Cáceres C F, Marín B V, Hudes E S, Reingold A L, Rosasco A M
Institute of Population Studies, Cayetano Heredia University, Lima, Peru.
AIDS. 1997 Sep;11 Suppl 1:S67-77.
(1) To describe psychosocial variables related to sexual activity and the prevalence of contextual factors (e.g. coercion, paid sex and drug/alcohol use) and various sexual experiences among young men and women in Lima; and (2) to assess the relationship between psychosocial, contextual and behavioral factors on one hand and negative sexual health events such as unplanned pregnancies and sexually transmitted diseases (STDs) on the other hand.
A cross-sectional serosurvey complemented with focus groups and in-depth interviews.
A total of 611 adolescents (16-17 years old) and 607 young adults (19-30 years old) were recruited randomly from among those registering for military service (adolescents) or seeking work/study permits (young adults). These subjects were asked to fill out a self-administered questionnaire with detailed information on sexual experiences and psychosocial variables. The response rates were 98% (adolescents) and 82% (young adults). A subsample of 858 subjects provided blood specimens, which were analyzed for antibodies to HIV-1, the hepatitis B virus and syphilis. The relationship between the main study variables and sociodemographic indicators was also assessed, and multivariate analysis was used to identify those variables associated with sexual health problems. A preliminary qualitative phase helped in the questionnaire design and in interpreting survey findings.
Thirty-four percent of adolescents and 75% of young adults were sexually experienced. The prevalence of bisexual behavior was high, particularly among males (12%). The males often reported paid sex (47%) and the females often reported sexual coercion (47%). Among the heterosexually active, only 11% reported consistent use of condoms. While 22% of the heterosexually active reported an unplanned pregnancy in self (females) or partner (males), 18% of the sexually active reported a history of STD symptoms or diagnoses. Among the sexually active who gave a blood sample, 0.2% were positive for HIV, 6.7% for hepatitis B and 1.5% for syphilis. Those who experienced an unplanned pregnancy or STD symptoms or, for the subsample, were seropositive for HIV or other STDs, were more likely to perceive social norms as restricting condom use to casual sex, to be older, to combine sex with alcohol or drugs and to report a history of sexual coercion or of having paid or been paid for sex. For females only, engaging in sex at a younger age was a risk marker, while engaging in any homosexual activity was protective.
Cultural norms that restrict condoms to casual sex may place many young people in Lima at risk of an unplanned pregnancy or STDs. Sexual behavior may be especially risky in a context of sexual coercion and paid sex, when sex is combined with drugs and alcohol, and when engaged in by younger females. Sexual health education should work to change such cultural norms and these risky contexts.
（1）描述与利马年轻男女的性活动相关的心理社会变量、背景因素（如强迫、有偿性行为及药物/酒精使用）的流行情况以及各种性经历；（2）评估心理社会、背景和行为因素与意外怀孕和性传播疾病（STDs）等负面性健康事件之间的关系。
一项横断面血清学调查，并辅以焦点小组讨论和深入访谈。
从登记服兵役的青少年（16 - 17岁）或申请工作/学习许可的年轻人（19 - 30岁）中随机招募了611名青少年和607名年轻人。要求这些对象填写一份自填式问卷，其中包含有关性经历和心理社会变量的详细信息。青少年的应答率为98%，年轻人的应答率为82%。858名对象的子样本提供了血样，对其进行了HIV - 1、乙型肝炎病毒和梅毒抗体分析。还评估了主要研究变量与社会人口学指标之间的关系，并使用多变量分析来确定与性健康问题相关的变量。一个初步的定性阶段有助于问卷设计和解释调查结果。
34%的青少年和75%的年轻人有性经历。双性行为的流行率很高，尤其是在男性中（12%）。男性经常报告有偿性行为（47%），女性经常报告性强迫（47%）。在有异性性行为的人群中，只有11%报告始终坚持使用避孕套。在有异性性行为的人群中，22%报告自己（女性）或伴侣（男性）意外怀孕，18%的有性行为者报告有性传播疾病症状或诊断史。在提供血样的有性行为者中，0.2%的人HIV检测呈阳性，6.7%的人乙型肝炎检测呈阳性，1.5%的人梅毒检测呈阳性。那些经历过意外怀孕或有性传播疾病症状的人，或者对于子样本来说，HIV或其他性传播疾病血清学呈阳性的人，更有可能认为社会规范将避孕套的使用限制在随意性行为中，年龄更大，性行为与酒精或药物同时发生，并报告有性强迫史或有偿或接受过性交易的历史。仅对女性而言，较早开始性行为是一个风险标志，而参与任何同性恋活动则具有保护作用。
将避孕套的使用限制在随意性行为的文化规范可能使利马的许多年轻人面临意外怀孕或性传播疾病的风险。在性强迫和有偿性行为的背景下，当性行为与药物和酒精同时发生时，以及年轻女性参与性行为时，性行为可能特别危险。性健康教育应致力于改变这种文化规范和这些危险的背景情况。
