Abstract
Objective:
Sexual and reproductive health services for disabled students are an important aspect of ensuring their overall well-being and empowerment. Therefore, the aim of this study was to assess the magnitude of risky sexual behavior and its associated factors among students with disabilities in higher academic institutions of Debre Markos city.
Methods:
An institution-based cross-sectional study was conducted among 168 study subjects with disabilities in higher academic institutions in Debre Markos city. The data were collected from November 5, 2024 to January 25, 2025, by using interviewer-administered structured questionnaires. Training for data collectors was conducted to maintain the quality of the data. The data were analyzed using SPSS version 20 software. Descriptive statistics with both bivariable and multivariable logistic regression were performed to estimate the crude and adjusted odds ratio with a 95% confidence interval.
Results:
The overall magnitude of risky sexual behavior among disabled students at higher academic institutions in Debre Markos city was 48 (28.6%). The mean (standard deviation) age of the participants was 24.7 (4.9), and 120 (71.4%) were male respondents. Sex (AOR = 0.125; 95% CI: 0.04–0.41), age group under 20 (AOR = 0.101; 95% CI: 0.02–0.59) and 21–24 years (AOR = 0.095; 95% CI: 0.03–0.31), religion (AOR = 0.132; 95% CI: 0.02–0.75), and place of residence (AOR = 4.129; 95% CI: 1.78–9.57) were significantly associated with risky sexual behavior.
Conclusion and recommendation:
Considerable proportions of students were engaged in risky sexual behavior and have an association with sex, age, religion, and place of residence. Interventions are needed for those female disabled students, aged greater than 25 years, Muslim religion followers, and urban residents to reduce the risky sexual behavior.
Keywords: disability, higher academic institution, risky sexual behavior, Ethiopia
Introduction
The number of persons with disabilities is expanding globally; of these, people are largely in developing nations. They are routinely excluded from social, cultural, educational, and economic possibilities, which leave them among the world’s most disadvantaged and marginalized young people.1,2 Ethiopia does not currently have a national survey on disabilities. However, 805,492 individuals with disabilities were listed in Ethiopia’s 2007 national population and housing census report. 3 Nonetheless, a recent global study by the World Health Organization calculated that at least 15% of each given country’s age cohort consists of impaired people.4,5 There could be 3.9 million disabled individuals in Ethiopia, according to this estimate of the entire population. 6
Individuals with disabilities are at greater risk for engaging in risky sexual behaviors due to various factors, including financial dependency, reliance on others for daily needs, and negative perceptions of their impairments.7,8 “Risky sexual behavior” refers to actions that increase the likelihood of negative health outcomes related to sexual activity, such as unprotected intercourse, multiple partners, substance use during sexual encounters, and engaging in sexual activities without adequate knowledge or consent. 9 This heightened vulnerability makes disabled students more susceptible to sexual abuse and exploitation, largely due to their dependence on caregivers. To ensure the well-being and empowerment of disabled students, it is critical to provide comprehensive, accessible, and inclusive sexual health education, alongside effective prevention strategies and reporting systems. 10
Studies indicate varying prevalence rates of risky sexual behavior among individuals with disabilities, influenced by factors such as gender, disability types, and cultural contexts. However, the study conducted in Ethiopia gives a general overview to understand the magnitude of risky sexual behavior by a pooled estimate of 40%. 11 According to a study done in Ethiopia, young individuals with impairments who were sexually active were engaging in dangerous sexual practices. Seventy-five percent of the study participants began having sex between the ages of 15 and 19.12,13
Riskier sexual activity is exhibited by various proportions of students, including 14.7% in Jiga preparatory and high schools, 30.5% in Mekelle town’s private colleges, and 83.5% at the Shire campus in Axum.14–16 Research from Northern Uganda revealed that around 17% of study participants had a risky sexual behavior in the 12 months preceding the survey. 17 And overall, 7.6% sexually active youth with physical disabilities in Accra, Ghana, and were engaged in risky sexual behavior at some point in their lives. 18
Research has indicated a connection between drugs, alcohol, smoking, and unsafe sexual activity among adolescents.19,20 Risky sexual conduct is more common in adolescents who have undergone abuse and antisocial behaviors. A number of other factors have also been linked to this behavior, including financial condition, unemployment, friends who are sexually active, unstable families, and differences in age, gender, and race. 21 In addition to this alcohol, social support, and substance-related factors affect the sexual behavior. 22
In order to better understand the issue and develop preventative efforts, it may be helpful to acknowledge the current state of affairs, challenges that are faced, and knowledge gaps that result from the risky sexual conduct of individuals with disabilities. Despite global efforts to promote sexual health and rights, there remains a significant gap in understanding the sexual behaviors and health outcomes of individuals with disabilities, particularly in higher education settings.
Students in higher education frequently become more independent and are subjected to peer and social pressures, which can influence their sexual choices. Students with disabilities are a vulnerable group because they may encounter additional obstacles when trying to access sexual and reproductive health information and services in these settings. In order to inform focused interventions and inclusive health policies, it is crucial to investigate risky sexual behavior in higher education settings. 23 To address current gaps and empower impaired students to make educated decisions regarding their sexual health, it is pertinent and appropriate to assess the level of risky sexual behavior. The prevalence of risky sexual behavior and related factors among impaired students in higher education institutions in Ethiopia has not been studied. Therefore, this study aims to assess the magnitude of risky sexual behavior and its associated factors among disabilities in higher academic institutions of Debre Markos City.
Methods
Study design, period, and setting
An institution-based cross-sectional study was conducted from November 5, 2024 to January 25, 2025. The study was conducted in Debre Markos City higher academic institutions. Debre Markos city is located in the Amhara National Regional State in northwest Ethiopia. It is 265 km from Bahir Dar, the regional capital, and 300 km from Addis Ababa. 24
Sampling procedure
The stratified sampling technique was used to identify institutions that could be included in this study. The strata include nine private academic colleges, one government-run polytechnic college, one university, and a preparatory school. Using a simple random sampling method, we selected three private colleges and the rest by using a purposive sampling technique. Hence, the total numbers of students with disabilities in these institutions were small; we used the census method.
Source population
The source population for this study was all students with disabilities in higher academic institutions in Debre Markos city.
Inclusion criteria
All students with disabilities are from three private colleges: Debre Markos University, Debre Markos Polytechnique, and Debre Markos Preparatory school.
Exclusion criteria
Those with severe illnesses and who were unable to avail themselves during the data collection period were not included in the study.
Dependent variable
The outcome variable for this study was risky sexual behavior among students with disabilities in higher academic institutions in Debre Markos City.
Independent variables
Sociodemographic factors: Age, sex, religion, residency, disability type, marital status, and family monthly income.
Behavioral factors: Peer pressure, consuming alcohol, using a condom during sex, HIV test, sexual intercourse with a commercial sex worker, having sex under the influence of alcohol.
Operational definition
Risky sexual behavior: A student was described as engaging in risky sexual behavior if they did at least one of the following: had multiple sexual partners; had sex without a condom with a partner; had sex before the age of 18; had sexual intercourse with commercial sex workers; and had sex under the influence of alcohol. 25 Therefore, we classified as binary “yes” for those participated in risky sexual behavior, and “no” for those not participated in risky sexual behavior.
Multiple sexual partners: A student who had more than one sexual partner in the last 12 months prior to the study. 26
Peer pressure: Peer pressure was measured as a dichotomous variable, coded as “Yes” if the respondent reported experiencing peer influence to engage in sexual activity, and “No” if they did not report such influence. 19
Data collection tools, procedure, and quality control
Structured, interviewer-administered questionnaires were used to gather quantitative data by the tool tailored to students with disabilities of any type, which was adapted from a previous study and adjusted to fit our context. The first draft of the questionnaire was prepared in English. Then, the first draft English version was translated to Amharic and back to English by language experts to check consistency and conceptual similarity. Finally, the Amharic version of the questionnaire was used to collect data. Four master’s degree holders collected the data, and a senior lecturer supervised the data collection process. A 2-day training was given for facilitators and supervisors on the objective of the study, data collection procedures, data collecting tools, respondents’ approach, data confidentiality, and respondents’ rights before the data collection date. The completeness of the questionnaires, the overall quality of the data collected, and the daily status of the data collector were checked every day by the supervisors and investigator. Before the actual data collection, prior to the main data collection, a pilot study was conducted with 15 students from Injibara University. The tool’s validity and internal consistency were assessed using Cronbach’s alpha. Based on the pretest findings, adjustments were made to the questionnaire.
Data processing and analysis
The collected data were entered and cleaned using the latest version of Epi Data Version 3.1. After that, it was exported to IBM SPSS Statistics version 26, IBM Corporation under its Data and AI (Analytics) software division for analysis. Descriptive analyses were computed for all variables in the study to present descriptive data. Bivariable and multivariable analysis with adjusted odds ratio (AOR) was used to measure the association of dependent and independent variables, 95% confidence intervals, and p-value was calculated to evaluate statistical significance. Variables with a p-value of ⩽0.25 on bivariate logistic regression analysis were entered and further computed on the multivariable logistic regression model. 27 AORs and 95% confidence intervals were calculated for each of the independent variables in logistic regression models. The goodness of fit of the model was assessed using Hosmer–Lemeshow’s statistical test, and multicollinearity test was performed for the variables included in the final multivariable model by using variance inflation factors, and no significant multicollinearity was detected among the variables included in the multivariable analysis.
Ethical approval and consent to participate
The study protocol was reviewed and obtained from the research ethical review committee of Debre Markos University with reference number DMU/RTTD/880/10/2024. After ensuring ethical clearance, informed written consent was obtained from each study participant after telling them the objective of the study. They were also informed about the benefits of the study. The data collection was anonymous, and the information was kept confidential.
Results
Sociodemographic characteristics of study participants
From the total number of participants, this study includes 168 disabled students with a 96% response rate. The mean (SD) age of the participants was 24.7 (4.9), and 120 (71.4%) were male respondents. The very highest numbers of respondents were orthodox in religion, with 160 (95.2%). Over half of the respondents, 96 (57.1%), were rural residents, and 120 (71.4%) respondents were single in their marital status. About 105 (62.5%) respondents were visually impaired, followed by physical disability, 59 (31%), and the majority, 96 (57.1%), of family monthly incomes were less than 5000 Ethiopian birr (Table 1).
Table 1.
Sociodemographic characteristics of disabled students at Debre Markos city (N = 168).
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Age | <20 years | 20 | 11.9 |
| 21–24 years | 72 | 42.9 | |
| >25 years | 76 | 45.2 | |
| Sex | Male | 120 | 71.4 |
| Female | 148 | 28.6 | |
| Religion | Orthodox | 160 | 95.2 |
| Muslim | 8 | 4.8 | |
| Residency | Rural | 96 | 57.1 |
| Urban | 72 | 42.9 | |
| Disability type | Visual impairment | 105 | 62.5 |
| Hearing impairment | 4 | 2.4 | |
| Mobility impairment | 59 | 35.1 | |
| Marital status | Single | 120 | 71.4 |
| Married | 36 | 21.4 | |
| Divorced | 12 | 7.1 | |
| Family monthly income | ⩾5000 | 96 | 57.1 |
| 5000–10,000 | 60 | 35.7 | |
| 10,000–15,000 | 8 | 4.8 | |
| >15,000 | 4 | 2.4 |
Sexual-related behaviors of participants
Of the total respondents, 50% reported that they had ever had sexual intercourse prior to the survey. Among those who had initiated sexual encounters, 16% had their first sexual intercourse before the age of 18 years. As shown in Figure 1, the primary reason for initiating sexual intercourse before the age of 18 was mostly attributed to falling in love (76.2%), followed by seeking pleasure (38.1%). About 9.5% of respondents reported that seeking experience and revenge was a reason for early sexual encounters, while financial incentives were less influential in prompting early initiation. Therefore, this illustrates that early initiation of sex was mainly driven by emotional and psychosocial motivations such as love and pleasure. The findings of this study further explored that among students with disabilities, 78.6% of respondents had tested for HIV, and also about 64.3% and 42.9% of respondents reported that they consumed alcohol and were influenced by peer pressures, respectively (Table 2).
Figure 1.
Reason for early initiation of sex among disabled students at Debre Markos city.
Table 2.
Sexual-related characteristics of disabled students at Debre Markos city (N = 168).
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Ever had sex | Yes | 84 | 50 |
| No | 84 | 50 | |
| Age at first sex | <18 years | 16 | 19 |
| >18 years | 68 | 81 | |
| Number of sexual partner in the last 12 month | One and no partner | 80 | 95.2 |
| Two and above | 4 | 4.8 | |
| Peer pressure | No | 96 | 57.1 |
| Yes | 72 | 42.9 | |
| Consuming alcohol | No | 60 | 35.7 |
| Yes | 108 | 64.3 | |
| Using condom during sex | Yes | 68 | 81 |
| No | 16 | 19 | |
| Tasted for HIV | Yes | 132 | 78.6 |
| No | 36 | 21.4 | |
| Sexual intercourse with commercial sex worker | Yes | 4 | 4.8 |
| No | 80 | 95.2 | |
| Having sex under influence of alcohol | No | 68 | 81 |
| Yes | 16 | 19 | |
| Risky sexual behavior | No | 120 | 71.4 |
| Yes | 48 | 28.6 |
Prevalence of risky sexual behaviors
The overall magnitude of risky sexual behavior among higher educational institution students in Debre Markos city was found to be 28.6%. Among disabled students who ever had practiced sexual intercourse, only 4.8% of them had sex with multiple partners and commercial sex workers. Of those participants who had experienced sexual intercourse, 19% had performed sex under the influence of alcohol and used a condom during their sexual intercourse (Table 2).
Factors associated with risky sexual behavior among disabled students in Debre Markos city
Bi-variable logistic regression was done for variables such as age, sex, religion, alcohol use, peer pressure, HIV test result, and place of residency at p-value < 0.25 to identify possible factors for multivariable logistic regression analysis. After adjusting for possible confounders in the multivariate logistic regression analysis, factors like age, sex, religion, and place of residency were associated with risky sexual behavior of study participants at p-value < 0.05. Place of residence was one of the significant factors associated with risky sexual behavior; respondents who were living in urban areas were 4.129 times more likely to participate in risky sexual behavior as compared to rural residents (AOR = 4.129; 95% CI: 1.78–9.57). Sex was also another significant factor associated with risky sexual behavior. AORs showed that male participants had lower odds (0.125; AOR = 0.125; 95% CI: 0.04–0.41) of risky sexual behavior than those female study participants. Another variable that was found to be associated with risky sexual behavior was religion. Participants who were orthodox in religion were 0.132 times less likely to participate in risky sexual behavior as compared to Muslim participants (AOR = 0.132; 95% CI: 0.02–0.75). Those disabled students in the age groups under 20 and 21–24 years were 0.101 times (AOR = 0.101; 95% CI: 0.02–0.59) and 0.095 times (AOR = 0.095; 95% CI: 0.03–0.31) less likely to practice risky sexual behavior as compared to those in the age group above 25 years (Table 3).
Table 3.
Bi-variable and multivariable logistic regression analysis for disabled students in Debre Markos city (N = 168).
| Variable | Category | Risky sexual behavior | COR (95% CI) | AOR (95% CI) | p-Value | |
|---|---|---|---|---|---|---|
| Not risky | Risky | |||||
| Sex | Male | 89 | 31 | 0.635 (0.31–1.30) | 0.125 (0.04–0.41) | 0.001 |
| Female | 31 | 17 | 1 | 1 | ||
| Religion | Orthodox | 116 | 44 | 0.38 (0.09–1.58) | 0.132 (0.02–0.75) | 0.023 |
| Muslim | 4 | 4 | 1 | 1 | ||
| Age | Under 20 years | 16 | 4 | 0.34 (0.11–1.13) | 0.101 (0.02–0.59) | 0.011 |
| 21–24 years | 60 | 12 | 0.28 (0.13–0.59) | 0.095 (0.03–0.31) | <0.001 | |
| Above 25 years | 44 | 32 | 1 | 1 | ||
| Place of residency | Urban | 44 | 28 | 2.42 (1.22–4.79) | 4.129 (1.78–9.57) | 0.001 |
| Rural | 76 | 20 | 1 | 1 | ||
| Peer pressure | No | 72 | 24 | 0.67 (0.34–1.31) | 0.452 (0.19–1.07) | 0.071 |
| Yes | 48 | 24 | 1 | 1 | ||
| Alcohol | No | 47 | 13 | 0.58 (0.28–1.20) | 0.894 (0.33–2.44) | 0.827 |
| Yes | 73 | 35 | 1 | 1 | ||
| HIV test | Yes | 88 | 44 | 0.25 (0.08–0.75) | 1.382 (0.39–4.95) | 0.619 |
| No | 32 | 4 | 1 | |||
AOR: adjusted odds ratio; COR: crude odds ratio.
Discussion
This institution-based cross-sectional study examined the magnitude of risky sexual behavior and associated factors among disabled students in Debre Markos higher academic institutions. The study found an overall prevalence of risky sexual behavior of 28.6% among all the study participants and 57.2% among those who had sexual intercourse. About 50% of the study participants were found to have ever had sexual intercourse, and 19% of them had initiated sex before 18 years of age.
Based on this study finding, students with disabilities were engaged in risky sexual behavior, implying that they were at higher risk of sexually transmitted diseases, including HIV/AIDS. It is also found that age, place of residence, sex, and religion were the main identified associated factors for risky sexual behavior.
This study revealed that the coverage of students’ risky sexual behaviors was highest compared to findings from Ethiopia (19.5%), 27 Axum Town (17.2%), 22 Bahirdar City (24.2%), 28 and from Africa, Uganda (17.1%), 29 and from the global study 13%. 20 On the other hand, this study was lower than the study conducted in Northwest Ethiopia, Gondar city (49.3%), 30 Hawasa (34.4%), 25 and northeast Ethiopia, Shewa Robit Town (49.7%), 31 and from India. 32
The disparity may be due to differences in the methods used to measure risky sexual behavior, the study participants, sample sizes, and educational levels. For instance, studies conducted in Hawassa and six randomly selected public universities across Ethiopia focused on university students, while those in Axum, Gondar, and Shewa Robit targeted high school and preparatory school students, that is, the type of the study participant brings the variation in the result of the study. Additionally, our study had a smaller sample size compared to previous studies, as there were a limited number of source populations.
Another factor contributing to the differences is the approach used to assess risky sexual behavior, with most studies using similar composite variables such as the number of sexual partners, inconsistent condom use, early sexual initiation, and sex with commercial sex workers. But the number of variables varied from three to five. Additionally when we see variation from African, and global studies, study conducted in Uganda indicates lower risky sexual behavior than our study because, study participant were 15–24 years aged only. Another global study shows the result of risky sexual behavior without association to alcohol and tobacco.
Regarding factors affecting risky sexual behavior among students with disabilities in Debre Markos City higher academic institutions, the age of participants is significantly associated with risky sexual behavior, where participants below the age of 20 and 21–24 years were less likely to practice risky sexual behavior as compared to those aged above 25 years. This finding is similar to studies conducted in Ethiopia among university students. 27 This might be due to the cultural and religious aspects that discourage early initiation of sex and sex before marriage, and also disabled students cannot get enough opportunities to participate in sexual activities when compared with normal students.
This study showed that the male disabled students were less likely to practice risky sexual behavior than the female. This finding is also supported by another study conducted in Ethiopia, Dilla town 33 and from Norway. 34 In contrast, studies from Bahirdar revealed that females had lower odds of participating in risky sexual behavior than males. 28
The alteration may be attributed to variation in participants; from studies conducted in Bahirdar, the city population was a big construction site daily laborer and male. Additionally, respondents who were living in urban areas were more likely to participate in risky sexual behavior as compared to rural residents; this may create an opportunity for male participant to have sexual activities. In our case, the study participants are disabled students; therefore, female disabled students can have a higher opportunity to participate in sexual activities than male students. This is because in Ethiopian culture males should have to get permission and interest from the female side to have sexual intercourse, and also this study is supported by another study conducted in Ethiopia 35 and China. 36
In our study, participants’ religion was another significantly associated factor with risky sexual behavior. Participants who were orthodox in religion were less likely to participate in risky sexual behavior as compared to Muslim participants; this study is consistent with a study conducted in Ethiopia.25,37 The possible explanation for this result may be variation in religious practice or rules on the marriage program. Sometimes Muslim religious practice supports the marriage of one male with more than one wife, whereas orthodox Christianity supports the marriage of one male to one female.
Limitations
The study was a cross-sectional design; it was difficult to examine any potential temporal relationships. This study did not include a sample size calculation because a census approach was applied; a relatively small number of participants may limit the generalizability of the findings to larger populations and to rural areas or nonacademic populations. However, during data collection, we tried to collect data from all disabled students in higher academic institutions in Debre Markos city, this shows major strengths of this study.
Conclusion and recommendation
A considerable proportion of students were engaged in risky sexual behavior and influenced by sex, age, religion, and place of residence. Interventions like risky sexual targeted education and also any behavioral intervention programs are needed on the identified factors to reduce the risky sexual behavior among disabled students. Future researchers should consider a qualitative study to get a comprehensive understanding of the underlying factors.
Supplemental Material
Supplemental material, sj-docx-1-smo-10.1177_20503121251398485 for The magnitude of risky sexual behavior and its associated factors among students with disabilities in higher academic institutions of Debre Markos City, Ethiopia by Andualem Fentahun Senishaw, Zegeye Regessa, Gizaw Hailiye Teferi, Getaye Tizazu Biwota, Temesgen Feyu Desalegn and Maru Meseret Tadele in SAGE Open Medicine
Acknowledgments
The authors would like to thank data collectors and study participants for participating in the study.
Footnotes
ORCID iDs: Andualem Fentahun Senishaw 
https://orcid.org/0000-0002-6496-1391
Gizaw Hailiye Teferi
https://orcid.org/0000-0002-8187-2366
Maru Meseret Tadele
https://orcid.org/0000-0003-3613-9357
Ethical considerations: The study protocol was reviewed and obtained from the research ethical review committee of Debre Markos University. The data collection was anonymous, and the information was kept confidential.
Consent to participate: Both written and oral informed consent were obtained from each study participant prior to their participation.
Consent for publication: All authors gave their consent for the publication of this article.
Authors contributions: AFS made significant contributions to the conception, design, supervision, investigation, data analysis, interpretation, and write-up of the manuscript. ZR, GHT, GTB, TFD, and MMT contributed extensively to revising the manuscript, analysis, and interpretation, and agreed to be accountable for all aspects of the work by approving the final version of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement: The data sets used during this study will be available within the article.
Supplemental material: Supplemental material for this article is available online.
References
- 1. World Health Organization. World Report on Disability, Geneva, https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/world-report-on-disability (2011, accessed 10 August 2013). [Google Scholar]
- 2. Groce NE. Adolescents and youth with disability: issues and challenges. Asia Pac Disabil Rehabil J 2004; 15(2): 13–32. [Google Scholar]
- 3. Central Statistical Agency (CSA). Population and Housing Census 2007 Report, National (Ethiopia). CSA. https://catalog.ihsn.org/catalog/3583/related_materials (2010) [Google Scholar]
- 4. United Nations Department of Economic and Social Affairs (DESA). Youth with disabilities, http://www.un.org/disabilities (2012, accessed 14 September 2012).
- 5. Better Health Channel. Disability and sexual issues, www.betterhealth.vic.gov.au (2025, accessed 10 August 2013).
- 6. UNICEF. Case study: multidimensional approach to disability inclusion. Eastern & Southern Africa Regional Office, https://www.unicef.org/esa/media/15201/file/UNICEF-Ethopia-Case-Study-Disability-Inclusion-2024.pdf (2024, accessed 12 November 2024) [Google Scholar]
- 7. Kakchapati S, Kc SP, Giri S, et al. Factors associated with access to sexual and reproductive health services among women with disabilities in Nepal. Dialog Health 2022; 1: 100068. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Svae GB, Hassel B, Søndenaa E. People with intellectual disabilities and harmful sexual behaviour: professionals’ views on the barriers to prevent harm. J Appl Res Intellect Disabil 2023; 36(1): 176–185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Centers for Disease Control and Prevention (CDC). Sexual risk behaviors, https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm (2020).
- 10. Nosek MA, Foley CC, Hughes RB, et al. Vulnerabilities for abuse among women with disabilities. Sex Disabil 2001; 19(3): 177–189. [Google Scholar]
- 11. Aynalem BY, Alemu AA, Zeleke LB, et al. Risky sexual behavior and associated factors among secondary and above education level students in Ethiopia: a systematic review and meta analysis. Family Med Prim Care 2022; 11(9): 5024–5030. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Tenaw Z, Gari T, Gebretsadik A. Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study. BMC Public Health 2023; 23(1): 1550. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Delie AM, Fenta ET, Mehari MG, et al. Magnitude of sexual and reproductive health service utilization among youths and adolescents living with disability in Ethiopia: a systematic review and meta-analysis. Health Sci Rep 2025; 8(3): e70573. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Kassa GM, Degu G, Yitayew M, et al. Risky sexual behaviors and associated factors among Jiga High School and preparatory school students, Amhara Region, Ethiopia. Int Sch Res Notices 2016; 2016: 4315729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Kebede A, Molla B, Gerensea H. Assessment of risky sexual behavior and practice among Aksum University students, Shire Campus, Shire Town, Tigray, Ethiopia, 2017. BMC Res Notes 2018; 11(1): 88. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Gebresllasie F, Tsadik M, Berhane E. Potential predictors of risk sexual behavior among private college students in Mekelle City, North Ethiopia. Pan Afr Med J 2017; 28: 151. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Bukuluki P, Wandiembe SP, Kisaakye P, et al. The sexual behavior of young people living with a disability: findings from the KAP study. Front Reprod Health 2023; 5: 1065437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Mumuni K, Okaikwei AN, Asah-Opoku K, et al. High risk sexual behavior among young persons with physical disability from selected schools in Accra metropolitan district and Akuapim north district: a cross sectional study. World J Adv Res Rev 2023; 20(1): 337–346. [Google Scholar]
- 19. Sifer SD, Getachew MS. Risky sexual behavior and associated factors among out-of-school youths in Addis Ababa, Ethiopia; mixed methods study. Reprod Health 2024; 21(1): 77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Sun J, Zhu Y, Yang L, et al. Associations of tobacco and alcohol use with sexual behaviors among adolescents in 59 countries: a population-based study. BMC Public Health 2024; 24(1): 2474. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. World Health Organization. Programming for adolescent health and development: report of a WHO/UNFPA/UNICEF study group on programming for adolescent health. World Health Organization, 1999. [Google Scholar]
- 22. Srahbzu M, Tirfeneh E. Risky sexual behavior and associated factors among adolescents aged 15-19 years at governmental high schools in Aksum Town, Tigray, Ethiopia, 2019: an institution-based, cross-sectional study. BioMed Res Int 2020; 2020(1): 3719845. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Argenyi MS, James TG. Sexual risk behavior and sexually transmitted infections among college students with disabilities. Sex Transm Dis 2021; 48(11): 851–854. [DOI] [PubMed] [Google Scholar]
- 24. Belay M. The roles of urban agriculture for climate change adaption in the case of Debre Markos town and surrounding districts, East Gojjam Zone, Amhara Region, Ethiopia. J Earth Sci Clim Change 2021; 12(1). DOI: 10.4172/2157-7617.1000540 [Google Scholar]
- 25. Simachew Y, Oumer G, Abebe A. Risky sexual behavior and associated factors among students of Hawassa University College of Medicine and Health Science, Ethiopia 2022. Ethiop J Reprod Health 2023; 15(3): 30–37. [Google Scholar]
- 26. Adal MA, Abiy SA, Reta MM, et al. Prevalence of risky sexual behavior and associated factors among Injibara University students, Northwest Ethiopia. Front Reprod Health 2024; 6: 1356790. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Belihu WB, Amogne MD, Herder T, et al. Risky sexual behavior and associated factors among university students in Ethiopia: a cross-sectional national survey. BMC Public Health 2024; 24(1): 1701. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Mitiku KW, Yenesew MA, Bantie GM, et al. Magnitude of risky sexual practice and associated factors among big construction site daily laborers in Bahir Dar city, Amhara Region, Ethiopia. PLoS One 2020; 15(10): e0241220. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29. Bukuluki P, Wandiembe SP, Kisaakye P, et al. The sexual behavior of young people living with a disability: findings from the KAP study in Northern Uganda. Front Reprod Health 2023; 5: 1065437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Azene ZN, Tsegaye L, W/Gebriel M, et al. Risky sexual practice and associated factors among youth preparatory students in Gondar City, Northwest Ethiopia. Front Public Health 2022; 10: 843359. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Bizuwork MG, Hailu A, Taderegew MM, et al. Assessment of risky sexual behaviours and associated factors among adolescents in Shewa Robit Town, Northeast, Ethiopia: a cross-sectional study. Pan Afr Med J 2022; 41(1): 264. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32. Liu B, Zhou D, Li Z, et al. A survey on the degree of eye discomfort caused by video terminal use among college students in different altitudes. BMC Public Health 2023; 23(1): 1209. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Fikre S, Tenkolu G, Mamo ZB. Risky sexual behavior and associated factors among street youth in Dilla town, Gedeo zone, South Ethiopia, 2018. Ethiop J Health Sci 2021; 31(5): 947–954. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34. Hukkelberg SS, Bjørknes R. Gender differences in risk behaviours and risk factors: a study of Norwegian youths undergoing Multisystemic Therapy (MST). Int J Adolesc Youth 2025; 30(1): 2480711. [Google Scholar]
- 35. Diress G, Adane S, Linger M, et al. Individual and community-level determinates of risky sexual behaviors among sexually active unmarried men: a multilevel analysis of 2016 Ethiopian Demographic and Health Survey. PLoS One 2022; 17(7): e0270083. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36. Song Y, Ji CY, Hu PJ, et al. [Comparative study of sexual behaviors of high school students between urban and rural China]. Beijing Da Xue Xue Bao Yi Xue Ban 2013; 45(3): 376–381. [PubMed] [Google Scholar]
- 37. Asresie MB, Worede DT. Factors associated with risky sexual behavior among reproductive-age men in Ethiopia: evidence from Ethiopian Demography and Health Survey 2016. HIV/AIDS 2023; 15: 549–557. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental material, sj-docx-1-smo-10.1177_20503121251398485 for The magnitude of risky sexual behavior and its associated factors among students with disabilities in higher academic institutions of Debre Markos City, Ethiopia by Andualem Fentahun Senishaw, Zegeye Regessa, Gizaw Hailiye Teferi, Getaye Tizazu Biwota, Temesgen Feyu Desalegn and Maru Meseret Tadele in SAGE Open Medicine