Medicine:Risky sexual behavior

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Short description: Sexual behavior that risks infection, unwanted impregnation or other harm

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, and the description of the partner's behavior. The behavior could be unprotected vaginal, oral, anal, or manual 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

AIDS Prevention - Condom dispensers in toilets (4612444296).jpg

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. ↑ "UNAIDS 'multiple sexual partners' core indicator: promoting sexual networks to reduce potential biases". Global Health Action 7 (1): 23103. 2014. doi:10.3402/gha.v7.23103. PMID 24647127. 
  2. ↑ 2.0 2.1 2.2 "Risky Adolescent Sexual Behavior: A Psychological Perspective for Primary Care Clinicians". Topics in Advanced Practice Nursing eJournal. 2004. http://www.medscape.com/viewarticle/467059. 
  3. ↑ "Drug use and sexual behaviors reported by adults: United States, 1999-2002". Advance Data (Centers for Disease Control and Prevention, National Center for Health Statistics) (384): 1–14. June 2007. PMID 17668724. https://www.cdc.gov/nchs/data/ad/ad384.pdf. 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. https://apps.who.int/iris/handle/10665/43122. Retrieved 11 June 2022. 
  5. ↑ "High Risk Sexual Behaviour". British Columbia, HealthLinkBC. 27 May 2016. https://www.healthlinkbc.ca/health-topics/tw9064. 
  6. ↑ "Levels of clinical condom failure for anal sex: A randomized cross-over trial". eClinicalMedicine 17: 100199. December 2019. doi:10.1016/j.eclinm.2019.10.012. PMID 31891134. 
  7. ↑ "Safe Sex". WebMD. https://www.webmd.com/hiv-aids/safe-sex-preventing-hiv-aids-stds#1. 
  8. ↑ 8.0 8.1 "Sexual health risk reduction interventions for people with severe mental illness: a systematic review". BMC Public Health 15 (1): 138. February 2015. doi:10.1186/s12889-015-1448-4. PMID 25886371. 
  9. ↑ 9.0 9.1 Potter, Patricia (2013). Fundamentals of nursing. St. Louis, Mo: Mosby Elsevier. p. 386. ISBN 9780323079334. 
  10. ↑ "Youth Risk Behavior Surveillance - United States, 2017". MMWR. Surveillance Summaries 67 (8): 1–114. June 2018. doi:10.15585/mmwr.ss6708a1. PMID 29902162. 
  11. ↑ "Substance use and HIV-related sexual behaviors among US high school students: are they related?". American Journal of Public Health 84 (7): 1116–20. July 1994. doi:10.2105/AJPH.84.7.1116. 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". https://www.samhsa.gov/data/. 
  13. ↑ "Does alcohol lead to sexual risk behavior? Findings from event-level research". Annual Review of Sex Research 11: 125–57. 2000. PMID 11351830. 
  14. ↑ "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. April 2012. doi:10.1007/s10461-011-9921-2. PMID 21390534. 
  15. ↑ "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. 2016. doi:10.3109/10826084.2015.1058823. PMID 26886405. 
  16. ↑ "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. February 2014. doi:10.1016/j.chiabu.2013.08.002. PMID 24041455. 
  17. ↑ "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. July 2002. doi:10.1097/00126334-200207011-00009. PMID 12107363. 
  18. ↑ 18.0 18.1 "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. January 2011. doi:10.1001/archpediatrics.2010.251. PMID 21199984. 
  19. ↑ "HIV sexual risk-reduction interventions for youth: a review and methodological critique of randomized controlled trials". Behavior Modification 27 (2): 135–90. April 2003. doi:10.1177/0145445503251562. PMID 12705104. 
  20. ↑ "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. February 2014. doi:10.1007/s11121-013-0383-9. PMID 23536124. 

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