Safer Sex Behaviors Research Articles

Gender Differences in Attitudes and Behaviors Toward Condoms and Birth Control Among Chicago Adolescents

Research shows that gender norms play a notable role in pregnancy prevention, often placing responsibility on females and allowing some males to pursue sexual encounters without considering the consequences of unprotected sex. This paper examines gender differences in attitudes and behaviors related to condom use and birth control among adolescents using survey, focus group, and interview data gathered from the evaluation of Chicago Healthy Adolescents and Teens (CHAT), a comprehensive sexual health education program implemented with adolescents in Chicago Public High Schools. Results indicate that safe sex attitudes and behaviors differ between male and female adolescents, specifically those related to condoms and birth control. Our findings suggest that (i) females have higher knowledge and presumed responsibility for pregnancy prevention, (ii) infrequent condom use among adolescents prioritizes male pleasure over female health needs, and (iii) social norms discourage females, but not males, from accessing and using birth control. We use the Theory of Gender and Power to show how our findings reflect gender dynamics within the United States and explain the potential health implications for adolescent sexual health.

Redeveloping a Digital Sexual Health Intervention for Adolescents to Allow for Broader Dissemination: Implications for HIV and STD Prevention.

HIV/STDs and unintended pregnancy persist among adolescents in the United States; thus, effective sexual health interventions that can be broadly disseminated are necessary. Digital health interventions are highly promising because they allow for customization and widespread reach. The current project involved redeveloping and expanding HEART (Health Education and Relationship Training)-a brief, digital sexual health intervention efficacious at improving safer sex knowledge, self-efficacy, and behavior-onto an open-source platform to allow for greater interactivity and accessibility while reducing long-term program costs. The authors describe the process of adapting, reprogramming, and evaluating the new program, which may serve as a guide for investigators seeking to adapt behavioral interventions onto digital platforms. The final product is an open-source intervention that can be easily adapted for new populations. Among 233 adolescents (Mage = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity.

A Systematic Review of Randomized Controlled Trials of School Based Interventions on Sexual Risk Behaviors and Sexually Transmitted Infections Among Young Adolescents in Sub-Saharan Africa.

Young adolescents in Sub-Saharan Africa (SSA) are at high risk of involvement in sexual risk behaviors; and curable sexually transmitted infections (STI), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and unintended pregnancies remain persistently high in this population. Evidence based strategies are urgently needed to improve these outcomes. The aim of this systematic review was to synthesize the evidence from randomized controlled trials (RCT) to determine whether school-based interventions promote safe sex behaviors, reduce sexual risk behaviors and risk of curable STIs, HSV-2, HIV and unintended pregnancies among young adolescents aged 9-19years in SSA. Electronic databases were searched for published studies and manual searches were conducted through reviewing of references of cited literature in the English language up to December 2019. Two independent reviewers screened and abstracted the data. We identified 428 articles and data from nine RCTs (N = 14,426 secondary school students) that fulfilled the selection criteria were analysed. Two studies measured pregnancy as an outcome and showed significant declines in unintended pregnancies. Of the five studies that measured HIV/AIDS related-knowledge, condom-use outcomes (normative beliefs, knowledge, and self-efficacy) and attitudes to HIV testing, four showed significant improvements. Of the six studies that measured sexual debut, four reported moderate but non-significant declines and in two studies sexual debut information was either incomplete or unreliable. One study measured curable STIs and found no significant declines; whilst the second study that measured HSV-2 and HIV, no significant declines were observed. This review highlights the need to undertake well-designed research studies to provide evidence on the impact of interventions on curable STIs, HSV-2 and HIV, critical to improving the health of young adolescents.

HIPERMASCULINIDAD Y USO DE CONDÓN EN HOMBRES QUE TIENEN SEXO CON HOMBRES Y MUJERES

Los hombres que tienen sexo con hombres y mujeres (HSHM) conforman un subgrupo de hombres que tienen sexo con hombres, son una población clave con mayor riesgo de exposición al virus de inmunodeficiencia humana. Al respecto, un método eficaz de prevención es el uso de condón, sin embargo, esta población se ve afectada por factores contextuales y sociales como la hipermasculinidad, la cual podría estar limitando la conducta sexual segura. Objetivo. Determinar la influencia de la hipermasculinidad sobre el uso de condón en hombres que tienen sexo con hombres y mujeres. Metodología. Estudio transversal correlacional en 106 HSHM. Se utilizó el muestreo virtual online, dos instrumentos y una cédula de datos sociodemográficos y de historia sexual. Resultados. Se encontró que la hipermasculinidad influye de manera negativa sobre el uso del condón (β= -.318, p= .001). Conclusiones. Las ideas hipermasculinas, están asociadas a menor uso de condón en los HSHM, los hallazgos sugieren que existe la necesidad de diseñar intervenciones específicas en el contexto de este subgrupo de hombres enfocadas a aumentar el uso de condón y contemplen los componentes de la ideología masculina.

“Hey, Have You Been Tested?” The Influence of Comprehensive or Abstinence-Only Sexuality Education on Safer Sex Communication and Behavior

This study explored how sexuality education relates to young and emerging adults’ sexual behavior and communication. A questionnaire measured 140 U.S. participants’ (18–28) school-based sexuality education, age at sexual debut, birth control use, relationship with recent sexual partner, and safer sex communication (SSC) during their last encounter. Those who underwent abstinence-only sexuality education began having sex a year later than those who had comprehensive sexuality education. Contraceptive use did not differ across sex education type. Overall, respondents reported high levels of SSC, with minimal differences in SSC across sexuality education types. Implications for sexuality education and SSC training are discussed.

83. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Adolescents

<h3>Background</h3> Approximately 1.6 million US youth under age 18 experience housing insecurity annually. These adolescents are at higher risk for negative reproductive health outcomes than their sheltered peers. Few studies have examined the relationship biopsychosocial factors have with sexual activity and contraception use in this population. This study aimed to address this gap. We hypothesize that biopsychosocial factors have relationships with sexual activity and contraceptive utilization among homeless adolescents. <h3>Methods</h3> An IRB-approved, retrospective cohort study was conducted on adolescents who presented between 2/21/2015-8/27/2019 for state mandated physical exams at a youth crisis shelter in Bethlehem, Pennsylvania. Statistical analyses were performed using univariate and multivariable techniques to describe the population and determine the relationship age, gender identity, substance use, and childhood trauma history have with sexual activity and contraceptive utilization. <h3>Results</h3> Medical records for 440 adolescents were reviewed. Of those, 53.7% (n=233) reported sexual activity and 65.2% (n=148 of 227) of sexually active youth reported using contraception. Sexual activity was significantly related to age (mean age 15.8+1.4 years in sexually active vs. 14.7+1.6 years in not sexually active youth, p<0.001); remote history of self-harm behavior (RR 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001) (Figure 1). Gender identity was related to contraceptive utilization, with 55.68% of sexually active females vs. 42.50% of sexually active males reporting contraception use (p=0.01). After adjusted analysis, older age and substance use remained significantly associated with sexual activity (AOR 1.58 [95% CI 1.36-1.84]; p<0.001 and AOR 5.25 [95% CI 3.33-8.28]; p<0.001, respectively). <h3>Conclusions</h3> Adolescents experiencing homelessness face challenges engaging in safe sex practices and are at higher risk for poor reproductive health outcomes compared to their housed peers. This analysis demonstrates that specific characteristics have significant relationships with sexual behaviors in this population. Older adolescents were one and a half times more likely and substance users were five times more likely to be sexually active. Further, a significant gap in contraceptive use existed between female and male-identifying youth. Understanding the potential risk factors for unsafe sex practices can inform interventions, careful history taking and further inquiry into methods to reduce poor outcomes and facilitate safe sexual behaviors in this at-risk population.

Social self-efficacy and sexual communication among adolescents in the United States: a cross-sectional study.

Data were collected in a cross-sectional survey from 222 high school girls in a rural school district in the south-eastern United States (Mage = 15.2; 38% White, 29% Latina, 24% Black; 50% were in a dating relationship in the past 3 months). Variables were measured with Likert-type scales. Bivariate correlation and regression analyses were conducted. Social self-efficacy was significantly positively associated with sexual assertiveness and sexual communication self-efficacy for all girls, and there was a positive trend in the relationship between social self-efficacy and communication frequency among the subsample of girls who had a dating partner. The significant relationship with sexual assertiveness (β = 0.22, s.e. = 0.07, P = 0.001) and sexual communication self-efficacy (β = 0.17, s.e. = 0.04, P = 0.013) remained when controlling for sexual activity status. Strengthening social self-efficacy may enhance girls' sexual communication and assertiveness skills. Future studies are needed to confirm the causal and temporal nature of these associations.

ZWIĄZEK POMIĘDZY CZYNNIKAMI SPOŁECZNO-DEMOGRAFICZNYMI, CZYNNIKAMI ZDROWEGO STYLU ŻYCIA I ZACHOWANIAMI ZAPOBIEGAJĄCYMI ZAKAŻENIOM WŚRÓD STUDENTÓW UNIWERSYTETU: BADANIE PRZEKROJOWE

Background. This study investigated the association between infection prevention behavior and socio-demographic and other lifestyle factors among the Lithuanian public and private university students. Material and methods. The cross-sectional survey took place from 15 January to 28 February 2021, and a total of 234 students responded to the survey. Survey questions included socio-demographic factors, compliance to hand hygiene, attitude towards vaccination, safe sexual behavior and risky sexual behavior, self-rated health, eating habits, physical activity, and compliance with COVID-19 preventative measures. Independent sample t-test, oneway ANOVA, correlation bivariate, and multiple regression tests were used to analyze the association between different factors. Results. Students with better health showed higher compliance to hand hygiene, but reported lower safe sex practices (p<0.05). Likewise, students with chronic disorders were more skeptical of vaccines (p<0.05). Students reporting healthy eating habits displayed a higher compliance to hand hygiene (p<0.05) and safe sex (p<0.05), while students who were more physically active showed lower confidence in vaccines (p<0.05). Conclusions. This study indicates that significant correlations exist between numerous variables related to socio-demographic and lifestyle factors with infection prevention behavior. Moreover, there is a need to increase the compliance of infection prevention behavior among youth. Hence, more health promotion programs should be implemented focusing on infection prevention behavior in young individuals.

Risky Attitudes and Behaviors of HIV-Positive People After Diagnosis

Objective: HIV/AIDS cases are increasing rapidly in our country. Although there are many transmission routes, unprotected sexual intercourse is the main reason for the increase in HIV prevalence. Despide newly data in the literature that show there is no HIV transmission from partners who have been given viral suppression by antiretroviral therapy, evaluation of sexual behavior pattern is still important for resource control. The aim of this study was to evaluate the changes in sexual behavior after diagnosis, the level of knowledge about safe sexuality, and the attitudes and behaviors of informing the sexual partner about HIV status in HIV-infected individuals under follow-up and treatment. Methods: A questionnaire consisting of fifteen questions was filled out by the volunteers who were followed up in the HIV outpatient clinic of our hospital and the data were evaluated with SPSS statistical package program. Results: The mean age of the fifty participants was 38 years. Most of them are men, 40% stated that they are gay and 40% of them are married. Seventy percent of the respondents stated that the frequency of risky sexual behavior decreased after being diagnosed with HIV. However, perhaps the most striking finding of our study is that approximately one third of the participants never informed their sexual partner about their HIV status and 44% said they did not use condoms during sexual intercourse. More than half of the participants stated that they would like to receive information about safe sex and sexually transmitted infections. They also stated that they wanted to get this information from physicians. Conclusion: As a result, there is a decrease in risky sexual behaviors after diagnosis in HIV positive patients. However, risky behaviors such as not using condoms still continue. Therefore, it is necessary to ensure that viral loads are negative with regular antiretroviral therapy and to promote safe sexual behavior.

Correlations between drug use, HIV disclosure and interpersonal communication on sexual risk behaviour of HIV-positive men who have sex with men

BackgroundThe Human Immunodeficiency Virus (HIV) epidemic is a global health problem whose number of cases are always higher among men who have sex with men (MSM). Most existing MSM have moderate and very high risk behaviour in HIV transmission. This study was designed to identify correlations between drug use, HIV disclosure and interpersonal communication patterns on sexual risk behaviour among HIV-positive MSM.MethodsThis study used a cross sectional design with a purposive sampling technique for participants who visited the voluntary counselling and testing (VCT) clinic in a referral hospital and snowball sampling technique for participants in the work area of a community health centre in Batam involving 126 HIV-positive MSM. Data were collected by 5 part questionnaire, namely demographic questionnaire, drug screening questionnaire, brief scale for HIV self disclosure, communication pattern questionnaire-short form, and safe sex behaviour questionnaire. Bivariate analysis was applied to determine whether there is a relationship between drug use, HIV disclosure, interpersonal communication and demographic characteristics (ethnicity, educational status) with sexual risk behaviour of MSM. Logistic regression analysis was used to explore the variables that most associated variable to sexual risk behaviour.The resultsThe results showed that there was significant correlation between HIV disclosure and sexual risk behaviour (p = 0.019, α = 0.05, OR = 2.530) and significant correlation between interpersonal communication patterns and sexual risk behaviour (p = 0.016, α = 0.05, OR = 2.589). There is no significant correlation between demographic characteristics, namely: ethnicity and educational status with sexual behaviour at risk of MSM. In multiple logistic regression analysis, educational status was the factor that most associated with sexual risk behaviour among HIV-positive MSM (p = 0.027, α = 0.05, OR = 2.807, 95% CI = 1.125–7.006).ConclusionsHIV disclosure and interpersonal communication patterns have a significant negative correlation with sexual risk behaviour among HIV-positive MSM. MSM with low HIV disclosure have high risk sexual behaviour opportunities. MSM with the closed interpersonal communication pattern also has a high risk of sexual behaviour. Education status was the most associated variable to sexual risk behaviour of HIV-positive MSM. Nurses as professional health workers need to improve comprehensive assessment, personal counselling and plan specific learning model by involving HIV-positive MSM in reducing HIV transmission from risky behaviour.

Providing medical care by family doctors in family planning services and prevention of unwanted pregnancies

Purpose of the study: to identify the types of medical services for family planning and prevention of unwanted pregnancies that should be provided by family doctors, and competencies they should have to provide, as well as to identify benefits and possible risks for family planning services at the primary level.Materials and methods. 50 obstetricians and gynecologists and 50 family doctors were interviewed as experts with the help of a specially designed questionnaire. Research results were analyzed using the method of structural-logical analysis.Results. The list of medical services for family planning and prevention of unwanted pregnancies to be provided by family doctors includes: formation of safe sexual behavior in adolescents and young people, formation of responsible attitude to reproductive health in adolescent girls, explanation to married couples about use of barrier contraception and emergency contraception immediately after sexual intercourse, information activities aimed at promoting a healthy lifestyle, formation of responsible parenthood, strengthening family and marital relations.The advantages of providing these services at the primary level are increased physical availability of medical care for family planning, possible reduction of unwanted pregnancies, early onset of sexual relations culture and higher opportunities for adolescents to develop a responsible attitude to reproductive health. Among the risks of providing family planning services at the primary level experts noted the low level of professionalism of family doctors and nurses, lack of motivation to provide this area of medical services, low level of interaction between primary and obstetric care services, low public confidence in family doctors.Conclusion. Applying of expertly defined list of services for family planning and prevention of unwanted pregnancies at the primary level of medical care when family doctors acquire the necessary competencies will increase the availability and effectiveness of this type medical care.

Digital crowdsourced intervention to promote HIV testing among MSM in China: study protocol for a cluster randomized controlled trial

BackgroundMen who have sex with men (MSM) are an important HIV key population in China. However, HIV testing rates among MSM remain suboptimal. Digital crowdsourced media interventions may be a useful tool to reach this marginalized population. We define digital crowdsourced media as using social media, mobile phone applications, Internet, or other digital approaches to disseminate messages developed from crowdsourcing contests. The proposed cluster randomized controlled trial (RCT) study aims to assess the effectiveness of a digital crowdsourced intervention to increase HIV testing uptake and decrease risky sexual behaviors among Chinese MSM.MethodsA two-arm, cluster-randomized controlled trial will be implemented in eleven cities (ten clusters) in Shandong Province, China. Targeted study participants will be 250 MSM per arm and 50 participants per cluster. MSM who are 18 years old or above, live in the study city, have not been tested for HIV in the past 3 months, are not living with HIV or have never been tested for HIV, and are willing to provide informed consent will be enrolled. Participants will be recruited through banner advertisements on Blued, the largest gay dating app in China, and in-person at community-based organizations (CBOs). The intervention includes a series of crowdsourced intervention materials (24 images and four short videos about HIV testing and safe sexual behaviors) and HIV self-test services provided by the study team. The intervention was developed through a series of participatory crowdsourcing contests before this study. The self-test kits will be sent to the participants in the intervention group at the 2nd and 3rd follow-ups. Participants will be followed up quarterly during the 12-month period. The primary outcome will be self-reported HIV testing uptake at 12 months. Secondary outcomes will include changes in condomless sex, self-test efficacy, social network engagement, HIV testing social norms, and testing stigma.DiscussionInnovative approaches to HIV testing among marginalized population are urgently needed. Through this cluster randomized controlled trial, we will evaluate the effectiveness of a digital crowdsourced intervention, improving HIV testing uptake among MSM and providing a resource in related public health fields.Trial registrationChiCTR1900024350. Registered on 6 July 2019.

Using Social Cognitive Theory to Predict Safer Sex Behaviors in College Students

Young adults engage themselves in unsafe sexual behaviors exposing themselves to getting aSTD and/or HIV/AIDS. The purpose of this study was to use social cognitive theory in predicting safer sex behaviors among college students. A cross-sectional study design was implemented among a sample of 180 sexually active college students. More than half of the survey responders were monogamous and less than a quarter had two sexual partners. A step-wise multiple regressions model indicated a statistically significant predictive model with self-efficacy, situational perceptions and self-control towards safer sex as significant predictors (48% predicted variance) of self-reported sexual behaviors.

Factors Influencing Young Korean Men's Knowledge and Stigmatizing Attitudes about HIV Infection.

Stigma against people living with HIV (PLHIV) fosters depression and negatively impacts the quality of life in PLHIV and is a barrier to the whole process of treatment. This study aimed to identify the levels of knowledge and stigmatizing attitudes toward HIV infection among Korean men in their 20s and the factors influencing them. A cross-sectional design was used. Two hundred and eight Korean men in their 20s responded to self-report questionnaires that included items on knowledge and stigmatizing attitudes about HIV infection, subjective norms for safer sexual behaviors (SSBs), participants’ HIV-related characteristics, sex-related characteristics, and general characteristics. The mean score (±SD) for knowledge was 13.9 (±5.28) and for stigmatizing attitudes was 64.1 (±11.42). In quantile regression analysis, exposure to HIV-related information was a significant factor for knowledge in every quantile, and experience of HIV education was a significant factor in the 50th quantile. Experience of meeting PLHIV was a significant factor for stigmatizing attitudes in the 25th quantile, and subjective norms for SSB were a significant factor for stigmatizing attitudes in the 25th and 50th quantiles. Findings suggest the need for intervention to improve young Korean men’s knowledge, as well as intervention focusing on norms for SSB, to prevent stigmatizing attitudes.

“Starting that Conversation Is Even Harder than Having It”: Female Patients’ Perceptions of Physicians’ Communication Competence in Communication about Sexual Behavior

Female college students demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behavior that puts them at risk for sexually transmitted infections and unplanned pregnancy. Physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particular young women, are reticent to talk to their physicians about sexual behavior because they typically consider the information to be private. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients. In this study, Communication Privacy Management (CPM) theory is used to investigate the criteria that female college students employ to negotiate the disclosure and concealment of information about sexual behavior in communication with physicians. Qualitative analysis of semi-structured interviews with female college students was used to explain their perceptions of disclosure of sexual behaviors to their physician. Specifically, the participants’ perceptions of physicians’ communication competence informed privacy management rules. These findings have the potential to improve communication interventions for both female college students and healthcare professionals.

Social Cognitive Theory as a Theoretical Framework to Predict Sexual Risk Behaviors among Older Adults

ABSTRACT Objectives Older adults vary in their safe and unsafe sexual behaviors. While researchers are beginning to understand more about the sexual and intimate expression of older adults, only recently are they beginning to understand how older adults make decisions about sexual risk. Bandura’s social cognitive theory offers a frame for understanding how self-efficacy, environmental factors, and goal motivation are related to sexual risk behaviors for older adults, including the interplay between these variables. Methods Using a diverse sample of older adults (n = 720) age 50+ years, social cognitive theory was modeled to determine the relationship between environment variables (age, gender, and sexual health conversations with practitioners), behavioral variables (self-efficacy), and cognitive variables (importance of sexual wellness goals) with the outcome variable of sexual risk behaviors. Results Self-efficacy had an indirect effect on sexual risk via sexual wellness goal motivation. Healthcare provider conversations had both direct and indirect effects on older adults’ sexual risk through sexual wellness goal motivation. Models were similarly predictive for older men and women. Conclusions Sexual risk behaviors among older adults are more influenced by environmental factors in their healthcare settings and their perception and prioritization of sexual wellness goals. Clinical implications Providers play a key role in initiating and maintaining sexual health discussions with older patients, potentially mitigating sexual risk and bolstering self-efficacy.

The impact of semen testing for Ebola virus RNA on sexual behavior of male Ebola survivors in Liberia.

Sexual transmission of Ebola virus (EBOV) is well established and has been implicated in multiple resurgences during the West African Ebola epidemic. Given the persistence of viral RNA in semen, guidelines from the World Health Organization (WHO) recommend abstinence or condom use for at least 1 year or until two semen PCR tests are negative. To better understand the impact of semen testing on sexual behavior, male EVD survivors were surveyed regarding their sexual behavior before and after semen testing. Of the 171 men who enrolled, 148 reported being sexually active following discharge from an ETU with 59% reporting episodes of condomless sex. At least one semen sample for testing was provided by 149 men and 13 of these men had EBOV RNA detected in their semen. When comparing sexual behaviors before and after semen testing, a positive semen test result had limited impact on behavior. Of those with seminal EBOV RNA detected, 61% reported no change in behavior pre- and post-semen testing with 46% engaging in condomless sex before and after testing and only 1 adopted safer sex behaviors following receipt of a positive result. Similarly, among men with undetectable EBOV in their semen, 66% reported no change in sexual behaviors with semen testing, with 55% forgoing condoms during sex. In only 11% was a negative semen result followed by abandoning condoms. There were no known sexual transmission events of Ebola virus in this cohort despite viral presence in semen during periods of condomless sex. This highlights the need to better understand the infectious potential of viral RNA persistence and determine what constitutes effective counseling for survivors and their partners.

Sexually Transmitted Infections: Part I: Genital Bumps and Genital Ulcers.

Sexually transmitted infections (STIs) affect young people in a disproportionate way, with more than half of the infections occurring in 15- to 25-year-olds, although as an age group they constitute only 25% of the sexually active population. Pediatricians should be familiar with the social, behavioral, and biological factors that predispose adolescents to STIs. Preventive visits for teens and pre-teens should incorporate education and counseling about sexuality, safe sexual behavior, and STIs. Pediatricians should be able to identify, diagnose, and manage STIs presenting as genital "bumps" and genital "ulcers." Pediatricians should also offer human immunodeficiency virus testing and expedited partner treatment to all adolescents who are diagnosed as having an STI.

Sex and the mission: the conflicting effects of early Christian missions on HIV in sub-Saharan Africa

AbstractThis paper investigates the long-term impact of historical missionary activity on HIV in sub-Saharan Africa. On the one hand, missionaries were the first to invest in modern medicine in the region. On the other hand, Christianity influenced sexual beliefs and behaviors that affect the risk of contagion. We build a new geocoded dataset locating Protestant and Catholic missions in the early 20th century, as well as the health facilities they invested in, that we combine with individual-level Demographic and Health Survey data. With these data, we can address separately these two channels, within regions close to historical missionary settlements. First, we show that proximity to historical missionary health facilities decreases the likelihood of HIV; persistence in healthcare provision and safer sexual behaviors in the region explain this result. Second, we show that regions close to historical missionary settlements exhibit higher likelihood of HIV. This effect is driven by the Christian population in our sample. This suggests conversion to Christianity as a possible explanatory channel. Our findings are robust to alternative specifications addressing selection.

An Epidemiology of Premarital Sexual Behaviour in India: Exploring Gender Differences

This article analyzes the social context of increasing premarital sex in India in a gender perspective, which affects the overall contexts, patterns and the characteristics of premarital sexual behaviour. The study has been conducted on data collected from 169,814 unmarried women and 40,003 unmarried men, a part of the Indian Demographic Health Survey (DHS), 2015–2016. Gender differences in premarital sex were pronounced, where unmarried men were five times more likely to have premarital sex (16%) as compared to unmarried women (3%). Cox regression portrays that both men and women at younger ages were significantly more likely to initiate premarital sex. Muslim men were significantly more likely (HR = 1.16 times) to have premarital sex at younger ages. Regional variations in the prevalence of premarital sex are pronounced. Findings reveal that unmarried women with higher education, residing in urban areas and who belong to richest wealth quintile and exposed to regular mass media were more likely to have multiple sexual partners in premarital sex. There is a striking regional variation in the low prevalence of condom use in the premarital sex reported by unmarried men as well as women. In fact, unmarried men were more likely to use condom in their first as well as last premarital sexual encounter than their women counterparts. Findings suggest strengthening the empowerment of youth, especially women, through enhancing their reproductive and sexual rights education and promoting safe sexual behaviour in premarital sexual encounters.