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Unsafe sexual behaviours among youth aged 18-24 in urban settings: Local study 

27 Jan 2022

  • Notes school-based sexual and reproductive health education insufficient to curb risks
BY Ruwan Laknath Jayakody Risky sexual behaviours occur among youth aged 18-24 years in urban settings, a local study found, which also noted that school based sexual and reproductive health (SRH) education has been insufficient in preparing them for their sexual debut or to avoid the unwanted consequences of sex. The same study pointed out that even though satisfactory knowledge on sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) per say is not protective, knowledge on contraceptive use which also deals with barriers for condom use is protective.  The researchers therefore emphasised that SRH education and messages have to be more targeted while healthcare services and the internet has to be utilised in such targeted interventions which also deals with the impact of pornography and the utilisation of social media for SRH needs in youth. These findings and recommendations were made by L.N. Siriwardena (Acting Consultant Venereologist at the Sexually Transmitted Diseases [STDs] clinic of Homagama) and N. Abeygunasekera (Consultant Venereologist at the STDs Clinic of Kalubowila) in a paper on “Sexual behaviour and correlates for risky sexual behaviour among youth attending government vocational training institutes in the Colombo District” which was published in the Sri Lanka Journal of Sexual Health and HIV Medicine (6) in December 2020.  Youth, as Siriwardena and Abeygunasekera observe, represent a proportion of the population that is most exposed to STIs due to early sexual discovery and initiation, and their engagement in risky sexual health-related behaviour makes them vulnerable to acquire STIs and HIV and unwanted pregnancies and other such outcomes. This vulnerability, per M. Qiaqin, M.O. Kihara, L. Cong, G. Xu, P. Xiaohong, S. Zamani, S.M. Ravari, D. Zhang, T. Homma, and M. Kihara’s “Early initiation of sexual activity: Risk factor for STDs, HIV infection, and unwanted pregnancy among university students in China” is due to biological, anatomical, and psychosocial factors associated with young age. Unprotected (without a condom) anal, vaginal, and oral intercourse is a risk factor for HIV and STIs with oral-anal contact without a barrier also being known to transmit infection. Incorrect, inconsistent, and non-use of condoms during sexual intercourse, as noted in S. Alford’s “Condom effectiveness”, is a risk factor for HIV, STIs, and unplanned pregnancies.  HIV annual data for Sri Lanka over the past few years (National STD/Acquired Immunodeficiency Syndrome [AIDS] Control Programme’s Annual Report of 2016) show more HIV infections among the 15-24-year age group. In Sri Lanka, approximately 35,000 youths get vocational education and training annually through a network of training centres under the Youth and Skills Development Ministry and nearly 16,000 of the youth thus enrolled are found to be in training centres within the Colombo District. Hence, Siriwardena and Abeygunasekera conducted a descriptive, cross-sectional study to look at the sexual behaviour and correlates for risky sexual behaviour among youth aged 18-24 years who were attending vocational training centres under the said Ministry in the Colombo District. There were 27 vocational training centres under six institutes in the Colombo District. The number of students enrolled at these centres at the time of the study was 15,942. The participants were selected randomly from the student registers in each vocational training centre.  A total of 415 students that fulfilled the inclusion criteria completed the questionnaire and were recruited as the study sample population. New recruits and part-time students were excluded. In this study, risky sexual behaviour was said to be present if the participants were, among others, having one of the following exposures: a) penetrative oral, vaginal, or anal intercourse or attempt with close genital contact and b) sex without condoms at last sexual exposure. Data was collected through a self-administered questionnaire. The majority (51%) were in the 18-20-year category. In terms of the biological sex, 52% were males. With regard to education, the majority (nearly 89%) had completed the General Certificate of Education Advanced Level (GCE A/L) or above. In terms of marital status, the majority (98%) were never married. Concerning their financial status, the majority (over 87%) were financially dependent. The majority (96%) said that they had heard of STIs and the majority (70-80%) had satisfactory or above satisfactory knowledge on STIs and HIV.  However, 40% could not name a scientific method of contraception while the majority (nearly 60%) of those who were not aware of scientific methods of contraception were females. Health services were the common source of information for STIs and contraception in 30%, with the internet being the preferred source of information on STIs for 13% and on contraception for 16%. On the issue of SRH education, nearly half/50% did not consider the SRH education provided in school as sufficient and the majority (over 50%) considered that school-based SRH education did not prepare them for their sexual debut, or to avoid STIs or unplanned pregnancies.  Nearly quarter (25%) were sexually active and 43% of them had had their sexual debut before the age of 18 years. The majority (93%) of those who were sexually experienced were not married. Regarding condom use, the majority (60%) of those who were sexually experienced had not used condoms at their sexual debut and another 14% could not remember if they had, and the majority (nearly 69%) had not used a condom at their last sexual exposure. Commonest sexual behaviour for the sexual debut was oral sex for both males (74%) and females (59%), while 10% of males who were sexually experienced had anal sex at their first sexual exposure.  One-tenth of the sexually active males had male partners in the last 12 months but only 2% had engaged in anal sex during the last 12 months. Half of the females who had ever had sex and almost all the males who had ever had sex (98%) had sexual partners in the last 12 months and 7% of them had more than one sexual partner within the last three months. The commonest last sexual exposure for unmarried males was cunnilingus (38%), followed by vaginal sex (30%), and fellatio (27%). For unmarried females, the last sexual exposure was mainly fellatio and cunnilingus (88%), while one participant had engaged in anal sex.  Only 8% and 6% of those who were sexually active were under the influence of drugs or alcohol at the time of last sexual exposure, respectively. A total of 13% had paid money for sex and nearly half of that had received gifts or money for sex at sometime during their life. Nearly 5% of those who had ever had sex had had sex without consent. Pertaining to pornography use, more than half (54%) had watched pornography in the last 12 months while 18% had used social media to seek partners in the last 12 months.  There was very strong evidence of the association between gender, the ability to generate an income, knowledge on STI prevention, knowledge on contraception, the use of pornography in the last 12 months and the use of social media to seek partners in the last 12 months and ever having had sex. Being of the male sex, the ability to earn and having knowledge on contraception were predictors of ever having had sex. The male gender was 1.56 times more likely to have had penetrative sex and the ability to earn was 1.1 times predictive towards engaging in penetrative sex and having knowledge on contraception methods was 1.36 times less predictive towards engaging in penetrative sex. Discussing the findings, Siriwardena and Abeygunasekera explained that risky sexual behaviour was seen in this youth sample despite being exposed to school-based SRH education and having satisfactory knowledge on STIs and HIV. The percentage who were sexually active in this youth group were similar to other studies conducted among university students (U.A.P. Perera and C. Abeysena’s “Prevalence and associated factors of risky sexual behaviours among undergraduate students in state universities of the Western Province in Sri Lanka: A descriptive cross-sectional study”) and national youth corps trainees (J. Vidhanapathirana, N. Wijegoonewardhana, M. Fernando, S. Nawarathna, M.A. Suranga, and M. Premachandra’s “Evidence on the knowledge and attitudes of Sri Lankan youth on SRH and their current sexual practices”).  Of those who had ever had sex, 43% had their sexual debut at or before 18 years. Oral sex is commonly practised. When queried about STI transmission through oral sex, only 41% correctly said that STIs could be acquired through oral sex. Siriwardena and Abeygunasekera opined that the reason for oral sex being practised commonly may be due to the belief that it is safer than vaginal or anal sex while the preference for oral sex among females who were not married and sexually active may also be due to sociocultural beliefs such as preserving virginity.  One-tenth of the males had anal sex in their sexual debut and one-tenth of the males had same-sex partners in the last 12 months. However, only 2% had engaged in anal sex in the last 12 months. Same-sex attraction was low among females and anal sex was also not common. Nearly 69% did not use a condom in their last sexual exposure. Condom use among these youth is very low in comparison to European studies (P.S.F. Miranda, J.M.G. Aquino, R. Monteiro, M. Dixe, A. Luz, and P. Moleiro’s “Sexual behaviours: Study in the youth”).  Oral sex being considered a safe sexual behaviour may have contributed to this, Siriwardena and Abeygunasekera observed. More than half had used pornography in the last 12 months and 18% had used the social media to find partners. Being of the male gender and financial independence were positively predictive of ever having had sex and knowledge on contraception was a negative predictor. Knowledge on HIV and STIs was not predictive of ever having had sex, which per Siriwardena and Abeygunasekera, implies that youth SRH education has to be re-evaluated. If you or someone you may know is in need of adequate information regarding safe sexual practices and/or STD/HIV testing, the following places/websites may be of assistance:  National STD/AIDS Control Programme – Sri Lanka: (011) 2 667 163/(011) 2 667 029  Family Planning Association of Sri Lanka: (011) 2 555 455  www.know4sure.lk  


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