Risky sexual behaviors among Malay adolescents: a comparison with Chinese adolescents in Singapore

OBJECTIVE

Malays, with majority of the individuals being Muslim, form the largest ethnic group in Southeast Asia. This region is experiencing a rising incidence of HIV infections. Due to circumcision and prohibition of sex outside marriage, being Muslim was argued to be a protective factor against sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). However, Malay adolescents were found to be more likely to contract chlamydia and gonorrhea than non-Malay adolescents in Singapore.

DESIGN

Using a cross-sectional survey, we examined and compared safer sex knowledge, attitudes and self-efficacy, and sexual behaviors of 248 sexually active Malay adolescents with 384 Chinese adolescents aged 16-19 years in Singapore. Poisson regression, adjusted for socio-demographic characteristics, was used for modeling each dependent variable. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were obtained.

RESULTS

On multivariate analysis, Malay adolescents were more likely to report marginally unfavorable attitude towards condom use (aPR 1.21 CI 1.00-1.48) and significantly lower confidence in using condoms correctly (aPR 1.24 CI 1.05-1.47) than Chinese adolescents. They were also more likely to report significantly younger first sex age (aPR 0.98 CI 0.96-1.00), never use of condoms for vaginal sex (aPR 1.32 CI 1.16-1.49) and anal sex (aPR 1.75 CI 1.11-2.76) and non-use of contraceptives at last sex (aPR 1.30 CI 1.17-1.45) than Chinese respondents. Malay males were less likely to buy sex (aPR 0.56 CI 0.37-0.85), but they reported higher likelihood of inconsistent condom use with female sex workers (aPR 2.24 CI 1.30-3.87).

CONCLUSION

Malay ethnicity was associated with unfavorable condom use attitude and lower self-efficacy in using condoms, which was consistent with risky sexual behaviors such as non-use of condoms. Future research should use mixed methods to explore and identify cultural influences to these behaviors.

Randomized controlled trial of abstinence and safer sex intervention for adolescents in Singapore: 6-month follow-up

We assessed the efficacy of an individual-based behavioral intervention on sexually transmitted infections' (STI) risk-reduction behaviors in Singapore. A randomized controlled trial of a behavioral intervention compared to usual care was conducted on sexually active heterosexual adolescents aged 16-19 years attending the only public STI clinic. The intervention included two on-site skills-based sessions targeting individual, relational and environmental influences on sexual behaviors, followed by online support. Participants were assessed at baseline and 6-month follow-up. Primary outcomes were self-reported abstinence, number of partners and consistent condom use for vaginal sex. We recruited 337 adolescents to the intervention and 351 to usual care (controls). Fifty-nine percent of intervention participants and 53% of controls completed follow-up. Young men [adjusted risk ratio (RR) 2.03; 95% CI, 1.25-3.30], but not young women, in the intervention were more likely than controls to report secondary abstinence. More non-abstinent young women in the intervention than controls kept to one partner (adjusted RR, 1.25; 95% CI, 1.04-1.50) compared to no differences in young men. There was no intervention effect on consistent condom use in both genders. Skill-based intervention can promote abstinence in young men and keeping to one partner in young women in a clinic setting.

Gender Differences in Factors Associated With Anal Intercourse Among Heterosexual Adolescents in Singapore

Using a cross-sectional survey, we examined the gender differences in prevalence of and factors associated with anal sex among adolescents attending the only public STI clinic in Singapore. Data were collected from 1035 sexually active adolescents aged 14 to 19 and analyzed using Poisson regression. Prevalence of anal intercourse was 28%, with significantly more females (32%) than males (23%) ever engaged in it. On multivariate analysis, the factors associated with anal intercourse for both genders were oral sex and the nonuse of contraception at last sex. For males, anal intercourse was associated with younger age of sexual debut and greater perceived external control. Among females, it was associated with higher rebellious scores and lack of confidence to resist peer pressure to engage in sex. Consistent condom use for anal sex was 22% and 8% for males and females, respectively. STI prevention programs for adolescents should address anal sex, be gender-specific, and take into consideration individual personality characteristics.