HIV/AIDS-Related Knowledge, Attitudes And Sexual Behaviors as Predictors of Condom Use Among Young Adults in Croatia

Knowledge about and prevalence of Chlamydia trachomatis in a population-based sample of emerging Croatian adults

To determine the prevalence of genital Chlamydia trachomatis (chlamydia) infection, knowledge about chlamydia and experience of previous testing for chlamydia, we carried out a national probability-based survey in emerging adults aged 18-25 years in Croatia in 2021-2022. Participants (n = 1197), members of a national online panel, completed a web-based questionnaire that collected information on socio-demographics, sexual behaviours and knowledge about sexually transmitted infections (STIs). Urine specimens from a sample of sexually experienced participants were self-collected and tested for chlamydia using Cobas 4800 CT/NG test. To achieve broad representativeness of the emerging adult population in the country, we applied post-hoc weighting for gender and age. Multivariable ordinary least squares linear regression was used to determine correlates of knowledge about chlamydia infection and binomial logistic regression to assess correlates of the willingness to test for chlamydia. Among 448 participants who sent in their urine specimens chlamydia prevalence was 2.5% (95% CI 1.2-5.1) in women and 1.0% (0.3-3.2%) in men. A total of 8.0% of women and 4.7% men reported testing for chlamydia prior to the survey. About a quarter of the sample was characterized by not answering correctly any of the six questions related to knowledge about chlamydia, while only 9.6% had five or six correct answers. In the multivariable analysis, significantly higher odds of willingness to test for chlamydia were found in females compared to males (OR = 1.34, p = 0.024), those with better knowledge about the infection (OR = 1.11, p = 0.005), and those with lower religiosity (OR = 0.91, p = 0.017). In conclusion, prevalence of chlamydia in emerging adults in Croatia is considerable. Efforts to control this infection should focus on primary prevention and targeted testing combined with effective case management strategies.

Changes in sexually transmitted infections-related sexual risk-taking among young Croatian adults: a 2005-2021 three-wave population-based study

AIM

To assess the prevalence and dynamics of risky sexual behaviors among Croatian emerging adults in the 2005-2021 period.

METHODS

Three surveys were conducted on large-scale national samples of young adults aged 18-24 in 2005 (N=1092) and 18-25 in 2010 and 2021 (N=1005 and N=1210, respectively). The 2005 and 2010 studies were conducted with face-to-face interviews on stratified probabilistic samples. The 2021 study was conducted by computer-assisted web-interviewing on a quota-based random sample from the largest national online panel.

RESULTS

Compared with 2005 and 2010, the age at coital debut increased for both genders in 2021 (by a median of one year, to 18 years, and by a mean of half a year, to 17.5 years, in men and to 17.9 in women). In the 2005-2021 period, condom use increased by about 15% both at first intercourse (to 80%) and in consistent use (to 40% in women and 50% in men). When we controlled for basic socio-demographics, Cox and logistic regressions indicated that, for both genders, in 2005 and 2010 compared with 2021, the risks/odds were significantly higher for reporting an earlier sexual debut (adjusted hazard ratio 1.25-1.37), multiple sexual partners (adjusted odds ratio [AOR] 1.62-3.31), and concurrent relationships (AOR 3.36-4.64), while the odds were lower for condom use at first sexual intercourse (AOR 0.24-0.46) and consistently (AOR 0.51-0.64).

CONCLUSION

Risky sexual behaviors decreased in the 2021 survey compared with the previous two waves, in both genders. Nonetheless, sexual risk-taking is still frequent among young Croatian adults. The introduction of sexuality education and other national-level public health interventions to reduce sexual risk-taking thus remains a public health imperative.

Determinants of condom use during last sexual intercourse among male college youth of Kaski, Nepal: A cross-sectional survey

Background

The National Family Planning program of Nepal has introduced the condom as an important family planning method. Despite the continuous effort from the public and private sectors at various levels, its use among youth remains low. Therefore, this study aimed to assess the factors associated with condom use during the last sexual intercourse among male college youth.

Methods

We conducted a cross-sectional study and analyzed the responses of 361 male college youth (aged 19 to 24 years who reported being sexually active preceding six months of the survey), among the 903 participants who reported being involved in vaginal and anal sexual intercourse. The chi-square test was primarily used to find the associated factors and then, stepwise logistic regression was performed by selecting the covariates after the multicollinearity test followed by adjustment of confounders.

Results

We found that more than one-fourth (27.4%) of the sexually active male youth had used the condoms during their last sexual intercourse. Postgraduate male youth were four times more likely to use the condoms during the last sexual intercourse than undergraduate male youth (AOR = 4.09, 95% CI; 2.08–8.06). Similarly, married youth were less likely to use the condoms during the last sexual intercourse with 95% lower odds than their counterparts (AOR = 0.05, 95% CI; 0.01–0.38). Male youth with adequate knowledge about the condoms were 8 times more likely to use them compared to those with inadequate knowledge (AOR = 8.42, 95% CI; 4.34–16.33). Likewise, male youth with favorable attitude towards the condoms were 2.5 times more likely to use them compared to their counterparts (AOR = 2.58, 95% CI; 1.23–5.42). Similarly, male youth having two or more sex partners were 4.5 times more likely to use the condoms than the youth having only a sex partner (AOR = 4.57, 95% CI; 2.38–8.76).

Conclusion

The study concluded that slightly more than one-fourth (27.4%) of male college youth in Kaski district used the condoms during their last sexual intercourse. Level of education, marital status, knowledge about condoms, attitude toward condoms, and number of sex partners are the determinants of condom use among male college youth so recommended for early behavioral interventions, especially in knowledge and attitude. Further studies focusing on including the rural youth and larger geography may help to reach a firmer conclusion.

Behavioral Profiles and Attitude toward Condom Use among College Students in Southwest Ethiopia

Background

Unsafe sexual behavior among adolescents still represents a public health challenge. To have safe sex, effective condom utilization is needed. Condom use remains relatively low among adolescents in sub-Saharan Africa. Even though adolescents have good knowledge about condom use, they are still engaged in risky sexual behavior.

Objective

To assess condom use and attitude toward condom use among college students in southwest Ethiopia.

Methods

A cross-sectional study was conducted among 453 students at Mizan-Aman Polytechnic College in southwest Ethiopia. Data were collected using a structured self-administered questionnaire. The collected data were entered using EpiData version 4.2.0.0 and analyzed using SPSS version 20 statistical software. Binary logistic regression was computed. Independent variables with a p value of less than 0.05 in the multivariable logistic regression model were considered significant.

Results

Of the 453, 180 were sexually active. Among those sexually active, 119 (66.1%) used condoms in their last sexual intercourse. The proportion of positive attitude toward condom use was 53.4%, and the mean attitude score for condom use was 28.6 (±9.99 SD) ranging from 10 to 50. The study also found that being male (AOR = 1.77, 95% CI [1.19-2.65]), rural resident (AOR = 2.20, 95% CI [1.47-3.30]), ever had sex (AOR = 1.87, 95% CI [1.23-2.85]), and knowledge of STIs (AOR = 1.66, 95% CI [1.10-2.51]) were factors associated with a positive attitude toward condom use.

Conclusion

The proportion of positive attitude toward condom use among college students in Ethiopia was low. The study also found that being male, rural resident, ever had sex, and knowledge of STIs were factors associated with a positive attitude toward condom use. Therefore, strengthening information, education, and communication (IEC) on condom self-efficacy; providing condoms on campuses; and imparting education about sexually transmitted infections for young adults are central for improving condom use and attitudes toward condom use. Besides, inculcating sexual and reproductive health in the educational curriculum plays paramount importance.

A cross-sectional survey of relationships between sexual knowledge, sexual attitudes, and reproductive health behaviour among female university students

BACKGROUND

Reproductive health includes responsible, satisfying, and safe sex as well as reproductive well-being. This study aimed to examine relationships between sexual knowledge, sexual attitudes, and reproductive health behaviour among female college students.

DESIGN

Cross-sectional survey.

METHODS

Female undergraduate students (N = 407) from 4 universities completed a series of self-report questionnaires consisted of sexual knowledge, sexual attitudes, and reproductive health behaviour.

RESULTS

Reproductive health behaviour was significantly influenced by sexual knowledge (β = .67) and sexual attitudes (β = .20). Structural equation modelling indicated that sexual knowledge directly and indirectly affected reproductive health behaviour with sexual attitudes acting as a mediator.

CONCLUSIONS

The findings indicate that it is necessary to consider sexual attitudes as well as sexual knowledge in promoting young women's reproductive health behaviour. The results may guide the development of sexual education programmes for young women. Impact Statement: Sexual attitude is an important factor influencing relationship between sexual knowledge and reproductive health behaviour among young female.

Prevalence and determinants of condom use among male adolescents in Indonesia

Adolescent sexual and reproductive health problems remain a public health concern in Indonesia. An increase of premarital sex as well as early sexual debut among adolescents without any protection leads to a high risk of adverse sexual and reproductive health consequences. This study aimed to assess condom use prevalence and identify its determinants among male adolescents who are sexually active in Indonesia. This was a cross-sectional study using secondary data from the Adolescent Reproductive Health component of the Indonesia Demographic and Health Survey (IDHS) 2012. The sample for this study was 1341 sexually active male adolescents aged 15-24 years old. Data were analyzed descriptively and using binary logistic regression for bivariate and multivariate analysis. This study found that condom use prevalence among male adolescents at first and last sex accounted for 25.0% and 27.4%, respectively. Determinants of condom use varied by time of sexual intercourse. Knowledge of sexual and reproductive health and obtaining information about condoms were consistently related to condom use at first and last sexual encounter. Meanwhile, residential type, age at first sex, and sexual partner were significant determinants of condom use at sexual debut whilst educational level was only associated with condom use at last sex. As the level of protected sex among male adolescents was very low, providing comprehensive sexuality education (CSE) is suggested in order to develop the capacity among adolescents in making informed decisions and preventing unsafe sex.

Psychometric Properties of the Condom Use Barriers Scale for Adolescents

Inconsistent condom use in young people is related to the perceived barriers to their use. The psychometric properties and factor structure of the new Condom Use Barriers Scale for Adolescents (CUBS-A) are analyzed. Concurrent validity was assessed by the Attitude towards condom use subscale of the validated HIV-AS test and the percentage of condom use variable. A total of 629 Spanish adolescents whose mean age was 15.17 (SD = 1.09; 51.5% boys) participated. Exploratory factor analysis supported a 15–item instrument with four factors: negotiation skills, perceived feelings, negative aspects of condoms, and disruption of the sexual experience, which explained 41.89% of the total variance (KMO = .84; χ2 = 1071.93; p < .001). The results show high internal consistency (α = .86) and a good fit of the data to the model (NNFI = .93; CFI = .95; IFI = .95; RMSEA = .04). Its total score and most of its factors show acceptable correlation with the percentage of condom use, values that support the criterial validity (p ≤ .05). Gender differences were found in most subscales (p ≤ .001). The CUBS-A is a valid and reliable new instrument for assessing perceived barriers in adolescents for using condoms to protect themselves during sexual intercourse.

Efficacy of Human Immunodeficiency Virus/Sexually Transmitted Infection Prevention Interventions Targeting Female Entertainment Workers: A Systematic Review and Meta-analysis

Female entertainment workers (FEWs) working in karaoke lounges, bars, pubs, nightclubs, discotheques, dance halls, massage parlours, restaurants (as hostesses or singers) and beer gardens are at high risk for human immunodeficiency virus (HIV)/sexually transmitted infection (STI). The aim of the systematic review and meta-analysis is to evaluate the efficacy of HIV/STI intervention programmes targeting FEWs. Among the 14 included studies, majority were in Asia and targeted native FEWs. Most studies were quasi-experimental and the overall quality was relatively low. While most studies employed only behavioural strategies, structural interventions were the least common. In studies with structural interventions, there was a preference for behavioural and biomedical-based outcome measurements rather than structural-related indicators. FEWs in the intervention group were significantly more likely to report condom use with paying (odds ratio OR 1.7; 95% CI 1.0-2.9, p 0.04), but not with regular (OR 1.0; 95% CI 0.8-1.3, p 0.84) partner than the control/comparison group post-intervention.

Knowledge, attitude, self-efficacy and estimation of frequency of condom use among Iranian students based on a crosswise model

BACKGROUND

This study aimed to evaluate the knowledge, attitude and self-efficacy and condom use among Iranian students.

METHODS

Knowledge, attitudes towards condoms and self-efficacy of condom use questionnaire were translated and back translated. Then content validity ratio (CVR) and content validity index (CVI) questions higher than 0.6 and 0.71 were accepted, respectively. A "crosswise model" was used to estimate condom use. After pretest on 10 students, reliability test was done by test-re-test and Cronbach's α. A multi stage sampling was done for 1500 students in Shahroud universities. They filled in a self administered questionnaire and gave it back to the researcher after 40-50 min.

FINDINGS

Knowledge, in females was (3.03±1.1) and in males was (3.53±0.83) (p=0.001). Also a small percentage of the students, i.e. 83 girls (9.1%) and six boys (1.1%) had good self-efficacy of condom use (p=0.001). Estimates relating to the use of condoms with a crosswise test showed that 16% of girls (CI=16, 24) and 27% of boys (CI=17, 38) had used a condom during intercourse.

CONCLUSION

It seems that these three important indicators of reproductive health should be incorporated in AIDS control programs and training programs should emphasize it more.

Sexual risk behaviors increasing among adolescents over time: comparison of two cohorts in Spain

Despite advances in treatment and prevention, HIV/AIDS remains a serious health and social problem. This study's objective is to examine sexual behavior, levels of knowledge, and attitudes toward HIV/AIDS between two cohorts in Spanish adolescents, and to analyze gender differences in these cohorts. Participants were 2132 adolescents between 15 and 18 years of age: 1222 in 2006 (43.2% boys) and 910 in 2012 (54.1% boys). The results indicate lower HIV knowledge and less favorable attitudes about HIV/AIDS in the 2012 cohort. In addition, adolescents from the 2012 cohort had their first sexual intercourse at an earlier age and have more sexual partners than those from the 2006 cohort. Compared to boys, girls engage in fewer risky behaviors, although they did not use condoms with their stable partner; girls tended to use condom less when they were in a stable relationship than boys. This study confirms the insufficiency of prevention campaigns as well as the need to improve the impact from programs that promote healthy sexual habits. Assuming comparability of cohorts, this study suggests increased risk of HIV/AIDS over time.

Attitudes of adolescents towards sexual health in three cities from Croatia and Bosnia and Herzegovina

AIM

This study aimed to determine the attitudes of adolescents towards sexual health and to assess their understanding of contraception use and knowledge about sexually transmitted infections in three ethnically different areas of Croatia and Bosnia and Herzegovina.

METHODS

A total of 146 adolescent high school students between 17 and 19 years of age from three different cities were enrolled in this cross-sectional study. The participants completed two anonymous questionnaires: one that measured attitudes towards safe sex practice and another that measured contraception and general sexual health knowledge.

RESULTS

Shame was identified as the main factor why adolescents did not seek information about sexual health and contraception. On average, respondents correctly answered only 35% of questions regarding sexual health. Adolescents from East Mostar, with a predominantly Bosniak population, had more positive attitudes towards safe sex and showed less contraception knowledge in comparison to their colleagues from two cities in Croatia.

LIMITATIONS

Our study design might be burdened by socially desirable reporting and other biases inherent to the survey design.

CONCLUSION

Adolescents from Croatia and Bosnia and Herzegovina, countries that experienced war and are still undergoing post-communist socio-economic transition, generally did not have adequate knowledge with respect to safe sex lifestyles. Respondents had major problems identifying sexually transmitted infections and their knowledge about contraception was insufficient.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Providing care for adolescent populations should address specificities in local ethnical and socio-economical circumstances. There is a need for further studies to determine social, cultural and religious factors influencing the knowledge and attitudes towards sexual health in order to provide most effective interventions for specific adolescent populations.

Repeat HIV testing at voluntary testing and counseling centers in Croatia: successful HIV prevention or failure to modify risk behaviors?

HIV testing plays a critical role in preventing the spread of the virus and identifying infected individuals in need of care. Voluntary counseling and testing centers (VCTs) not only conduct testing but they also provide counseling. Since a proportion of people who test negative for HIV on their previous visit will return for retesting, the frequency of retesting and the characteristics of those who retest may provide insights into the efficacy of testing and counseling strategies. In this cross-sectional, retrospective study of 1,482 VCT clients in Croatia in 2010, 44.3% had been tested for HIV before. The rate of repeat HIV testing is lower in Croatia than in other countries. Men who have sex with men (MSM) clients, those with three or more sexual partners in the last 12 months, consistent condom users with steady partners, and intravenous drug users were more likely to be repeat testers. This finding suggests that clients presenting for repeat HIV testing are those who self-identify as being at a higher risk of infection. Our data showed that testing positive for HIV was not associated with repeat testing. However, the effects of repeat testing on HIV epidemiology needs to be explored.

Is religiosity a barrier to sexual and reproductive health? Results from a population-based study of young Croatian adults

Following the demise of socialism in 1989, religious identification substantially increased in most countries of Central, East, and Southeast Europe. Considering that there is evidence that religiosity is associated with reduced sexual risk taking among young people, this study explored associations between religiosity--assessed at three different levels (religious upbringing, personal religiosity, and social network religiosity)--and sexual risks among young Croatian adults. In addition, we examined whether religiosity predicted chlamydial infection among women and men aged 18-25. The data were collected in a national probability survey carried out in 2010 (n = 1,005). Overall, the effects of religiosity were sporadic, present primarily among women, and of small size. This lack of a sizeable impact of religiosity on young adults' sexuality was likely related to a particular type of religiosity, characterized by individualized morality, found among young people in the country. Although Croatia seems to be one of the most religious countries in Europe, our findings suggest that promoting religious morality--as recently attempted by an abstinence-based educational program--may not be an efficient tool in reducing sexual risks.

Condom use errors and problems in a national sample of young Croatian adults

In this study, we examined the correlates of condom use errors and problems in a population-based study conducted in 2010 among young Croatian adults aged 18-25 years. Out of a total sample of 1,005 participants, 679 reported condom use in the preceding year. The analyses focused on four outcomes: condom breakage, condom slippage, condom-related erection loss, and delayed condom application. Eighteen percent of participants experienced breakage, 13% reported slippage, 17% reported erection loss, and 34% applied a condom after intercourse started. Multivariate logistic regression analyses were performed to examine the correlates of these condom use errors and problems. Condom breakage was less likely to be reported by women and older participants. The odds of breakage were increased for participants who reported being under the influence of drugs during sex and who reported other condom use errors and problems in the past year. Condom slippage was more likely to occur among younger participants and those who reported condom breakage and delayed condom application. Condom-related erection loss was positively associated with a higher number of sexual partners in the preceding year, condom breakage, and a higher score on the Anti-Erotic Obstacles to Condom Use Scale. Odds of delayed condom application were increased for participants who experienced condom breakage and for those who consumed alcohol before sex in the past year. Having used a condom at first sex significantly reduced the odds of applying a condom after intercourse started. In comparison to non-habitual condom users, habitual users were found less likely to report any of the assessed condom use errors and problems. Improving condom use skills remains an important task in Croatia, which is currently hampered by the absence of evidence-based sex education in schools.

Knowledge of HIV/AIDS prevention and factors associated with condom use among adolescents in northeast Brazil

AIM

To assess the knowledge of HIV/AIDS prevention and factors associated with condom use among adolescent.

METHODS

A cross-sectional study was conducted among 410 outpatient adolescents. Association between knowledge on the transmission of HIV/AIDS and variables were analyzed using the chi-square test. Logistic regression model was used to estimate the factors associated to condom use.

RESULTS

The knowledge about HIV/AIDS transmission was high and lower percentages of knowledge were observed regarding the non-transmission of HIV/AIDS. Younger adolescents revealed less knowledge than older adolescents. After multiple logistic regression the following factors were associated with condom use: male gender (p = 0.029), same age between partners (p = 0.002) and having until 1 year elapsed since sexual initiation (p = 0.001).

CONCLUSION

The knowledge regarding HIV/AIDS prevention was satisfactory. However, this does not imply that adolescents put such knowledge to use.

Adolescent optimistic bias toward HIV/AIDS in Seoul, South Korea

The reported rates of HIV/AIDS cases and risky sexual behaviors have increased among adolescents in South Korea. This study reports the presence, impact, and development of optimistic bias toward HIV/AIDS in Korean adolescents. Survey data from 2996 participants were randomly collected from 8 high school and 8 middle school students in Seoul, South Korea. This study found that Korean high and middle school students had greater optimistic bias toward HIV/AIDS compared with their peers (P = .000). Involvement (r = -0.19; P < .01) decreased optimistic bias, whereas self-esteem (r = 0.13; P < .01) and self-control (r = 0.22; P < .01) increased it. Univariate analysis results indicated that gender and academic performance significantly influenced optimistic bias. However, according to hierarchical multiple regression, this significance was lost, and involvement, self-esteem, and self-control exerted a greater effect. Equipping Korean adolescents with involvement, awareness, and tailored interventions will reduce optimistic bias and yield greater protection against HIV/AIDS.

Understanding the association between condom use at first and most recent sexual intercourse: an assessment of normative, calculative, and habitual explanations

The aim of this study was to provide a better understanding of the likely mechanisms underlying regular condom use. In 2009, 1145 sexually active individuals aged 18-65 years were surveyed online, after being recruited via an e-mail message circulated at a large Croatian university and posted on various social networking websites. Participants' mean age was 28.1 years (SD = 8.01). Women constituted a slight majority of the sample (51.6%). The research questions - whether the frequently observed association between condom use at first and most recent sexual intercourse could be best predicted by (a) norm-oriented behavior; (b) calculative decision-making; or (c) habit formation - were tested using multiple logistic regression. Only the calculative and habitual motivational determinants of condom use were significant predictors. Unlike calculative use, which decreased the odds of condoms being used at both occasions, habitual use, as expected, increased the odds of condom use. In addition, the habitual modality of condom use significantly predicted consistent condom use with both casual and steady sexual partners. Age, being in a relationship, and the number of lifetime sexual partners were negatively associated with habitual condom use. The finding that habit plays a substantial role in consistent condom use suggests the need for further exploration of personality and relational factors associated with the initiation of habitual condom use.

Global lessons on healthy adolescent sexual development

PURPOSE OF REVIEW

Examining global trends of adolescent sexual behavior is essential to inform clinical practice as well as for developing interventions and educational strategies to ensure healthy sexual development in young people.

RECENT FINDINGS

Most young people begin sexual activity in their teenage years. Extensive research has been conducted to elucidate risk and protective factors for sexual activity in adolescence and to evaluate the success of different sex education programs in influencing these factors. Some risk and protective factors were similar globally, whereas others differed by sex and community. Research findings suggest that comprehensive sex education, which includes skills-based interventions, is effective in changing youth behavior. In addition, research points towards the importance of addressing larger structural and contextual issues such as gender equality, poverty, and education in improving the sexual health of adolescents.

SUMMARY

Adolescents begin their sexual lives in their teen years; therefore, clinicians need to focus on positive ways to help teenagers develop healthy relationships while providing guidance around reducing risky sexual behaviors.

Determinants of actual condom use among adolescents in Thailand

This study examined the relationships among attitudes toward condom use, personal characteristics, condom use self-efficacy, and actual condom use among Thai adolescents. Predictors of condom use were also investigated. Bandura's self-efficacy model for safer sexual behavior provided the theoretical framework for this descriptive correlational design. The sample consisted of 270 Thai vocational students aged 18 to 21 years. Multiple regressions were used to estimate the correlates between the independent study variables and condom use among Thai adolescents. Additionally, two open-ended questions regarding attitudes toward premarital sex among males and females in Thai culture were asked. The results showed that self-reported history of alcohol/drug use, attitudes toward condom use, and condom use self-efficacy were related to actual condom use. Results that emerged from the open-ended questions suggested sexual double standards among Thais. This study contributes to strengthening Thai health policy and expanding nursing knowledge about condom use and prevention of sexually transmitted diseases.

HIV testing and sexually transmitted infection care among sexually active youth in the Balkans

In light of the imminent threat of a growing HIV epidemic in east and southeast Europe, optimal accessibility of primary and secondary HIV preventative interventions, including HIV testing and sexually transmitted infection (STI) care, are fast becoming public health priorities. We surveyed 2150 high school students in Bosnia and Herzegovina, FYR of Macedonia, Serbia, and Montenegro to examine the uptake of HIV testing and associated predictors. Among sexually active youth (n = 651), 5.9% had already been tested for HIV. In marginal logistic regression, country of origin, type of high school, knowing a friend or relative with HIV, poor self-assessed health status, suspicion of having had an STI, and not having used a condom at first sex were independently associated with HIV testing. Fear of the diagnosis, fear of violation of confidentiality, and not knowing where to go for HIV testing were reported as barriers to HIV testing. Of sexually active adolescents who thought they might have contracted an STI, only 42% had subsequently visited a doctor or health facility. The main reasons for not doing so were spontaneous disappearance of the complaints, fear of the diagnosis and being ashamed of discussing the problem. In conclusion, the uptake of HIV testing among this population of sexually active, urban high school students was found to be low, although a higher prevalence of HIV testing history was observed among students showing evidence of risky sexual behavior. Practical and psychological factors seem to challenge the accessibility of facilities for HIV testing and STI care.