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Behavioural risk factors of men associated with transmission of sexually transmitted infections (STIs) in Sri Lanka

Background: Unprotected sex is a major risk factor for transmission of sexually transmitted infections (STIs). We explored the behavioural risk factors for STIs among men who presented with STI-related symptoms. Methods: A systematic sample of 112 males presenting with STI symptoms at district sexually transmitted disease (STD) clinic located in Kandy, Sri Lanka were enrolled during 2009. They were interviewed using a semi-structured questionnaire. Selected sexual behaviours were discussed with them in greater detail. The chi-square and difference-in-two-proportion tests were used for testing the statistical significance for quantitative data, and qualitative methods were used for the analysis of responses to open-ended questions and in-depth discussion. Results: The median age of the respondents was 28 years. The majority of them (56%) had never been married. The median age at the first sexual intercourse was 22 years. The majority (87%) of respondents had their first intercourse before marriage; mostly with older females. Most (103, 92%) men reported having sexual intercourse during the past six months; of them, 40.8% had sex with multiple partners. Only 18.5% used condoms at the first premarital intercourse. The consistent use of condoms with non-marital partners during the past six months was only 13.7%. Common reasons for non-use of condoms were: belief that partner was faithful; poor knowledge about risk of unprotected sex; view that condoms reduce pleasure and negatively affect intimacy; and inhibition in accessing condoms in public. Conclusions: Sexual behaviours were found to be risky among men attending STD clinics in Sri Lanka. Strategies of sexual health promotion among vulnarable groups should be evaluated for planning proper interventions.