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Sandisiwe Mahlangu
RECENT years have seen a widespread public concern with the practice of safe sex. While this concern has been brought on mainly by the advent of the Aids epidemic, the benefits of safe sex are plenty.
Some of the benefits include protection against sexually transmitted diseases (STDs) and unwanted pregnancies. In particular, sexual risk taking behaviours include unprotected sex, unfamiliarity with the partner and multiple partners.
While the last two outcomes are not necessarily risky behaviours, they are included under the rubric of risky sexual behaviour because when the partner is not well-known and when there are multiple partners, it is more likely that the infection status of the partner is unknown.
Knowledge of the infection status can lead to practices such as condom use or abstinence which compensate for the risk of contracting an STD.
Infection with HIV/Aids is the fourth leading cause of mortality in the world. Most of the 42 million people globally who are infected with HIV are concentrated in Africa, but epidemics elsewhere in the world are growing. Infections with chlamydia, gonorrhoea, human papillomavirus (HPV) and trichomoniasis are included in the burden estimates, causing morbidity in all regions of the world. Infection with some of these agents enhances the transmission and susceptibility to HIV.
The most significant risks with which sexually active people must contend are HIV infection, acquisition of an STD like gonorrhoea, chlamydia, syphilis, HPV and trichomoniasis as well as unintended pregnancy. The correct and consistent use of condoms is a highly effective means of reducing the risk of sexual transmission of HIV and other STDs as well as unintended pregnancy.
Limiting sexual activity to a single, uninfected partner is another highly effective means of managing the risks associated with sexual activity. Despite the efficacy of these widely publicised risk reduction strategies, many sexually active people do not routinely take measures to lower the risk of infection and unintended pregnancies.
Although the vast majority of sexually active people are aware of the preventive efficacy of condoms, most do not use them on a consistent basis. Research has also revealed that although 97 percent of college students know that condom use is an effective means of avoiding HIV infection and STDs, only about 40 percent translate this knowledge into action.
Unprotected sex remains prevalent risky behaviour. Some men are known to “stray” when their wives or partners are menstruating.
There are some, however, who engage in sexual activity during menstruation.
Taboos surrounding menstruation and sex have existed since times of the Old Testament. In the ancient Hebrew tradition, menstruating women were considered unclean during days of bleeding and for a week afterwards.
Sexual intercourse was forbidden. This belief is still customary in many cultures today throughout the world including our own in Zimbabwe. You find many after engaging in “menstrual sex”, they become so anxious and fearful that something bad might happen to them to the extent of looking for and using the so-called cleansing traditional medicines to prevent the foreseen and unknown calamity.
Medically, menstrual fluid itself is not harmful. Having sex with a healthy, uninfected woman during her period is not dangerous.
The key word is healthy and by that we mean uninfected with HIV or other sexually transmitted infections.
However, intercourse during menstruation may heighten the likelihood of disease transmission like HIV and Hepatitis B since both these viruses are spread through infected blood. Risk of infection during menstruation is actually greater for women because the cervix is more open than usual.
If a woman does not have any blood borne infections, then having sex during menstruation is not dangerous. It is simply a personal choice.
In addition to unprotected sex and sex with multiple partners outside a committed relationship, certain situational factors increase the likelihood that HIV infection, an STD, or an unwanted pregnancy will result from a sexual encounter.
The use of alcohol and other substances prior to a sexual encounter significantly impairs perception of risk, even contributing to positive expectations regarding the outcomes of risky sexual behaviour. Thus the likelihood of unprotected sex or other risky behaviour in a sexual encounter is elevated by the consumption of alcohol.
Other situational factors concern characteristics of the partners in a sexual encounter. Sex between strangers or individuals not in a committed relationship or casual sex poses a variety of risks including HIV and STIs as well as interpersonal violence.
The risks associated with casual sex are often exacerbated by the use of alcohol.
Research on sexual knowledge and practices of adolescents reveal that a substantial number of boys and girls in many developing countries engage in sexual activity before their 15th birthdays. Early and unprotected sexual initiation can trigger a succession of harmful physical, emotional and social outcomes, especially for girls.
Moreover, compared with adults, adolescents are less likely to have the foresight, skills, cognitive maturity, information and support they need to protect themselves from unwanted pregnancy, HIV and STIs. In addition, the rising number of new HIV infections among this young demographic signal an urgent need to identify behaviour and situations that contribute to sexual and reproductive health in adolescence.
Adolescence, as one of the most important stages in life, has been identified as the transitional phase of human growth and development, a stage between childhood and adulthood where a juvenile individual matures to an adult. This period has been identified to consist of dramatic transformations accompanied by several physiological, sexual behavioural, emotional and psychological changes. Depression, anxieties, restlessness and other obsessions are reasonably observable during adolescence.
This transition stage, between the ages of 10 and 19, according to WHO, puts the adolescent in a dilemma of how to adhere to the societal expectations. Thus they are confronted with numerous developmental and adjustment challenges, whereby sex issues are the most prominent challenge.
The youth of today is constantly bombarded with high rise of sexually tendency through films, advertising, music, pictures, television and the internet. The western media tells adolescents that sex is romantic, exciting and titillating without ever showing the real life consequences of spontaneous and irresponsible sexual behaviour.
Peer influence seems to be the most important factor in adolescent’s decision making and risk-taking behaviour. Affiliation with delinquent peers and having sexually active friends are two significant factors for initiation of early sexual intercourse among adolescents. The structure of peer pressure has been used to explain these associations.
Peer pressure is defined as “pressure from peers to do something or to keep from doing something else, whether you personally want to or not”. In this way, peer delinquency can act as a source of pressure for adolescents to become involved in risky sexual practices. Delinquent peers provide adolescents the opportunity to expose themselves to health risks by contributing to poor decision making.
Parents and teachers may be important in influencing adolescents’ early orientation towards peers. Adolescents who have harmonious relationships with their family members are less likely to associate with delinquent peers. Parents also provide social norms related to appropriate behaviour as well as having an important function in the supervision and monitoring adolescents’ tendencies towards inappropriate behaviour.
This relationship is more complex, as weakened bonds to family and school and risky behaviour operate in an interactional manner with mutual and simultaneous influences on one another.
Early sexual activity and multiple partners are associated with pain and suffering from broken relationships, a sense of betrayal and abandonment, confusion about romantic feelings, altered self-esteem, depression and impaired ability to form healthy long term relationships. Teen parents are more likely to drop out of school, continue to have non-marital pregnancies, have mental and physical health problems.
Teenage mothers suffer a lot of complications during delivery which in most cases result in high morbidity and mortality of both mother and infants.
If untreated, women with chlamydia and gonorrhoea develop pelvic inflammatory disease (PID). PID often leads to infertility, pelvic pain and ectopic pregnancies. HPV infection causes genital warts, cervical cancers and other forms of cancers like vulvar, vaginal, anal cancers.
Sandisiwe Mahlangu is a Health professional who specialised in psychiatry and mental health.
Her contact details are cell: 0774 782 282, email: [email protected].
Online Reporter