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Researchers at the Boston University School of Public Health have found that multi-person sex (MPS), defined as sexual activity involving several people simultaneously, may be an emerging public health problem among teens. Results of their exploratory study conducted in the greater Boston area among females ages 14-20 years old showed that 1 in 13 participants had ever engaged in MPS.
Participants ages 14-15 were the most likely to report ever engaging in MPS, and over half (54%) of all study participants who reported ever engaging in MPS had their first experience before they turned 16 years old. More than half of the young women (65%) reported that their involvement in MPS had been pressured, forced, or coerced. Not surprisingly, alcohol and substance use were related to events of MPS. According to Dr. Emily Rothman, lead researcher on the study, “one-third of the young women who had a multi-person sex experience had used alcohol or drugs immediately prior, and of those, 50% said the alcohol and drug use itself was not consensual.”
One of the most interesting findings was the relationship between pornography and MPS. “Exposure to pornography in the past month was associated with a five-fold increase in the odds of having had a multi-person sex experience,” Rothman said. Among participants who reported involvement in MPS, 50% reported that they had been pressured to perform a sexual activity that their partner had seen in porn. “That really raises questions about whether pornography may be influencing the sexual behavior of very young teens and young adults.”
Why is MPS a public health concern for teens?
Participants reported low levels of condom use during acts of MPS, increasing their vulnerability to HIV, other STIs, and unintended pregnancy. “What’s particularly worrisome in terms of public health is that 45% of the most recent multi-person sex experiences, at least one male had not used a condom,” Rothman said. Forced or coerced sex is also linked to increased risk of STI/HIV transmission. Researchers point out that young women who experience unwanted sex, or sex with multiple partners in a row, may not be physiologically prepared for intercourse, increasing the risk of vaginal tearing and thus the risk of contracting HIV or other STIs. Finally, researchers believe that the risks of STI/HIV transmission associated with multiple concurrent partnerships also likely translate to MPS.
The study conducted by the Boston team was an exploratory study; thus, further research is needed to determine the prevalence of MPS among adolescents in other parts of theUnited Statesand the world. There is a need for larger studies examining the relationship between MPS and HIV/STI risk. Also, more research is needed to determine how engaging in risky sexual behaviors, such as MPS, during the teenage years affects sexual and reproductive health outcomes later in life.
“The take-home message here is that both consensual and non-consensual group sex is happening among youth,” Rothman said. “Parents, pediatricians, health organizations, and rape crisis centers really need to be prepared to talk about, provide education about it, and address it.”
To learn more about this issue, read the full study, “Multi-person Sex among a Sample of Adolescent Female Urban Health Clinic Patients.”
This is the second post in our series, Adolescent Girls, Microbicides, and HIV Prevention Trials. Ms. Anna Kaale, study coordinator; Ms. Doreen Bangapi, community recruitment officer; and Dr. Sylvia Kaaya, local principal investigator, are with the Muhimbili University of Health and Allied Sciences (MUHAS) and work with FHI 360 on the Adolescents, Women, and Microbicides Trial.
An essential component of the “Adolescents, Women and Microbicides” trial is creating clinical spaces where adolescents feel comfortable. The Infectious Disease Centre (IDC) in Dar es Salaam,Tanzania, offers dedicated hours for youth-friendly HIV and reproductive health services to young people ages 12 to 24. They provide voluntary HIV counseling and testing, HIV care and treatment services, prevention and treatment of other sexually transmitted infections, and counseling for prevention of unintended pregnancy. We asked two nurse counselors from this site to share their experiences providing these services and working with adolescent and young women (ages 15-21 years) who are participating in the trial.
The nurses noted the following challenges in providing youth-friendly services (YFS):
- Standalone YFS are often not well known within communities; thus, young people often do not know they exist.
- Providers face challenges in creating dedicated space and time for YFS.
- It is difficult to segregate young people and adults in the same clinical care environment. Young people often report discomfort when meeting adult patients in the clinic. They worry that their parents, guardians, or other adults they know will discover their use of SRH services.
- The clinic faces stock-outs, particularly of HIV testing kits. As a result, nurses must either refer young people to another clinic or ask them to wait until supplies become available. Young people might not have transportation to other health services and also might fail to return once HIV kits are back in stock.
- Stock-outs of drugs used in treatment of STIs were also not uncommon, and the nurses highlighted the higher impact of such stock-outs on youth compared to adults. Many young people do not have the financial resources to purchase drugs privately and may be unable to request assistance from parents or guardians due to threats to their privacy.
- Even after being counseled on risk-reduction strategies, young women often face difficulties in attempts to implement them.
- Increase advocacy about YFS and awareness within the community about the existence and location of YFS.
- Place a greater priority for YFS in the provision of clinical and drug supplies, paying special attention to the logistical challenges young people face during stock-outs.
- Create private spaces for YFS within facilities.
- Augment clinic-based health education with interventions to address broader relationship and community-level factors that affect adolescent and young women’s ability to take measures to prevent unplanned pregnancies and STIs, including HIV.