Exploring Self-efficacy for Condom Use in Spanish People: A Trend Analyses by Gender from 2004 to 2020

Self-efficacy seems to be one of the most important resources for the different stages underlying condom use and STI prevention. For this reason, this study evaluates trends in self-efficacy by gender, from 2004 to 2008, 2013 and 2020 in Spain. Throughout these years, 6,698 people ranging from 17 to 40 years old, participated filling the Brief scale of condom use self-efficacy. According to our findings, despite the slight improvement in the recent years, self-efficacy still maintains a risky profile for safe sex, especially among the youngest people. Moreover, most of the traditional gender differences continue over the years with women reporting lower scores for condom purchase and men for putting them. However, these differences are not relevant in other dimensions such as using condoms despite drug consumption where women reveal worse results over the years. Therefore, our findings reaffirm the need of intensifying gendered preventive efforts aimed at Spanish people and, particularly, among the youngest.

Factors associated with sexually transmitted infection/HIV diagnosis among a predominantly university population in Brazil

In Brazil, the increasing prevalence of HIV infection in young people makes it critical to know its distribution in university communities. In this cross-sectional study, we evaluated the impact of STI/HIV testing campaigns on university campuses from 2013 to 2017. The participants took part in rapid testing for HIV, syphilis, hepatitis B and C, and counseling sessions. A total of 2691 people participated in the campaigns. Of these, 79.4% were single, and 50.3% were women. The median age was 24 years old, and 77.9% of participants had ≥12 years of formal education. Most reported having unprotected sex in the last year (87.4%). The positivity rates for HIV, syphilis, hepatitis B virus, and hepatitis C virus were 0.56%, 1.20%, 0.19%, and 0.11%, respectively. The characteristics associated with HIV infection were being men who have sex with men (MSM) (aOR = 12.06; 95% CI = 3.83-37.99) and having <12 years of schooling (aOR = 3.28; 95% CI = 1.03-10.38). Factors associated with syphilis seropositivity were older age (aOR = 1.06; 95% CI = 1.03-1.09), multiple partners (aOR = 2.44; 95% CI = 1.08-5.50), and being MSM (aOR = 5.40; 95% CI = 2.49-11.72). Positivity for hepatitis B tended to decrease with the years of testing (p = 0.023) and for hepatitis C to increase with age (p = 0.035). Our study observed a high vulnerability to HIV and syphilis infection in a university community, which needs an early prevention strategy, including regular testing, continuing sexual education, easy access to condoms, and pre- and postexposure HIV prophylaxis.

Risky sexual behavior and its associated factors among patients with severe mental disorder in University of Gondar Comprehensive Specialized Hospital, 2018

BACKGROUND

People with severe mental disorders are more likely to engage in high-risk sexual behaviors. As a result of these high-risk behaviors, they might contract sexually transmitted infections and become pregnant unintentionally. Despite the high burden of this problem, very little is known about the association between mental disorders and high-risk sexual behaviors; for this reason, the current study aimed at determining the association between these two behaviors in patients with mental disorders attending an outpatient clinic at the University of Gondar Comprehensive Specialized Hospital, Psychiatric Clinic.

METHODS

A total of 223 study participants were recruited via a stratified sampling followed by a systematic sampling technique. An institutional-based cross-sectional study was conducted from April to May 2018. Data were collected using a pretested interviewer-based questionnaire. A four-item questionnaire was adopted from a behavioral surveillance survey and different literature sources. A multivariable logistic regression model was fitted to assess the strength in addition to the direction of the association between risky sexual behavior and independent variables. An interpretation was made based on the adjusted odds ratio and p-value at a 95% confidence interval (CI).

RESULT

Nearly half of the study participants (49.8, 95% CI; 43.9-56.5%) presented risky sexual behavior. The study found that male gender (2.98; adjusted odds ration [AOR] = 2.98; 95% CI; 1.49-5.95), no ability to read and write (3.99; AOR = 3.99; 95% CI: 1.53-10.4), history of hospitalization (3.95; AOR = 3.95; 95% CI: 1.87-8.32), perceived internal stigma (2.45, AOR = 2.45; 95% CI: 1.18-5.11), and poor social support (3.07, AOR = 3.07; 95% CI: 1.29-7.30) were significant predictors of risky sexual behaviors among patients with severe mental disorder.

CONCLUSION

Risky sexual behavior among patients with a severe mental disorders was high (49.8%). Special attention should be given to male patients, incorporating people with severe mental disorders into the adult education programs, continuous health education regarding risky sexual behavior and utilization of condoms, building self-esteem, and engaging others to provide good social support systems are strongly recommended to alleviate this type of behavior in this population.

Needs assessment for sexual health services development in a small European Union member state

Introduction

Awareness of sexual health in Malta – a small European Union member state started to gain momentum in the new millennium. Taboos and norms about sexuality pose strong barriers for the provision of information, and reproductive health services. A major contributor is the strong influence of the Roman Catholic Church, which holds fast to its prohibitions of sexual behaviours, albeit counterbalanced by the liberal standpoint adopted by the State in recent years.

Methods

Survey data were collected from 269 students aged 16–21 (response rate 89.7%) in a state post-secondary school. The sample was selected through convenience sampling within the school grounds.

Results

Women were more knowledgeable in relation to available services and risks when compared to men. No geographical differences were found. School was the most common source for information, while health professionals, namely general practitioners were considered trusted resources for their needs. Confidentiality was deemed to be the most requested and crucial feature of sexual health services.

Conclusions

Three important multisectoral needs emerged, namely adequate dissemination system of sexual health information, scientifically based sexual health education for professionals in contact with young people, and well-designed and accessible sexual health services. Implications for management include updating health sexual education and promotion strategies, as well as designing better services. Young people should be able to make informed choices regarding their sexual health, in line with contemporary needs.

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

BACKGROUND

We investigated how STI risk perception relates to behavioural STI risk and STI healthcare (sexual health clinic attendance/chlamydia testing) in the British population.

METHODS

Natsal-3, a national probability-sample survey undertaken 2010-12, included 8397 sexually-active 16-44 year-olds. Participants rated their risk of STIs (excluding HIV) given their current sexual lifestyle. Urine from a randomly-selected sub-sample of participants (n = 4550) was tested for prevalent STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis).

FINDINGS

Most men (64% (95% CI: 62-66)) and women (73% (72-74)) rated themselves as not at all at risk of STIs, 30% (29-32) men and 23% (22-25) women self-rated as not very much, and 5% (5-6) men and 3% (3-4) women as greatly/quite a lot at risk. Although those reporting STI risk behaviours were more likely to perceive themselves as at risk, > 70% men and > 85% women classified as having had unsafe sex in the past year, and similar proportions of those with a prevalent STI, perceived themselves as not at all or not very much at risk. Increased risk perception was associated with greater STI healthcare-use (past year), although not after adjusting for sexual behaviour, indicating in a mediation analysis that risk perception was neither necessary or sufficient for seeking care Furthermore, 58% (48-67) men and 31% (22-41) women who had unsafe sex (past year) and rated themselves as greatly/quite a lot at risk had neither attended nor tested.

INTERPRETATION

Many people at risk of STIs in Britain underestimated their risk, and many who correctly perceived themselves to be at risk had not recently accessed STI healthcare. Health promotion needs to address this mismatch and ensure that people access healthcare appropriate to their needs.

Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model

BACKGROUND

University students are within the age group at highest risk for acquiring sexually transmitted infections and other negative health outcomes. Despite the availability of sexual health services at university health centres to promote sexual health, many students delay or avoid seeking care. This study aimed to identify the perceived barriers and enablers to sexual health service use among university undergraduate students.

METHODS

We used a qualitative descriptive design to conduct semi-structured focus groups and key informant interviews with university students, health care providers, and university administrators at two university health centres in Nova Scotia, Canada. The semi-structured focus group and interview guides were developed using the Theoretical Domains Framework and COM-B Model. Data were analyzed using a directed content analysis approach, followed by inductive thematic analysis.

RESULTS

We conducted 6 focus groups with a total of 56 undergraduate students (aged 18-25) and 7 key informant interviews with clinicians and administrators. We identified 10 barriers and enablers to sexual health service use, under 7 TDF domains: knowledge; memory, attention and decision-making processes; social influences; environmental context and resources; beliefs about consequences; optimism; and emotion. Key linkages between students' social opportunity and motivation were found to influence students' access of sexual health services.

CONCLUSIONS

We identified barriers and enablers related to students' capability, opportunity and motivation that influence sexual health service use. We will use these findings to design an intervention that targets the identified barriers and enablers to improve students' use of sexual health services, and ultimately, their overall health and well-being.

Risk Factors Associated with Self-reported Sexually Transmitted Infections among Postsecondary Students in Canada

Background:

Despite major public health efforts in addressing the burden of disease caused by sexually transmitted infections (STIs), rates among young adults continue to rise in Canada. The purpose of the study was to examine the prevalence and risk factors associated with acquiring STIs among postsecondary students in Canada.

Methods:

A secondary analysis of the American College Health Association-National College Health Assessment II-C Spring 2016 survey data (n = 43,780) was conducted. Sexually active participants (n = 28,831) were examined for their demographics, sexual behavior, alcohol and marijuana use, testing for human immunodeficiency virus (HIV), and human papillomavirus vaccination history. These factors were analyzed to help identify their possible association with acquiring an STI using logistic regression and multivariate modeling.

Results:

Among the study participants, 3.88% had an STI, with the highest rates observed among females and individuals aged 21–24 years old. Multivariate logistic analysis showed that participants who engaged in anal intercourse within the past 30 days (odds ratio [OR] = 1.634; 95% confidence interval [CI], 1.343–1.988), had four or more sexual partners in the last 12 months (OR = 4.223; 95% CI, 3.595–4.962), used marijuana within the past 30 days (OR = 1.641; 95% CI, 1.387–1.941), and had ever been tested for HIV (OR = 3.008; 95% CI, 2.607–3.471) had greater odds of acquiring an STI.

Conclusions:

The findings of this study highlight certain high-risk behaviors that are strongly associated with acquiring an STI among postsecondary students. Thus, efforts to design and deliver relevant educational programming and health promotion initiatives for this particular population are of utmost importance.

Exploring psychosocial predictors of STI testing in University students

Background

To explore university students’ Sexually Transmitted Infection (STI) testing knowledge, psychosocial and demographic predictors of past STI testing behaviour, intentions to have an STI test, and high risk sexual behaviour, to inform interventions promoting STI testing in this population.

Methods

A cross-sectional, quantitative online survey was conducted in March 2016, recruiting university students from North East Scotland via an all-student email. The anonymous questionnaire assessed student demographics (e.g. sex, ethnicity, age), STI testing behaviours, sexual risk behaviours, knowledge and five psychological constructs thought to be predictive of STI testing from theory and past research: attitudes, perceived susceptibility to STIs, social norms, social fear and self-efficacy.

Results

The sample contained 1294 sexually active students (response rate 10%) aged 18–63, mean age = 23.61 (SD 6.39), 888 (69%) were female. Amongst participants, knowledge of STIs and testing was relatively high, and students held generally favourable attitudes. 52% reported ever having an STI test, 13% intended to have one in the next month; 16% reported unprotected sex with more than one ‘casual’ partner in the last six months. Being female, older, a postgraduate, longer UK residence, STI knowledge, perceived susceptibility, subjective norms, attitudes and self-efficacy all positively predicted past STI testing behaviour (p < 0.01). Perceived susceptibility to STIs and social norms positively predicted intentions to have an STI test in the next month (p  < 0.05); perceived susceptibility also predicted past high-risk sexual behaviour (p < 0.01).

Conclusions

Several psychosocial predictors of past STI testing, of high-risk sexual behaviour and future STI intentions were identified. Health promotion STI testing interventions could focus on male students and target knowledge, attitude change, and increasing perceived susceptibility to STIs, social norms and self-efficacy towards STI-testing.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5587-2) contains supplementary material, which is available to authorized users.

Prevalence and factors associated with sexually transmitted infections among HIV positive women opting for intrauterine contraception

Background

Women living with HIV/AIDS (WLHA) are a high risk group for sexually transmitted infections (STIs). However, the majority of women with STIs are asymptomatic. Data on prevalence of STIs among WLHA in Uganda are limited. The objective of the study was to determine prevalence and factors associated with STIs among WLHA opting for intrauterine contraceptive device (IUD).

Methods

Three hundred fifty one WLHA deemed free of STIs using a syndromic logarithm were enrolled into the study. Endo-cervical swabs were taken before IUD insertion and PCR test for Nisseria gonorrhea (NG), Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) infections conducted.

Results

Participants’ mean age was 29.4 ± 6.2 years, 83% were under 35years, 50% had secondary education and 73% were married. The majority (69%) had disclosed their HIV sero status to their spouses, 82% used Cotrimoxazole prophylaxis, 70% were on antiretroviral therapy, 90% had CD4 count greater than 350, about 60% reported condoms use and 70% were of parity 2-4. Over 50% of the participants’ spouses were older than 35 years and 72% had attained secondary education. STIs prevalence was 11.1%, (95% CI 7.8-14.4) and individual prevalence for TV, NG, and CT was 5.9%, 5.4% and 0.9% respectively. Factors independently associated with STI were having primary or less education (OR= 2.3, 95% CI: 1.09 - 4.85) having a spouse of primary or less education (OR= 3.3, 95% CI: 1.6 - 6.78) and muslim faith (OR= 0.2, 95% CI: 0.04 - 0.78).

Conclusion

STI prevalence was 11.1%. TV and NG were the commonest STIs in this population. Having primary or less education for both participant and spouse was associated with increased risk while being of muslim faith was associated with reduced risk of STI.

Factors perceived to influence risky sexual behaviours among university students in the United Kingdom: a qualitative telephone interview study

Background

In the United Kingdom people under the age of 25 years are at increased risk of contracting sexually transmitted infections. Most university students belong to this age group but little is known about their sexual behaviours. The aim of the study was to explore university students’ perspectives of factors and mechanisms that influence risky sexual behaviours among university students in the United Kingdom.

Methods

All students at a university in a northern city of England were invited via email to participate in qualitative telephone interviews. Interviews were audio recorded and transcribed verbatim. Framework analytical approach was used.

Results

Twenty interviews were conducted with a diverse sample of students. The social context of university lifestyle was perceived to affect risky sex through high levels of alcohol consumption, increased sexual opportunities, liberation from moral surveillance and expectations of the stereotypical highly sexually active student. Individual and cultural differences were also perceived to account for some patterns of risky sex with older students, overseas students and religious students perceived to be less likely to engage in risky sex due to academic priorities and a tendency to be more likely to adhere to moral values. Risk denial was also a key factor that led students to engage in risky sex. Poor access to sexual health services including inconvenient opening times, lack of confidentiality and stigma were perceived to contribute to the limited use of sexually transmitted infections testing and contraceptive services.

Conclusions

Lifestyle, individual and structural factors seem to play an important role in influencing the risky sexual behaviours of university students. Therefore preventive interventions that focus on these factors could be very useful in this sub-population of young people. This study provides useful baseline information that helps us understand how and why some United Kingdom university students engage in risky sexual behaviours that puts them at risk of contracting sexually transmitted infections.