Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, The Netherlands
Social Medicine and Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Sex Transm Infect. 2023 Mar;99(2):97-103. doi: 10.1136/sextrans-2021-055355. Epub 2022 May 6.
Alcohol use and drug use are common behaviours among young people. STI positivity is higher in young people than in people aged above 25 years. While there is an increasing amount of knowledge about drug use during sex among men who have sex with men (MSM), data on this behaviour among young women and heterosexual men are scarce. Therefore, this study aims to assess the proportion and characteristics of women and heterosexual men aged under 25 years reporting alcohol and/or drug use during sex and its association with STI positivity.
Surveillance data of heterosexual individuals younger than 25 years visiting two Dutch STI clinics between 2016 and 2019 were assessed (n=11 714). We used multivariable logistic regression analyses to assess associations between alcohol and drug use during sex and STI positivity ( and/or diagnosis), adjusting for sociodemographic characteristics (sex, age, ethnicity, educational level, socioeconomic status and urbanisation) and sexual behaviour (condom use, number of sex partners).
Alcohol use during sex was reported by 45.3% (5311/11 714; 49.5% in men vs 43.2% in women, p<0.001) and drug use during sex by 22.0% (2580/11 714; 30.7% in men vs 17.6% in women, p<0.001). The most reported drugs were cannabis (17.9%), ecstasy (XTC)/methylenedioxymethamphetamine (MDMA) (6.9%) and cocaine (4.7%). The use of at least one of the following drugs (XTC/MDMA, cocaine, speed, ketamine, gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL), heroin, crystal meth and/or designer drugs) was significantly associated with STI positivity after adjustment for sociodemographic characteristics (adjusted OR (aOR): 1.3, 95% CI 1.1 to 1.4), but this association did not remain significant after adjustment for sexual behaviour (aOR: 1.12, 95% CI 0.94 to 1.34). Significant associations between drug use during sex and inconsistent condom (aOR: 2.5, 95% CI 1.9 to 3.2) use and having four or more sex partners (aOR: 3.2, 95% CI 2.8 to 3.6) in the past 6 months were assessed.
Alcohol and drug use during sex was highly prevalent among young women and heterosexual men visiting the STI clinic and drug use during sex was associated with an increased risk for STI, probably mediated by sexual behaviour. This indicates that a holistic health promotion strategy, addressing STI prevention and alcohol and drug use-related harm reduction, is important in this group. STI clinics should address this behaviour not only among MSM, but also among young women and heterosexual men.
在年轻人中，饮酒和吸毒是常见行为。性传播感染（STI）在年轻人中的发生率高于 25 岁以上的人群。虽然越来越多的研究了解了男男性行为者（MSM）在性行为中使用毒品的情况，但关于年轻女性和异性恋男性的此类行为的数据却很少。因此，本研究旨在评估报告在性行为中使用酒精和/或毒品的 25 岁以下女性和异性恋男性的比例和特征，以及这种行为与 STI 阳性率的关系。
评估了 2016 年至 2019 年间在荷兰两家性传播感染诊所就诊的 25 岁以下异性恋个体的监测数据（n=11714）。我们使用多变量逻辑回归分析评估了性行为中使用酒精和毒品与 STI 阳性（和/或诊断）之间的关联，调整了社会人口学特征（性别、年龄、种族、教育水平、社会经济地位和城市化）和性行为（避孕套使用、性伴侣数量）。
报告性行为中使用酒精的比例为 45.3%（5311/11714；男性为 49.5%，女性为 43.2%，p<0.001），报告性行为中使用毒品的比例为 22.0%（2580/11714；男性为 30.7%，女性为 17.6%，p<0.001）。最常报告的毒品是大麻（17.9%）、摇头丸（XTC）/甲基苯丙胺（MDMA）（6.9%）和可卡因（4.7%）。使用至少一种以下毒品（XTC/MDMA、可卡因、冰毒、氯胺酮、γ-羟基丁酸（GHB）/γ-丁内酯（GBL）、海洛因、冰毒和/或设计毒品）与 STI 阳性率显著相关，调整社会人口学特征后（调整后的比值比[aOR]：1.3，95%置信区间[CI]：1.1 至 1.4），但在调整性行为后，这种关联不再显著（aOR：1.12，95% CI：0.94 至 1.34）。在过去 6 个月中，评估了性行为中使用毒品与使用避孕套不一致（aOR：2.5，95% CI：1.9 至 3.2）和性伴侣数量为四个或更多（aOR：3.2，95% CI：2.8 至 3.6）之间的显著关联。
性行为中使用酒精和毒品在年轻女性和异性恋男性中非常普遍，且性行为中使用毒品与 STI 风险增加有关，这可能是通过性行为介导的。这表明，在该人群中，需要采取整体健康促进策略，解决 STI 预防和与酒精及毒品使用相关的减少伤害问题。性传播感染诊所不仅应关注男男性行为者，还应关注年轻女性和异性恋男性的此类行为。
