Sex and nightlife: Risky sexual behavior and young people’s attitude toward STIs

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Sex and nightlife: Risky sexual behavior and young people’s attitude toward STIs

Matej Sande

To cite this article: Matej Sande (2020) Sex and nightlife: Risky sexual behavior and young people’s attitude toward STIs, American Journal of Sexuality Education, 15:3, 357-370, DOI:

10.1080/15546128.2020.1796867

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Sex and nightlife: Risky sexual behavior and young people ’ s attitude toward STIs

Matej Sande

Faculty of Education, University of Ljubljana, Ljubljana, Slovenia

ABSTRACT

The purpose of the research was to explore the characteristics of the risky sexual behavior of young people in nightlife settings in Slovenia. We used an online questionnaire to collect data on the use of psychoactive substances (PAS), risky sexual behavior and sexually transmitted infections (STIs). The final sample included 1,103 respondents. The respondents are of the opinion that they lack information about STIs and testing.

A third responded that getting infected with an STI was a likely possibility for them. The recommendations for upgrading preventive programs in nightlife settings include efforts toward providing information on less known STIs and testing.

KEYWORDS Nightlife; sexually transmitted infections;

STI testing

Introduction

Despite the fact that sexually transmitted infections (STI) remain a major public health concern in the EU (European Centre for Disease Prevention and Control [ECDC], 2015, 2018a), the results of cross-sectional research studies conducted among young people suggest a low level of awareness and knowledge of STIs, the exemption being HIV (Samkange-Zeeb et al., 2011). Every year, around 30,000 people become infected with HIV in EU/

EEA countries (ECDC, 2018a). In 2016, the majority of those diagnosed were men (76%), with the largest proportion of new diagnoses (40%) attributable to the population of men who have sex with men (MSM), and 4% to the population of injecting drug users. With 50 infections per year (ECDC, 2018a), Slovenia is considered a country with a low prevalence of HIV infections (Klavs et al., 2009). EU countries record a relatively high incidence of chlamydia infections, with 403,807 new infections in 2016 (ECDC, 2018b). The most commonly reported sexually transmitted infections among the general population in Slovenia are chlamydia and human papillomavirus (HPV) (Klavs & Kustec, 2014).

Along with assessing STIs among the general population, specific popu- lations with an increased risk of infections should be evaluated. In

ß2020 Taylor & Francis Group, LLC

CONTACTMatej Sande matej.sande@pef.uni-lj.si Department of Social Pedagogy, Faculty of Education, University of Ljubljana, Kardeljeva ploscad 16, 1000 Ljubljana, Slovenia.

https://doi.org/10.1080/15546128.2020.1796867

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addition to PAS-related risks (Lomba et al., 2009; Palamar et al., 2015), the nightlife setting contributes to riskier sexual behavior (Calafat, Blay, Bellis, et al., 2010) and sexual violence (Kavanaugh & Anderson, 2009).

Recently, most research studies in the field of sexual behavior in nightlife settings have addressed chemsex events (Bourne et al., 2014; Marillier et al., 2017; Sewell et al., 2018), the MSM population (Bourne et al., 2014;

John et al., 2019), and gender (Kovac & Trussell, 2015; Romo et al., 2009;

Roman Isler et al., 2016; Schnitzer et al., 2010). Given the increased risk of infections that are characteristic of such settings, STIs are mostly addressed by chemsex, and MSM-related research settings mostly address STIs.

The main purpose of our research was to examine the characteristics of the risky sexual behavior of young people in nightlife settings, as well as their knowledge and attitude toward STIs. The research study does not focus on specific subgroups, but rather on sexual behavior and the attitude toward STIs among the general population in nightlife settings. We were interested in young people’s opinions about the likelihood of infections, the reasons behind this, and their habits in terms of protection. In view of planning preventive programs, we were interested in how informed young people are about STIs, what information gaps needed to be bridged, and what kind of preventive measures at clubs and bars would best respond to their needs.

The evaluation part and the part studying sexual behavior within the research study were connected to the HIV in Nightlife project, while the results of this research study helped to set the course for a larger social marketing campaign addressing STIs in nightlife.

Materials and methods Participants

The Sex and Nightlife online survey was conducted by the Association DrogArt in 2018. Given its purpose, the research study included nightlife participants who we reached out to via various online channels. The data- base recorded 11,700 entries, 9,864 of which were insufficiently completed surveys (clicks on the cover letter, partially empty survey, etc.). This indi- cates a wide reach of the online survey. There were 1,836 partially completed questionnaires. Due to geographical data, stated at the end of the questionnaire, only 1,119 fully completed questionnaires were included in the research study. Subsequently, we excluded a further 16 questionnaires that were missing answers about gender or age. In the end, the sample included 1,103 responses which were then further processed.

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Data collection

The online questionnaire was available from the beginning of April until the end of May 2018 (from April 6 to May 23, 2018. We did not collect any personal data with the questionnaire, which was used immediately before the General Data Protection Regulation (GDPR) came into force;

therefore, respondents did not provide any specific consent. We recruited respondents through various websites, including those of nightlife-related organizations, through social media, and various existing social media groups. Altogether, the sample included respondents from 24 different sources (websites or groups). Given the number of clicks or redirections to the online survey, the great majority (96.2%) of respondents accessed the questionnaire through social media (various groups or profiles of clubs and organizations).

Questionnaire

The Sex and Nightlife¹ research study employed a quantitative method- ology which was based on our previous research studies on the use of amphetamine-type stimulants and new psychoactive substances (NPS) (Dekleva & Sande, 2003; Sande, 2016). We supplemented the questionnaire in the section referring to STIs and the preventive measures that addressed them and performed a pilot test of the questionnaire, where we mostly examined the clarity of the text and the time needed to complete it. The questionnaire was pilot tested in March 2018 on a small pilot sample of 15 people. After the pilot test was conducted, we supplemented the questionnaire and slightly changed the terminology based on respondents’ com- ments. In addition, we changed some questions in order to achieve greater clarity, moved the demographic block to the end of the questionnaire and added the questions about assessment of testing accessibility. The final questionnaire consisted of 46 questions. We were checking young people attitudes toward STIs with five different questions. In addition, we were checking testing accessibility or possible infection with six questions, and the same number of questions was used to check condom use and the possibility of purchasing condoms in clubs or bars, or from condom machines.

The use of drugs and alcohol was checked with four questions and sexual relations under the influence of drugs and alcohol was also checked with four questions, while the topic of having different sexual partners was cov- ered by three questions. Six four-point scales and one three-point scale were used. With questions addressing the possibility of becoming infected,

1This study was performed according to the Code of Ethics for researchers at the University of Ljubljana, Slovenia.

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the scale ranged from“Very unlikely”to “Very likely,” while the statements in other scales ranged from “Not true at all” to “Always true” and from “I don’t agree at all” to “I completely agree.” With seven statements for risky sexual behavior, for example, the scale ranged from “Not true at all” to

“Always true.” With questions addressing the use of drugs, we asked, for example, “What drugs have you used in the last 12 months?” and “What drugs did you use at the last party you went to?.” With questions on STIs, we asked, for example, “Do you think that you have available sufficient information on the following STIs?” “How likely it is for you to become infected with an STI?,” and “What kind of preventive actions around STIs at clubs and bars would best meet your needs?” and “You answered that you don’t use condoms at parties. What are the principal reasons behind your decision?”

We used the 1KA open-source online application to set up, test, and conduct the survey. The average time needed to complete the questionnaire was seven and a half minutes.

Analysis

The basic results in the research study were illustrated with the use of descriptive statistics. To study the differences between genders, we used t- tests for independent samples. A t-test was also used to test differences in risky sexual behavior among users of illicit drugs and those who did not use them. The Chi-square test was used to test the hypotheses stating that testing was more accessible to the LGB² population, that the LGB population is better-informed on STIs, and that the majority of LGB population members have already performed an STI test.

Results

Sample characteristics

The final sample included 1,103 respondents (59.7% women and 40.3%

men). The mean age of respondents was 24.6 years (SD ¼ 5.7; Me ¼ 23;

Mo ¼ 20). The sample mostly included young people (according to Slovenia’s Public Interest in Youth Sector Act, young people are considered adolescents and young adults between the ages of 15 and 29³) who were going out in 2019. The sample included 83.2% heterosexuals, 10.6% bisexuals, and 6.2% homosexuals. Just over half of respondents (54.8%) had a

2The research study included a basic segmentation, according to which respondents were divided into heterosexuals, bisexuals, and homosexuals.

3According to the definition from the WHO, young people are considered those between the ages of 10 to 24, which means that our sample included a broader definition of youth, which should be observed when interpreting and comparing data.

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stable partner at the time of the survey. Others responded that they were single (30.5%) or had occasional partners or open relationships (14.7%).

The majority of respondents indicated that they were attending education, with 13.6% attending secondary schools and 44.6% attending tertiary education. The rest indicated that they were employed (37.6%) or unemployed (4.2%). The majority (29.1%) responded that they went out once per month, followed by a few times per year (24.2%), and once every 2 weeks (20.7%). When asked about how often they went out, 16.3% of respondents indicated that they went out once per week, 7.6% more than once per week, and 2.1% never. Given the purpose of the research study, we man- aged to include in the sample respondents who go out relatively often, with 44.6% of them going out at least once every 2 weeks. The men in the sample went out statistically significantly more often than women (t(1,097)¼3.22, p<0.001).

The use of psychoactive substances

Given that the focus of the research was STIs and the characteristics of sexual behavior, less attention was paid to the prevalence of PAS use, which was addressed with only four questions. We sought to identify the prevalence of use in the last 12 months and on the last occasion or at the last party, and the frequency of the use of alcohol and other PASs.

With regard to alcohol use, 97.5% of respondents reported using it in the last 12 months. The men from the sample used alcohol statistically significantly more often than women (t(868.29)¼3.08,p<0.001).

In addition to alcohol, other popular PASs in nightlife settings remain marijuana, MDMA, cocaine, and amphetamines (Table 1), with GHB (gamma hydroxybutyrate) or GBL (gamma-butyrolactone) still used significantly, while the use of synthetic cathinones seems to be in decline in comparison with past research studies in this field (Sande 2016; Sande &

Purkart, 2011).

Table 1. Prevalence of the use of PASs.

PAS

Used in the last 12 months n¼1,065

%

Used at the last party or on the last occasion n¼1,030

%

Alcohol 97.5 90.6

Marijuana 63.0 34.0

MDMA 37.8 19.9

Cocaine 30.7 14.1

Amphetamines 17.7 10.4

Hallucinogens 13.1 2.5

GHB/GBL 7.6 2.7

Tranquillisers 7.3 0.6

Ketamine 5.5 1.4

3-MMC 4.6 1.2

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When asked about the use of illegal PASs, 35.5% of respondents said that they do not use them, while 7.7% have ceased to use them. Of those who use illegal PASs, 22.4% responded that they used them a few times per year, 7.6% reported that they used them once per month, 9.5% used them a few times per month (but less than once per week), 5.4% used them once per week, 6.1% used them a few times per week, and 5.8% used them every day. As in the case of alcohol, the men from the sample used PASs statistically significantly more often than women (t(864.58)¼3.06,p<0.001).

Characteristics of (risky) sexual behavior

The respondents had had on average three sexual partners in the last year.

The majority of them (34.8%) had engaged in unprotected sexual relations with one or two partners in their lifetime, 26.4% had engaged in unprotected sexual relations with three to five partners, 10.8% with six to ten partners, and 12.8% with more than ten partners. When asked about protection, 15.2% of respondents reported not engaging in unprotected sexual relations. Men reported engaging in unprotected sexual relations with more partners than women (t(1,096) ¼ 2.33 p<0.05).

Slightly over a quarter of respondents (27.3%) had already experienced sexual relations at a club or bar. A third of them (33.1%) reported that they had used a condom on such an occasion, while 66.9% had failed to do so (26.4% of whom did not use a condom because they were having inter- course with a stable partner) (n¼299).

Over half of respondents (53.2%) had engaged in sexual relations under the influence of illegal PASs and 79.5% of them reported doing this under the influence of alcohol. As far as protection goes, 28.9% of those who engaged in sexual relations under the influence of illegal PASs did not use condoms, 30.8% used these occasionally, 15.1% used them often, and 25.3% always used them. A quarter of all respondents (25.2%) are of the opinion that they would be less likely to use a condom under the influence of illegal PASs, while 30.1% responded that this was not true for them. Others responded that this was not true for them because they had stable partners (30.9%) or remained undecided (13.7%). A third of all respondents (33.2%) are of the opinion that they would be less likely to use a condom under the influence of alcohol, whereas 30.5%

responded that this was not true for them. A quarter said (25.2%) that this was not true for them because they had stable partners, and the rest (11.0%) remained undecided.

Experiencing unwanted sexual relations was reported by 17.8% of respondents, 63.6% of whom were under the influence of illegal PASs or

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alcohol on that occasion (n¼195). Some 6.4% of respondents had been offered drugs in exchange for sexual relations, 15.5% of whom had accepted the offer (n¼71). The research study recorded a very high percentage of those who had been victims of verbal or non-verbal sexual harassment at a party or bar (41.1%). Statistically significant differences between the sexes manifested in sexual harassment (v²¼234.13, p<0.001) and unwanted sexual relations (v²¼22.90, p<0.001), with women experiencing these more than men.

Respondents were asked to assess how much various statements on risky sexual behavior apply to them. With regard to that, 30.5% agreed with the statement that they have sexual relations with strangers, 6.9% agreed that they have sexual relations with sex workers, and 15.3% agreed that they have sexual relations with same sex partners, while 3.8% respondents agreed with the statement that they attend chemsex parties. The LGB respondents agreed more with the statements about having sexual relations with strangers, having sexual relations under the influence of illegal PASs, and attending chemsex parties (t(243.15)¼3.70, p<0.001), while this was not true for statements about unprotected sexual relations.

Illegal PAS users engaged in risky sexual relations statistically significantly more often than those who did not use illegal PASs (t(1,094) ¼ 5.33, p<0.001). PAS users agreed more with the statements about engaging in unprotected sexual relations and sexual relations with strangers (t(989.60)

¼ 2.87, p<0.001). This also applied for the subgroup the members of which stated that they went out more often (at least once every 14 days) (t(924.98) ¼ 4.85, p<0.001).

Sexually transmitted infections

The respondents were asked to assess how likely it was for them to become infected with the STIs which were among the most common in Slovenia during the research period.

Almost a third responded that it was possible for them to become infected with most STIs (combined answers I believe it is possible and I believe it is very possible). HIV infection was considered possible for 29.3% of respondents and 28.6% responded that it was possible for them to become infected with hepatitis viruses. With regard to other infections, 30.8% answered that it was possible for them to become infected with HPV, 29.6% said the same for chlamydia, and 31.9% for genital herpes.

They assessed the possibility of them becoming infected with gonorrhea (23.3%) and syphilis (22.6%) as slightly less likely. Men consider infections with most STIs statistically significantly more likely than women (HIV, hepatitis viruses, chlamydia, gonorrhea, and syphilis) (t(1,088) ¼ 3.20,

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p<0.001). The respondents who indicated going out often (at least once every 2 weeks), considered infections with almost every STI more likely (t(1,085) ¼ 3.86, p<0.001). Half of those (53.0%) who responded that getting infected was a likely possibility confirmed that it was more likely in nightlife settings (n¼315).

We tested the reasons behind the responses of nearly two thirds of respondents who answered that it was not possible for them to get infected with STIs, namely for becoming infected with HIV and chlamydia. For both STIs the answers were relatively similar (Table 2), with the main reasons why respondents assessed that infection is not possible for them being having a stable sex partner, not engaging in risky sexual relations, trusting their partners, and using condoms.

Furthermore, the respondents answered questions about STI testing in Slovenia. In that regard, 60.1% of respondents knew where in Slovenia they can get tested for HIV and hepatitis viruses, while less than a fifth (19.4%) had already been tested at their own initiative. The percentage of those who knew where to get tested for other STIs was lower (51.5%). Testing for HIV and hepatitis was considered accessible by 59.5% of respondents (combined answers accessible and very accessible), while testing for other STIs was deemed accessible by 48.6% of respondents. Of those who reported that they had already been tested, 71.7% were bisexual and homosexual, and 17.3%

were heterosexual. The difference is statistically significant (v²¼70.82, p<0.001). Moreover, the research study explored whether testing was more accessible for the LGB population. While we were not able to confirm the difference in the assessment of testing accessibility, the LGB population was statistically significantly more informed about HIV and hepatitis viruses (v²¼8.10,p<0.05), and testing (v²¼17.16,p<0.001).

Respondents were asked whether they have had or currently have an STI. The majority of them responded to having been infected with genital warts (4.4%), chlamydia (2.6%), and genital herpes (1.6%). Seven respondents indicated that they had been infected with syphilis, six with HEP virus, and five with HIV.

Table 2. Reason why respondents assessed that it was not possible for them to get infected with STIs (multiple answers possible).

Reasons why respondents assessed that it was not possible for them to get infected with STIs

HIV n¼711

%

Chlamydia n¼711

%

I have a stable partner. 66.4 65.8

I do not engage in risky sexual relations. 50.8 47.4

I trust my partner. 35.5 33.9

I always use a condom. 32.9 31.2

I don’t think it is likely for me to get infected. 18.0 20.1

I do not engage in sexual relations often. 17.8 15.9

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Knowledge of STIs and prevention

Respondents were best informed about HIV (46.3%) and hepatitis (29.0%) infections, and least so about other STIs. They responded that they lack information on gonorrhea (39.0%), HPV (38.1%), chlamydia (36.0%), syphilis (30.6%), and genital herpes (26.7%) (n¼1,939–1,082). Nearly a third of respondents (30.3%) lack sufficient information on STI testing (n¼1,039).

Half of respondents (53.7%) believe that they need more information on STIs.

With a view to exploring the potential for preventive actions, we were interested in obtaining data on the use of condoms in nightlife settings.

Half (51.7%) responded that they do not carry condoms when going out, and 14.2% reported that they always carry condoms. Significantly more men than women from the sample carry condoms in nightlife settings (t(848.93) ¼ 9.73, p<0.001). With regard to purchasing condoms, 12.6%

of respondents said that they had already bought a condom from a condom machine in a club, while 44.5% responded that they would do so if there were a condom machine in the club.

Those who would not refrain from engaging in sexual relations without a condom amounted to 40.4%, 25.2% of whom would opt for less risky sexual practices. On the other hand, 40.9% said that they would refrain from engaging in sexual relations without a condom, and the rest were undecided.

We asked those who responded that they do not use condoms during sexual relations in clubs what the reason for their decision was. The main reasons stated were that they do not like using condoms (58.5%) and that they have a stable partner (55,3%⁴). The rest argued that they do not consider infections likely (37.9%), that they were too “high” (33.9%), or that they do not use condoms because they do not care about infections (10.3%). Condoms proved to be very important to prevent unwanted preg- nancy (64.4%) and STIs (68.8%).

We asked respondents what kind of preventive actions around STIs in clubs and bars would best meet their needs. Most of them (85.9%⁵) responded that free condoms or machines selling condoms at reduced prices would best meet their needs (79.8%). This was followed by website information (79.8%), informative materials on STI testing possibilities (76.6%), informative materials on STIs (65.9%), and outreach workers in clubs (51.2%).

Discussion

The research study explored the characteristics of risky sexual behavior and knowledge of STIs and young people’s attitudes toward STIs in nightlife

4Combined answersI agreeandI completely agree.

5Combined answersWould meet my needsandWould very much meet my needs.

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settings. Nightlife remains a particular setting characterized by an increased risk of PAS use and risky sexual behavior. Compared to previous research studies (Bellis et al., 2008; Sande & Purkart, 2011), the most widely used drugs in nightlife settings in Slovenia remain marijuana, MDMA, cocaine, and amphetamines, while the use of NPSs or, specifically, synthetic cathinones, is in pronounced decline (Sande, 2016). Compared to nightlife research studies in the USA, Belgium, and the UK, the use of PASs in the last year is higher in Slovenia (Measham et al., 2011; Palamar et al., 2015;

Van Havere et al., 2011). Understandably, the prevalence of use in the last 12 months is higher in nightlife settings than in the general population, both in Slovenia and the EU (Drev et al., 2015; European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2017).

In addition to drug use, it is also important to monitor risky sexual behavior and the attitudes of young people toward STIs in nightlife settings. The findings cannot be directly compared to other research findings, since recent research studies mostly addressed the sexual behavior of specific groups, like the MSM population and/or chemsex parties’ participants (Bourne et al., 2014; Marillier et al., 2017; Sewell et al., 2018), or the general population. That said, certain limitations should be applied to the interpretation of the comparison below. Another limitation to observe is the fact that the sample was unrepresentative and based on self-selection.

Compared to those who did not use drugs, young people who used them reported having more unprotected sexual relations. Similarly, statements about unprotected sexual relations and sexual relations with strangers applied more to drug users. These findings may provide input to understanding the correlation between PAS use and risky sexual relations (Lomba et al., 2009;

Rhodes & Stimson, 1994). With regard to protection, 15% of respondents said that they have never engaged in unprotected sexual relations. A third used condoms if engaging in sexual relations at a club or bar. Slightly over half of respondents reported having engaged in sexual relations under the influence of illegal PASs which is, with certain limitations, comparable with a nightlife research study conducted in Portugal (Lomba et al., 2009). A quarter of respondents were of the opinion that they would be less likely to use condoms when using PASs, and a third said the same for alcohol. This is less compared to the research study mentioned above, where nearly half of respondents were of such an opinion. The research study recorded a very high percentage of those who had been victims of verbal or non-verbal sexual harassment in nightlife settings (41.1%) and 17.8% of respondents reported engaging in unwanted sexual relations, over half of which were under the influence of alcohol or PASs. Alcohol was the reason for engaging in unwanted sexual relations for 10.4% of Slovenian students in the last years of secondary school (Dekleva & Sande, 2003). LGB respondents were not

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more likely to engage in unprotected sexual relations, but they engaged in more sexual relations with strangers and under the influence of illegal drugs and were more likely to attend chemsex parties.

To some extent, risky sexual behavior in nightlife settings has already been researched (Bellis et al., 2008; Lomba et al., 2009), but there is little information about young people’s attitudes toward STIs in nightlife settings. Slightly under a third of respondents responded that it was possible for them to become infected with STI, with men assessing that this was more likely than women, half of whom were of the opinion that they were more likely to become infected in nightlife settings. Young people are more informed about testing for HIV and hepatitis viruses than other STIs. A relatively small (17.3%) percentage of heterosexual respondents reported getting tested for HIV and hepatitis viruses, which can be, with certain limitations, compared to the findings of the 2006 research study conducted on a smaller nightlife setting sample in nine countries (Bellis et al., 2008;

Calafat, Blay, Hughes, et al., 2010), which showed that adolescents from Slovenia were the least likely to have been tested.

A statistically significant higher number of bisexual and homosexual respondents reported having been tested than heterosexuals. The LGB population in the sample had more information about HIV, hepatitis viruses, and testing, but did not assess testing to be more accessible than heterosexuals did. The nightlife sample data revealed that HPV and chlamydia are the most common infections, which coincided with data on reported STIs among the general population in Slovenia (Klavs & Kustec, 2014). In 2014, there were 24.3 reported instances of HPV infections per 100,000 people in the general population of Slovenia (Klavs & Kustec, 2014). With regard to planning preventive actions in nightlife settings, it is important to explore what information on STIs young people have, what kind of preventive measures would best meet their needs, and what their attitude toward condoms as the predominant form of protection is. Respondents were best informed about HIV and hepatitis (29.0%) infections, and least so about other STIs, namely gonorrhea, HPV, chlamydia, syphilis, and genital herpes. Half of respondents are of the opinion that they need more information about STIs.

The findings from nightlife settings can be compared to the findings of research studies conducted among the general adolescent population (Samkange-Zeeb et al., 2011). Given that the findings from the nightlife study conducted by Bellis et al. (2008) in nine European cities showed that Slovenian adolescents in nightlife settings were the most likely to engage in sexual relations without using condoms, data on the use of this form of protection are also important. Half of respondents reported not carrying condoms when going out and a significant proportion said that they would get condoms at the club if they were available there. The research study recorded

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a high percentage of those who would not refrain from engaging in sexual relations without a condom. Respondents from nightlife settings said that free condoms, website information, and information about STI testing would best meet their needs.

The research study also measured the reach of the HIV is not Picky social marketing campaign, which was part of the HIV in Nightlife project, much like the research study. Some 40.4% of respondents confirmed that they had noticed the campaign. Together with the respondents’ positive assessment of the suitability of the information tools available, this shows a relatively high reach and suitability of comprehensive social marketing campaigns addressing sexual health in nightlife settings.

In addition to directing necessary action toward specific groups of population (e.g., the MSM population and chemsex parties’ participants), the recommendation for upgrading preventive programs in nightlife settings includes providing information about STIs and testing possibilities to the wider nightlife population and improving access to condoms in such settings. In view of the accompanying risks, information about sexual relations under the influence of PASs should also be provided.

Given the high percentage of unwanted sexual relations due to PAS use, the policies set up to foster sexual health in nightlife settings should include information on such risks for nightlife participants. Gender-specific materials should be prepared to instruct participants on how to identify and avoid sexual harassment. In addition, training courses for staff and security per- sonnel should also include content on preventing sexual harassment.

Based on the research findings, we planned to develop the campaign further and studied the possibility of making condoms available in clubs and bars. We included information about STIs and condom availability in the process of preparing standards for nightlife in Slovenia. In this way, we will further develop sexual health policies by implementing specific nightlife interventions and upgrade the prevention program activities.

Acknowledgements

The author would like to acknowledge the contributions of other study team members (Tanja RudolfCen cic and Simona Kepic) and the rest of the Association DrogArt team.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

This study was part of the HIV in Nightlife Settings project which was financed by the Ministry of Health of the Republic of Slovenia. The financing did not affect the results of the study.

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ORCID

Matej Sande http://orcid.org/0000-0001-5556-2973

References

Bellis, M. A., Hughes, K., Calafat, A., Juan, M., Ramon, A., Rodriguez, J. A., Mendes, F., Schnitzer, S., & Phillips-Howard, P. (2008). Sexual uses of alcohol and drugs and the associated health risks: A cross sectional study of young people in nine European cities.

BMC Public Health,8, 155.https://doi.org/10.1186/1471-2458-8-155

Bourne, A., Reid, D., Hickson, F., Torres Rueda, S., & Weatherburn, P. (2014). The Chemsex study: drug use in sexual settings among gay and bisexual men in Lambeth, Southwark and Lewisham. Technical Report. Sigma Research, London School of Hygiene

& Tropical Medicine.

Calafat, A., Blay, N., Bellis, M., Hughes, K., Kokkevi, A., & Mendes, F. (2010). Tourism, nightlife, and violence: A cross cultural analysis and preventive recommendations. IRE- FREA.

Calafat, A., Blay, N. T., Hughes, K., Bellis, M., Juan, M., Duch, M., & Kokkevi, A. (2010).

Nightlife young risk behaviours in Mediterranean versus other European cities: Are ster- eotypes true? The European Journal of Public Health, 21(3), 311–315.https://doi.org/10.

1093/eurpub/ckq141

Dekleva, B., & Sande, M. (2003). Tri leta kasneje – uporaba drog ob koncu srednje sole.

Zdruzenje DrogArt.

Drev, A., Kvaternik, I., & Macur, M. (2015). Prepovedane droge. In H. Koprivnikar, M.

Zorko, A. Drev, M. Hovnik Kersmanc, I. Kvaternik., M. Macu (Eds.), Uporaba tobaka, alkohola in prepovedanih drog med prebivalci Slovenije ter neenakosti in kombinacije te uporabe. Nacionalni institut za javno zdravje.

European Centre for Disease Prevention and Control. (2015).Sexually transmitted infections in Europe 2013. ECDC.

European Centre for Disease Prevention and Control. (2018a). HIV and AIDS. In ECDC (Ed.),Annual epidemiological report for 2016. ECDC.

European Centre for Disease Prevention and Control. (2018b). Chlamydia infection. In ECDC (Ed.),Annual epidemiological report for 2016. ECDC.

European Monitoring Centre for Drugs and Drug Addiction. (2017).European drug report 2017: Trends and developments. Publications Office of the European Union.

John, S. A., Parsons, J. T., Rendina, H. J., & Grov, C. (2019). Club drug users had higher odds of reporting a bacterial STI compared with non-club drug users: Results from a cross-sectional analysis of gay and bisexual men on HIV pre-exposure prophylaxis.

Sexually Transmitted Infections, 95(8), 626–628. https://doi.org/10.1136/sextrans-2018- 053591

Kavanaugh, P. R., & Anderson, T. L. (2009). Managing physical and sexual assault risk in urban nightlife: Individual- and environmental-level influences.Deviant Behavior, 30(8), 680–714.https://doi.org/10.1080/01639620902854639

Klavs, I., & Kustec, T. (2014). Spolno prenesene okuzbe v Sloveniji: letno porocilo 2014.

Nacionalni institut za javno zdravje.

Klavs, I., Rodrigues, L. C., Wellings, K., Weiss, H. A., & Hayes, R. (2009). Sexual behaviour and HIV/sexually transmitted infection risk behaviours in the general population of Slovenia, a low HIV prevalence country in central Europe. Sexually Transmitted Infections,85(2), 132–138.https://doi.org/10.1136/sti.2008.034256

(15)

Kovac, L. D., & Trussell, D. E. (2015). ‘Classy and Never Trashy’: Young Women’s Experiences of Nightclubs and the Construction of Gender and Sexuality. Leisure Sciences,37(3), 195–209.https://doi.org/10.1080/01490400.2014.986347

Lomba, L., Apostolo, J., & Mendes, F. (2009). Drugs and alcohol consumption and sexual behaviours in night recreational settings in Portugal. Adicciones, 21(4), 309–325.https://

doi.org/10.20882/adicciones.222

Marillier, M., Batisse, A., Richeval, C., Labrouve, V., Martinez, M., Allorge, D., Gregoire, M., Batel, P., Nefau, T., Chevallier, C., Gaulier, J.-M., & Djezzar, S. (2017). CHEMSEX, NPS & risk reduction management: Preliminary results of a pilot study. Toxicologie Analytique et Clinique,29(1), 47–56.https://doi.org/10.1016/j.toxac.2016.12.003

Measham, F., Moore, K., & Østergaard, J. (2011).Emerging drug trends in Lancashire: Night time economy surveys: Phase one report. Lancaster University.

Palamar, J. J., Griffin-Tomas, M., & Ompad, D. C. (2015). Illicit drug use among rave attendees in a nationally representative sample of US high school seniors. Drug and Alcohol Dependence,152, 24–31.https://doi.org/10.1016/j.drugalcdep.2015.05.002

Rhodes, T., & Stimson, G. V. (1994). What is the relationship between drug taking and sexual risk? Social relations and social research. Sociology of Health and Illness, 16(2), 209–228.https://doi.org/10.1111/1467-9566.ep11347330

Roman Isler, M., Golin, C., Wang, J., Hughes, J., Justman, J., Haley, D., Kuo, I., Adimora, A., Chege, W., & Hodder, S. (2016). Venues for Meeting Sex Partners and Partner HIV Risk Characteristics: HIV Prevention Trials Network (HPTN064) Women’s HIV Seroincidence Study (ISIS). AIDS and Behavior, 20(6), 1208–1218. https://doi.org/10.

1007/s10461-015-1057-3

Romo, N., Marcos, J., Rodrıguez, A., Cabrera, A., & Hernan, M. (2009). Girl power: Risky sexual behaviour and gender identity amongst young spanish recreational drug users.

Sexualities,12(3), 355–377.https://doi.org/10.1177/1363460709103895

Samkange-Zeeb, F. N., Spallek, L., & Zeeb, H. (2011). Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: A systematic review of published literature. BMC Public Health, 11, 727. https://doi.org/10.1186/1471- 2458-11-727

Sande, M. (2016). Characteristics of the use of 3-MMC and other new psychoactive drugs in Slovenia, and the perceived problems experienced by users. The International Journal on Drug Policy,27(2016), 65–73.https://doi.org/10.1016/j.drugpo.2015.03.005

Sande, M., & Purkart, B. (2011). Cocaine use in nightlife in Slovenia and Italy. In M. Sande (Ed.), Nightlife reconsidered. (pp. 73–85). The Etnoblog Intercultural Association. http://

pefprints.pef.uni-lj.si/688/1/Nightlife_reconsidered.pdf

Schnitzer, S., Bellis, M. A., Anderson, Z., Hughes, K., Calafat, A., Juan, M., & Kokkevi, A.

(2010). Nightlife violence: A gender-specific view on risk factors for violence in nightlife settings: A cross-sectional study in nine European countries. Journal of Interpersonal Violence,25(6), 1094–1112.https://doi.org/10.1177/0886260509340549

Sewell, J., Cambiano, V., Miltz, A., Speakman, A., Lampe, F. C., Phillips, A., Stuart, D., Gilson, R., Asboe, D., Nwokolo, N., Clarke, A., Hart, G., & Rodger, A. (2018). Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016.

Sexually Transmitted Infections, 94(7), 494–501. https://doi.org/10.1136/sextrans-2017- 053439

Van Havere, T., Vanderplasschen, W., Lammertyn, J., Broekaert, E., & Bellis, M. (2011).

Drug use and nightlife: More than just dance music. Substance Abuse Treatment, Prevention, and Policy,6, 18.https://doi.org/10.1186/1747-597X-6-18