“It was protected, except, it wasn’t [with] a condom”: A mixed-methods study of BBVs/STIs protective practices among international university students in Sydney

Abstract

Abstract Background: Little is known about factors associated with protective sexual practices among international students in Australia. This study used quantitative data to examine BBVs/STIs protective practices among East Asian and sub-Saharan African international students in Sydney. In addition, qualitative data was used to further explore how a sample of sexually active participants understand, practice and rationalise condom use in protective sex.Methods: This mixed-methods study generated quantitative data using anonymous online survey (n=149), and qualitative data through in-depth interviews (n=20). The main recruitment strategy involved advertising the study through paper and electronic flyers. Quantitative data were analysed using logistic regression, while interviews data were analysed using reflexive thematic analysis. Results: Self-reported BBVs/STIs protective practices in the last 12 months include abstinence (28.7%), consistent condom use (19.9%), occasional condom use (18.7%), single partner fidelity (25.1%), other strategies (1.8%), and nothing (5.8%). Further, findings from the bivariate analysis showed that higher BBVs/STIs prevention knowledge, lower acculturation into Australian sexual culture, greater access to sexual health information, less conservative sexual norms, greater emotional social support and older age were significantly associated with increased protective practices. Variables significant at bivariate level were entered into a logistic regression. The model was statistically significant, (X2(6) = 31.33, p = 0.000) and explained 33.1% of the variance in BBVs/STIs protective practices. Only older age (OR = 1.096, 95% CI = 1.002–1.199, p<0.05) and acculturation to Australian sexual norms (OR = 1.016, 95% CI = 0.911–1.132, p<0.05) were independent predictors of BBVs/STIs protective practices. The study results based on the quantitative data, indicated that condom use (consistent and occasional) was the most reported BBVs/STIs protective behaviour among sexually active participants. Therefore, interviews data was used to explore condom-use motives and practices. The interviews results showed that participants primary concern as regards condom use was around pregnancy and not BBVs/STIs. Thus, some participants described safe sex largely as contraception, with BBVs/STIs constituting a secondary concern or no concern at all. Conclusions: Based on the results of this study, tailored sexual health interventions for international students; which incorporate strategies for modifying perceived sexual norms in Australia, are advocated. In addition, this study recommends sexual health interventions that promote dual protection of condoms for both contraception and BBVs/STIs.