OBJECTIVES:
We
assessed the proportion of and socio-ecological factors associated with ever
having had sex with female sex workers (FSWs) among heterosexual adolescents.
We also described the characteristics of the adolescents who reported
inconsistent condom use with FSWs.
METHODS:
This is a
cross-sectional study (response rate: 73%) of 300 heterosexually active male
adolescents of 16 to 19 years attending a national STI clinic in Singapore
between 2009 and 2014. We assessed the ecological factors (individual,
parental, peer, school and medial influences) and sexual risk behaviors using a
self-reported questionnaire. Poisson regression was used to obtain the adjusted
prevalence ratios (aPR) and confidence intervals (CI).
RESULTS:
The
proportion of heterosexual male adolescents who had ever had sex with FSWs was
39%. Multivariate analysis showed that significant factors associated with ever
having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI:
1.30-2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28-2.38),
reported lower self-esteem score (aPR 0.96 CI: 0.93-0.98), higher
rebelliousness score (aPR 1.03 CI: 1.00-1.07) and more frequent viewing of
pornography (aPR 1.47 CI: 1.04-2.09). Lifetime inconsistent condom use with
FSWs was 30%.
CONCLUSIONS:
A
significant proportion of heterosexual male adolescents attending the public
STI clinic had ever had sex with FSWs. A targeted intervention that addresses
different levels of influence to this behavior is needed. This is even more so
because a considerable proportion of adolescents reported inconsistent condom
use with FSWs, who may serve as a bridge of STI transmission to the community.
National surveys on adolescent health should include the assessment of
frequency of commercial sex visits and condom use with FSWs for long-term
monitoring and surveillance.
Below: Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by country of female sex workers
Below: Percentage of sexually active adolescents aged 16–19 years who used condom inconsistently with female sex workers in the past year by type of female sex workers
1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
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