Research Article
Austin J HIV/AIDS Res. 2016; 3(2): 1025.
Exploring Sexual Relational Satisfaction and HIV Transmission Risk among Youth in Low Income Communities of Mumbai
Sharma B¹*, Siddhanta A² and Singh SK³
¹Masters in Population Studies, IIPS, Mumbai, India
²PhD Scholar, IIPS, Mumbai, India
³Department of Mathematical Demography and Statistics, IIPS, Mumbai, India
*Corresponding author: Sharma B, Masters in Population Studies, IIPS, Mumbai, India
Received: July 20, 2015; Accepted: May 31, 2016; Published: June 02, 2016
Abstract
Sexual satisfaction has been highlighted as a metaphorical barometer of relationship satisfaction in the West influenced society including India [1]. This craving for intercourse not in terms of romantic relationship but in terms of casual sex has led to multiple partner relationship and risky sexual behaviour including the transmission of HIV. The present study report findings derived from a survey in the slums of Mumbai with a randomized cluster sample of 1239 men aged 18-29. Results show that almost one third of respondent reported their age at sexual debut below 18 years. There is also a wide variability in nature and pattern of sexual partners which is mostly influenced by education, occupation, marital status, type of partner, media exposure, leisure time activity, alcohol use and level of drinking. Study highlights that there is a wide gap between relational and sexual satisfaction (overall 20%) among married and unmarried youth in low income communities. Leisure time activities, high level of drinking and high exposure to mass media have a direct influence on coercion in first sex, especially when girlfriend is a sexual partner. Those respondents who had their first sexual intercourse with relatives/strangers/co-workers & others and who used alcohol during their first sex are less likely (p<0.01) to use condom in their first sex. Findings facilitate understanding of changing sexual culture and behaviour, growing liberalised sexual attitude and increased vulnerability among the youth. Programmes to equip and aware youth fully to make safe choices are required for elimination of sexual risk behaviour including transmission of HIV.
Keywords: Youth; Combination of partners; Relational satisfaction; Sexual satisfaction; HIV risk; STI
Abbreviations
HIV: Human Immunodeficiency Virus; STD: Sexually Transmitted Diseases; STI: Sexually Transmitted Infections; BBFSW: Brothel Based Female Sex Workers; UNAIDS: United Nations Programme on HIV and AIDS
Introduction
Thirty years into the HIV pandemic, a tremendous need remains to understand the factors shaping HIV transmission among youth, especially in higher HIV prevalence settings. Though the number of HIV infections declined by more than 50% in 26 countries between 2001 and 2012 [2], the shifting pandemic has been particularly burdensome to young adults. Multiple factors contribute to the rapid and expansive amplification of HIV, prevalence time of HIV, conditions of poverty that foster the spread of HIV, poor health care, co-occurring epidemics of other Sexually Transmitted Infections (STIs), limited access to condoms, and sexual networking patterns, including concurrent sex partners [3]. Sexual satisfaction is an important component in a good relationship as well as in good life. Though sexual satisfaction is relevant for both men and women as they have the capacity, desire and right to experience a satisfying sexual life [4], yet the study of sex in general is relatively new and is still a taboo in country like India. Sexual behaviour is mainly constructed in relation with social norms and influenced by individuals’ experiences. Hence, all individuals do not have the same social representations or the same norms when it comes to sexuality and are not expected to put the same set of values to it [5]. Generally in all societies, sexual permissiveness is often reinforced in men while women are rewarded for being sexually restrictive. Many societies exploit and degrade a man for any emotional weakness or outbursts while allowing women to become more emotionally invested in the relationship [6].
Sexuality in Indian society is seen as a cultural construct, which differs with age, social class and gender, division of labour, freedom of social life, moments and kinship arrangements [7]. There is exposure of liberal sexual culture through mediums like mass media, sexual stimuli and other sexual avenues, where youth have easier access to erotic materials which enhances opportunities for sexual liaison and substance abuse [8]. But the low income communities are overcrowded affecting the privacy of each and every individual in the community.
The concept of relationship which consisted of love, commitment, trust, support, intimacy and mutual exchange of emotions, has changed among youth and nature of relationship has become casual. This deteriorating meaning of relationship has led to multiple partner sexual relationship and heterosexual intercourse which is the most common mode of HIV transmission. Moreover substance like alcohol and drugs play a dominant role in sexual activity among youth since it reduces self-control and increases risky behaviors, such as unsafe sex. It is a primary cause of injuries, violence and premature deaths. It also can lead to health problems in later life and affect life expectancy [9]. This including the type of above mentioned sexual activity is frequently risky. There are signs of an increase in risky sexual behaviours in several countries. The examples of high sexual risk behaviour include: early sexual activity, especially before age 18; unprotected intercourse without male or female condom use; having multiple sex partners; having a high-risk partner (one who has multiple sex partners or other risk factors); having sex with a partner who injects or has ever injected drugs; unprotected mouth-to-genital contact; exchange of sex (sex work) for drugs or money [10]. These sexual behaviours results in the form of sexually transmitted diseases which affects the working population of the country. When young people have unprotected sex with multiple partners, they are putting themselves and others at increased risk of contracting various sexual transmitted infections and diseases especially HIV. Having multiple sexual partners in adolescence has also been identified as an indicator of risk-taking behaviours such as early sexual debut and unsafe sexual behaviours, smoking, and substance use [11,12]. Hence, there exists a persistent challenge to effective HIV prevention efforts for adolescents and young people that includes adequate access to highquality, youth friendly HIV and sexual and reproductive education and health services, as well as sexual violence against young women and girls. The purpose of this study is to understand sexual relation status and partner variation among youth. Further, this study aims to examine the relational and sexual satisfaction among both married and unmarried youth and to understand the risky sexual behaviour that leads to HIV transmission among youth.
Methods and Materials
The study has used data of a project entitled “Alcohol Use, Sexual Health Risks and HIV Prevention among Young Men in Low Income Communities in Mumbai, India” under the guidance of International Institute of Population Sciences (IIPS), Mumbai with Institute for Community Research and University of Connecticut Health Center (UCHC), Connecticut, USA as partners, sponsored by National Institute on Alcohol Abuse and Alcoholism. The survey was done over a span of 4 years from September 2005 to August 2009. The study consists of a sample of 1239 youth from 18 to 29 years of age selected from low income communities of Mumbai. The study has used some of the basic descriptive statistical tool to assess the age at first sexual intercourse, combination of partners, marital satisfaction, girlfriend relationship satisfaction, sexual satisfaction etc. In addition, bi-variate technique has been used to understand the relationship between predictors and response variables. The study has used Chi-square test to find the statistical association and significance of different variables. Binary logistic regression is also used under multivariate analysis.
Indices and scales used in the study
The following indices and scales have been used in the present study. A detailed description of each of them is given below.
Relationship satisfaction with wife
It is computed by recoding a continuous Guttaman’s scale, created by merging three statements concerning relationship with wife (You feel happy about your marital relationship, you feel discouraged about your marital relationship, you are very satisfied with your marital relationship). The continuous scale has been converted in two categories: satisfied and not satisfied.
Relationship satisfaction with girlfriend
It is computed by recoding a continuous Guttman’s scale by merging seven statements concerning relationship with girlfriend. These statements are; ‘you are better at your relationship with your girlfriend than most other people are with their relationships, you feel happy about your relationship, your needs are not satisfied in your relationship, you feel discouraged about your relationship, you are very satisfied with your relationship, you feel sad when you think about your relationship and your relationship with your girlfriend/ lover is very bad compared to most’. The continuous scale has also been converted into two categories: satisfied and not satisfied.
Self- assessment as a sexual partner
It is computed by recoding a continuous scale created by merging seven statements (you are a good sexual partner, your sex life meets your expectations, your sex life is very bad compared to most, you feel happy when you think about your sexual experiences, you are disappointed about the quality of your sexual relationships, you are worried about your sex life and you feel happy about your sexual relationship). The continuous scale has been converted in three categories: not satisfactory, somewhat satisfactory and satisfactory in the study.
Exposure to mass media
It is computed by adding five different forms of media exposures (Newspaper, Magazine, Movies (Hall/video parlour) T.V., Radio, and Internet) which is measured on five point scale. The index has been classified into three categories namely, low, medium and high.
Exposure to sexual stimuli
It is computed by recoding a Guttman’s scale, which is created by merging six statements concerning exposure to different forms of sexual stimuli (Romantic movies, Blue films, Other pornographic materials, Watching women, Watching women dance, Drinking alcohol). The continuous scale has been converted into three categories low, medium and high.
Leisure time activity
The leisure time activity was taken as a measure of the involvement in the more risk related activities among the youth with their peer group including roaming, drinking, playing cards, gambling, seeing women etc. This index has been classified into three categories no leisure time activity, one or two leisure time activity and three or four leisure time activity.
Level of drinking
The pattern of drinking is a composite scale indicator of the amount and the frequency of drinking of the respondent. The amount of drinking was first divided in low (1 to 2 pegs) and high (three or more pegs) and the frequency of drinking was categorized as the low (those who drank once or less than once in a month), moderate (drinking three to four times in a month), and high (drinking two or more times in a week).
Results
Socio-demographic profile
The study consists of youth from 18 to 29 years age group. Among them half of the respondents belong to 25-29 age group, almost onethird of them are in the age group 21-24 and less than one fifth belong in 18-20 age group. Regarding marital status, it was found 60% of them are married and 40% are unmarried respondents. The level of overall education is very low in these communities where one third of them are educated to just primary and middle level. Majority of the respondents are Hindu followed by Muslim, Buddhist and others. Almost 51% of respondents live in rented house and their standard of living is also very low. In total, almost one-third of the respondents included in the study are factory workers and almost one-fifth of the youth are drivers.
Sexual relation and sexual satisfaction
The first goal of this study is to see the sexual behaviour of the respondents according to their age at first intercourse and combination of lifetime sexual partners. The analysis further proceeds by giving details about the marital relational satisfaction as well as sexual satisfaction for married men, and girlfriend relational satisfaction together with sexual satisfaction for unmarried youth.
Profiling of respondents according to their age at first sex
The study has brought out an important fact that premarital sexual intercourse among youth in low income communities in Mumbai is not uncommon. Around 12% of unmarried men had sex with their girlfriend and nearly 4 % and 2% had sex with ‘others’ and BBFSW respectively. The age at first sexual intercourse is also found to be below 18 years of age. Early sex i.e. before age 18 is inversely associated with increasing educational attainment, which shows that education plays an important role in generating awareness regarding sexual behaviour. Among different occupations, the drivers (44%) are more prone to have an early sexual debut. Exposure to sexual stimuli is positively associated with early sex. Around 58% respondents having high exposure to sexual stimuli had early sexual debut. A little less than half respondents involved in three or more leisure time activities have experienced first sex at very early age, whereas only23% respondents who are not involved in any leisure time activity are found to be involved in early sex.
Combination of lifetime sexual partners
The combination of lifetime partners affects sexual health of every individual. In this study the combination of partners includes ‘wife only’ ‘girlfriend only’ ‘brothel based female sex workers only’’ wife and girlfriend’ ‘girlfriend and female sex workers’ and ‘others’. The last category ‘others’ includes partners as MSM, strangers, bar girls etc.
The variation of partners are mostly found between 21 to 24 years age group where 6% have only girlfriend as a partner, 3% have both wife and girlfriend as partners and 3% reported there were other sexual partners. It is surprising to know that primary and secondary educated respondents have only female sex workers as partners.
Among unmarried males 4% have ‘others’ as partners. More than half of the respondents who are drivers by occupation have only wife as partners, 6% have only girlfriend as partners and 5% have others as partners. Among the respondents who are involved in three or more leisure time activities, around 7% have only girlfriend as their partner and 5% have others as their partner. The combination of partners is found increasing with the increase in standard of living i.e. low to high SLI. All the above taken background variables viz: age, education, occupation, marital status, type of partner, media exposure, leisure time activity, alcohol use in first sex and level of drinking are showing significant relationship with combination of partners when chisquare was applied (Table 1).
Background characteristics
Combination of partners
None
Wife only
GF only
BBFSW only
Wife and gf
Gf and BBFSW
Others
Chi-square
Age
Below 20
72.5
8.3
11.5
0.5
0.0
0.0
0.0
399.62***
21-24yrs
43.3
43.0
6.2
1.0
2.7
1.0
2.7
25 & above
13.2
79.2
1.5
0.8
0.0
0.0
0.0
Education
Illiterate
30.4
57.5
2.8
0.6
3.9
1.7
3.3
23.8*
Primary and middle
32.6
56.4
4.5
0.8
2.1
1.0
2.6
High school and above
35.8
52.1
6.0
0.9
2.0
0.2
3.1
Marital status
Married
2.5
91.2
0.0
0.0
3.9
0.0
2.4
1126.2***
Unmarried
80.3
0.0
12.0
2
0.0
2.0
3.7
Occupation
Rock breaker/loader/ construction
27.7
65.2
1.9
0.6
2.6
0.0
1.9
23.79*
Driver
25
59.5
6.0
0.9
1.7
1.7
5.2
Contract/self-home
23.4
64.9
5.2
0
3.9
2.6
0.0
Factory workers and others
38.1
50.6
4.9
0.9
2.3
0.5
2.7
Exposure to mass media
Low
35.2
50.6
6.4
0.8
2.7
0.8
3.4
38.5***
medium
29.9
64.6
1.0
0.6
1.6
1
1.3
High
24
70
0.0
2
0.0
0
4.0
Leisure time activity
No activity
30.7
65.9
1.1
0.0
1.5
0.0
0.8
49.8***
One or two activity
34.7
59.4
2.9
0.3
1.7
0.3
0.8
Three or more activities
33.1
36.9
11.6
2.5
4.4
2.5
9.1
Standard of living
Low
30.1
61.3
3.2
0.8
2
0.6
2.1
41.4***
Medium
37.1
49.8
6
1.1
2.2
0.9
2.9
High
37.8
40.2
8.7
0
4.7
1.6
7.1
Total- 1239
33.4
55
4.8
0.8
2.3
0.8
2.9
Note: P value: *** P<0.01, ** P<0.05, * P<0.1
Table 1: Percent distribution of respondents by the combination of their lifetime sexual partners according to some selected background characteristics.
Relational satisfaction
Relational satisfaction indicates the degree of satisfaction of one’s needs, expectations, and desires in the relationship [13]. There are numerous variables such as love, commitment, communication, mutual trust, support, fidelity, common interests, mutual understanding, intimacy and mutual exchange of emotions, thoughts, and experiences which depicts marital satisfaction [14].
The overall gap between perceived marital relational satisfaction and perceived sexual satisfaction is almost 20%. Similar results were found when the age, education and difference in education between husband and wife are considered. It is worth knowing that 85% respondents are satisfied in marital relationship but yet they chose to have others also as their sexual partners. In arranged marriages, high marital satisfaction was found among 85% respondents and 63% are satisfied in their sexual life also, which is comparatively less in love marriages. Interestingly around 84% respondents who are not involved in any leisure time activity with friends have high marital satisfaction, but only 42% have perceived sexual satisfaction.
Perceived relational satisfaction and sexual satisfaction is very less among respondents below 21 years of age (49% and 38% respectively) in terms of girlfriend relational satisfaction. It is surprising to know that illiterates have very low relational satisfaction but high sexual satisfaction with girlfriend. In contrast the highly educated respondents have reported high relational satisfaction and very less sexual satisfaction with girlfriend. Around 48% respondents who are involved in three or more leisure time activities have perceived less relational satisfaction with girlfriend as compared to 60% respondents who are sexually satisfied with girlfriend (Table 2).
Background characteristics
Perceived Relational satisfaction with wife
Perceived Sexual satisfaction with wife
Perceived Relational satisfaction with girlfriend
Perceived Sexual satisfaction with girlfriend
Age
Below 20
75.0
55.0
48.9
38.2
21-24 yrs
85.3
59.9
46.7
48.6
25 & above
84.2
63.5
66.7
51.9
Education
Illiterate
83.3
62.3
12.5
39.4
Primary and middle
85.1
60.9
48.9
48.3
High school and above
83.2
64.5
56.5
45.3
Type of partner
Wife only
84.3
63.2
_
_
Girlfriend
_
_
52.30
47.50
Others
85.1
53.2
40.00
44.70
Difference in age
0-2 years older husband/wife
85.5
63.8
_
_
3-5 years older husband
83.1
62.3
_
_
5 years and above older husband
83.7
59.3
_
_
Marriage Type
Arrange
84.7
62.8
_
_
Love
76.7
56.5
_
_
Education difference between husband and wife
Wife more educated
83.0
60.8
_
_
Husband more educated
85.1
63.4
_
_
Both are equally educated
84.7
62.9
_
_
Leisure time activity
No activity
83.5
42.2
0.0
10.5
One or two activity
84.8
69.0
53.8
36.6
Three or more activities
83.2
68.5
48.3
59.8
Total -1239
84.2
62.4
49.5
46.0
Table 2: Percent distribution of respondents by their relationship and sexual satisfaction with their wife and girlfriend according to some selected background characteristics.
Risky sexual behaviour
Since a vast gap exists between relational satisfaction and sexual satisfaction, it is perceived that youth try various ways to gain sexual satisfaction and hence gradually they get involved in risky sexual behaviour which includes multiple partner sexual relationship and coercion in sex. To find out the risky sexual behaviour among the youth, condom use during first and last sexual activity is also analysed.
Multiple partner relationship
As one moves from having relationship with one partner to many, sexual health risk increases. Analysis of transition from one to another partner was based on some selected background characteristics to determine whether these factors affect the number of partners of the youth. The partners were categorized as multiple partners other than wife in case of married men and girlfriend as well as others in case of unmarried men.
It is evident that 10% of young married men below age 21 have partners other than wife. The number of two or more non spousal partner is fluctuating with increasing age group, but a direct relationship was found with educational status of the respondents. Drivers especially are found to have more number of partners; the reason might be because of their mobility from one place to another which often may include a number of nights away from home. Around 10% respondents who are not involved in any leisure time activity with friends have two or more non-spousal partners compared to those involved in three or more activities. Respondents who have high exposure to sexual stimuli (11%) have multiple numbers of nonspousal partners. It is noticeable that among the respondents who are engaged in high level of drinking, almost 7% have one partner other than wife and 17% have two or more partners other than wife.
Variations have been found in the number of partners according to age among unmarried respondents. Firstly it is seen that overall 9% of the unmarried respondent below 21 years of age and 8% unmarried respondent above 25 years of age have two or more sexual partners. Findings reveal that 13% illiterates and 15% drivers have two or more sexual partners. One sixth of the respondents involved in three or more leisure time activities and almost one third respondents who have high exposure to sexual stimuli have two or more sexual partners. The results also shows that 41% respondents who are engaged in high level of drinking and 16% respondents involved in moderate level of drinking have two or more sexual partners (Table 3).
Background characteristics
Percentage of married men by number of sexual partners other than spouse
Percentage of unmarried men by number of sexual partners
One
Two or more
One
Two or more
Age
Below 21
10.0
0.0
11.6
8.6
21-24yrs
5.2
1.6
13.3
6.6
25 and above
3.4
2.6
10.8
7.2
Education
Illiterate
6.8
0.8
7.9
12.7
Primary and middle
3.2
2.2
12.0
8.1
High school and above
3.9
3.1
13.8
5.1
Occupation
Rock breaker/loader/construction
2.7
2.7
8.9
2.2
Driver
2.0
4.6
17.3
14.8
Contract/self home/
5.6
0.0
17.4
8.7
Factory workers and others
4.9
1.6
11.1
6.4
Leisure time activity
No activity
9.3
10.0
2.6
1.3
One or two activity
2.9
0.0
7.3
3.7
Three or more activities
2.2
1.1
23.5
15.9
Exposure to media
Low
4.8
3.2
14.6
7.7
Moderate
2.3
0.5
4.0
6.9
High
2.7
0.0
7.7
7.7
Exposure to sexual stimuli
Low
2.2
0.9
8.6
3.3
Moderate
6.6
3.7
16.3
9.5
High
11.4
11.4
20.7
34.5
Level of drinking
Low
3.8
1.5
12.9
5.5
Moderate
6.0
3.0
23.2
16.1
High
6.9
17.2
29.4
41.2
Total -1239
4.0
2.3
12.2
7.5
Table 3: Percent distribution of respondents showing multiple partner relationship by their background characteristics.
Coercion in first sex
Sexual coercion is the act of using subtle pressure, drugs, alcohol, or force to have sexual contact with someone against their will. It is mostly done by males except in the cases of female sex workers [15]. It is evident from the study results that 5% respondents below 21 years of age are involved in coercion during their first sex. Illiterate respondents are 2 times more involved in coercion in their first sex compared to literate respondents. Around 4% Unmarried respondents are involved in coercion in their first sex. Coercion is also found among 5% respondents who have girlfriend as their partner. Around 5% respondents having high exposure to mass media are also involved in coercion in their first sex. Alcohol use prior or during sex has also shown high effects on coercion during sex as one tenth of high drinkers are seen involved in coercion in their first sex. The analysis also points that 5% respondents with high exposure to sexual stimuli are involved in coercion in their first sex.
Condom use in first and last sex
While considering method of safe sex, the first thing that comes to mind is condom, which is exclusively designed for safe sexual practices. It is worth knowing that 12% respondents who had sexual debut below 18 years of age have used condom in their first sex. Respondents whose age at first sex was between 18-20 years and 21 years & above are 55% (p<0.01) and 70% (p<0.01) less likely respectively to use condom in their first sex. Respondents who had their first sexual intercourse with relatives/strangers/co-workers/ others with reference to wives are also likely to use condom in their first sex. Moreover, compared to non-alcohol users, the alcohol users are 90% (p<0.01) less likely to use condom in their first sex. Other predictors such as education, occupation, exposure to mass media and leisure time activities do not have significant relationship with condom use in first sex.
Condom use in last sex reveals that the condom use has increased among the respondents compared to first sex. The condom use is seen more among highly educated respondents as well as among contract workers/ self-employed men in the last sex. Compared to married men, 46% unmarried respondents used condom in last sex. Only 6% respondents are found using condom in their last sex with their regular partner. The youth involved in more leisure time activities are the highest condom users in last sex compared to respondents who are involved in no activity or one or two leisure time activities (Table 4).
Background characteristics
Condom use in First Sex
Percentage
Exp (ß)
Age at first sex
Below 18®
11.8
-
18-20
13.6
0.457***
21 and above
5.7
0.309***
Education
Illiterate®
10.2
Primary and middle
11.8
1.044
High school and above
10.0
1.217
Occupation
Rock breaker/loader/ construction®
8.0
Driver
15.7
0.709
Contract/self home/and others
6.2
1.657
Factory workers and others
10.4
0.919
Type of partner
Wife only®
0.7
Relative/Strangers/Co-workers/others
18.6
0.025***
Exposure to mass media
Low®
11.5
Moderate
9.9
0.972
High
7.1
0.789
Leisure time activity
No activity®
6.0
One or two activity
8.1
1.221
Three or more activities
19.9
0.706
Alcohol use in first sex
No®
63.2
Yes
9.9
0.105***
Total- 937
10.9
Table 4: Percent distribution of respondents by their condom use in their first sex according to some background characteristics.
Discussion
It has been revealed from the findings of the present study that nearly one third of the currently married respondent reported their age at sexual debut below 18 which was much lower than their age at marriage, indicating the existence of premarital sex among these youth. A sizeable portion of unmarried youth also had sex with girlfriend or FSW in these slum communities. Singh et al., (2014) found that premarital sex in on the rise among the slum youth [8]. Study by Bajosand Bonzon (2008), have stressed that the age at first sexual intercourse is associated with attitude towards sexuality [16]. This clearly shows that individuals who had their first sexual intercourse early are more likely to have permissive attitude towards sexuality. Large number of partner variation is found among respondents of 21- 24 years age group. This partner variation was mostly influenced by more number of leisure time activities with friends and high standard of living. This indicates that the social network of the peer group where there is easier accessibility and affordability of sex related materials, attracts the youth of these communities to indulge with different kind of sexual partners. In many countries with generalized epidemics, the high HIV prevalence rates are caused by people having unprotected sex with multiple sex partners, especially when those sex partners are concurrent (as opposed to sequential) [3]. Emotional and sexual aspects of intimacy in romantic relationships and sexual satisfaction are important correlates of couple’s relationship satisfaction, commitment, and stability [6,17]. Byers (2005) and Spreecher (2002) also found that sexual satisfaction among couples is positively associated with relational satisfaction [18,19]. The present study reveals that there is a huge gap between the relational satisfaction and sexual satisfaction both among married and unmarried men. The probable reason for this gap might be attributed to the fact that the respondents are exposed to sexual stimuli and pornographic materials in the slums which may increase their sexual craving leading to their unmet sexual expectation in relationships. Ashdown et al., (2011) found that aspects of one’s sexual behaviours, such as expectations, frequency, and types of behaviours affect one’s sexual satisfaction [20]. Unsatisfactory sexual relation from own partner leads to multiple partner relationship and gradually the risk of HIV transmission. The present study also highlights that multi-partner relationship exits both among married as well as unmarried men. A study by Chen et al., (2007) shows that multiple sex partners lead to promotion of HIV transmission [21]. Having multiple sexual partners has also been identified as an indicator of risk-taking behaviour such as early sexual debut and unsafe sexual practice, smoking, substance abuse etc [12]. Hence, having fewer lifetime partners is strongly associated with a reduced risk of HIV infection [22]. Coercion/force in sex is against the sexual and reproductive rights of women but it has been found increasing along with the level of drinking, exposure to mass media and sexual stimuli and with leisure time activity in present study. A study by Chandrasekaranet al., in 2007 indicated a direct link between intimate partner violence and HIV risk [3]. An important fact from the study is that respondents having early sexual debut also used condom, which means that there is knowledge and accessibility of safe sexual practices in these communities. This study also highlights the fact that respondents who had their first sexual intercourse with relatives/strangers/co-workers & others and who used alcohol during their first sex are less likely (p<0.01) to use condom in their first sex. With reference to respondents having sexual debut at age 18 or below, respondents who had their first sex between 18 to 20 years and 21 years and above are significantly less likely to use condom in their first sex. A study by Schenshul et al., 2010, found the reason why men do not use condom includes discomfort with fit, concerned whether it will remain inserted or reduction in pleasure [23]. Various other studies have proved that the main cause of STIs transmission is alcohol use [23,24,25]. This should be dealt with an approach of imparting awareness among the youth about the importance of safe sexual practices to prevent sexually transmitted infections and HIV.
Conclusion and Recommendations
Results of this paper establish that a mix of traditional and modern values, norms and practices regarding sexuality and sexual behaviour among youth have resulted in higher risks, increased risky sexual behaviour and raised vulnerability among youth. Findings also highlight the importance of dyadic approaches to HIV-namely, that relationship dynamics appeared strongly linked to risky sexual practices. This study is hardly the first to find associations between relationship dynamics, communication, and sexual health among young people, there are other literature also which reveals the relational dynamics and risky sexual practices resulting into STDs mainly HIV. It is very important to understand the psyche and the norms that govern the risky factors affecting relation and sexual satisfaction.
Young people need to know how to protect themselves from sexually transmitted infections and should know the right means to do so. This includes being able to obtain condoms to prevent sexual transmission of the virus and clean needles and syringes for those who inject drugs, better access to HIV testing and counselling. The programme, policy makers and planners can have intervention that focuses on the main factors affecting the sexual health at individual level. The couples should be taken as a unit and should be dealt according to their personal issues in their marital life like stress, frustration, etc. There is a scope to start peer laid intervention to change the recourse of the risky sexual behaviour which should be at both community as well as individual level. The condoms should be positioned as sexual stimuli rather than as a means of disease prevention. Awareness programmes regarding sex education, gender sensitization, reproductive and sexual rights for women for illiterates should be introduced. For literates, the schools and colleges should deliver exemplary sexual health education emphasizing HIV and other STD prevention, increasing youth access to key sexual health services, and establish safe and supportive environments for students and staff. Local education agencies should implement multiple program activities and develop strategic partnerships and collaborations between schools/colleges and community-based, mental health, and social services organizations. Services like counselling and psychological support should be provided to men as well as women that include awareness for their family life, family planning, legal age at marriage, adolescent health, sexual health, reproductive and sexual rights and laws related to violence.
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