Barriers to Safe Sex Practices
Social Factors
While you may think it’s easy to tell based on someone’s clothes, cleanliness or their social reputation, anybody could be the carrier of a sexually transmitted infection.
Young people often use social status and appearance to gauge the risk of sexual partners and use this assessment of “clean” or “unclean” to decide when to use a condom [4].
Not only do adolescents choose not to use a condom because they perceive their partners to be of low risk, but also because they are afraid of seeming to have a lack of trust in their partner, or implying that they are diseased themselves [4]. Some boys avoid using condoms because they are afraid of losing an erection if they use one. Furthermore, carrying, buying or proposing using a condom is perceived as showing enhanced sexual experience which can have a negative impact on the chaste reputation, particularly of girls [4].
Misinformation
Another barrier to condom use is a lack of knowledge about what constitutes a sexually transmitted infection and what the long-term outcomes of STI’s are. Many adolescents are aware that HIV is a sexually transmitted infection, but have difficulty identifying Chlamydia and Gonorrhea as STI’s that can cause pelvic inflammatory disease (PID) and are unaware of the risks of PID on future fertility [6]. Since many adolescents value future fertility, increasing awareness of PID as a cause of infertility might help to promote STI prevention [6].
The rate of gonorrhea in Canada increased by 46% from 1997 to 2001, especially among men in their thirties, although young women still account for the vast majority of new infections [15]. Some outbreaks of sexually transmitted infections have been linked to on-line partner seeking behaviour which presents a whole new risk factor that adolescents are becoming increasingly exposed to [16].
Don’t forget to talk to your adolescent patients about the risks of STI’s and the importance of condom use, and let them know you’re available to answer any questions.
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4. Marston, C, & King, E. Factors that shape young people’s sexual behaviour: a systematic review. Lancet. 2006: 368; 1581-1586
6. Trent , M., Millstein, S.G., & Ellen, J. M. Gender-based differences in fertility beliefs and knowledge among adolescents from high sexually transmitted disease-prevalence communities. Journal of Adolescent Health. 2006: 38;282-287.
15. Hansen, L., Wong, T., & Perrin, M. Gonorrhoea resurgence in >. International Journal of STD & AIDS. 2003: 14(11);727-31.
16. Klausner, J.D., Wolf, W., Fischer-Ponce, L., Zolt, I. & Katz, M.H. Tracing a syphilis outbreak through cyberspace. JAMA. 2000: 284; 447-449.
