![]() The data for these analyses, as inclusion criteria, were derived from a baseline survey administered to sixth and seventh grade students (age range = 13–19 years) attending eight high schools in Monrovia, the capital city and most urbanized commercial hub of Liberia. To our knowledge, this is the first published account of HIV/STD risk behaviors among junior high school students in post-conflict Liberia. For this paper, we analyzed the baseline data to describe the prevalence and determinants of high-risk sexual behaviors among in-school adolescents in Liberia. To improve reproductive health among adolescents, we conducted a school-level randomized trial to culturally adapt, implement, and evaluate an evidence-based HIV/STD prevention program in Liberia. With Liberian youth representing a majority of the country’s population ( LDHS, 2007), the effective delivery of skills-directed HIV/STD evidence-based prevention programs in schools to prevent risky sexual behaviors such as the strengthening of condom negotiation skills is critical to preventing the spread of HIV infections. As such, Liberia accounts for one of the highest teenage pregnancy rates in the world ( UNICEF & the New African Research and Development Agency, 2005), including a significantly high total fertility rate, with many of these pregnancies ending in abortions ( LDHS, 2007 National AIDS Commission, Republic of Liberia, 2010). Adolescent females in Liberia are particularly vulnerable to HIV a higher proportion of young women (17%) who have had sex before the age of 15 than young men (9% LDHS, 2007). Also, findings from a survey conducted by the Liberia Institute of Statistics and Geo-Information Services in four political sub-divisions (or counties) in 2008 revealed that 33% of respondents (41% females and 28% males) received money or were given gifts for sex while the use of preventive risk reduction measures such as condoms was not generally practiced ( National AIDS Commission, Republic of Liberia, 2010). Furthermore, of approximately 1,548 Liberian youth, ages 10 to 25 years, who completed a cross-sectional survey conducted by the United Nations Children’s Fund (UNICEF) and the New African Research and Development Agency (2005), 76% reported ever having had sex, with only 14% using condoms at sexual debut ( National AIDS Commission, Republic of Liberia, 2010). For example, a 2006 key informant-based needs assessment indicated that there are few, if any, structured behavioral-driven HIV/STD prevention interventions for Liberian youth and none were evidence-based programs ( Atwood, Johnson, Kennedy, & Harris, 2006). Strikingly, risky sexual behaviors among youth have also not been adequately addressed in Liberia. In addition, the difference in HIV rates between women and men was particularly strong in the younger age groups, with HIV rates among young women being 3 times higher than those of young men in the 15- to 24-year-old age group ( LDHS, 2007 National AIDS Commission, Republic of Liberia, 2010). The 2007 population-based Liberia Demographic and Health Survey (LDHS) documented an HIV prevalence rate of 1.5% among the general population ages 15 to 49 years with rates higher for women (1.8%) than for men (1.2%). The scarcity of reliable HIV prevalence data provides a blink picture of the HIV epidemic among adolescents in Liberia. Furthermore, youth residing in high poverty endemic environments tend to initiate sexual activity at earlier ages, engage in high-risk sexual behaviors, and face increased risk for a host of adverse health outcomes ( Kennedy et al., 2004 Liberia Demographic and Health Survey, 2007). Also, HIV/STD prevention programs are rarely tailored or designed to meet the needs of adolescents, and local health workers and peer educators are usually not adequately trained to implement structured behavioral-driven prevention programs ( Cowan & Pettifor, 2009 Michielsen et al., 2010 Paul-Ebhohimhen, Poobalan, & van Teijlingen, 2008). ![]() Adolescents and young adults lack access to accurate health information about reproductive health services for HIV/STD prevention, care, and support ( Kennedy et al., 2004 Kennedy et al., 2007). Contributing factors include, for example, engaging in unprotected sexual intercourse having multiple sexual partners lacking the skills to correctly and consistently use condoms, including inadequate knowledge about condom use and the unavailability of condoms and perceived invulnerability. ![]() Adolescents and young adults ages 10–24 years in Sub-Saharan Africa account for a large burden of the global HIV/sexually transmitted disease (STD) crisis ( Joint United Nations Programme on HIV/AIDS & the World Health Organization, 2009). ![]()
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