Risky sexual behavior

Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected[1] or become pregnant, or make a partner pregnant. It can mean two similar things: the behavior itself, the description of the partner's behavior. The behavior could be unprotected vaginal, oral, or anal intercourse. The partner could be a nonexclusive partner, HIV-positive, or an intravenous drug user.[2] Drug use is associated with risky sexual behaviors.[3]

Factors

Risky sexual behavior can be:[4]

  • Barebacking, i.e. sex without a condom.
  • Mouth-to-genital contact.
  • Starting sexual activity at a young age.
  • Having multiple sex partners.
  • Having a high-risk partner, someone who has multiple sex partners or infections.
  • Anal sex without condom and proper lubrication.
  • Sex with a partner who has ever injected drugs.
  • Engaging in sex work.[5][6][7]

Risky sexual behavior includes unprotected intercourse, multiple sex partners, and illicit drug use.[8] The use of alcohol and illicit drugs greatly increases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS. Trauma from penile-anal sex has been identified as a risky sexual behavior.[9]

Risky sexual behaviors can lead to serious consequences both for person and their partner(s). This sometimes includes cervical cancer, ectopic pregnancy and infertility.[2] An association exists between those with a higher incidence of body art (body piercings and tattoos) and risky sexual behavior.[9]

Epidemiology

According to the National Youth Behavior Risk Survey, 19% of all sexually active adolescents in the US consumed alcohol or used other drugs before their last sexual intercourse.[10] In contrast, adolescents who reported no substance use were found to be the least likely to engage in sexual risk-taking.[11]

Most Canadian and American adolescents aged 15 to 19 years describe having had sexual intercourse at least one time. In the same population, 23.9% and 45.5% of young, adolescent females describe having sex with two or more sexual partners during the previous year. Of the males in the same population, 32.1% of Canadian males had two or more partners and 50.8% of American males also describe a similar experience.[2]

Alcohol is the most commonly used substance among youth aged 18–25 years. 10% of young adults had an alcohol use disorder in 2018, which is greater than the prevalence among all other age cohorts.[12] Research indicates that alcohol can lead to risky sexual behavior including lack of condom use, sexual intercourse with a non-primary partner, as well as lower likelihood of using contraception in general.[13]

Among older age cohorts, a similar positive trend can be observed in risky sexual behavior when combined with alcohol use. For instance, research on older men who have sex with men (MSM) showed that the likelihood of engaging in risky sexual activities increased with the use of alcohol and other drugs.[14]

Treatment and interventions

There are several factors linked to risky sexual behaviors. These include inconsistent condom use, alcohol use, polysubstance abuse, depression, lack of social support, recent incarceration, residing with a partner, and exposure to intimate partner violence and childhood sexual abuse. Further research is needed to establish the exact causal relationship between these factors and risky sexual behaviors.[15][16] Sexual health risk reduction can include motivational exercises, assertiveness skills, educational and behavioral interventions. Counseling has been developed and implemented for people with severe mental illness, may improve participants' knowledge, attitudes, beliefs, behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior.[8]

There are several studies on the management of risky sexual behavior among youth, with most focusing on the prevention of sexually transmitted infections (STIs) such as HIV.[17][18][19] A meta-analysis evaluating prevention interventions among adolescents offers support for these programs in contributing to successful outcomes such as decreased incident STIs, increased condom use, and decreased or delayed penetrative sex.[18] The findings showed that most interventions were administered in a group format and involved psychoeducation on HIV/AIDS, active interpersonal skills-training with some additionally focusing on self-management skills-training and condom information/ demonstrations. Some evidence suggests that family interventions may be beneficial in preventing long-term risky sexual behavior in early adulthood.[20]

References
  1. Dimbuene ZT, Emina JB, Sankoh O (2014). "UNAIDS 'multiple sexual partners' core indicator: promoting sexual networks to reduce potential biases". Global Health Action. 7 (1): 23103. doi:10.3402/gha.v7.23103. PMC 3955766. PMID 24647127.
  2. Hall PA (2004). "Risky Adolescent Sexual Behavior: A Psychological Perspective for Primary Care Clinicians". Topics in Advanced Practice Nursing eJournal.
  3. Fryar CD, Hirsch R, Porter KS, Kottiri B, Brody DJ, Louis T (June 2007). "Drug use and sexual behaviors reported by adults: United States, 1999-2002" (PDF). Advance Data. Centers for Disease Control and Prevention, National Center for Health Statistics (384): 1–14. PMID 17668724. Retrieved 21 April 2017.
  4. World Health Organization. Mental Health: Evidence and Research Team (2005). Alcohol Use and Sexual Risk Behaviour: A Cross-Cultural Study in Eight Countries. World Health Organization. hdl:10665/43122. Retrieved 11 June 2022.
  5. "High Risk Sexual Behaviour". British Columbia, HealthLinkBC. 27 May 2016. Retrieved 21 April 2017.
  6. Siegler AJ, Rosenthal EM, Sullivan PS, Christina Mehta C, Moore RH, Ahlschlager L, et al. (December 2019). "Levels of clinical condom failure for anal sex: A randomized cross-over trial". EClinicalMedicine. 17: 100199. doi:10.1016/j.eclinm.2019.10.012. PMC 6933145. PMID 31891134.
  7. "Safe Sex". WebMD. Retrieved 26 February 2020.
  8. Pandor A, Kaltenthaler E, Higgins A, Lorimer K, Smith S, Wylie K, Wong R (February 2015). "Sexual health risk reduction interventions for people with severe mental illness: a systematic review". BMC Public Health. 15 (1): 138. doi:10.1186/s12889-015-1448-4. PMC 4330652. PMID 25886371.
  9. Potter P (2013). Fundamentals of nursing. St. Louis, Mo: Mosby Elsevier. p. 386. ISBN 9780323079334.
  10. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. (June 2018). "Youth Risk Behavior Surveillance - United States, 2017". Morbidity and Mortality Weekly Report. Surveillance Summaries. 67 (8): 1–114. doi:10.15585/mmwr.ss6708a1. PMC 6002027. PMID 29902162.
  11. Lowry R, Holtzman D, Truman BI, Kann L, Collins JL, Kolbe LJ (July 1994). "Substance use and HIV-related sexual behaviors among US high school students: are they related?". American Journal of Public Health. 84 (7): 1116–20. doi:10.2105/AJPH.84.7.1116. PMC 1614756. PMID 8017535.
  12. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. "Home Page | CBHSQ Data". www.samhsa.gov. Retrieved 21 October 2020.{{cite web}}: CS1 maint: multiple names: authors list (link) CS1 maint: url-status (link)
  13. Weinhardt LS, Carey MP (2000). "Does alcohol lead to sexual risk behavior? Findings from event-level research". Annual Review of Sex Research. 11: 125–57. PMC 2426779. PMID 11351830.
  14. Heath J, Lanoye A, Maisto SA (April 2012). "The role of alcohol and substance use in risky sexual behavior among older men who have sex with men: a review and critique of the current literature". AIDS and Behavior. 16 (3): 578–89. doi:10.1007/s10461-011-9921-2. PMC 3743230. PMID 21390534.
  15. Engstrom M, Winham K, Gilbert L (2016). "Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors Among Women in Methadone Treatment in New York City?". Substance Use & Misuse. 51 (3): 277–94. doi:10.3109/10826084.2015.1058823. PMC 6385865. PMID 26886405.
  16. Icard LD, Jemmott JB, Teitelman A, O'Leary A, Heeren GA (February 2014). "Mediation effects of problem drinking and marijuana use on HIV sexual risk behaviors among childhood sexually abused South African heterosexual men". Child Abuse & Neglect. 38 (2): 234–42. doi:10.1016/j.chiabu.2013.08.002. PMC 4075286. PMID 24041455.
  17. Mullen PD, Ramírez G, Strouse D, Hedges LV, Sogolow E (July 2002). "Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States". Journal of Acquired Immune Deficiency Syndromes. 30 Suppl 1: S94–S105. doi:10.1097/00126334-200207011-00009. PMID 12107363.
  18. Johnson BT, Scott-Sheldon LA, Huedo-Medina TB, Carey MP (January 2011). "Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008". Archives of Pediatrics & Adolescent Medicine. 165 (1): 77–84. doi:10.1001/archpediatrics.2010.251. PMC 4361805. PMID 21199984.
  19. Pedlow CT, Carey MP (April 2003). "HIV sexual risk-reduction interventions for youth: a review and methodological critique of randomized controlled trials". Behavior Modification. 27 (2): 135–90. doi:10.1177/0145445503251562. PMC 2441937. PMID 12705104.
  20. Caruthers AS, Van Ryzin MJ, Dishion TJ (February 2014). "Preventing high-risk sexual behavior in early adulthood with family interventions in adolescence: outcomes and developmental processes". Prevention Science. 15 Suppl 1 (S1): S59-69. doi:10.1007/s11121-013-0383-9. PMC 3749294. PMID 23536124.
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