Sexual Risk Behaviors Research Articles

Effectiveness of Comprehensive Sexuality Education to Reduce Risk Sexual Behaviours Among Adolescents: A Systematic Review

Background: Adolescence is a critical life period marked by significant vulnerability to risky sexual behaviours. Comprehensive sex education offers better sexual and reproductive health to adolescents. Aim: We aimed to analyse the effectiveness of sex education interventions on reducing risk behaviours among adolescents. Methods: A systematic peer review was conducted. The databases consulted were PubMed, Scopus, Web of Science, and CINAHL. The inclusion criteria were as follows: randomized clinical trials published between 2013 and 2023 and methodological quality ≥ 5 points as per the Van Tulder scale. Results: A total of 255 studies were identified, with 25 finally selected. Of them, sixteen dealt with non-condom use, one was about early sexarche, and eight combined several risk behaviours. There was predominance of in-person teaching at schools with lectures and varied activities. The sample was predominantly comprised by girls aged between 14 and 16 years old. Certain variability regarding content, technique, number of sessions, duration, locus, and teaching modality and staff was observed in the com-prehensive sex education interventions. Almost all the interventions were effective in reducing risky sexual behaviours; however, two studies failed to achieve a reduction in risky sexual behaviours.

Hepatitis C Treatment and Behavioral Risk Among Men Who Have Sex With Men With HIV: Comparing Interferon and Direct-Acting Antiviral Eras.

Little is known about the effect of hepatitis C virus (HCV) treatment on sexual risk behavior among men who have sex with men (MSM) with HIV by treatment type (interferon [IFN]-based vs direct-acting antiviral [DAA]-based). MSM with HIV and recently acquired HCV infection enrolled in the MSM Observational Study of Acute Infection with hepatitis C (MOSAIC) cohort. Using data from 2009 to 2018, we evaluated risk behavior through a validated HCV risk score (where ≥2 indicated high risk) and its individual risk behaviors. Levels of risk behavior before, during, and after treatment were modeled for each treatment episode using linear and logistic regression with Generalized Estimating Equations adjusting for DAA availability and number of reinfections. One hundred forty MSM with a median age of 45 years (interquartile range = 40-49) yielded 180 treatment episodes (n = 131 IFN-based, n = 49 DAA-based). Adjusted mean risk score before, during, and after treatment was 2.4 (95% confidence interval [CI] = 2.1 to 2.6), 0.9 (95% CI = 0.8 to 1.0), and 1.7 (95% CI = 1.5 to 1.8), respectively. Before treatment, no differences in mean HCV risk score or proportion of specific behaviors were found between the regimen groups. During treatment, MSM treated with DAAs had a higher average risk score and proportion of receptive condomless anal sex, sharing toys and unprotected fisting than those treated with IFN. After treatment, the proportion sharing straws were significantly higher in MSM treated with DAAs than in MSM treated with IFN. MSM treated with DAAs, compared with MSM treated with IFN, had higher levels of HCV-related risk behavior during treatment. The higher risk of HCV reinfection in the DAA-era underscores the need for ongoing HCV testing and behavioral interventions against HCV.

Sexualized drug use factors among rural sexual minority men.

Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with past year sexualized drug use among rural SMM. Rural SMM in the Southern region of the United States (N = 345) completed an online cross-sectional survey from February to March 23, 2024. Participants answered questions about their sexualized drug use behaviors, sexual behaviors, minority stressors, and demographics. We conducted a hierarchical logistic regression to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with past year sexualized drug use. Over three-quarters of participants (79.7%) used substances immediately before/during sex in the past year. Sexualized drug use was associated with exposure to sexual minority stressors, polysubstance use, sexually transmitted infection testing, having oral sex, receiving drugs from a man in exchange for sex, and older age. Sexualized drug use is prevalent among rural SMM, and sexual minority stressors and past year sexual risk and substance misuse behaviors were contributing factors. Rural primary care clinics, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) service organizations, and outpatient and inpatient substance use organizations should implement integrative sexual and substance use screening, counseling, and referral services for their rural clients.

Racism, homophobia, and the sexual health of young Black men who have sex with men in the United States: A systematic review.

Black gay, bisexual, and other men who have sex with men (BMSM) experience the highest rates of HIV acquisition annually out of any population in the United States, and young BMSM (YBMSM) are heavily impacted by this inequity as they enter adulthood. Despite a high annual HIV incidence, extant literature has found BMSM to engage in fewer sexual risk behaviors than White and Hispanic/Latino men who have sex with men, resulting in a gap between risk behaviors and the inequity of HIV infection. Structural factors, such as racism and homophobia, are thus being examined in order to understand this disconnect between behavior and HIV incidence. The purpose of this systematic review was to examine the discrimination experiences of YBMSM due to racism and homophobia in the United States and to evaluate the effect of these experiences on their sexual health. Four databases (MEDLINE, CINAHL Complete, APA PsycINFO, and Sociology Source Ultimate) were searched to examine the available qualitative, quantitative, and mixed method studies relevant to the research question. Out of 17 included studies, the majority were qualitative in design and were conducted in urban settings. Racism and homophobia affected YBMSM's sense of belonging, sexual identity, and sexual partnership choices. Often, masculinity would interact with these two constructs to impact how YBMSM engaged in sexual behavior, such as condomless sex, as well as their likelihood to seek sexual health care. Future research is needed to fully understand the relationships between discrimination and sexual health to develop effective structurally responsive interventions that will help decrease the inequities experienced by YBMSM.

Sexual socialization and the sexual debut of Laotian adolescents in sociocultural context: a qualitative approach

ABSTRACT This study aims to discover how sexual socialization shapes adolescents’ sexual behaviours and attitudes by considering various socialization agents and the sociocultural context of the country. Sexual socialization in adolescents is vital to formulating sexual attitudes and behaviours that determine their health and well-being. However, little is known about how various socialization agents share their norms, ideas, and beliefs about sexuality, influencing adolescents’ sexual attitudes and behaviours from a sociocultural perspective. In order to conduct a qualitative study, in-depth semi-structured interviews were used with 21 young people aged 15 to 24 in the capital of Lao PDR. A thematic analysis presents three significant themes that emerged from the data, including social norms about premarital sex, the taboo on sexual discussion and expression, and the normalization of sexual violence. The findings contribute to theories of sexual socialization and provide suggestions for projects and policies to prevent sexual risk behaviours and sexual violence.

Oral human papillomavirus infections in Zambian Rural and Urban residents-a community cross-sectional study

BackgroundHow common it is with the presence of human papillomavirus (HPV) in the healthy and diseased oral cavity is largely unknown for Africans. In this cross-sectional study we assessed the prevalence of oral HPV and the risk factors associated with HPV contraction including sexual practice in the urban and rural Zambian population.MethodsUrban (N = 188) and rural (N = 211) Zambian adults aged 21 years and older living in Ndola and Mansa, respectively, were interviewed about demographical data, oral and coital sexual history and tobacco and alcohol use. Participants were orally examined and underwent a buccal swab test for 12 high-risk HPVs (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) and two low-risk HPVs (HPV6 and 11) with real-time PCR.ResultsAlcohol consumption was higher in urban participants than rural participants, i.e., 34.1% and 16.6%, respectively, consumed alcohol once a week or more (p = 0.001). Ever-smokers constituted 38.8% of urban and 32.2% of rural participants (p = 0.363). Engaging in orogenital sex was uncommon, however, more common in urban than rural participants (13.3% and 4.3%, respectively, p = 0.003). Only three participants were positive for HPV (HPV16, 35, and 45, respectively).ConclusionsUrban participants displayed higher sexual risk behaviour than rural participants. However, the prevalence of oral HPV infection in Zambia was low, which contrasts to the high incidence of cervical cancer reported for the country.

Earlier First Anal Sex Predicts Engagement in Chemsex Among Men Who Have Sex with Men in the United Kingdom

ABSTRACT Chemsex, a form of sexualized drug use, is prevalent among men who have sex with men (MSM) in the United Kingdom (UK), contributing to public health concerns like increased HIV transmission and overdose risk. This study explored the link between early first anal sex and chemsex engagement among MSM, a connection that has been underexplored in the UK. Analyzing data from 10,702 UK-based MSM from the European MSM Internet Survey (EMIS-2017), we used ordinal and binomial logistic regressions to assess how the age of first anal intercourse correlated with sexual risk behaviors and chemsex. The median age of anal sex debut was 17, with most participants (65%) reporting their first experience at 18 or older. A smaller group (7%) had their first anal intercourse at 13 or younger. Compared to those who had their first anal sex at 18 years or older, MSM who initiated anal sex at 17 years or younger were more likely to report having more non-steady condomless intercourse partners (aOR = 1.46, p < .001), using chemsex-associated drugs (aOR = 1.26, p = .013), engaging in non-sober sex (aOR = 1.22, p < .001), and recent involvement in chemsex (aOR = 1.48, p < .001). These findings highlight the need for interventions that address early sexual experiences to reduce sexual risk behaviors and chemsex among MSM.

Higher identity resilience - self-efficacy is associated with sexual risk behaviours in gay men.

Cross-sectional survey data from 226 heterosexual and 201 gay men in the UK and Germany, analysed using moderation analyses, showed a positive relationship between identity resilience -self-efficacy and engaging in condomless sex and drug use in sexualised settings in gay men only. It is proposed that higher self-efficacy may lead to increased feelings of invincibility in gay men, which in turn is associated with sexual risk-taking.

Effectiveness of a Sexual Risk Behaviors Prevention Program among Early Adolescent Thai Muslim Girls: A Quasi-Experimental Study

Effectiveness of a Sexual Risk Behaviors Prevention Program among Early Adolescent Thai Muslim Girls: A Quasi-Experimental Study

Exploratory Qualitative Study to Investigate Factors Influencing Men's Utilization of Sexual and Reproductive Health Services in Kwa-Zulu Natal.

Sexual and reproductive health (SRH) is essential for men's health, but a large body of research has indicated that the underutilization of most SRH services by men is a persistent issue that needs to be addressed. Men's reluctance to access sexual and reproductive health services is one of the factors that leads to high morbidity and mortality rates among men, although their diseases may have been prevented or cured. This study aimed to explore factors that influence the decision of men who resided in men's hostels and who accessed urology clinics in KwaZulu-Natal to seek help for their sexual and reproductive health issues. An exploratory qualitative approach was adopted using focus group discussions. We interviewed seventy-two men of ages above 15 years. The data were analyzed thematically. The Biomedical Research Ethics Committee (BREC) of UKZN granted ethical clearance (BE 347/19). Of the 72 interviewed men, thirty-three men attended urology clinics in the selected hospitals, and thirty-nine men resided in the hostels around Durban in KZN. Seven themes (lack of awareness of SRH services; participants' reluctance to access SRH services; influence of culture and religion; lack of financial resources; influence of relationship dynamics; perceived low risk of individual sexual behaviors; and healthcare factors that discourage men from accessing SRH services) emerged from the data that were identified as barriers to SRH service utilization by men, whilst three themes (healthcare enabling factors; access to general information on SRH services; and personal motivational factors) emerged as factors that encouraged the participants to access these services. The participants' reluctance to access SRH services was attributed to the lack of awareness of available SRH services, the influence of culture and religion, lack of financial resources, relationship dynamics, the perceived low risk of sexual behaviors for individuals, and healthcare workers' negative attitude towards men requiring SRH services. The availability of healthcare resources, the appointment of more male healthcare workers, and more positive attitudes among healthcare workers will encourage men to utilize SRH services. The exposure of various barriers to SRH service utilization by this investigation warrants urgent attention from the government to impart knowledge about this phenomenon to men.

Differences in HIV risk factors between South African adolescents and adult women and their association with sexually transmitted infections

ObjectivesIn sub-Saharan Africa, approximately 86% of HIV infections in adolescents aged 15–19 years occur among girls. Their heightened susceptibility is likely influenced by converging sociobehavioural and biological factors, although the...

Happy and resilient? Mental health, resilience, substance use and sexual behaviour of college students in Bhutan: Policy implications

Bhutan is known for its guiding philosophy of Gross National Happiness (GNH). However, concerns have increased about the well-being of its young people, and many young people are leaving Bhutan, uncertain about their futures if they remain. A survey of 2471 Bhutanese college students in 2016 explored mental health, substance use, and sexual behaviour. The survey was repeated in 2023 with 2043 college students with the addition of the Brief Resilience Scale and questions about optimism and the future. A relatively low prevalence of problematic mental health, substance use, and sexual risk behaviour was identified, but the findings continue to raise concerns. Specific concerns identified related to suicidal ideation, an increase in current alcohol, tobacco and betel nut use, low-level condom use, over 50% not regarding themselves as resilient, and many wanting a future outside Bhutan. Evidence informed policy is required to shape and support responses to the health and well-being concerns identified and to create realistic pathways for young people to feel valued, appreciated and optimistic.

HIV Prevention Intervention Reduced Sexually Transmitted Infections Among Male Tajik Labor Migrants Who Inject Drugs.

In a cluster-randomized controlled trial, the "Migrants' Approached Self-Learning Intervention in HIV/AIDS for Tajiks" (MASLIHAT) reduced intervention participants' sexual risk behaviour including any condomless sex, condomless sex with female sex workers, and multiple sexual partners. This analysis investigates if observed changes in sexual risk behaviors translated into fewer reported STIs among participants over 12-month follow-up. The MASLIHAT intervention was tested in a cluster-randomized controlled trial with sites assigned to either the MASLIHAT intervention or comparison health education training (TANSIHAT). Participants and network members (n=420) were interviewed at baseline and 3-month intervals for one year to assess HIV/STI sex and drug risk behaviour. We conducted mixed effects robust Poisson regression analyses to test for differences between conditions in self-reported STIs during 12 months of follow-up, and to test the contribution of sexual risk behaviours to STI acquisition. We then tested the mediating effects of sexual behaviours during the first six months following the intervention on STIs reported at the 9 and 12-month follow-up interviews. Participants in the MASLIHAT condition were significantly less likely to report an STI during follow-up (IRR=0.27, 95% CI 0.13-0.58). Condomless sex with a non-main (casual or commercial) partner was significantly associated with STI acquisition (IRR=2.30, 95% CI 1.26-4.21). Adjusting for condomless sex with a non-main partner, the effect of MASLIHAT intervention participation was reduced (IRR=0.36, 95% CI 0.16-0.80), signalling possible mediation. Causal mediation analysis indicated that the intervention's effect on reported STI was partially mediated by reductions among MASLIHAT participants in condomless sex with a non-main partner. The MASLIHAT peer-education intervention reduced reported STIs among Tajik labour migrants partly through reduced condomless sex with casual and commercial partners.

Development of an eHealth Intervention Prototype to Prevent Health Risk Behaviors Among Hispanic Adolescents: A User-Centered Formative Study.

Health risk behaviors continue to disproportionately affect Hispanic youth. Despite the existence of successful family and school-based interventions, there is a need for developing and testing individually-based preventive interventions that are easily accessed and widely disseminated. Therefore, this study aimed to develop a prototype (proof of concept) for an individual-level mobile application (app), informed by Hispanic parents and adolescents, to prevent/reduce drug use and sexual risk behaviors among Hispanic youth. An iterative user-centered approach was used to inform the development of the app prototype via focus groups with 66 participants (n = 46 adolescents, n = 20 parents). A coding team analyzed data from the focus groups and identified major themes. The coding team summarized interview data into sub-categories that yielded five intervention modules for Hispanic adolescents, three more than originally proposed (i.e., drug use and sexual risk behaviors): (1) effective communication, (2) depression, (3) sexual health, (4) drug use, and (5) mindfulness. A mobile application for health risk behaviors can be used as an additional preventive tool to decrease the existing behavioral health disparities among Hispanic youth. Incorporating a user-centered approach to inform development is important for including the needs and voices of this population.

The impact of Internet pornography on children and adolescents: A systematic review

ObjectivesYoung people's exposure to online pornographic material has increased in the past years. Its impact is a complex topic but an important issue due to growing concerns. Therefore, we reviewed the literature on Internet pornography consumption and its impact on children and adolescents. Furthermore, we examined young people's thoughts about pornography and their reasons for consumption. MethodWe performed a systematic literature search in the online databases ERIC, PsycARTICLES, PsycINFO, and PSYNDEX for peer-reviewed articles in English, published between 2000 and 2022 and additionally identified secondary references. ResultsWe could determine associations between pornography consumption and demographic variables (e.g., age, gender), personal characteristics (e.g., [sexual] sensation seeking, sexual interest and experience, general risk behavior), environmental variables (e.g., peers, family), attitudes (e.g., gender role attitudes, permissive sexual attitudes), behavior (e.g. sexual risk behaviour, sexting) and sexual aggression (e.g., sexual cybervictimization, grooming). Moreover, we found that girls have a more negative attitude towards pornography than boys who have an ambivalent opinion on the subject. Most adolescents are aware that the majority of pornographic material is exaggerated and unrealistic. Furthermore, pornography is not only watched out of curiosity and for sexual arousal but also used as a source of sexual information, especially by minority groups. DiscussionMany effects that impair children's development have been documented. The results found in this review are often contradictory. Therefore, further replication studies are needed. In addition, we propose several preventive measures, e.g., sexual health education at schools for both heterosexuals and LGBT (Lesbian, Gay, Bisexual, and Transgender) people.

Self-Reported Diagnosis of Autism Is Associated With a Lower Likelihood of HIV Testing

Abstract: Sexuality and sexual risk behaviors among autistic adults are often overlooked, resulting in inadequate sexual education courses and a reliance on peers or the internet as primary sources of information. Here, we plan to begin to fill this gap by assessing HIV and sexually transmitted infection (STI) outcomes among autistic adults. Data come from the 2007 NHIS data set, the only nationally representative and publicly available data set to host measures of HIV and autism alongside one another (and the only year of this survey to do so). Survey-weighted models were used to examine the association between self-reported measures of HIV/STIs and self-reported autism diagnosis. Compared with those who had not been told that they have autism, participants with an autism diagnosis had lower odds of ever having an HIV test in their lifetime (adjusted odds ratio [aOR] = 0.05; 95% confidence interval [CI]: 0.01 to 0.26). No association was observed between autism diagnosis and plans for an HIV test within the next year, nor did any autistic adults report testing positive for any STI within the past 5 years. These results suggest that further research is needed among the autism spectrum disorder community, particularly in terms of achieving the US goal of ending the HIV epidemic by 2030.

Men who have sex with men perceiving that sex with women carries the greatest risk of HIV acquisition: results from a mixed-methods systematic review in sub-Saharan Africa.

In sub-Saharan Africa (SSA), men who have sex with men (MSM) often have female sexual partners. Their overall risk of acquiring HIV is higher with male partners. Risk perception is associated with HIV knowledge, sexual risk and preventive behaviours. This synthesis aimed to summarize existing data about HIV knowledge and perceived HIV acquisition risk regarding sex with men and with women in MSM in SSA. We conducted a systematic literature review of MSM's relationships with women in SSA (PROSPERO-CRD42021237836). Quantitative and qualitative data related to MSM's perceived risk from sex with men and with women and HIV knowledge (published up to 2021) were selected and synthesized. Twenty studies were selected. More MSM perceived that the greatest risk of HIV acquisition came from heterosexual/vaginal sex than from homosexual/anal sex (53% vs. 15%; 51% vs. 39%; 42% vs. 8%; 27% vs. 25%; 43% vs. 11%; 23% vs. 13%; 35% vs. 16%, cumulative sample n = 4396, six countries). A higher proportion of MSM received preventive information on heterosexual HIV transmission than on homosexual transmission (79% vs. 22%; 94% vs. 67%; 54% vs. 19%; cumulative sample n = 1199, four countries). The qualitative synthesis (eight studies) highlighted biology- and behaviour-based misconceptions leading MSM to perceive lower or negligible HIV risk from sex with men, compared to sex with women. These misconceptions were partly fuelled by the predominant focus on heterosexual and vaginal HIV transmission in HIV prevention information. Common misconceptions regarding sexual risk between men remain unaddressed by the heteronormative messaging of HIV prevention. Underestimation by MSM of their HIV acquisition risk with male partners can pose significant barriers to effective HIV preventive behaviours and strengthen the transmission risk from MSM to their female partners. Improving access of MSM to tailored HIV prevention information and tools that address their practices with male and female partners is crucial. Integrating messages about anal sex into broader public health initiatives, including sexual health programmes targeting the general population, is essential. Further research in diverse settings in SSA is necessary to gain a greater understanding of the drivers and implications of HIV risk perception in MSM.

Examining marijuana use, sexual risk, and HIV testing outcomes among young people with intersecting marginalized social identities in juvenile drug courts

AbstractWe explored clinical outcomes among adolescents in juvenile drug court (JDC) by ethnoracial or gender identity, economic security, and mental health problems. Self‐report and drug testing data were obtained through a randomized control trial (RCT) with 101 adolescents in JDC at four time points (i.e., baseline, 3‐month immediate post, 6‐month follow‐up, and 12‐month follow‐up). Participants who identified as an adolescent girl and who were identified as having a mental health disorder demonstrated significant increases in talking about HIV 12 months after completing the intervention. Sexual risk behaviors increased for girls, Black, and Latine youth and decreased among adolescents with mental health problems. Marijuana use did not differ over time by identity. Programing that targets risk behaviors, including substance use and seemingly unrelated risk behaviors like risky sexual behavior, is warranted in addition to mental health services to improve health outcomes of adolescents with a history of juvenile legal system involvement.

Has the switch to sexual risk behaviour screening impacted deferrals for pre- and post-exposure prophylaxis therapy for human immunodeficiency virus?

Canadian Blood Services defers donors during and for 4 months after oral pre-exposure or post-exposure prophylaxis (PrEP/PEP) for human immunodeficiency virus (HIV) because of concerns about altered viral kinetics. We assessed the impact of the switch from a time-based deferral for men who have sex with men (MSM) to sexual risk behaviour criteria on PrEP/PEP deferrals. Data on PrEP/PEP deferral codes were extracted from our National Epidemiology Database for the 22 months before (Period 1) and after (Period 2) the criteria change. PEP deferrals remained stable (2.3 vs. 1.7 per 100,000 donations in Periods 1 and 2, p = 0.2892), about 45% and 33%, respectively, of these donors who reported a recent needle stick injury. PrEP deferrals increased from 5.9 to 12.4 per 100,000 (p = 0.0001); approximately 30% of donors in both periods had other HIV risk factor deferrals. Donors deferred for PrEP use alone were more likely to be male, first-time users and younger than other donors. The switch to sexual risk behaviour led to a small increase in deferrals for PrEP. We may not be measuring the full impact of deferral criteria because potential donors may self-defer and PrEP use is increasing.

Contraceptive Choice and Sexual Behaviors in Both-Sex Attracted Adolescents: A Retrospective Cohort Study

Study ObjectiveBisexual adolescents have higher rates of unintended pregnancy than their heterosexual peers and increased rates of high-risk sexual behaviors. They may be less likely to use effective contraception, though limited data is available. This study sought to compare contraceptive choice and sexual risk behaviors of both-sex attracted and opposite-sex attracted adolescents and young adults (AYA) presenting to a contraception clinic. MethodsA retrospective chart review of AYA aged 14-24 years who presented for an initial visit to a contraception clinic from 2014 to 2020. The primary outcome was contraceptive choice (long-acting reversible contraception (LARC), non-LARC, or nothing). Secondary outcomes included sexual behaviors. Results were analyzed using Pearson's chi-square and Wilcoxon tests. Results2369 AYA were included in this study. Both-sex attracted and opposite-sex attracted patients were similar in age, race, and ethnicity. There was no difference between groups in percent selecting LARC (71% vs 66.1%, p=0.11). Both-sex attracted patients reported a younger age at first sex (14.6 years vs 15.5 years, p < .001), more lifetime sexual partners (4.1 vs 2.8, p < .001), and a higher prevalence of forced intercourse (21.9% vs 8.8%, p < .001). ConclusionsBoth-sex attracted and opposite-sex attracted AYA patients chose LARCs at similar rates in a setting with standardized contraceptive counseling. Both-sex attracted patients had more sexual risk behaviors. Healthcare providers should be inclusive in their approach to obtaining sexual health histories and providing contraceptive counseling and be cognizant that adolescents with both-sex attraction may be at higher risk of forced intercourse.