The impact of implementation of sex education in schools, and its applicability in Kazakhstan.

Introduction Sexuality education varies considerably from abstinence-only to comprehensive sex education and can influence knowledge, attitudes, and behaviors about sexuality. We examined the relations among types of sex education, sex-positive and purity culture attitudes, and sexual and reproductive health knowledge among a group of diverse high school graduates. Methods This study captured the sexuality knowledge and attitudes pursuant to the type of sex education received among a sample of 1005 high school graduates. Data were collected in the summer of 2023. We used ANOVAs, MANOVA, and linear regressions to examine relations among sex education type, sexual and reproductive health knowledge, sex-positive and purity culture beliefs, and participants’ self-reported readiness for their sexual lives. Results Participants who reported receiving abstinence-only sex education endorsed more purity culture beliefs and fewer sex-positive beliefs than those who experienced comprehensive sex education. Sexual and reproductive health knowledge was poor. Participants who experienced comprehensive sex education rated that education as better preparing them for a healthy sexual life compared to those who had abstinence-only education. Conclusions Findings reveal the relation of sex education type on attitudes toward sexuality and self-reported readiness for adults’ sexual lives. Policy Implications Policymakers, educators, and others who work with young people should champion sex-positive, comprehensive sex education. More work is needed to ensure sex education yields an informed public who can navigate their sexual lives effectively.

BackgroundReproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia.MethodsUsing a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation.ResultsIndividual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers’ choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers’ motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners.ConclusionThe CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its’ implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy’s intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.

BACKGROUND: Understanding gender differences in adolescent sexual and reproductive health (SRH) has implications beyond immediate health outcomes, potentially shaping future gender relations, relationship dynamics, and demographic patterns. This study examines patterns of gender divergence in SRH dimensions among adolescents and evaluates whether comprehensive sexuality education (CSE) has differential effects by gender. METHODS: This is a secondary analysis utilizing the April 2019 and June 2020 survey data from a cluster randomized controlled trial implemented in 29 vocational high schools in China’s Guangdong and Yunnan provinces. Included schools should have at least 100 10th -grade students and should not have already delivered comprehensive sexuality education. Schools were randomized at the school level using a computer-generated random number generator following allocation concealment. The intervention was a web-based comprehensive sexuality education program. Analysis for this secondary study was conducted at the individual level. Multilevel linear and binary logistic regressions were used to analyze SRH knowledge, attitudes (toward power, homosexuality, premarital sex, and help-seeking), sexual behaviors, and health indicators. Three-way interactions between gender, time, and intervention were tested to examine gender differences in intervention effectiveness. RESULTS: The analytic sample included 2996 10th -grade students (n = 1332 control; n = 1664 intervention). Results show that while sexuality education showed uniform effectiveness across genders, natural gender divergence patterns persisted and widened. At baseline, girls demonstrated higher sexual and reproductive health knowledge and more liberal attitudes toward power and homosexuality, but more conservative views on premarital sex. Behaviorally, girls had lower odds of sexual debut and multiple partners but also lower odds of consistent condom use and higher odds of infection symptoms. Over one year, regardless of intervention status, girls showed continued gains in knowledge and increasingly liberal attitudes across multiple dimensions, while boys’ changes were limited to a modest increase in acceptance of homosexuality, though their overall attitude remained disapproving. CONCLUSIONS: The study reveals a pattern of persistent gender divergence in sexual and reproductive health dimensions despite uniform intervention effectiveness. These diverging patterns, which are already evident by mid-adolescence and continue to widen over one year, highlight the importance of early implementation of comprehensive sexuality education that explicitly addresses aspects on sexual and reproductive health, gender dynamics, and power relations in an analytical and critical way, while maintaining effectiveness across genders. TRIAL REGISTRATION: The original randomized controlled trial, where data used in this article came from, was registered with the Chinese Clinical Trial Registry (chictr.org.cn). The registry number is ChiCTR1900021582. The trial was registered on Feb 28, 2019.

Youths in sub-Saharan Africa, particularly Nigeria, face significant barriers to accessing sexual and reproductive health (SRH) information and services because of limited awareness, confidentiality concerns, restrictive policies, and provider attitudes. These barriers contribute to poor SRH knowledge and high rates of HIV infection, unintended pregnancies, and unsafe sexual practices. Digital interventions offer a promising approach to improve SRH outcomes, but evidence of their effectiveness in Nigerian university settings remains limited. This study assessed the impact of a mobile health (mHealth), internet-based, comprehensive sexuality education (CSE) intervention on SRH knowledge, sexual behavior, and service utilization among university students in Lagos, Nigeria. A quasi-experimental study was conducted among 600 undergraduate students (300 in intervention group and 300 in control group) who were selected from two public universities in Lagos, Nigeria, via multistage sampling. The intervention consisted of weekly live CSE webinars via Google Meets, peer-led WhatsApp discussions, and digital linkages to youth-friendly SRH services. Quantitative data were collected through self-administered digital questionnaires before and after the intervention. Data analysis included baseline and end-line comparisons via Pearson chi-square tests and difference-in-differences (DID) analysis to estimate intervention effects. At baseline, 57.7% of the participants in the intervention group and 49.7% of the participants in the control group had good knowledge of SRH (p = 0.05). A total of 41.0% of the respondents in the intervention group and 37.0% in the control group had ever had sex, and consistent condom use was low (23.6% in the intervention group and 28.8% in the control group). Only 26.0% of the intervention group and 23.3% of the control group respondents had access to SRH services. Post-intervention, SRH knowledge improved by 10.2% in the intervention group compared with 2.6% in the control group. Condom use during the last sexual encounter increased significantly by 11.7% (from 32.5% to 44.2%, p < 0.05), in the intervention group but decreased by 7.5% in the control group. Uptake of SRH services in the intervention group rose by 9% (from 26.0% to 35.0%, p < 0.05), alongside increased use of teaching hospitals and primary health care centres (PHCs). Sexual behaviour outcomes were mixed, with some indicators (e.g., multiple sexual partners) worsening post-intervention. The mHealth CSE intervention improved SRH knowledge, increased condom use, and enhanced the utilisation of SRH services among university students. However, its effect on risky sexual behaviours was mixed. For greater effectiveness, digital CSE should be integrated with broader SRH services.

The need for science-based knowledge about sexual life is natural for children and youth all over the world. Official statistics on the incidence of sexually transmitted infections, gender-based violence, and early pregnancies emphasize the urgency of the problem of developing sexual competence for Ukrainian children and youth. The purpose of the article is to study the foreign and Ukrainian experience of sexual education at school, to understand the essence of the concept of comprehensive sexuality education, its actors, and the requirements for their training. The main research method was document analysis. The results of a review of approaches to developing the researched problem in foreign and national scientific publications and a comparative analysis of Ukrainian, some foreign and international standards (guidelines, recommendations) regarding sexual education are highlighted. It was found that today there is no unity in terminology, interpretation, and criteria for defining sexual education. There are national differences in approaches to understanding its goals and content. Sexual education is interpreted in a narrow and broad sense, but in this matter, scientists are gradually more and more inclined to use a complex approach. A broad interpretation of sexuality education shifts the traditional emphasis from the physiological and biological features of the sexes, the problems of sexual life, including the prevention of accidental pregnancy, sexually transmitted diseases, and the achievement of safe sexual satisfaction (sex education, sexual health education) to the issues of forming a culture of sexuality and related feelings, understanding and protection of one's rights, including sexual, throughout life, humane treatment and responsible behavior in relationships, clear and respectful communication, preparation for marriage and family life (comprehensive sexual health education, comprehensive sexuality education). Comprehensive sexuality education has strong support in the international discourse and is supported by a relatively robust evidence base. A comprehensive approach enables educators and policymakers to address not only the individual determinants of young people's sexual and reproductive health but also the social determinants of their health and well-being. Comprehensive sexuality education is not reduced to the activity or responsibility of an individual teacher. However, it is the result of the collective actions of all teachers in conditions of mutual support and exchange of experience in implementing sexual education programs. Health, biology, and physical education teachers considered critical in sexual education at school. At the same time, it is necessary to strengthen teachers' ability in sexuality education by improving the qualifications of teachers and providing constant support. The document analysis proved the inadequacy of the development and practical solution of the introduction of comprehensive sexuality education in Ukrainian schools. At the same time, the European and American experience of a number of foreign and international standards, guidelines, and technical documents, which relate to the content and results of sexuality education for students, the quality of the application of education standards, and professional training of teachers, shows a reasonably stable conviction that comprehensive sexuality education contributes to children and society as a whole.

BackgroundHong Kong lacks comprehensive school-based sexuality education. Recent public health concerns have brought the inadequacies of sex education in Hong Kong to the forefront. The aim of the proposed study is to develop and evaluate the effectiveness of a comprehensive school-based sexuality education program in Hong Kong.MethodsThe proposed study is a prospective longitudinal study implemented in six secondary schools in Hong Kong over two academic years. The study adopts an ecological approach providing informational workshops for students, teachers and school management, social workers and guidance counsellors and parents. Study outcomes will be evaluated through pre- and post-tests.ResultsKey outcomes of interest among students include sexual health knowledge, awareness of values motivating healthy sexual decisions, understanding and efficacy of sexual communication and intention to use contraception. Among school employees and parents key outcomes include self-efficacy to engage in sexual health discussions with students/children, sexual health knowledge and awareness of Hong Kong community sexual health resources.ConclusionsThe proposed study will result in the development of a tested school-based culturally relevant comprehensive sexual health education program. Ultimately, this program aims to not only empower adolescents and their trusted adults in building a supportive environment for sexual health promotion but also construct a learning network to generate longitudinal evidence for the effectiveness of comprehensive sexuality education in improving sexual health outcomes. The program has the potential for expansion through widespread adoption in Hong Kong schools to benefit more adolescents and reduce the medical and societal burdens related to crisis pregnancy, sexually transmitted infections and sexual abuse.

Young women remain disproportionately vulnerable to sexually transmitted infections, partly due to gaps in access to structure and evidence-based sexual health education. Although comprehensive sexual health education is widely advocated, evidence regarding its effectiveness in improving sexually transmitted infection prevention and sexual health knowledge among young women in low- and middle-income settings remains limited. To evaluate the impact of health education on knowledge and sexually transmitted infections prevention in young married women. A quasi-experimental study was conducted among 160 young married women aged 18-25years attending a primary healthcare center, Port Said City, Egypt. Participants received a structured sexual health education program focusing on safe sexual practices, contraception, and sexually transmitted infection prevention. Sexual health knowledge, attitudes, behaviors, and infection-related outcomes were assessed before and after the intervention using validated assessment tools. Following the educational intervention, participants demonstrated statistically significant improvements in sexual health-related knowledge and attitudes. Positive changes were also observed in reported health practices, including a reduction in risk-related behaviors and an increase in preventive practices after the intervention (p<0.001). Additionally, overall sexual health outcome scores showed a significant improvement, indicating the effectiveness of the educational program. Comprehensive sexual health education contributes to improved knowledge related to the prevention of sexually transmitted infections and supports the adoption of healthier personal health practices among young women. These findings underscore the value of structured educational interventions as an important public health nursing strategy for promoting reproductive health and preventing infection. It is recommended that structured reproductive and sexual health education be integrated into community-based and educational health programs, with ongoing evaluation to ensure responsiveness to young women's sexual and reproductive health needs.

BACKGROUND: Their sexual and reproductive health decision making is greatly influenced by their knowledge. This study, therefore, aimed to determine sexual and reproductive health knowledge among secondary school-going girls in Homabay County, Kenya. METHODS: This was a cross-sectional analytical study design that used quantitative approaches to determine factors associated with sexual and reproductive health knowledge among day school-going girls. A sample size of 491 participants were proportionately distributed in the selected 28 school. Data was entered, cleaned, and managed in the SPSS software version 17. Descriptive analysis was conducted to determine the level of sexual and reproductive health knowledge while logistic regression was used to determine factors associated with sexual and reproductive health knowledge. RESULTS: The study reported 39.4%, 40.4% and 82.9% of participants to be having good overall knowledge of risky sexual behavior, pregnancy related issues and HIV/AIDS transmission and prevention. From the participants 207(42.1%),203(41.3%),230 (46.7%),188(38.2%),173(35.2%) correctly identified risky sexual behavior as sexual intercourse without a condom, starting sexual activities before age 14, multiple sexual partners, more frequent sexual activities and having sex under influence of alcohols respectively. On pregnancy, 303(61.6%),416(84.6 %),315(64.0%) of the participants correctly answered that a girl has the greatest chance of becoming pregnant in the middle of her menstrual cycle, Abstinence is the safest method to prevent pregnancy and Adolescent pregnancy is a risk for maternal complication respectively. Participant with catholic religion background were less likely to have good sexual and reproductive health knowledge (OR 0.18, CI 0.318-0.84, P 0.0080). CONCLUSION AND IMPLICATIONS FOR TRANSLATION: This study concludes that most girls have good knowledge on HIV but poor knowledge of risky sexual behavior and pregnancy-related issues and also identify role of religion in improving sexual and reproductive health knowledge. The study, therefore, recommends upscaling of school-based sexual and reproductive health education.

The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students' current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n =13), qualitative (n =7) and mixed methods (n =1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students' sexual health risks.

This study's objective was to investigate the influence of sexual and reproductive health knowledge on risky sexual behaviour among female students in public teacher training colleges. Using ex post facto research design, data was collected through a personally delivered questionnaire from 350 female students in 13 public teachers’ training colleges in Kenya and subsequently analysed using simple regression statistic at 0.05 alpha level. The findings revealed a linear and statistically significant relationship (F=4.172; df= 1,345; P=.042) between sexual and reproductive health knowledge and risky sexual behaviour. The computed beta index (? = -.109) was negative, weak but statistically significant (t = 12.278; P = .042). This finding suggests that the selected domains of sexual and reproductive health knowledge had the capacity to predict risky sexual behaviour. The adjusted R2 value (R2 = .012) further revealed that Sexual and reproductive health knowledge could account for 1.2% of the variation in risky sexual behaviour among female students. These findings have important implications in regard to reducing incidences of risky sexual behaviour among female teacher trainees, specifically, stakeholders in teacher training colleges including, college administrators, counsellors, and curriculum developers. These should develop and adopt strategies suggested in this study to address the challenge of sexual risk-taking among female teacher trainees.

A survey conducted in Sri Lanka reveals low levels of sexual and reproductive health knowledge among students aged 16-19. (1) For example, only one in 10 could correctly identify a method of contraception, and fewer than 1% correctly answered all four of the survey's primary sexual knowledge questions. The survey also examined sexual attitudes and behaviors, and found that males were more likely than females to consider sexual relationships acceptable among youth their own age (21% vs. 8%). Just 2% of the adolescents had had sexual intercourse; 57% of these youth had used contraceptives at first sex, and 63% had ever used contraceptives. The lack of information on the reproductive and sexual health needs of adolescents in Sri Lanka has been highlighted as an area of national concern. To help identify these needs and to inform reproductive health policy, in 2010 researchers conducted the first survey in 10 years to assess the sexual and reproductive health knowledge, attitudes and behaviors of in-school teenagers. Students from randomly selected government schools in Badulla District (an area socioeconomically similar to the rest of the country) were eligible for inclusion if they were aged 16-19, were attending grades 11-13 and had been registered in a state school between July 2007 and June 2009. The self-administered survey, which was completed by 2,020 students (response rate, 90%), included questions on social and demographic characteristics, socioeconomic status, sexual and reproductive knowledge, attitudes toward premarital sex, and sexual behaviors. The researchers computed descriptive statistics and used chi-square testing to identify statistical differences between males and females in sexual knowledge, attitudes and behaviors. Overall, 26% of the respondents were male and 74% were female, reflecting the sex ratio in state schools. The majority of students were aged 16-17; almost all of the students were Sinhalese (97%) and Buddhist (96%). Nine percent characterized their home environment as poor, most often because of financial difficulties or paternal alcoholism. Levels of parental closeness were high: Nine-tenths of participants reported being very close to their mother, and two-thirds reported being very close to their father. Although 57% of females and 34% of males identified their parents as their most important source of general support, only 45% of females and 3% of males identified them as their most likely source of support and information concerning sex. About one-third of males and one-fifth of females said they had no one with whom to discuss sexual matters; their most preferred sources of information on sexual issues were health personnel (midwives and public health inspectors; 20%) and doctors (18%). The four questions that served as indicators of reproductive health knowledge revealed substantial deficits. Fewer than 25% of respondents were aware that it is possible to acquire an STI at first sex, and a similarly small proportion knew that it is possible to become pregnant at first sex. Just one in 10 correctly identified a contraceptive method, and even fewer (6%) could identify a way to prevent STI transmission. Only 0.4% of respondents answered all four questions correctly. …

Aim: Young people need protective information and skills in order to reduce the risk associated with unsafe sex. This study assessed and compared the sexual health knowledge, attitude and risk perception of in-school and out-of-school female unmarried adolescents in Onitsha North Local Government Area, Anambra State, Nigeria. Methods: A comparative cross-sectional design was used in which 391 in-school female adolescents (mean age: 15.9±1.4 years ) were selected from 25 private and 17 public schools in Onitsha North Local Government Area, Anambra State, Nigeria using multistage sampling method. A comparison group of 392 out-of school female adolescents (mean age: 15.5±2.5 years) was also selected from a major market in the same Local Government Area using cluster sampling technique. Data was collected from the respondents with pre-tested, interviewer-administered questionnaires on reproductive and sexual health knowledge, risk perception and attitude, sexual behaviour, contraceptive knowledge and sources of sexual health information. Results: In-school girls demonstrated better knowledge of sexual and reproductive health compared to their out-of-school counterparts. The awareness of fertile period, contraception methods, STI and HIV transmission and prevention were all significantly better among the in-school adolescents compared to their out-of-school counterparts (P&lt;0.05). They also had markedly higher risk perception of getting pregnant (P&lt;0.05) or acquiring HIV infection (P&lt;0.05) compared to their out-of-school counterparts. Conclusion: About 21% of adolescents in this study area were involved in risky sexual behaviour and this was higher among the out-of-school adolescents than their in-school counterparts. All stakeholders in the state and the Local Government Area should come together and develop interventions that would improve the sexual health knowledge and sexual risk perception of the adolescents.

Chinese universities have been conducting a variety of sexuality education programs, including a sexuality curriculum (SC) to increase sexual and reproductive health (SRH) knowledge and improve sexual attitudes and practices among college students. However, little is known regarding the effect of SC on students' sexual attitudes and behaviors. The purpose of this study was to evaluate the effect of SC on SRH knowledge, sexual attitudes, and practices among college students of Shandong University. To assess these issues, an online cross-sectional survey was conducted via a WeChat applet. Four hundred and forty-nine freshmen were recruited from Shandong University, including 209 students with SC and 240 students without SC. We assessed their SRH knowledge, sexual attitude, and practice. We found that 15.8% engaged in sexual activities, while 59.2% had viewed nonscientific books or videos describing sexual behavior within the past 2 weeks. Regarding the initial source of their SRH information, 65.9% taught themselves through reading or viewing SRH content in the media, and 46.8% participated in school lectures on SRH, while only 31.2% of the participants discussed SRH matters with their parents. As compared with students without SC, students with SC had significantly greater total scores with regard to reproductive health knowledge (P < 0.001) and sexual health knowledge (P < 0.001). Students without SC showed a significant degree of prejudice against sexually transmitted disease patients and were more resistant to interact with acquaintances infected with human immunodeficiency virus (P < 0.001). Exposure to a school-based SC had a beneficial effect on increasing the SRH knowledge of these students as well as mitigating risky sexual attitudes and behaviors.NEW & NOTEWORTHY To assess the SRH knowledge, sexual attitudes, and practices in freshmen of Shandong University and assess the effect of SC, an online cross-sectional survey was conducted via a WeChat applet. Our findings indicate that these freshmen demonstrate a high prevalence of being sexually active and exposure to a school-based SC had a beneficial effect on increasing the SRH knowledge of these students as well as mitigating risky sexual attitudes and behaviors.

Aim: Young people need protective information and skills in order to reduce the riskassociated with unsafe sex. This study assessed and compared the sexual health knowledge, attitude and risk perception of in-school and out-of-school female unmarried adolescents in Onitsha North Local Government Area, Anambra State, Nigeria. Methods: A comparative cross-sectional design was used in which 391 in-school female adolescents (mean age: 15.9±1.4 years ) were selected from 25 private and 17 public schools in Onitsha North Local Government Area, Anambra State, Nigeria using multistage sampling method. A comparison group of 392 out-of school female adolescents (mean age: 15.5±2.5 years) was also selected from a major market in the same Local Government Area using cluster sampling technique. Data was collected from the respondents with pre-tested, interviewer-administered questionnaires on reproductive and sexual health knowledge, risk perception and attitude, sexual behaviour, contraceptive knowledge and sources of sexual health information. Results: In-school girls demonstrated better knowledge of sexual and reproductive health compared to their out-of-school counterparts. The awareness of fertile period, contraception methods, STI and HIV transmission and prevention were all significantly better among the in-school adolescents compared to their out-of-school counterparts (P&lt;0.05). They also had markedly higher risk perception of getting pregnant (P&lt;0.05) or acquiring HIV infection (P&lt;0.05) compared to their out-of-school counterparts. Conclusion: About 21% of adolescents in this study area were involved in risky sexualbehaviour and this was higher among the out-of-school adolescents than their in-school counterparts. All stakeholders in the state and the Local Government Area should come together and develop interventions that would improve the sexual health knowledge and sexual risk perception of the adolescents.

There is little information on sexual and reproductive health knowledge (SRHK) and practices in Angola and no data on the prevalence of sexually transmitted infections. The objective of this study was to assess the SRHK and behaviors, and estimate the prevalence of four sexually transmitted infections (STIs) among adolescents and young adults from 4 municipalities in Benguela province, Angola prior to an educational intervention. We performed a cross-sectional study to assess SRHK and sexual behavior using a structured questionnaire among adolescents and young adults aged 15 to 25years old from two urban and two rural municipalities of Benguela province. We also evaluated the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis using rapid tests. A total of 1400 youths were included in the study. Overall, 818 (58.4%) participants had adequate SRHK. Urban origin [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.35-2.04], older age (OR 1.14, 95% CI 1.09-1.20), being female (OR 2.06, 95% CI 1.57-2.71) and having journals and internet as the main sources of information (OR 1.37, 95% CI 1.00-1.86 and OR 2.33, 95% CI 1.69-3.21, respectively) were significantly associated to a good SRHK in the multivariate analysis. Four hundred and fifty-three [45.9% of those who have had sexual intercourse (n=986)] reported risky sexual behavior. We observed that risky sexual behavior was associated with male gender (OR 2.89 95% CI 2.13-3.92, P<.001). Prevalence of STI was: 5 (0.35%) for HIV, 190 (13.6%) for HBV, 4 (0.3%) for HCV, and 20 (1.4%) for syphilis. SRHK was higher than expected although in-depth knowledge was uncommon, especially in men from rural areas with lack of access to journals or the internet. Unsafe sexual behavior was widespread among our sample. Prevalence of HBV was higher than expected. Sexual education campaigns using both digital and non-digital approaches should be focused on reaching the young population dispersed in rural areas where internet connection is difficult and should be accompanied by HBV vaccination promotion.