INTRODUCTION

More than one million Sexually Transmitted Infections (STIs) are acquired every day worldwide. Three hundred and seven million people are estimated to become ill each year due to curable STIs such as those caused by Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Treponema pallidum (syphilis) and Trichomonas vaginalis (trichomoniasis). ^{1 2 3}

Among the existing STIs, this study will address the most prevalent in the young population: chlamydia infection, gonorrhea, genital herpes, human papilloma virus (HPV), hepatitis B (HBV), syphilis and human immunodeficiency virus (HIV). The Brazilian Ministry of Health recently signaled an increased resistance and decreased sensitivity of pathogens to antimicrobials, reducing the number of treatment options for some infections, especially gonorrhea ⁴.

Young people aged 18 to 24 have are the majority among people enrolling in Brazilian universities.⁵Admission to a university implies a change in the behavior of young people. They start to face another reality, sometimes quite different from their daily lives and relationships. The sexual behavior of young students is inevitably influenced by their entry in the university, considering that this event expands their self-knowledge, because they get in contact with a larger number of people, and this ends up interfering with their way of thinking, acting and also their sexual behavior. The change in the pattern of conduct of young people after admission to a university is due to several factors, including new friendships, interaction with people with different life habits, and the university environment that favors differentiated activities. ^{2 6}

This research aims to “Analyze the sexual practices and behavior of university students from a private institution towards Sexually Transmitted Infections”.

MATERIAL AND METHOD

This is a descriptive cross-sectional study with a quantitative approach conducted in a private higher education institution in the city of Rio de Janeiro.

The study participants were students of both sexes, aged 18 to 29 years and enrolled in the courses offered by the University Campus. The sample size was determined by a uniform stratified sampling process by sex, with a 95% confidence interval and a sampling error of 5% percentage point (pp). In this process, we obtained a sample of 768 university students, among 384 male and 384 female.

Data were collected by applying a structured questionnaire with 60 questions. For this study, 17 variables were selected from the data collection instrument that addressed social aspects (sex, age, marital status, children, religion, color, sexual orientation), sexual practices (age of first sexual intercourse, condom use at first sexual intercourse, condom use in all sexual intercourses, condom use with steady partner, condom use with casual partners, sexual intercourse with same sex, sexual intercourse with multiple partners, condom negotiation with partner, and use of alcohol or other drugs before the last intercourse).

Data collection took place in June and July 2016 on the campus of the university where the research was held. The questionnaires were transcribed into a spreadsheet using the Excel 2003 software, thus creating a database. Data were analyzed using descriptive and inferential statistics with aid of the Statistical Package for Social Sciences (SPSS). The Pearson's chi-square test was used in order to check associations between variables, with a significance level of 95%.

All ethical procedures concerning research with human beings were respected. The study was approved by the Research Ethics Committee of the host institution with Opinion nº 1,577,311 and CAAE 56763316.1.0000.5291.

RESULTS

Seven hundred and sixty-eight questionnaires were applied to undergraduate students, distributed into 384 (50%) males and 384 (50%) females. Most of the young people were aged between 18 and 23 years (85.63%), more than half were single (58.72%), and had white skin color (56.25%), as shown in Table 1.

Table 1. Social characterization of university students. Rio de Janeiro (RJ), 2018. (n = 768). 

Among the study participants, 654 (85.16) were sexually active. Of this total, 318 (48.62%) were women and 336 (51.38%) men. Regarding sexual orientation, 659 (85.80%) declared to be heterosexual; 47 (6.11%) homosexual; 08 (1.04%) other orientation, and 05 (0.06%) did not provide this information. Among those who reported other type of sexual orientation, six were pansexual, one asexual and declared to be undefined.

Table 2. Sexual practices and health care of college students. Rio de Janeiro (RJ), 2018. (n = 654). 

Most participants (99.2%) reported that the first sexual intercourse occurred between the ages of 12 and 23 years. The age group that presented the highest representation was 12 to 17 years old. It is also noteworthy that half of respondents reported having had sex with more than one partner at the same period of time (50.31%). Of these, 66.57% (219) were men and 33.74% (111) women.

Regarding condom use at first sexual intercourse, most reported that they had used it, being 49.17% (237) males and 50.83% (245) females. Regarding condom use in all sexual intercourses, there was a higher prevalence among those who reported not using it. Regarding condom negotiation, it was observed that most did not negotiate, or negotiated sometimes.

Regarding alcohol consumption, 66.41% (510) of the students reported using alcohol and, of these, 50.39% make sporadic use. As for the use of alcohol before the last sexual intercourse, 30.28% (198) confirmed the intake of alcohol and of this total, more than half were men (113/57.07%).

When the participants were asked if they use health services with regularity, only 17.58% (135) said yes. When asked whether they sought health care in the last 12 months, it was observed that 57.81% of the students did so, and of these 72.40% were females.

Table 3. Health care in the last 12 months and the sex of university students. Rio de Janeiro (RJ), 2018. (n = 768). 

The data also indicate that more than half of the female university students (56.77%/218) informed that they had made the Pap smear examination. Having made the examination depended on the age group; the relation between making the examination and the age of the girls (x2 (1) = 20.324; df = 2; p = 0.000), resulted in p-value of less than 0.05.

The occurrence of STIs according to the sex of university students, shown in Table 4, indicates that most participants of both sexes (89.14%) denied this type of manifestation. The occurrence of STIs was reported by only 5.35% (37) of the young people. It is noteworthy that having had a STI or not did not depend on the sex of the students. The STIs reported by the young paticipants (37) were: candidiasis (eight), herpes (eight), Human Papilloma Virus (HPV) (eight), chlamydia (two), gonorrhea (two), condyloma (one), gardnerella (one), hepatitis (one), HPV and gonorrhea (one), syphilis (one), and some participants did not inform the type of infection (four).

Table 4. Ocurrence of Sexually Transmitted Infections and the sex of young university students. Rio de Janeiro (RJ), 2016. (n = 654) 

The number of young people who reported the occurrence of a STI was compared with condom use in all sexual relations (x2 (1) = 9.771; df = 2; p = 0.008) and the null hypothesis was rejected. That is, having or not a STI depended on the use of condoms in all sexual intercourses.

DISCUSSION

In Brazil, the most frequent age of the people enrolled in universities is between 18 and 24 years. Regarding the age of admission, the average is 18 years and the age at finishing the course is 23 years. The modal age of students regularly enrolled is 21 years, and of these university students, women are majority.⁵

Regarding marital status, more than half of the students (58.72%) reported being single, and 37.24% had a steady partner. The analysis of the age of young people and their marital status showed that most students up to 24 years old were single and/or had no fixed partners, unlike young people over 25 years old. The population in Brazil has 55.3% of the single people, and the average age for marriage is 24.4 years.⁷

Also, 47.7% of the Brazilian population declares to be white, 43.1% brown and 7.6% black. Evaluating the population's access to education levels, it can be observed that among people attending higher education under the age of 24, 31.1% declared to be white, only 12.8% black, and 13.4% brown.⁷In the sample set investigated there was a predominance of students who declared to be white (56.72%).

The social data of this research are in line with other studies conducted with university students, which showed a predominance of the female population in students enrolled in higher education institutions, who were young, declared to be predominantly white or brown, were active adepts of the Catholic religion, and with an average age ranging from 19 to 22 years.^{2 8 9 10}

Regarding the sexual orientation of the participants, it was observed that most declared to be heterosexual (85.80%) and 47 (6.11%) homosexual. Same-sex sexual intercourse was reported by 21.25%, which is in line with other studies. Research found that in the group of 1,070 young people with active sex lives, 4.4% (59) declared to be bisexual and 4% (54) homossexual ⁸. Another investigation found that 9% of college students declared to be bisexual. ¹¹

In the group investigated, six young people said they were pansexual. These are individuals who appreciate and are attracted to all sexes, including people who claim to be transgender (born with one sex but who identify with the opposite sex) or intersexuals (who identify with both genders). Asexual orientation, the option of one young boy, indicates that the individual feels no desire or interest in sex life. Young people often differentiate relationships according to commitment and loving involvement with each other, so they build a game that varies between sensation and superficiality, feeling and depth. Young people's current relationships are based on freedom, gender equality, superficiality, individuality and disposability. ¹²

Regarding the beginning of sexual activities, most reports were in the age group between 12 and 17 years (76.45%). These findings are in line with other studies that report the onset of sexual life in adolescents and young people under 18 years of age. ^{9 11}Having sex at an early age is an advance in freedom, and brings a more uninhibited and more liberal conception of sex and sex life. ¹³. In line with these findings, research identified that onset of sexual life has happened at an increasingly early age. ^{14 15}

Multiplicity of partners was also observed in other studies. Investigations found that more than 20% of respondents had had sex with more than one partner within a year. ^{9 16}The multiplicity of sexual partners is one of the factors that favors the vulnerability of young people to STIs.

Sexual practice with a steady partner was reported by more than half of the young participants in this investigation. Similar results were found in other studies that indicated the presence of sTable partners in the affective relationships of young people, and this was more frequent among women. ^{8 17}

Condom use was more frequent among males, similar to the findings of other studies, and it is noticeable that this practice is directly related to the sex of the participants ¹⁶. Negotiation of condom use is more present in casual relationships. In sTable relationships, it is believed that women are more unlikely to negotiate condom use. Women often assume a passive role in affective and sexual relationships and have no decision-making power in negotiations with partners, especially as to the nature and quality of sexual relations. Condom use is very much linked to the prevention of an unplanned pregnancy and not necessarily to STIs. Thus, when many young people reach other levels of intimacy in dating, they usually replace condoms with oral hormonal contraceptive (pill), because of the trust that is established between the partners¹⁵.

The occurrence of STIs was associated with condom use by the participants, and it was found that having or not a STI directly depended on the use of condoms in all sexual intercourses. The chances of contracting an STI, therefore, is directly related to condom use in sexual intercourses. Research conducted in Sweden investigated experiences and attitudes of young adults traveling abroad towards prevention of STIs and human immunodeficiency virus (HIV). Young people are at higher risk for being affected by STI/HIV because they often have sex with multiple partners and they do not use condoms or use them sporadically. Efforts should be made to make young people aware of risky behaviors and attitudes with respect to STI prevention. ¹⁸

A study conducted with 291 nursing students at the University of Seville, Spain, observed a high prevalence of alcohol consumption, and a strong association with the non-use of protective measures in sexual practices, that is, with the use of condoms.¹⁹A research conducted with young Americans on alcohol consumption patterns in 2012 found that while young people consume alcohol less frequently than adults, the amount of alcohol consumed is considerably higher, and the average levels of alcohol consumption are higher, especially on festive occasions. It is known that alcohol is directly related to risk behaviors, such as the practice of unprotected sex. ²⁰The association between alcohol and other drugs before sexual intercourse favors the practice of unprotected sex. A study conducted in Bogotá found that the use of alcohol can cause numerous damages, including the losses in academic performance and exposure to risk behaviors, among others. ²¹

Regarding the search for health care by university students, in the last 12 months, it was found that more than half (57.81%) of the students did that, and 72.40% were female. Women are known to take better care of their health compared to men. Similar results were presented in a study in which most of the female participants had attended medical consultations and gynecological examinations in the last two years. ¹⁴These findings also corroborate a study conducted in the city of São Paulo, southeastern Brazil, showing that males did not have the habit of seeking these services, unlike women. In the view of the authors, some factors may be associated with this behavior and may significantly interfere with seeking care, such as the work of users, the working hours of services, and the person's belief that they are healthy. ²²

Some aspects may favor the adherence of women to the Pap smear examination, namely: receiving information about the exam before it is performed; the educational work and good care provided by health professionals associated with the empathic relationship; and the small distance of the health service to the place where the women live. ^{6 23}

Although in this study the data pointed to a reduced rate of occurrence of STIs among university students, it is appropriate to add that this subject is surrounded by prejudice and information may be omitted. Young people represent a population group vulnerable to STIs due to risky behaviors such as early onset of sexual life, non-use and sporadic use of condoms, multiple partners, and use of alcohol and other drugs, especially before sexual intercourse. ^{24 25}

CONCLUSION

Unprotected sexual practices make young people vulnerable to STIs. The results of this investigation, similar to other studies, highlight the importance of sensitizing young college students about the importance of preventing STIs and rethinking their often unprotected sexual practices. The young population should be encouraged to adopt self-care measures and to be responsible for the actions of attention to their health.

The demand for health care in Brazil, for cultural reasons, is more frequent among the female population. In this context, dialogical strategies should be adopted in which young people have an active participation in the process, and feel responsible for the self-care when it comes to their health.

Considering that some STIs have treatment available free of charge in the Unified Health System, while others are not curable and can have significant repercussions on the person's life, actions to raise awareness in this group are timely. They will encourage educational measures, and as a consequence, changes in the sexual behavior of woung people to prevent their exposure to STIs may effectively occur.