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JOURNAL OF ADOLESCENT HEALTH CARE 1990;11:295-297 BRIEF SCIENTIFIC REPORT JEANNE T. HERNANDEZ, Ph.D., p- AND FRANK J. S College students are often viewed as being at high risk for human immunodeficiency virus (l-W) infection, due to their needs to engage in exploratory behavior and their needs for peers’ social approval, and their sense of invulnerability. The Rroportion of adolescents who are sexually active is known to be relatively stable; however, the amount of unsafe sex taking place on the college campus is still in question, as well as the relationship between dating patterns and HIV-risk behavior. In this study college students’ self-reports of sexual and dating practices were related to sexual frequency and condom use. The results highlight the amount of unprotected sexual behavior in the college group and the difficulty in assessing adolescents’ risk of HIV transmission on the basis of self-reported sexual activity and dating behavior. Key issues to target in educating college students about WIV infection are the roles of planning and spontaneity in dating and the fact that inaccurate self-perceptions of monogamy an& abstinence may lead them to assume falsely that they are safe from sexually transmitted diseases. KEY WORDS: HIV infection AIDS Sexually transmitted disease Given the importance of preventing the spread of human immunodeficiency virus (HIV) infection, new studies are providing information on the sexual behaviors of the population at large (1) and on target groups in particular (2). The sexual activity patterns From the Department of Psychiutry, University of North Carolirra School of Medicine, Chapel Hill (1.T.H.L and the Deparfment of Psy&ology, North Carolina State University, Raleigh fF.J.S.J. Address reprint requests to: Dr. J.T. Henlmndez, Department of Psychiatry, University of North Carolina, School of Medicine, CB #7160, Chapel Hill, NC 27514-7160. Manuscript accepted ]uly 25, 1989. of adolescents and young adults are of particular interest because the majority of AIDS patients are young adults, and the lag time between the transmission of HIV and the presentation of symptoms suggests that many are infected as adolescents. Furthermore, it may be more effective to assist young people in the formation of healthy behaviors before unhealthy patterns are established (3). Recent reports conclude that even though adolescents possess at least moderate knowledge of disease transmission and symptoms (4), they underestimate the personal relevance of acquired immunodeficiency syndrome (AIDS) (5) an d are still not protecting themselves appropriately (6). Designed to test the effects of AIDS education programs on college students’ inteiltions and behaviors, our research allowed us to compare self-reports of sexual and dating practices with sexual frequency and condom use. The results reveal the amount of unprotected sexual behavior in one college sample and the difficulty in assessing adolescents’ risk of HIV transmission on the basis of self-repor% sexual activity and dating behavior. Methods Three hundred eighty-eight student volunteers from two Southeast state university campuses took part in this study and received credits in an Introductory Psychology class. Subjects were scheduled for participation in groups of approximately 20. When the students reported for the experiment on AIDS education, they were asked to complete a preprogram questionnaire that asked about their sexual orientation: whether or not they were sexually active; whether or not they had beer in a monogamous relationship in the past 2 years; whether they were dating,one or more people; and whether or not they were interested in dating different people. Subjects 8 Society for Adokent Medicine, 1990 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010 295 0197-5070/90/$5.50 2% HERNANDEZANDSMITH were also asked questions about their sexual activity and contraceptive behavior over the previous 23 weeks (since the beginning of the previous semester). Anonymity and veracity were guaranteed in several ways: students did not use their names on the form; they were seated so that others could not read their answers; the room was monitored to prevent talking and the consent form, guaranteeing confidentiality of the questionnaire results, was read out loud by the researcher before the subjects signed it. These data were collected on the first of two visits for all subjects. The attrition rate was only 5%, which suggests that students’ commitment to the study was excellent. (Students knew that they would be questioned about sexual behavior and attitudes and agreed to answer as truthfully as possible or not at all,) Results The sample was 55% male and 85% Caucasian. The proportion : .r la-, 19-, 20-, and 21-year-old students was 2796, 36%,22%, and 15%, respectively. Eighty percent of the subjects were students at a campus in a large urban setting, where 62% live off campus. The other 20% were students at a campus in a smaller urban setting. Ten percent (41) reported being personally involved in a pregnancy, and 8% (32) reported having a previous or existing sexually transmitted disease (STD). One percent (4) of the sample said that they were bisexual, and 1.5% (5) admitted to being homosexual. These reports of homosexuality and bisexuality are similar to another recent self-report study (7). The report of pregnancy and previous STD were similar to the prevalence rates estimated from university student health service data (J. Cowan, pers. comm.). Previous experience with a pregnancy or an STD did not appear to deter students from sexual activity; those students were significantly more likely to be sexually active (n  = -2.46, p < 0.01) and significantly less likely to use condoms than their counterparts. Fifty-one percent (199) reported currently dating just one person. Of those, 83% (165) were sexually active, and 44% were still interested in dating different people. Overall, 67% (260) said that they were sexually active (59% of these were male). These findings are consistent with other research (8). There were 38 previous pregnancies reported in the sexually active group (15%) and 3 (3%) in the inactive group. Eleven percent of the active group and 3% of the inactive group re- JOURNAL OF ADOLESCENT HEALTH CARE Vol. 11, No. 4 ported an STD. Twenty-seven percent (34) of the inactive group reported abstaining from sex because of the danger of AIDS. Forty-six percent of those who considered themselves sexually inactive said that they had at least one sex partner during the previous 23 weeks, with 20% having more than one partner. Three percent of the sexually active group reported having no partners. Sixty percent of the active group and 20% of the inactive group had more than one partner. Thirty-seven percent (96) of the active group and 15% (19) of the inactive group ha.d picked up someone for sex during the 23-week period, and 24% of the active group and 7% of the inactive group did so more than once. Three percent of the sexually active group reported abstaining during the previous 23 weeks, whereas 56% had sex with more than one person. Ten percent had more than one ongoing sexual relationship. Sixty-two percent said that they were dating just one person at the time of the questionnaire. Thirty-nine percent (101) of the sexually active group carried a condom during the 23 weeks, as did 28% (36) of the sexually inactive group. Seventythree percent of the sexually active students reported using a condom during that time, with 35% using condoms regularly. Forty-eight percent (187) reported that they were “dating around now or interested in doing so.” Interest in dating, however, did not indicate sexual activity any more than any other categorization. Fifty-seven percent (106) of the interested group stated that they were sexually active, whereas 77% (154) of those who were not interested in dating different people were also sexually active. The majority of those reporting a monogamous relationship (81%) were not interested in dating different people. Seventy-one percent (153) of the males and 62% (107) of the females reported being sexually active. An equal proportion of men and women (58%) had used a condom during the previous 23 weeks. Three percent (5) of the women and 20% (43) of the men carried a condom much of the time or all of the time. Overall, there were more men (52%) than women (38%) with multiple partners, more women (41%) than men (2%) with only one partner, and a similar percentage of men (19%) and women (21%) with no partner. Thirty-five percent (75) of the men and 7% (13) of the women said that on a date they used alcohol or drugs, enough to have their judgement impaired one or more times a month. July 1990 Discussion AIDS education is still a critical need on the college campus for the minority of college students who are putting themselves at risk by their sexual behavior and for those who may in the future. Some students did not appear to learn from a past experience, as unplanned or at least unscheduled sex is not uncommon, and many who generally use a condom do not always use one. There were 68 sexually active students who were not serially monogamous and were interested in dating different people. Of those, 80% had had more than one sex partner, and only 25% had used a condom during the previous 23 weeks. Of greatest concern were the 34 sUents who were sexually active with multiple partners and who were still not using a condom, even after the experimental AIDS program presentations. They represented 9% of this sample. What differentiates these 34 students from the 91 sexually active students who used a condom regularly and from the 69 students who were abstinent is unclear and therefore an important subject for future study. The highlights of this study help to clarify the relationships among perceived and actual dating patterns and sexual behaviors. Self-report of sexual inactivity did not predict abstinence, interest in dating different people, monogamy, or sexual orientation. One correlate was noteworthy: Students who reported that they were sexually inactive were significantly more likely than their counterparts to say that they would abstain during the upcoming month (n  = - 17.33, p < 0.01). Apparently, perception of oneself in the present depends on one’s expectations for the future as much as on one’s recollections of the past, i.e., a self-report of sexual activity may be time bound or mood specific. When AIDS educators-teachers, physicians, or others-know the sexual and dating patterns of their audience, they can target behaviors and attitudes more specifically in their educational message. The findings from this study may serve as a guide to more applied AIDS education work. For example, key attitudes to target in AIDS education are the roles of planning and spontaneity in dating, and the self-perception of monogamy and abstinence, which are not always consistent and could lead young people to assume AIDS-RISK DATING BEHAVIOR 297 falsely that they are safe from STD. The often conflicting responses among the categories of dating and sexual behavior suggest that researchers, programmers, and service providers need to ask about specific behaviors and blocks of time when using young people’s self-report to design or target edncation programs. Inconsistencies in attitudes and behavior may be a productive area for open discussions with adolescent audiences. Generalization of the results of our study to 18to 21-year-old subjects who live in AIDS epicenters or in other areas of the country, or do not attend college should be made with caution. Southernstate university students’ attitudes toward sexual behavior, or their abilityto discuss those attitudesopenly, -maybe different than that of their peers in other circumstances. _Althoughthe percentages of behaviors may be different, it is probable that misperceptions about safe dating and monogamy that occur among this sample of better educated and less vulnerable students are present in other adolescent groups as well. References 1. Leads from the Morbidity and Mortalitv Weeklv Reoort. Number of sex partners and potential risk of sexual exposure to human immunodeficiincy virus. JAMA 1988; 260(14):2020-l. 2. National Institute of Mental Health (NIMH). Program announcement: Research on behavior change and prevention strategies to reduce transmission of human immunodeficiency (HIV). Rockville, MD: AIDS Program Office, NIMH. September, 1988. 3. Hochbaum GM. Health behavior. Belmont, CA: Wadsworth Publishing, 197043-54. 4. Goodwin MP and Roscoe B. AIDS: Students’ knowledge and attitudes at a midwestern university. J Am COBHealth Assor 1988; 3621422. 5. McCleary K. Students believe they won’t get AIDS. In The National College Newspaper, February, 1988,4U. 6. Kegeles SM, Adler NE, and Irwin CE. Sexually active adolescents and condoms: changes over one year in knowledge, attitudes, and use. Am J Public Health, 1988; 78(4):460-l. 7. Hingson R, Strunin L, Craven DE et al. Survey of AIDS knowledge and behavior changes among Massachusetts adults. Presented at the 116th Annual American Public Health Association Meeting, Public Health Education Section, Boston, MA, November, 1988. 8. Lester, LF and Leach JH. College student behavior: a ten-year look. J Am COB Health Assoc 1983; 31(5):209-13.