold><italic>n</italic></bold><bold>= 412)</bold><hr></hr></th><th align="right" valign="bottom"><bold>Statistic</bold><hr></hr></th></tr><tr><th align="left"> </th><th align="left" char="."><bold>Number</bold></th><th align="left" char="."><bold>SD (%)</bold></th><th align="left" char="."><bold>Number</bold></th><th align="left" char="."><bold>SD (%)</bold></th><th align="left" char="."><bold>Number</bold></th><th align="left" char="."><bold>SD (%)</bold></th><th align="right"> </th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom">Socio-demographics<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Age (years)<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">18–22<hr></hr></td><td align="left" valign="bottom" char=".">272<hr></hr></td><td align="left" valign="bottom" char=".">33.0<hr></hr></td><td align="left" valign="bottom" char=".">114<hr></hr></td><td align="left" valign="bottom" char=".">27.7<hr></hr></td><td align="left" valign="bottom" char=".">158<hr></hr></td><td align="left" valign="bottom" char=".">38.3<hr></hr></td><td rowspan="3" align="right" valign="bottom">0.005<hr></hr></td></tr><tr><td align="left" valign="bottom">23–25<hr></hr></td><td align="left" valign="bottom" char=".">325<hr></hr></td><td align="left" valign="bottom" char=".">39.4<hr></hr></td><td align="left" valign="bottom" char=".">177<hr></hr></td><td align="left" valign="bottom" char=".">43.0<hr></hr></td><td align="left" valign="bottom" char=".">148<hr></hr></td><td align="left" valign="bottom" char=".">35.9<hr></hr></td></tr><tr><td align="left" valign="bottom">26–30<hr></hr></td><td align="left" valign="bottom" char=".">227<hr></hr></td><td align="left" valign="bottom" char=".">27.5<hr></hr></td><td align="left" valign="bottom" char=".">121<hr></hr></td><td align="left" valign="bottom" char=".">29.4<hr></hr></td><td align="left" valign="bottom" char=".">106<hr></hr></td><td align="left" valign="bottom" char=".">25.7<hr></hr></td></tr><tr><td align="left" valign="bottom">Family background<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Quite poor<hr></hr></td><td align="left" valign="bottom" char=".">162<hr></hr></td><td align="left" valign="bottom" char=".">20.6<hr></hr></td><td align="left" valign="bottom" char=".">108<hr></hr></td><td align="left" valign="bottom" char=".">27.7<hr></hr></td><td align="left" valign="bottom" char=".">54<hr></hr></td><td align="left" valign="bottom" char=".">13.7<hr></hr></td><td rowspan="3" align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Not very well off<hr></hr></td><td align="left" valign="bottom" char=".">489<hr></hr></td><td align="left" valign="bottom" char=".">62.3<hr></hr></td><td align="left" valign="bottom" char=".">236<hr></hr></td><td align="left" valign="bottom" char=".">60.5<hr></hr></td><td align="left" valign="bottom" char=".">253<hr></hr></td><td align="left" valign="bottom" char=".">64.1<hr></hr></td></tr><tr><td align="left" valign="bottom">Quite well off, wealthy<hr></hr></td><td align="left" valign="bottom" char=".">134<hr></hr></td><td align="left" valign="bottom" char=".">17.1<hr></hr></td><td align="left" valign="bottom" char=".">46<hr></hr></td><td align="left" valign="bottom" char=".">11.8<hr></hr></td><td align="left" valign="bottom" char=".">88<hr></hr></td><td align="left" valign="bottom" char=".">22.3<hr></hr></td></tr><tr><td align="left" valign="bottom">Religious affiliation<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Muslim<hr></hr></td><td align="left" valign="bottom" char=".">144<hr></hr></td><td align="left" valign="bottom" char=".">17.5<hr></hr></td><td align="left" valign="bottom" char=".">72<hr></hr></td><td align="left" valign="bottom" char=".">17.5<hr></hr></td><td align="left" valign="bottom" char=".">72<hr></hr></td><td align="left" valign="bottom" char=".">17.5<hr></hr></td><td rowspan="5" align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Protestant<hr></hr></td><td align="left" valign="bottom" char=".">301<hr></hr></td><td align="left" valign="bottom" char=".">36.5<hr></hr></td><td align="left" valign="bottom" char=".">169<hr></hr></td><td align="left" valign="bottom" char=".">41.0<hr></hr></td><td align="left" valign="bottom" char=".">132<hr></hr></td><td align="left" valign="bottom" char=".">32.0<hr></hr></td></tr><tr><td align="left" valign="bottom">Catholic<hr></hr></td><td align="left" valign="bottom" char=".">339<hr></hr></td><td align="left" valign="bottom" char=".">41.1<hr></hr></td><td align="left" valign="bottom" char=".">140<hr></hr></td><td align="left" valign="bottom" char=".">34.0<hr></hr></td><td align="left" valign="bottom" char=".">199<hr></hr></td><td align="left" valign="bottom" char=".">48.3<hr></hr></td></tr><tr><td align="left" valign="bottom">Others<hr></hr></td><td align="left" valign="bottom" char=".">40<hr></hr></td><td align="left" valign="bottom" char=".">4.9<hr></hr></td><td align="left" valign="bottom" char=".">31<hr></hr></td><td align="left" valign="bottom" char=".">7.5<hr></hr></td><td align="left" valign="bottom" char=".">9<hr></hr></td><td align="left" valign="bottom" char=".">2.2<hr></hr></td></tr><tr><td align="left" valign="bottom">Religiousness<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">4.9<hr></hr></td><td align="left" valign="bottom" char=".">1.3<hr></hr></td><td align="left" valign="bottom" char=".">4.8<hr></hr></td><td align="left" valign="bottom" char=".">1.4<hr></hr></td><td align="left" valign="bottom" char=".">5.0<hr></hr></td><td align="left" valign="bottom" char=".">1.2<hr></hr></td><td align="right" valign="bottom">0.027<hr></hr></td></tr><tr><td align="left" valign="bottom">Non-organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">3.5<hr></hr></td><td align="left" valign="bottom" char=".">1.9<hr></hr></td><td align="left" valign="bottom" char=".">3.3<hr></hr></td><td align="left" valign="bottom" char=".">1.9<hr></hr></td><td align="left" valign="bottom" char=".">3.8<hr></hr></td><td align="left" valign="bottom" char=".">1.8<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Intrinsic religiosity<hr></hr></td><td align="left" valign="bottom" char=".">16.2<hr></hr></td><td align="left" valign="bottom" char=".">2.1<hr></hr></td><td align="left" valign="bottom" char=".">15.9<hr></hr></td><td align="left" valign="bottom" char=".">2.2<hr></hr></td><td align="left" valign="bottom" char=".">16.4<hr></hr></td><td align="left" valign="bottom" char=".">1.9<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Traumatic experiences<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been hit by a sex partner<hr></hr></td><td align="left" valign="bottom" char=".">53<hr></hr></td><td align="left" valign="bottom" char=".">7.2<hr></hr></td><td align="left" valign="bottom" char=".">14<hr></hr></td><td align="left" valign="bottom" char=".">3.9<hr></hr></td><td align="left" valign="bottom" char=".">39<hr></hr></td><td align="left" valign="bottom" char=".">10.3<hr></hr></td><td align="right" valign="bottom">0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been forced to have sex<hr></hr></td><td align="left" valign="bottom" char=".">109<hr></hr></td><td align="left" valign="bottom" char=".">14.7<hr></hr></td><td align="left" valign="bottom" char=".">29<hr></hr></td><td align="left" valign="bottom" char=".">7.9<hr></hr></td><td align="left" valign="bottom" char=".">80<hr></hr></td><td align="left" valign="bottom" char=".">21.2<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Physically abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">99<hr></hr></td><td align="left" valign="bottom" char=".">13.5<hr></hr></td><td align="left" valign="bottom" char=".">65<hr></hr></td><td align="left" valign="bottom" char=".">17.7<hr></hr></td><td align="left" valign="bottom" char=".">34<hr></hr></td><td align="left" valign="bottom" char=".">9.2<hr></hr></td><td align="right" valign="bottom">0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Sexually abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">35<hr></hr></td><td align="left" valign="bottom" char=".">4.7<hr></hr></td><td align="left" valign="bottom" char=".">14<hr></hr></td><td align="left" valign="bottom" char=".">3.8<hr></hr></td><td align="left" valign="bottom" char=".">21<hr></hr></td><td align="left" valign="bottom" char=".">5.6<hr></hr></td><td align="right" valign="bottom">0.258<hr></hr></td></tr><tr><td align="left" valign="bottom">HIV positive<hr></hr></td><td align="left" valign="bottom" char=".">8<hr></hr></td><td align="left" valign="bottom" char=".">1.1<hr></hr></td><td align="left" valign="bottom" char=".">4<hr></hr></td><td align="left" valign="bottom" char=".">1.1<hr></hr></td><td align="left" valign="bottom" char=".">4<hr></hr></td><td align="left" valign="bottom" char=".">1.1<hr></hr></td><td align="right" valign="bottom">0.997<hr></hr></td></tr><tr><td align="left" valign="bottom">Mental health<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Screened positive for depression<hr></hr></td><td align="left" valign="bottom" char=".">143<hr></hr></td><td align="left" valign="bottom" char=".">17.6<hr></hr></td><td align="left" valign="bottom" char=".">63<hr></hr></td><td align="left" valign="bottom" char=".">15.4<hr></hr></td><td align="left" valign="bottom" char=".">80<hr></hr></td><td align="left" valign="bottom" char=".">19.8<hr></hr></td><td align="right" valign="bottom">0.228<hr></hr></td></tr><tr><td align="left" valign="bottom">Screened positive for PTSD<hr></hr></td><td align="left" valign="bottom" char=".">88<hr></hr></td><td align="left" valign="bottom" char=".">10.8<hr></hr></td><td align="left" valign="bottom" char=".">38<hr></hr></td><td align="left" valign="bottom" char=".">9.4<hr></hr></td><td align="left" valign="bottom" char=".">50<hr></hr></td><td align="left" valign="bottom" char=".">12.3<hr></hr></td><td align="right" valign="bottom">0.240<hr></hr></td></tr><tr><td align="left" valign="bottom">Heavy episodic drinking<hr></hr></td><td align="left" valign="bottom" char=".">68<hr></hr></td><td align="left" valign="bottom" char=".">8.3<hr></hr></td><td align="left" valign="bottom" char=".">55<hr></hr></td><td align="left" valign="bottom" char=".">13.3<hr></hr></td><td align="left" valign="bottom" char=".">13<hr></hr></td><td align="left" valign="bottom" char=".">3.2<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">HIV risk<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="right" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Two or more sexual partners<hr></hr></td><td align="left" valign="bottom" char=".">261<hr></hr></td><td align="left" valign="bottom" char=".">33.9<hr></hr></td><td align="left" valign="bottom" char=".">177<hr></hr></td><td align="left" valign="bottom" char=".">45.5<hr></hr></td><td align="left" valign="bottom" char=".">84<hr></hr></td><td align="left" valign="bottom" char=".">22.1<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left" valign="bottom">Inconsistent condom use<hr></hr></td><td align="left" valign="bottom" char=".">430<hr></hr></td><td align="left" valign="bottom" char=".">66.3<hr></hr></td><td align="left" valign="bottom" char=".">207<hr></hr></td><td align="left" valign="bottom" char=".">61.8<hr></hr></td><td align="left" valign="bottom" char=".">223<hr></hr></td><td align="left" valign="bottom" char=".">71.0<hr></hr></td><td align="right" valign="bottom">0.013<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol in the context of sex<hr></hr></td><td align="left" valign="bottom" char=".">171<hr></hr></td><td align="left" valign="bottom" char=".">23.6<hr></hr></td><td align="left" valign="bottom" char=".">110<hr></hr></td><td align="left" valign="bottom" char=".">30.0<hr></hr></td><td align="left" valign="bottom" char=".">61<hr></hr></td><td align="left" valign="bottom" char=".">17.1<hr></hr></td><td align="right" valign="bottom"><0.001<hr></hr></td></tr><tr><td align="left">History of STI</td><td align="left" char=".">122</td><td align="left" char=".">16.7</td><td align="left" char=".">50</td><td align="left" char=".">13.8</td><td align="left" char=".">72</td><td align="left" char=".">19.6</td><td align="right">0.036</td></tr></tbody></table></table-wrap><sec><title>Predictors of multiple sexual partners</title><p>In bivariate analysis among men, lack of organised and non-organised religious activities, lack of intrinsic religiosity, heavy episodic drinking, alcohol use in the context of sex and having screening positive for depression were associated with two or more sexual partners in the past 12 months. In multivariate analysis among men, lack of non-organised religious activity and alcohol use in the context of sex were associated with two or more sexual partners in the past 12 months. Further, in bivariate analysis among women, poorer family background, lack of non-organised religious activity, lack of intrinsic religiosity, experience of physical and sexual partner violence and alcohol use in the context of sex were associated with two or more sexual partners in the past 12 months. In multivariate analysis among women, poorer family background, experience of sexual partner violence and alcohol use in the context of sex were associated with two or more sexual partners in the past 12 months. Among both men and women, childhood physical and sexual abuse was not found to be associated with multiple sexual partners (see Table
<xref ref-type="table" rid="T2">2</xref>).</p><table-wrap position="float" id="T2"><label>Table 2</label><caption><p>Logistic regression analyses predicting multiple sexual partners</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="top"><tr><th align="left" valign="bottom"><bold>Variable</bold><hr></hr></th><th colspan="2" align="left" valign="bottom"><bold>Men</bold><hr></hr></th><th colspan="2" align="left" valign="bottom"><bold>Women</bold><hr></hr></th></tr><tr><th align="left"> </th><th align="left"><bold>Crude odds ratio (95% CI)</bold></th><th align="left"><bold>Adjusted odds ratio (95% CI)</bold></th><th align="left"><bold>Crude odds ratio (95% CI)</bold></th><th align="left"><bold>Adjusted odds ratio (95% CI)</bold></th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom">Socio-demographics<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Age (years)<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">18–22<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">23–25<hr></hr></td><td align="left" valign="bottom">1.30 (0.80–2.13)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.72 (0.96–3.06)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">26–30<hr></hr></td><td align="left" valign="bottom">1.16 (0.69–1.97)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.63 (0.86–3.08)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Family background<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Quite poor<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td></tr><tr><td align="left" valign="bottom">Not very well off<hr></hr></td><td align="left" valign="bottom">0.99 (0.61–1.59)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">0.52 (0.27–1.00)*<hr></hr></td><td align="left" valign="bottom">0.45 (0.20–1.02)<hr></hr></td></tr><tr><td align="left" valign="bottom">Quite well off, wealthy<hr></hr></td><td align="left" valign="bottom">0.86 (0.42–1.76)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">0.47 (0.21–1.05)<hr></hr></td><td align="left" valign="bottom">0.35 (0.12–0.99)*<hr></hr></td></tr><tr><td align="left" valign="bottom">Religious affiliation<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Muslim<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Protestant<hr></hr></td><td align="left" valign="bottom">0.59 (0.34–1.05)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">0.59 (0.27–1.29)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Catholic<hr></hr></td><td align="left" valign="bottom">1.26 (0.71–2.25)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.39 (0.71–2.72)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Others<hr></hr></td><td align="left" valign="bottom">0.93 (0.39–2.18)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.21 (0.22–6.69)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Religiousness<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Organised religious activity<hr></hr></td><td align="left" valign="bottom">0.78 (0.67–0.96)***<hr></hr></td><td align="left" valign="bottom">1.11 (0.84–1.45)<hr></hr></td><td align="left" valign="bottom">0.86 (0.70–1.05)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Non-organised religious activity<hr></hr></td><td align="left" valign="bottom">0.79 (0.70–0.89)***<hr></hr></td><td align="left" valign="bottom">0.79 (0.65–0.97)*<hr></hr></td><td align="left" valign="bottom">0.87 (0.76–1.00)*<hr></hr></td><td align="left" valign="bottom">0.88 (0.75–1.05)<hr></hr></td></tr><tr><td align="left" valign="bottom">Intrinsic religiosity<hr></hr></td><td align="left" valign="bottom">0.54 (0.35–0.83)**<hr></hr></td><td align="left" valign="bottom">0.59 (0.31–1.13)<hr></hr></td><td align="left" valign="bottom">0.56 (0.33–0.95)*<hr></hr></td><td align="left" valign="bottom">0.73 (0.39–1.39)<hr></hr></td></tr><tr><td align="left" valign="bottom">Traumatic experiences<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been hit by a sex partner<hr></hr></td><td align="left" valign="bottom">1.81 (0.58–5.66)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">2.04 (1.00–4.21)*<hr></hr></td><td align="left" valign="bottom">1.21 (0.48–3.06)<hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been forced to have sex<hr></hr></td><td align="left" valign="bottom">1.34 (0.62–2.91)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">2.99 (1.72–5.19)***<hr></hr></td><td align="left" valign="bottom">2.53 (1.25–5.12)**<hr></hr></td></tr><tr><td align="left" valign="bottom">Physically abused as a child<hr></hr></td><td align="left" valign="bottom">0.96 (0.56–1.66)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.12 (0.48–2.59)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Sexually abused as a child<hr></hr></td><td align="left" valign="bottom">1.54 (0.53–4.56)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.52 (0.56–4.10)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Diagnosed HIV positive<hr></hr></td><td align="left" valign="bottom">0.00<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td><td align="left" valign="bottom">1.17 (0.12–11.36)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Heavy episodic drinking<hr></hr></td><td align="left" valign="bottom">2.66 (1.45–4.88)**<hr></hr></td><td align="left" valign="bottom">2.17 (0.82–5.73)<hr></hr></td><td align="left" valign="bottom">2.42 (0.67–8.77)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use in the context of sex<hr></hr></td><td align="left" valign="bottom">2.62 (1.64–4.18)***<hr></hr></td><td align="left" valign="bottom">2.78 (1.39–5.58)**<hr></hr></td><td align="left" valign="bottom">4.13 (2.27–7.50)***<hr></hr></td><td align="left" valign="bottom">3.07 (1.50–6.29)**<hr></hr></td></tr><tr><td align="left" valign="bottom">Mental health<hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td><td align="left" valign="bottom"> <hr></hr></td></tr><tr><td align="left" valign="bottom">Screened positive for depression<hr></hr></td><td align="left" valign="bottom">1.88 (1.00–3.48)*<hr></hr></td><td align="left" valign="bottom">2.24 (0.89–5.65)<hr></hr></td><td align="left" valign="bottom">1.55 (0.81–2.93)<hr></hr></td><td align="left" valign="bottom">–<hr></hr></td></tr><tr><td align="left">Screened positive for PTSD</td><td align="left">0.54 (0.24–1.20)</td><td align="left">–</td><td align="left">1.36 (0.62–2.98)</td><td align="left">–</td></tr></tbody></table><table-wrap-foot><p>*<italic>P</italic> < .05; **<italic>P</italic> < .01; ***<italic>P</italic> < .001.</p></table-wrap-foot></table-wrap></sec><sec><title>Predictors of inconsistent condom use</title><p>In bivariate analysis among men, only other religious affiliation was associated with inconsistent condom use in the past 3 months. Further, in bivariate analysis among women, experience of physical and sexual partner violence was associated with inconsistent condom use in the past 3 months. In multivariate analysis among women, experience of physical partner violence remained associated with inconsistent condom use in the past 3 months (see Table
<xref ref-type="table" rid="T3">3</xref>).</p><table-wrap position="float" id="T3"><label>Table 3</label><caption><p>Logistic regression analyses predicting inconsistent condom use</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col></colgroup><thead valign="top"><tr><th align="left" valign="bottom"><bold>Variable</bold><hr></hr></th><th align="left" valign="bottom" char="."><bold>Men</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Women</bold><hr></hr></th></tr><tr><th align="left"> </th><th align="left" char="."><bold>Crude odds ratio (95% CI)</bold></th><th align="left" char="."><bold>Crude odds ratio (95% CI)</bold></th><th align="left" char="."><bold>Adjusted odds ratio (95% CI)</bold></th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom">Socio-demographics<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Age (years)<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">18–22<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">23–25<hr></hr></td><td align="left" valign="bottom" char=".">1.01 (0.59–1.75)<hr></hr></td><td align="left" valign="bottom" char=".">1.16 (0.66–2.04)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">26–30<hr></hr></td><td align="left" valign="bottom" char=".">1.02 (0.57–1.81)<hr></hr></td><td align="left" valign="bottom" char=".">1.42 (0.76–2.66)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Family background<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Quite poor<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Not very well off<hr></hr></td><td align="left" valign="bottom" char=".">1.11 (0.65–1.88)<hr></hr></td><td align="left" valign="bottom" char=".">1.50 (0.74–3.05)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Quite well off, wealthy<hr></hr></td><td align="left" valign="bottom" char=".">1.66 (0.74–3.72)<hr></hr></td><td align="left" valign="bottom" char=".">1.42 (0.63–3.20)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Religious affiliation<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Muslim<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Protestant<hr></hr></td><td align="left" valign="bottom" char=".">1.86 (0.98–3.51)<hr></hr></td><td align="left" valign="bottom" char=".">2.09 (0.97–4.52)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Catholic<hr></hr></td><td align="left" valign="bottom" char=".">1.69 (0.89–3.22)<hr></hr></td><td align="left" valign="bottom" char=".">0.98 (0.51–1.88)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Others<hr></hr></td><td align="left" valign="bottom" char=".">3.28 (1.14–9.47)*<hr></hr></td><td align="left" valign="bottom" char=".">0.97 (0.16–5.82)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Religiousness<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">0.93 (0.78–1.10)<hr></hr></td><td align="left" valign="bottom" char=".">1.19 (0.97–1.45)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Non-organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">0.93 (0.82–1.05)<hr></hr></td><td align="left" valign="bottom" char=".">1.09 (0.95–1.26)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Intrinsic religiosity<hr></hr></td><td align="left" valign="bottom" char=".">0.83 (0.52–1.32)<hr></hr></td><td align="left" valign="bottom" char=".">1.22 (0.72–2.08)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Traumatic experiences<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been hit by a sex partner<hr></hr></td><td align="left" valign="bottom" char=".">1.28 (0.38–4.34)<hr></hr></td><td align="left" valign="bottom" char=".">2.64 (1.00–6.05)*<hr></hr></td><td align="left" valign="bottom" char=".">5.62 (1.29–24.57)*<hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been forced to have sex<hr></hr></td><td align="left" valign="bottom" char=".">1.53 (0.61–3.80)<hr></hr></td><td align="left" valign="bottom" char=".">1.94 (1.02–3.75)*<hr></hr></td><td align="left" valign="bottom" char=".">1.49 (0.73–3.04)<hr></hr></td></tr><tr><td align="left" valign="bottom">Physically abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">0.96 (0.54–1.72)<hr></hr></td><td align="left" valign="bottom" char=".">1.03 (0.41–2.57)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Sexually abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">3.56 (0.78–16.37)<hr></hr></td><td align="left" valign="bottom" char=".">0.81 (0.29–2.23)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Diagnosed HIV positive<hr></hr></td><td align="left" valign="bottom" char=".">0.00<hr></hr></td><td align="left" valign="bottom" char=".">0.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Heavy episodic drinking<hr></hr></td><td align="left" valign="bottom" char=".">1.28 (0.68–2.41)<hr></hr></td><td align="left" valign="bottom" char=".">0.56 (0.17–1.80)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use in the context of sex<hr></hr></td><td align="left" valign="bottom" char=".">1.02 (0.63–1.66)<hr></hr></td><td align="left" valign="bottom" char=".">0.84 (0.45–1.55)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Mental health<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Screened positive for depression<hr></hr></td><td align="left" valign="bottom" char=".">0.69 (0.35–1.36)<hr></hr></td><td align="left" valign="bottom" char=".">1.04 (0.54–2.01)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left">Screened positive for PTSD</td><td align="left" char=".">0.89 (0.39–2.04)</td><td align="left" char=".">1.13 (0.48–2.68)</td><td align="left" char=".">–</td></tr></tbody></table><table-wrap-foot><p>*<italic>P</italic> < .05.</p></table-wrap-foot></table-wrap></sec><sec><title>Predictors of history of STI</title><p>In bivariate analysis among men, lack of non-organised religious activity and alcohol use in the context of sex were associated with a history of STI, while in multivariate analysis, lack of non-organised religious activity remained associated with a history of STI. Further, in bivariate analysis among women, alcohol use in the context of sex and having screened positive with depression were associated with a history of STI, while multivariate analysis having screened positive with depression remained associated with a history of STI (see Table
<xref ref-type="table" rid="T4">4</xref>).</p><table-wrap position="float" id="T4"><label>Table 4</label><caption><p>Logistic regression analyses predicting history of STI</p></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col><col align="left" char="."></col></colgroup><thead valign="top"><tr><th align="left" valign="bottom"><bold>Variable</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Men</bold><hr></hr></th><th colspan="2" align="left" valign="bottom" char="."><bold>Women</bold><hr></hr></th></tr><tr><th align="left"> </th><th align="left" char="."><bold>Crude odds ratio (95% CI)</bold></th><th align="left" char="."><bold>Adjusted odds ratio (95% CI)</bold></th><th align="left" char="."><bold>Crude odds ratio (95% CI)</bold></th><th align="left" char="."><bold>Adjusted odds ratio (95% CI)</bold></th></tr></thead><tbody valign="top"><tr><td align="left" valign="bottom">Socio-demographics<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Age<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">18–22<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">23–25<hr></hr></td><td align="left" valign="bottom" char=".">1.54 (0.68–3.51)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.51 (0.82–2.77)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">26–30<hr></hr></td><td align="left" valign="bottom" char=".">1.85 (0.79–4.30)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.26 (0.65–2.44)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Family background<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Quite poor<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Not very well off<hr></hr></td><td align="left" valign="bottom" char=".">0.72 (0.37–1.42)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.88 (0.42–1.88)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Quite well off, wealthy<hr></hr></td><td align="left" valign="bottom" char=".">0.83 (0.30–2.31)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.49 (0.19–1.25)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Religious affiliation<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Muslim<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Protestant<hr></hr></td><td align="left" valign="bottom" char=".">1.65 (0.64–4.31)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.08 (0.47–2.47)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Catholic<hr></hr></td><td align="left" valign="bottom" char=".">1.50 (0.56–3.99)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.45 (0.68–3.12)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Others<hr></hr></td><td align="left" valign="bottom" char=".">1.41 (0.37–5.43)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.00<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Religiousness<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">1.00 (0.80–1.24)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.82 (0.66–1.01)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Non-organised religious activity<hr></hr></td><td align="left" valign="bottom" char=".">0.84 (0.70–1.00)*<hr></hr></td><td align="left" valign="bottom" char=".">0.82 (0.68–0.99)*<hr></hr></td><td align="left" valign="bottom" char=".">0.90 (0.78–1.04)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Intrinsic religiosity<hr></hr></td><td align="left" valign="bottom" char=".">0.77 (0.40–1.47)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.95 (0.55–1.66)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Traumatic experiences<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been hit by a sex partner<hr></hr></td><td align="left" valign="bottom" char=".">2.03 (0.53–7.78)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.97 (0.41–2.31)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Ever been forced to have sex<hr></hr></td><td align="left" valign="bottom" char=".">1.12 (0.37–3.41)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.75 (0.98–3.13)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Physically abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">0.88 (0.39–1.99)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.63 (0.72–3.68)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Sexually abused as a child<hr></hr></td><td align="left" valign="bottom" char=".">1.84 (0.49–6.94)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.12 (0.36–3.49)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Diagnosed HIV positive<hr></hr></td><td align="left" valign="bottom" char=".">3.05 (0.77–34.34)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">1.42 (0.15–13.84)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Heavy episodic drinking<hr></hr></td><td align="left" valign="bottom" char=".">1.53 (0.71–3.28)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">0.74 (0.16–3.42)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td></tr><tr><td align="left" valign="bottom">Alcohol use in the context of sex<hr></hr></td><td align="left" valign="bottom" char=".">1.96 (1.05–3.66)*<hr></hr></td><td align="left" valign="bottom" char=".">1.67 (0.87–3.19)<hr></hr></td><td align="left" valign="bottom" char=".">1.92 (1.01–3.64)*<hr></hr></td><td align="left" valign="bottom" char=".">1.68 (0.57–3.24)<hr></hr></td></tr><tr><td align="left" valign="bottom">Mental health<hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td><td align="left" valign="bottom" char="."> <hr></hr></td></tr><tr><td align="left" valign="bottom">Screened positive for depression<hr></hr></td><td align="left" valign="bottom" char=".">1.55 (0.67–3.58)<hr></hr></td><td align="left" valign="bottom" char=".">–<hr></hr></td><td align="left" valign="bottom" char=".">2.17 (1.17–4.03)*<hr></hr></td><td align="left" valign="bottom" char=".">1.99 (1.03–3.85)*<hr></hr></td></tr><tr><td align="left">Screened positive for PTSD</td><td align="left" char=".">1.54 (0.59–4.02)</td><td align="left" char=".">–</td><td align="left" char=".">1.75 (0.81–3.76)</td><td align="left" char=".">–</td></tr></tbody></table><table-wrap-foot><p>*<italic>P</italic> < .05.</p></table-wrap-foot></table-wrap></sec></sec></sec><sec sec-type="discussion"><title>Discussion</title><p>This study found a high prevalence of poor mental health (depression and PTSD symptoms), high reported childhood physical and sexual abuse and high HIV risk behaviour (multiple sexual partners, unprotected sex, alcohol in the context of sex and history of STI) among a sample of university students in Ivory Coast. The high prevalence of HIV risk behaviour is calling for HIV prevention intervention programs among university students.</p><p>The prevalence of depression and PTSD was similar to other studies in Africa
[<xref ref-type="bibr" rid="B16">16</xref>,<xref ref-type="bibr" rid="B34">34</xref>-<xref ref-type="bibr" rid="B36">36</xref>]. The study found that poor mental health (depression) including alcohol use was associated with HIV risk behaviour among this sample of university students in Ivory Coast. This finding is in concordance with previous studies among university students
[<xref ref-type="bibr" rid="B16">16</xref>,<xref ref-type="bibr" rid="B17">17</xref>,<xref ref-type="bibr" rid="B19">19</xref>-<xref ref-type="bibr" rid="B23">23</xref>]. While associations between alcohol use
[<xref ref-type="bibr" rid="B17">17</xref>-<xref ref-type="bibr" rid="B22">22</xref>] and HIV risk behaviours have previously been found among university students, the mechanisms explaining the association between alcohol use and HIV risk behaviours in this setting are not fully understood
[<xref ref-type="bibr" rid="B17">17</xref>]. Alcohol use in the context of sex and binge drinking seem to be associated in particular with indiscriminate forms of risky sex (e.g., having multiple or casual sex partners), which is keeping with the studies of American college populations
[<xref ref-type="bibr" rid="B37">37</xref>,<xref ref-type="bibr" rid="B38">38</xref>].</p><p>The prevalence of childhood physical and sexual abuse was in this study (17.7% and 9.2% physical abuse among men and women, respectively, and 3.8% and 5.6% sexual abuse among men and women, respectively) similar to what was found in community samples in South Africa, Tanzania and Zimbabwe (14.9%–27.4% and 4.3%–15.6% physical abuse among men and women, respectively, and 1.6%–4.5% and 2.4%–4.9% sexual abuse among men and women, respectively)
[<xref ref-type="bibr" rid="B15">15</xref>]. Contrary to some other studies
[<xref ref-type="bibr" rid="B15">15</xref>,<xref ref-type="bibr" rid="B24">24</xref>,<xref ref-type="bibr" rid="B39">39</xref>], this study did not find an association between childhood physical and sexual abuse and HIV risk behaviour. The study found that among women, the experience of physical and/or sexual partner violence was associated with HIV risk behaviour. As found in other studies
[<xref ref-type="bibr" rid="B23">23</xref>,<xref ref-type="bibr" rid="B40">40</xref>-<xref ref-type="bibr" rid="B44">44</xref>] women who experience intimate partner violence are at risk for HIV through high-risk heterosexual contact. Overall, poor mental health, traumatic experiences and substance use may synergistically interact to increase HIV risk behaviour
[<xref ref-type="bibr" rid="B26">26</xref>].</p><p>The study found that among men, lack of religiousness was associated with HIV risk behaviour (multiple sexual partners and history of STI), but it was not associated with condom use. Similarly, in a study among university students in Uganda for those who rated religion as less important in their family, the probability of having a high number of lifetime partners increased significantly, while the role of religion seemed to have no impact on condom use
[<xref ref-type="bibr" rid="B45">45</xref>]. Religious beliefs and attitudes on sexual matters appear to have considerable influence on the sexual conduct of young men in the Ivory Coast
[<xref ref-type="bibr" rid="B46">46</xref>] which can be utilised for HIV prevention programs. Finally, women from poorer family backgrounds were more likely to be engaging in sex with multiple partners. It is possible that students from poorer backgrounds engage more likely in transactional sex
[<xref ref-type="bibr" rid="B47">47</xref>].</p><sec><title>Study limitations</title><p>Limitation pertains to the generalizability of the study results, where caution should be taken when interpreting these results, as only full-time undergraduate students between the ages of 18 to 30 years were included in this study. It is unknown to what extents these findings can be generalised to part-time or non-resident students. The data used in the study were obtained by self-report which could have been the result of desired participants' responses. Although the study was anonymous, the sensitive nature of the items related to sexual behaviour could have an impact on the participants' responses. Moreover, this study was based on the data collected in a cross-sectional survey. We cannot, therefore, ascribe causality to any of the associated factors in the study. A further limitation was that certain mental health measures were brief screenings and may be interpreted only as indicators of poor mental health
[<xref ref-type="bibr" rid="B26">26</xref>,<xref ref-type="bibr" rid="B27">27</xref>]. In addition, the study did not screen for the history of severe mental illness, which has been found to be associated with HIV risk behaviour
[<xref ref-type="bibr" rid="B44">44</xref>], and should be included in future studies.</p></sec></sec><sec sec-type="conclusions"><title>Conclusions</title><p>High rates of depression, PTSD, childhood abuse and HIV risk behaviour were found among the studied university student population. Poor mental health (depression) including alcohol use and partner violence was associated with HIV risk behaviour. Coordinated mental health and sexual and reproductive health services to meet the needs of university students would be desirable.</p></sec><sec><title>Competing interests</title><p>The authors declare that they have no competing interests.</p></sec><sec><title>Authors' contributions</title><p>KP was the main contributor to the conceptualization of the study. KP and SP contributed significantly to the first draft of the paper, and KP, SP and IT contributed to the subsequent drafts and finalization. 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