Khảo sát về tình dục toàn cầu 2012

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Health & Medicine

Published on March 12, 2014

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Khảo sát về tình dục toàn cầu 2012
Thực hiện bởi Durex

THE FACE OF GLOBAL SEX 2012 Fırst sexUsing a condom and its impact on future sexual behaviour

First Sex  |  Using a condom and its impact on future sexual behaviour Contents Foreword  4 Overview  6 Introduction   8 Country highlights  10 Condom use at first sex   Age at first sex Age at first sex education Experience of unplanned pregnancy Experience of STI Condom use at last sex Main results  16 1.  Key determinants of condom use at first sex   2. Prospective implications of condom use at first sex in positive sexual health outcomes later in life Conclusion 34 Appendix 36 Methodology Country highlights data table References 42 The first time is always memorable

54 The Face Of Global Sex 2012 The first time you have sex is always memorable. For some it is a pleasurable experience that has been planned in advance and in which both partners have made an informed choice to share intimacy. However, for others, first sex may be unplanned, unexpected and uninformed. These first sexual experiences impact not only upon how people feel about their first time, but also upon their future sexual health, wellbeing and confidence. People using condoms at first sex are more likely to be satisfied with their overall sex life and to be confident that they know how to avoid unplanned pregnancy. The results also clearly show that condom use at first sex is strongly associated with sexually responsible behaviour in the future. People using a condom when they lost their virginity are more likely to have used a condom the last time they had sex, and are less likely to contract STIs or experience an unplanned pregnancy in the future. The results from this report can have positive implications for public health, particularly on the importance of sexual education, as seen in all countries surveyed. We see that early sex education can have a strong potential role in helping people make an informed choice to use a condom at first sex. This provides public health professionals with an effective intervention to reduce the incidence of STIs, unplanned pregnancies and, more importantly, help people adopt positive sexual health practices later in life. At Durex, we believe everyone has the right to a healthy, fulfilling sex life. Being informed and empowered promotes confidence to experience the best of sex – free to enjoy sex without safety fears and free to express sexual emotions physically and verbally. We know that good sexual health promotes a better sense of sexual wellbeing and leads to healthier lives. Highlighting the results of this report increases the potential for lifelong improvement to sexual health. It can help provide healthcare professionals and sexual health policymakers with valuable information that can be used to promote sexual health and wellbeing in the future. Foreword People using condoms at first sex are more likely to be satisfied with their overall sex life and to be confident that they know how to avoid unplanned pregnancy. …early sex education can have a strong potential role in helping people make an informed choice to use a condom at first sex. First sexual experiences impact upon how people feel about their first time and their future sexual health, well being and confidence.

76 The Face Of Global Sex 2012 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour Overview Adults in these 37 countries who managed to never have an unintended pregnancy or an STI were also more likely to have used a condom the first time that they had sex. Of special importance are the characteristics that might be influenced, like the amount of sexuality education that they receive or their access to sexual and reproductive health resources. Freya L. Sonenstein, Ph.D. Professor and Director Center for Adolescent Health Johns Hopkins Bloomberg School of Public Health Why should we care whether condoms are used at first intercourse? This study, as well as many others in the literature, finds that one of the best predictors of condom use among sexually active adults is whether or not these adults began their sexual activity using condoms. Further, adults in these 37 countries who managed to never have an unintended pregnancy or an STI were also more likely to have used a condom the first time that they had sex. Thus it is important for us to understand the characteristics of young people who tend to protect themselves at first intercourse because these are the individuals who will be more likely to have intended children and not be burdened by disease. These are positive outcomes for themselves as individuals and for society in general. Of special importance are the characteristics that might be influenced, like the amount of sexuality education that they receive or their access to sexual and reproductive health resources. The survey findings indicate that condom use at first sexual intercourse is far from a universal practice. Across time, condom use has however increased as is shown by the negative relationship between age and condom use. Older respondents are less likely to have used condoms when they first began to have sex compared to younger respondents. Younger survey participants appear to have responded to efforts to increase condom use. The results of the survey will prove useful in informing sexual health programmes all over the world, as they indicate that focusing further educational and marketing efforts to get young people to use condoms more consistently when they initiate sex can pay off immediately, as they protect themselves from the negative consequences of sex. These efforts are also likely to have longer term effects, as these adults continue to protect themselves and their partners as they grow older. Having sexual intercourse for the very first time is a critical and expected step for most adolescents around the world as they move into adult roles. The circumstances under which first sex occurs vary substantially across societies and time periods. • In countries where early marriage is the norm, young women are more likely to first experience sex with their husbands, while elsewhere first sexual intercourse more often occurs outside of marriage • Across time and countries circumstances change • In many developed nations young people are delaying the age of marriage • Across the globe, the numbers of children desired or expected have decreased, making pregnancy prevention increasingly important • And the appearance in the past 30 years of HIV as a life-threatening condition that can be sexually transmitted has reinvigorated reliance on condoms for STI prevention All these patterns are embedded within the Face of Global Sex 2012 survey whose results are presented here on the following pages. In this survey, adults aged 18-64 in 37 countries provided information about the circumstances of their first experience with sexual intercourse, whether it occurred almost 40 years ago or more recently. We learn that adults in Columbia and Brazil report the youngest ages at first intercourse (around age 17) and those in Malaysia and Indonesia report the oldest ages (around 23) on average. Whether or not a condom was used at first intercourse varied much more extensively, with two thirds of the adults in Brazil and Greece reporting condom use, contrasted with less than one third in Indonesia, the Czech Republic and New Zealand.

9 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 98 The Face Of Global Sex 2012 8 Introduction Since the 1990s, Durex has carried out global surveys investigating and documenting sexual attitudes and practices of the general population around the world. Initially, these surveys were intended to help raise brand awareness and profile. The results of these reports, therefore, were not specifically targeted at the academic world or sexual health experts, disseminated instead, to the general populations of the participating countries through mass media channels. However, it quickly became apparent that the information being gathered and disseminated served as a valuable tool in: • Raising public awareness regarding unsafe sexual behaviours • Highlighting the value of condom use as a public health measure • Encouraging public policy debate As a result, the reports were made more widely available to the academic world and healthcare media. Their focus was also refined to include more academic information that could specifically be used for policy-making and sexual wellbeing programs. Scientific studies on human sexuality This process eventually led to the development of scientific studies on human sexuality, regularly produced by Durex since 2005. Using data from the Durex Sexual Wellbeing Global Surveys, the brand has been able to develop statistical models for better understanding specific trends and associations of variables related to human sexuality. A good example of how this worked took place in 2007, when Durex had a scientific paper published on likelihoods of unprotected sex among the UK population in the Journal of the European Society for Contraception; and in 2008 the brand developed a statistical model that clearly demonstrated a strong association between parental involvement in children’s sex education and higher levels of sexual confidence later in their life. The importance of these studies is becoming increasingly recognised for two main reasons: • Firstly, the results of these surveys allow the general population to have access to unique sets of data, important for awareness of critical public health issues • Secondly, the results promote an in-depth scientific analysis and debate for strengthening public policies on sex education Evolving survey format The format of the surveys has also evolved in the past few years to accommodate the needs of the new audiences. Originally, the surveys were presented to the public in a form of descriptive analysis of the data. Information on associations and determination modelling was limited to scientific forums. In this context, sexual programmes only benefited from an understanding of overall sexual health figures, such as the proportion of condom use, STI incidence etc. Other important information, such as socio-demographic, behavioural, and/ or attitudinal determinants, that could have been used for understanding and promoting regular use of contraception and protection against STIs, were not previously available and have only recently been incorporated into the reports to be made available to the public domain. As one of the few organisations in the world to have adequately developed an integrated social marketing approach within its unique strategy, Durex is now recognised as a key player in sexual health issues and policy by major sex education world leaders, such as the UNFPA and the European Commission. Durex is also a world leader in systematising the social needs of its consumers and the public, recognised by GBCHealth, the organisation that mobilises the power of the global business community to build a healthier world. The new Face of Global Sex 2012 report has as its main focus the importance of condom use during the first sexual experience. In addition, it relates to other variables in sexual health, providing important insights into determinants that impair or promote condom use throughout life and sexual wellbeing in general. In particular, the report examines and finds important associations between the use of condoms at first sex with future positive sexual health behaviours and outcomes in later life. Durex used findings from the Durex Sexual Wellbeing Global Survey 2011–2012 to develop this new study for testing these two important associations. The new Face of Global Sex 2012 report has as its main focus the importance of condom use during the first sexual experience.

11 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 1110 The Face Of Global Sex 2012 Country highlights 20% 30% 40% 50% 60% 70% USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia 15 yrs old 17 yrs old 19 yrs old 21 yrs old 23 yrs old 25 yrs old USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia Condom use at first sex Proportions of condom use at first sex varied across countries as shown in the graph below: • Brazil was the country reported to have the highest proportion of condom users at first sex (66.0%), followed by Greece (65.5%) and South Korea (62.8%) • By contrast, the lowest proportion of individuals using condoms at first sex was observed in Indonesia (27.6%), Czech Republic (30.4%) and New Zealand (32.6%) Age at first sex Age at first sex differed by more than four years between participating countries: • Brazil was the country with the lowest age at first sex (17 on average) – followed closely by Colombia and Austria which had similar results • Malaysia, Indonesia and India were the countries with the highest average age at first sex, each of them at over 22 years Condom use at first sex Mean age at first sex Proportion(%) Ageinyears To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey

13 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 1312 The Face Of Global Sex 2012The Face Of Global Sex 2012 12 Age at first sex education • Sex education was found to start on average between the ages of 12 and 12.5 in Mexico, Austria and Germany • By contrast, respondents in India, Malaysia and China reported receiving their first formal sex education over the age of 15 Experience of unplanned pregnancy • More than 80% of respondents in Italy, France, the Netherlands and Mexico reported having never experienced an unplanned pregnancy • However, these figures were significantly lower in Turkey, New Zealand, and Romania where the equivalent number was at around 60% of all respondents Country highlights 11 yrs old 12 yrs old 13 yrs old 14 yrs old 15 yrs old 16 yrs old USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia 50% 60% 70% 80% 90% USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia Mean age at first sex education Ageinyears Never experienced an unplanned pregnancy Proportion(%) To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey

15 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 1514 The Face Of Global Sex 2012The Face Of Global Sex 2012 14 Condom use at last sex Despite the number claiming current use of condoms as a contraception/ protection method, rates of condom use at last sex varied markedly across countries: • From 79% in China, to • 39% in the Czech Republic Country highlights 40% 50% 60% 70% 80% 90% USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia 30% 40% 50% 60% 70% 80% USA UK Turkey Thailand Taiwan Switzerland Spain SouthKorea SouthAfrica Singapore Russia Romania Portugal Poland Nigeria NewZealand Netherlands Mexico Malaysia Japan Italy Ireland Indonesia India Hungary HongKong Greece Germany France CzechRepublic Croatia Colombia China Canada Brazil Austria Australia Experience of STI In the case of having experienced an STI: • Russia, Croatia and especially Turkey were the countries at greatest risk • Taiwan, UK and Indonesia were countries with the smallest incidence rates, with proportions of individuals never experiencing STIs at over 88% Never experienced an STI Proportion(%) Used condom at last sex Proportion(%) To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey To review the country highlights data, please refer to the appendix on pages 40–41 Source: 2011–2012 Durex Sexual Wellbeing Global Survey

17 FIRST SEX | Using a condom and its impact on future sexual behaviourFIRST SEX | Using a condom and its impact on future sexual behaviour 1716 THE FACE OF GLOBAL SEX 2012 Main results 1. Key determinants of condom use at first sex To identify the factors helping to determine condom use at first sex, seven independent variables were examined. They were: • Gender • Age • Income level • Education level • Relationship at first sex • Did not plan for first sex • Never received sex education Seven univariate and one multivariate (including all independent variables) models were created. In addition, other variables were also examined – including age at first sex, drug and/or alcohol use at first sex and discussing with parents prior to first sex – but these were found to have no statistically significant level of association. The table below shows the results for the univariate and multivariate models. REGRESSION MODELS UNIVARIATE MULTIVARIATE Condom Use at First Sex Robust Odds Ratio Std. Err. z P>z [95% Conf. Interval] Robust Odds Ratio Std. Err. z P>z [95% Conf. Interval] Male 1.191 0.047 4.430 0.000 1.102 1.286 1.214 0.048 4.940 0.000 1.124 1.311 Current age 0.963 0.004 -9.340 0.000 0.956 0.971 0.971 0.004 -7.130 0.000 0.963 0.979 Income very much above average 0.867 0.119 -1.040 0.297 0.662 1.134 0.776 0.113 -1.740 0.081 0.584 1.032 Income above average 1.017 0.080 0.210 0.830 0.872 1.187 0.953 0.095 -0.480 0.631 0.784 1.159 Income somewhat above average 0.986 0.053 -0.260 0.795 0.887 1.096 0.973 0.053 -0.510 0.609 0.874 1.082 Income somewhat below average 0.838 0.048 -3.060 0.002 0.748 0.938 0.909 0.068 -1.280 0.202 0.785 1.053 Income below average 0.744 0.049 -4.480 0.000 0.653 0.847 0.826 0.062 -2.540 0.011 0.712 0.957 Income very much below average 0.638 0.059 -4.880 0.000 0.533 0.764 0.715 0.080 -3.010 0.003 0.575 0.889 Highest education level: PhD, MBA or similar 0.951 0.087 -0.550 0.584 0.796 1.137 1.015 0.108 0.140 0.890 0.824 1.251 Medium education level 0.825 0.065 -2.420 0.015 0.706 0.964 0.910 0.070 -1.230 0.220 0.782 1.058 Low education level 0.674 0.057 -4.640 0.000 0.570 0.796 0.876 0.068 -1.710 0.088 0.752 1.020 Still in education 1.729 0.161 5.870 0.000 1.440 2.075 1.459 0.167 3.300 0.001 1.166 1.826 Married at first sex 0.522 0.040 -8.390 0.000 0.449 0.608 0.689 0.065 -3.950 0.000 0.573 0.829 In stable relationship at first sex 1.790 0.076 13.730 0.000 1.647 1.945 1.611 0.086 8.920 0.000 1.451 1.789 In casual relationship at first sex 1.034 0.062 0.570 0.572 0.920 1.163 1.266 0.096 3.110 0.002 1.091 1.468 Did not plan for first sex 0.737 0.038 -5.950 0.000 0.666 0.815 0.777 0.041 -4.730 0.000 0.700 0.862 Never received sex education 0.470 0.050 -7.170 0.000 0.382 0.578 0.680 0.067 -3.890 0.000 0.560 0.826 The intention of this study was to: 1. Identify the key determinants for condom use at first sex. 2. Identify prospective implications of condom use at first sex in regular condom use and positive sexual health outcomes later in life

19 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 1918 The Face Of Global Sex 2012The Face Of Global Sex 2012 18 Interestingly, the Durex study found that for each one-year increase in age past the age of 18, the likelihood for having used a condom at first sex reduces by 2.9%. The impact of age The survey showed age of respondent to be another important predictor for condom use at first sex. Interestingly, the Durex study found that for each one- year increase in age past the age of 18, the likelihood for having used a condom at first sex reduces by 2.9%. However, this could be a period effect, with older people, especially those who reached puberty before the arrival of HIV, being less likely to have used condoms. The graph below shows that over 70% of respondents below the age of 20 affirmed having used condoms at first sex. This proportion decreased significantly as age progressed, reaching less than 40% of total at the age of 50 and less than 25% by the age of 64. The marked difference in condom use by males and females suggests that it should be considered carefully when devising interventions to influence behaviour at first sex. Gender – an important predicting factor Gender is considered an important factor in predicting condom use at first sex. International literature suggests that males are more likely to have protected sex at their first sexual experience: • Yilmaz et al (2010), found that male Turkish students had started sexual relations at a younger age but had unprotected first sex less often than female students • Similarly, Sneed et al (2012), observed that males were significantly more likely to report using condoms for protection at first intercourse than females The results of the Durex survey confirm this data from international literature, showing a significant correlation between gender and likelihood to use condoms at first sex. After adjusting for weighting and clustering effects, the multivariate model indicated a 21.4% higher likelihood for using male condoms at first sex for males compared to female respondents (95%CI: 12.4–31.1%). The marked difference in condom use by males and females suggests that it should be considered carefully when devising interventions to influence behaviour at first sex. This result would merit further research to establish the gender difference – whether it lies in a simple misunderstanding of the question by respondents, through women using other contraception options that are open to them, to the potential of females being pressured into sex before they are ready. The results enable the creation of a clear picture of a person most likely to use condoms at first sex: Main results INFLUENCING FACTOR EXAMINED INDIVIDUAL MOST LIKELY TO USE CONDOMS AT FIRST SEX • Gender • Income level • Education level • Relationship at first sex • Did not plan for first sex • Never received sex education • Male • From average or higher income family • Currently still in education • In a stable relationship but not married • Planned for sex • Received sex education Each of these factors had a significant impact on the use of condoms at first sex and which in itself impacts upon future sexual behaviour, as detailed in this report. 20 20 30 40 50 60 70 Age of repsondent Percentofuse(%) 40 60 80 Fitted values95% CI Percentage condom use at first sex by age of respondent

21 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 2120 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 20 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 Still inLow levelMedium levelHigh levelHighest level: PhD, MBA etc 1.02 1.0 0.91 0.88 1.46 Education level – no clear association with condom use Despite a general belief of education being associated with less risky behaviours, the study did not show a strong association between the level of education and the likelihood of condom use at first sex. The only strong association was found in respondents who claimed to still be studying. For that particular group, condom use at first sex was 45.9% more likely than the average to use condoms at first sex. Other international studies confirm this finding (Andrade et al 2008 and Paiva et al 2008). Paiva observed that more schooling was also associated with delaying of sexual intercourse and commented that the postponement of the first sexual intercourse is more frequent among youths with more years of schooling. This is an area that would benefit from further research to establish the causes for the high figure. Potential reasons could include: • Better access to medical facilities • Receiving counselling and information in a college environment • A better knowledge base about sexual health among students • Peer influence resulting in safer behaviour • People investing in education may simply have more to lose if an unintended pregnancy occurs Below average income reduces likelihood of condom use In the case of income, keeping in mind that the majority of respondents reported having a level of family income as ‘about average’ for their country, statistically significant differences in Odds Ratio were found for poorer segments of the population in all 37 countries: • Respondents that reported having an income ‘very much below average’ were 39.9% less likely to have used a condom at first sex • Similarly, individuals who reported being from ‘below average’ income families were 21.1% less likely to have used a condom at first sex • This could indicate the importance of targeting people from the lower income end of the spectrum for safer sex initiatives 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 Very much below average Below average Somewhat below average Somewhat above average About average Above average Very much above average 0.78 0.95 0.97 0.91 0.83 0.72 1.0 Main results Odds ratio of ‘Condom use at first sex’ by ‘Income’ Income Education level Odds ratio of ‘Condom use at first sex’ by ‘Education’

23 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 2322 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 22 Relationship at first sex – one of the most important factors Relationship status was found to be one of the most important factors associated with the likelihood of condom use at first sex. • Individuals who were in a stable relationship were 61.1% more likely to have used a condom at first sex • This trend is dramatically reversed in the case of people who engaged in first sex only when they got married. In this group the likelihood of use of condoms at first sex was found to be negative by 45.1% Main results 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 In stable relationship at first sex Not in a stable relationship at first sex 1.0 1.61 Odds ratio of ‘Condom use at first sex’ by ‘Being in a stable relationship’ Relationship status 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0 Married at first sex Not married at first sex 1.0 0.69 Odds ratio of ‘Condom use at first sex’ by ‘Being married’ Marital status This association, between a stable relationship and condom use is surprising, as, intuitively, it would be more expected that condom use would be higher with casual relationships. Manlove et al (2008) also found the negative association between casual partners and the odds of condom use at first sex. The reason for this seemingly odd result could lie in what young people before first sex perceive as being a stable relationship. In this case, a relationship of just a few weeks could potentially be described as stable by a young person when, later in life that same person would describe it as casual.

25 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 2524 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 24 Planning for first sex – increases condom usage Planning of the first sexual experience was also found to be directly associated with condom use at first sex. The Durex study found that those who did not plan their first sexual experience were 28.7% less likely to have used a condom. The significance of planning is also noted by Stone and Ingham (2002) who commented in their study that only one variable emerged as a significant independent predictor of condom use for both sexes – the degree of discussion about contraception preceding first intercourse. They also pointed out that its impact appears to be stronger and more consistent among females than it was among males. The association of condom use with planning and enjoyment could also be as a result of couples sharing their anxieties about unplanned pregnancy or transmission of STIs, thus making the use of condoms more likely. Those who did not plan their first sexual experience were 28.7% less likely to have used a condom. The association of condom use with planning and enjoyment could also be as a result of couples sharing their anxieties about unplanned pregnancy or transmission of STIs, thus making the use of condoms more likely. Never received sex education – a dramatic indicator In the case of correlation of no sex education with condom use at first sex, the impact is shown to be even more pronounced. Respondents that reported never having received sexual education were 47.1% less likely to have used condoms at first sex. The same trend was also reported by Manlove et al (2008), where they found that those who did not receive formal sex education had lower odds of condom use and/or consistency. This outcome is to be expected, as individuals receiving no formal sex education would generally be expected to have lower knowledge levels about the nature of the risks associated with unprotected sex and how to avoid them. However, this result should be treated with caution as, across time, levels of sex education and condom use have both risen. Respondents that reported never having received sexual education were 47.1% less likely to have used condoms at first sex. 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Did not plan for first sex Planned for first sex 1.0 0.78 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Never received sex education Received sex education 0.68 1.0 Main results Odds ratio of ‘Condom use at first sex’ by ‘Having not planned for first sex’ Odds ratio of ‘Condom use at first sex’ by ‘Never receiving sex education’ Planning approach Access to sex education

27 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 2726 The Face Of Global Sex 2012The Face Of Global Sex 2012 26 2. Prospective implications of condom use at first sex in positive sexual health outcomes later in life For the second model, for each predictive model created, the following control variables were used: • Gender • Age • Income • Education • Current relationship status • Region of residence (urban, suburban and rural) • Current employment status • Sexual orientation (heterosexual, homosexual and bisexual) Based on these control variables, ‘Condom use at first sex’ was used as the main independent variable on the controlled logistical regressions to check for potential associations with: 1. Level of confidence in how to prevent AIDS 2. Level of confidence in how to prevent unplanned pregnancy 3. Level of confidence in how to have a happy sex life 4. Level of confidence in sources of sex education 5. Agreement with the statement ‘Sex education makes people more responsible’ 6. Feeling satisfied overall with sexual life 7. Never having experienced unplanned pregnancy 8. Never having experienced an STI 9. Use condoms at the moment 10. Always use condoms with main partner 11. Always use condoms with other partner(s) 12. Used condoms the last time he/she had sex The 12 logistic regressions were also adjusted for clustering effects and weighting of the dataset. The following table presents the main findings for results of association of condom use at first sex with each of the variables in the model: Dependent Variables OR (Used condom at first sex) Robust SE z p-value 95% CI Domain 1 1. Level of confidence in how to prevent AIDS 1.087 0.088 1.03 0.302 0.928 1.273 2. Level of confidence in how to prevent unplanned pregnancy 1.355 0.112 3.67 0.000 1.152 1.594 3. Level of confidence in how to have a happy sex life 1.134 0.078 1.82 0.069 0.990 1.298 4. Level of confidence in sources of sex education 1.130 0.077 1.79 0.073 0.989 1.291 Domain 2 5. Agreement with the statement ‘Sex education makes people more responsible’ 1.208 0.077 2.95 0.003 1.066 1.370 6. Feeling satisfied overall with sexual life 1.196 0.083 2.59 0.010 1.045 1.370 Domain 3 7. Never having experienced unplanned pregnancy 1.479 0.073 7.93 0.000 1.343 1.629 8. Never having experienced an STI 1.262 0.086 3.43 0.001 1.105 1.442 Domain 4 9. Use condoms at the moment 2.764 0.198 14.19 0.000 2.402 3.180 10. Always use condoms with main partner 1.392 0.113 4.08 0.000 1.187 1.631 11. Always use condoms with other partner(s) 1.397 0.208 2.24 0.025 1.043 1.871 12. Used condoms the last time he/she had sex 1.423 0.127 3.97 0.000 1.196 1.694 Statistically significant levels of association were found for nine of the tested variables. These variables can be subdivided into four domains: Domain 1 Level of confidence in sexual health knowledge Domain 2 Agreement with specific attitudinal issues concerning sexual health Domain 3 Current and previous incidence of STIs and unplanned pregnancy Domain 4 Current condom use Main results

29 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 2928 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 28 Results – impact of using condoms at first sex on future behaviour The results enable the creation of a simple profile of the future behaviour of a person using condoms at first sex. The individual will on average: • Be confident they can prevent unplanned pregnancy • Be satisfied with their overall sex life • Believe sex education enables people to be more responsible when having sex • Be unlikely to have experienced an STI or unplanned pregnancy • Probably use condoms as their current contraception choice • Probably use a condom with their main and other partners • Probably have used a condom at their last sexual intercourse These sexual health and wellbeing benefits are highly significant and suggest that targeting programmes to encourage condom use at first sex would be beneficial to global sexual health. However, more research would be needed as the results could be influenced by reverse causality, with individuals with better overall sexual health being more likely to also use condoms. To see how the profile of a condom user at first sex was reached, we need to look at the findings for each of the domains. Domain 1 – Level of confidence in sexual health knowledge 1. Level of confidence in how to prevent AIDS 2. Level of confidence in how to prevent unplanned pregnancy 3. Level of confidence in how to have a happy sex life 4. Level of confidence in sources of sex education Out of the four variables related to the level of confidence: • A strong association was found only for the variable of level of confidence in how to prevent unplanned pregnancy (p<0.05). Individuals that reported having used condoms at first sex were 35.5% more likely to indicate that they felt confident in being able to prevent an unplanned pregnancy • However, for the other three confidence variables (AIDS, happy sex life and source of sex education) no statistically significant associations were found This obviously leads to the conclusion that, while people are aware of the value of condoms in preventing pregnancy, they are not aware of their role in preventing the transmission of STIs such as HIV. This may be perpetuated by the fact that some people view STIs and AIDS as being treatable. The fact that they are also unsure of where to find a source of sexual information also implies a lack of knowledge on the subject. 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 Used condoms at first sex and confidence on how to prevent unplanned pregnancy Did not use condom at first sex 1.0 1.36 Main results Odds ratio of ‘Confidence on how to prevent unplanned pregnancy’ by ‘Condom use at first sex’

31 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 3130 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 30 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 Used condom at first sex and never experienced a STI Used condom at first sex and never experienced an unplanned pregnancy Did not use condom at first sex 1.0 1.48 1.26 Domain 2 – Agreement with specific attitudinal issues concerning sexual health 5. Agreement with the statement ‘Sex education makes people more responsible’ 6. Feeling satisfied overall with sexual life In the second domain, the level of association was strongest for attitudinal questions regarding sexual education and health. • Respondents claiming to have used condoms at first sex were 20.8% more likely to agree with the statement: ‘Sex education enables people to be more responsible when having sex’ • Furthermore, for the statement “I am satisfied with my overall sex life”, the increase of likelihood for individuals who have used condoms at first sex is very similar at 19.6% This result is interesting when compared with the result of Domain 1 (Level of confidence in sexual health knowledge), where people were unsure where to find a source of sexual information or about how to protect themselves from AIDS. Respondents obviously value sex education, yet would appear to have had limited access to it or for the quality of that education to have been low. Domain 3 – Current and previous incidence of STIs and unplanned pregnancy 7. Never having experienced unplanned pregnancy 8. Never having experienced an STI A very strong significant association was found for the unplanned pregnancies and STI incidence variables and condom use at first sex. • In the case of STIs, respondents who had used condoms at first sex were 26.2% more likely to have not experienced an STI • When it came to unplanned pregnancy, respondents using condoms at first sex were at an even lower risk, with 47.9% more likely to have never experienced an unplanned pregnancy Main results 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 Used condom at first sex and agree with the statement “Sex education enables people to be more responsible when having sex” Did not use condom at first sex Used condom at first sex and agree with statement “I am satisfied with my overall sex life” 1.0 1.21 1.20 Odds ratio of ‘Sexual health attitudes’ by ‘Condom use at first sex’ Odds ratio of ‘Past unplanned pregnancy and STI experience’ by ‘Condom use at first sex’

33 First sex | Using a condom and its impact on future sexual behaviourFirst sex | Using a condom and its impact on future sexual behaviour 3332 The Face OF GlObal Sex 2012The Face OF GlObal Sex 2012 32 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Used condoms at first sex and used condoms the last time he/she had sex Used condoms at first sex and always use condoms with other partner(s) Used condoms at first sex and always use condoms with main partner Used condom at first sex and use condoms at the moment Did not use condom at first sex 1.0 2.76 1.39 1.4 1.42 Domain 4 – Current condom use 9. Use condoms at the moment 10. Always use condoms with main partner 11. Always use condoms with other partner(s) 12. Used condoms the last time he/she had sex The strongest significant association was found between the independent variable, condom use at first sex and current behaviour in the use of contraception. Individuals claiming using condoms as their current method for contraception were 176% more likely to have used a condom at first sex. This particular association is widely reported in many other studies: • Traeen et al (2011) reported that using a condom at most recent sexual intercourse was significantly associated with condom use at first intercourse • Similarly Ma et al (2009), found that condom use during the first sexual experience, oral contraceptive use in the previous year and a higher condom self-efficacy score in both genders were potent predictors of frequent condom use • And Thomas et al (2004), observed that using condoms at the first sexual experience is a strong predictor of future condom use Individuals claiming using condoms as their current method for contraception were 176% more likely to have used a condom at first sex. Other very significant results were found in frequency of condom use with the main partner and other partner(s). The likelihood of respondents who used condoms at first sex also using one with their main partner was 39.2% and 39.7% with other partner(s). Finally, individuals who had used condoms at first sex and were currently using condoms as a method of contraception were 42.3% more likely to have used condoms at their last sexual intercourse. These results clearly show the value of targeting sexual health programmes at young people before first sex to encourage condom use as it has beneficial effects throughout their sexual life. Main results Odds ratio of ‘Present condom use’ by ‘Condom use at first sex’

353534 The Face Of Global Sex 2012 Appendix The results of the Face of Global Sex 2012 have strong implications for the field of public health. The study clearly demonstrates that early sexual education and making first sex a planned experience, is important to ensure: • Condom use at first sex • Positive sexual health practices later in life Children and adolescents that receive sexual health orientation and have their questions answered by people whom they trust, show a significantly stronger tendency to use condoms at first sex and later in life. These results attest to the importance of sexual education in all countries surveyed. Individuals who have used condoms at first sex are: • Significantly less likely to experience an STI or unplanned pregnancy. (This is true even after adjusting the model for gender, age, sexual orientation, relationship status, area of residence, country of origin, etc.) • Significantly more likely to demonstrate higher levels of confidence in preventing unplanned pregnancy and to have positive attitudes concerning sexual education. The strongest association with the use of condoms at first sex was found with variables of regular condom use later in life, with both main and other sexual partners. This knowledge offers public health professionals an effective intervention for reducing the incidence of STIs and unwanted pregnancies. The results of the study enable the identification of a profile of the person who is most likely to use condoms at first sex: • Male • About average income • Currently continuing education • In a stable relationship • Planned first sex • Received sex education Understanding this profile will enable the tailoring of sexual health strategies to be more effective in encouraging condom use at first sex, with all the subsequent benefits that this action brings to the sexual health life of the individual. Conclusion Children and adolescents that receive sexual health orientation and have their questions answered by people whom they trust, show a significantly stronger tendency to use condoms at first sex and later in life. This knowledge offers public health professionals an effective intervention for reducing the incidence of STIs and unwanted pregnancies.

Potential determinants of condom use at first sex Condom use at first sex Current sexual health confidence, attitudes, condom use and outcomes Model 1 Model 2 37 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 3736 The Face Of Global Sex 2012 36 The main research question examined in the report was the following: What are the key determinants of condom use at first sex and what are the prospective implications for regular condom use and positive sexual health outcomes later in life? Based on the initial assessment, two specific hypotheses were tested: • Ho1: Specific socio-demographic characteristics and previous exposure to sex education are not associated with condom use at first sex • Ho2: Condom use at first sex is not associated with continuous condom use and positive sexual health outcomes later in life All data collected electronically by Harris Interactive was compiled into a single database using Excel. • A descriptive and explanatory analysis was first carried out before translating the consolidated database into STATA statistical software and conducting the statistical analysis The statistical analysis included two different models of analyses: • Model 1 was used for identifying the determinants of condom use at first sex • Model 2 was used for identifying the implications of condom use at first sex on continuous and positive sexual health behaviours and outcomes later in life The diagram below presents the two temporal levels of association to be tested by these statistical models: Appendix Methodology The 2011–12 Durex Sexual Wellbeing Global Survey was carried out in 37 countries. • The sampling of the respondents was conducted by Harris Interactive via a web-based panel system in 36 of 37 countries • In the 37th country, Nigeria, data was collected using face-to-face interviews • The minimum sample was composed of 500 respondents per country including people 18 and up to 64 (for a margin of error in each country of approximately 4.3%) In addition, based on the composition of the samples, the data collecting agency made the necessary adjustments for weighting the data in a way to include a representative sample. Below is a list and description of samples collected from each of the participating countries: Country Frequency Percent Cumulative Australia 1,009 3.4 3.4 Austria 501 1.7 5.0 Brazil 1,004 3.4 8.4 Canada 1,015 3.4 11.8 China 2,060 6.9 18.6 Colombia 1,007 3.4 22.0 Croatia 504 1.7 23.7 Czech Republic 506 1.7 25.4 France 1,059 3.5 28.9 Germany 1,006 3.4 32.2 Greece 513 1.7 34.0 Hong Kong 508 1.7 35.6 Hungary 510 1.7 37.3 India 1,005 3.4 40.7 Indonesia 1,014 3.4 44.1 Ireland 500 1.7 45.7 Italy 1,064 3.6 49.3 Japan 509 1.7 51.0 Malaysia 506 1.7 52.7 Country Frequency Percent Cumulative Mexico 1,019 3.4 56.1 Netherlands 1,013 3.4 59.5 New Zealand 510 1.7 61.2 Nigeria 500 1.7 62.8 Poland 1,029 3.4 66.3 Portugal 507 1.7 68.0 Romania 507 1.7 69.6 Russia 1,030 3.4 73.1 Singapore 506 1.7 74.8 South Africa 504 1.7 76.4 South Korea 1,010 3.4 79.8 Spain 1,000 3.3 83.1 Switzerland 506 1.7 84.8 Taiwan 1,012 3.4 88.2 Thailand 505 1.7 89.9 Turkey 1,004 3.4 93.2 UK 1,014 3.4 96.6 USA 1,018 3.4 100 Total 29,994 100 The main goal of the survey was to collect data on various sexual knowledge, attitude and practice variables, including specific domains of respondents’ first sexual experiences, their current propensity to use contraception protection and other specifics of their current sexual health status.

39 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 3938 The Face Of Global Sex 2012The Face Of Global Sex 2012 38 Appendix Methodology continued For Model 1, the following analyses were conducted: 1. Review of all variables included in the final dataset and check for inconsistencies and missing numbers 2. Codebook of all variables for identification of quartiles, means and medians of all variables 3. Weighting the dataset to adjust for distribution discrepancies 4. Calculating the mean and 95% confidence intervals for all variables 5. T-tests for statistically significant differences between various control variables 6. Generation of box-plot graphs for main variables 7. Development of univariate and multiple logistic regression models for identifying specific associations between various independent variables and condom use at first sex 8. Generation of two-way associative graphs for examining the association between the specific independent variables and the dependent variable 9. Confounding and interaction testing for all independent variables included in the final multiple logistic regression model For Model 2, similar procedures were carried out for steps one to six included in Model 1, while the final regression model used a different approach as follows: 1. Development of multiple logistics regression models for identification of potential associations of condom use at first sex (used as independent variable) with multiple dependent variables (multiple models). All of these models were adjusted for socio-demographic variables, such as age of respondents, income, education, location of residence, sexual orientation and relationship status 2. Generation of likelihood graphs and odds ratios based on the models created for each dependent variable Only non-virgin respondents were included in the final dataset for the analysis of the descriptive statistics in Models 1 and 2 given the assumption of the model that respondents had already lost their virginity. • Out of the 29,994 respondents for all countries, 4,290 respondents (14.3%) claimed they were still virgins and were therefore excluded from the sample, leaving a total of 25,704 respondents whose response to the question: “Have you lost your virginity?” was positive Method Number of respondents % of total number of respondents Condoms 13,219 51.4 Withdrawal 5,155 20.1 Oral contraceptive pill 4,801 18.7 Rhythm/natural method 2,112 8.2 Coil/IUD/IUS 707 2.8 Diaphragm/Cap 304 1.2 Female condom 533 2.1 Contraceptive injections/implants 491 1.9 Emergency contraception 1,107 4.3 Contraceptive patch 376 1.5 Male sterilisation 239 0.9 Female sterilisation 278 1.1 Other form of contraception/protection 398 1.5 Can’t remember 1,175 4.6 No contraception/protection used 4,780 18.6 Decline to answer 552 2.1 Condoms Oral Contraception No Yes Total No 10,451 2,034 12,485 Yes 10,452 2,767 13,219 Total 20,903 4,801 25,704 As mentioned previously, the key independent variable used across all statistical models was condom use at first sex. The table below shows the distribution of birth control methods used by respondents in absolute number and as a percentage of the total: As presented in the table above, condom use is cited as the contraceptive method most utilised (51.4%) by all respondents, followed by withdrawal (20.1%) and oral contraceptive pill (18.7%). • It is important to observe that 18.6% of respondents claimed not using any contraception/protection • In addition, as respondents were allowed to respond to more than one method, a significant number of respondents indicated dual usage. For instance, in the case of condoms and oral contraception, dual protection was observed in 10.8% (or 2,767 respondents) as presented below

41 First Sex  |  Using a condom and its impact on future sexual behaviourFirst Sex  |  Using a condom and its impact on future sexual behaviour 4140 The Face Of Global Sex 2012The Face Of Global Sex 2012 40 Appendix Country Condom Use at First Sex Mean Age at First Sex – Years Age at First Sex Education – Years Never Experienced an Unplanned Pregnancy Never Experienced a STI Used Condoms at Last Sex Australia 42.3% 18.1 12.9 70.4% 81.4% 64.4% Austria 57.4% 17.5 12.4 78.3% 79.0% 57.3% Brazil 66.0% 17.3 12.9 74.6% 76.8% 68.2% Canada 39.2% 18.5 12.7 73.8% 83.1% 66.8% China 49.4% 21.2 15.3 69.1% 71.7% 78.9% Colombia 52.8% 17.4 12.9 76.7% 81.5% 50.7% Croatia 44.7% 18.5 13.6 71.2% 69.5% 48.2% Czech Republic 30.4% 17.6 13.5 67.1% 82.7% 39.1% France 34.8% 18.7 13.3 81.3% 84.0% 53.7% Germany 45.7% 17.8 12.5 79.2% 82.6% 61.9% Greece 65.5% 18.4 13.6 69.1% 74.9% 65.0% Hong Kong 56.9% 20.8 12.9 70.2% 82.3% 76.0% Hungary 35.8% 18.4 13.2 69.6% 76.7% 55.6% India 51.8% 22.5 15.9 73.2% 69.8% 71.3% Indonesia 27.6% 23.6 14.8 72.2% 87.6% 54.5% Ireland 48.6% 18.8 13.3 68.2% 83.8% 70.6% Italy 55.1% 19.4 13.4 85.6% 76.8% 55.3% Japan 60.9% 20.4 12.8 75.6% 82.6% 64.5% Malaysia 54.0% 23.7 15.5 66.7% 78.6% 57.0% Mexico 51.0% 19.1 12.3 80.7% 78.5% 59.7% Netherlands 48.1% 18.5 12.6 81.0% 83.1% 62.7% New Zealand 32.6% 17.5 12.8 63.0% 71.7% 66.2% Nigeria 45.0% 20.6 15.0 77.4% 83.0% 57.3% Poland 60.9% 19.4 14.2 71.4% 76.6% 52.6% Portugal 49.6% 18.4 13.1 78.8% 78.2% 48.0% Romania 43.5% 19.3 14.7 63.2% 78.5% 55.4% Russia 50.1% 17.9 14.6 70.1% 67.2% 56.9% Singapore 50.1% 22.0 14.5 74.9% 75.6% 62.5% South Africa 49.5% 19.4 13.3 70.2% 81.1% 63.1% South Korea 62.8% 22.1 14.4 65.9% 83.5% 60.5% Spain 61.0% 19.5 13.2 78.9% 84.9% 67.1% Switzerland 55.1% 18.6 13.1 76.4% 76.0% 61.4% Taiwan 55.8% 21.9 13.7 69.0% 89.0% 71.5% Thailand 60.5% 20.2 13.8 73.4% 83.0% 69.7% Turkey 41.4% 21.3 14.6 62.4% 55.3% 54.7% UK 50.2% 18.3 12.6 75.9% 87.6% 63.6% USA 39.6% 18.4 12.9 72.9% 80.4% 65.3% Country highlights data table

4242 The Face Of Global Sex 2012 References Andrade, H. H. S. M., de Mello, M. B., Sousa, M. H., Makuch, M. Y., Bertoni, N., & Faundes, A. 2009. Changes in sexual behavior following a sex education program in Brazilian public schools. Cadernos De Saude Publica, 25(5): 1167-1175 Atienzo, E. E., Walker, D. M., Campero, L., Lamadrid-Figueroa, H., & Gutierrez, J. P. 2009. Parent-adolescent communication about sex in Morelos, Mexico: does it impact sexual behaviour? European Journal of Contraception and Reproductive Health Care, 14(2): 111-119. Fontes, M. & Roach, P. 2007. Predictors and confounders of unprotected sex: A UK web-based study. European Journal of Contraception and Reproductive Health Care, 12(1): 36-45. Gubert, D. & Madureira, V. S. F. 2009. Sexual initiation in male adolescents. Ciencia & Saude Coletiva, 14(4): 1119-1128. Ma, Q. Q., Ono-Kihara, M., Cong, L. M., Pan, X. H., Xu, G. Z., Zamani, S., Ravari, S. M., & Kihara, M. 2009. Behavioral and psychosocial predictors of condom use among university students in Eastern China. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/HIV, 21(2): 249-259. Manlove, J., Ikramullah, E., & Terry-Humen, E. 2008. Condom Use and Consistency Among Male Adolescents in the United States. Journal of Adolescent Health, 43(4): 325-333. Paiva, V., Calazans, G., Venturi, G., & Dias, R. 2008. Age and condom use at first sexual intercourse of Brazilian adolescents. Revista De Saude Publica, 42 (Supl. 1) Stone, N. & Ingham, R. 2002. Factors affecting British teenagers’ contraceptive use at first intercourse: The importance of partner communication. Perspectives on Sexual and Reproductive Health, 34(4): 191-197. Thomas, B. E., Rehman, F., Malaisamy, M., Dilip, M., Suhadev, M., Priyadarsini, P., Purushotham, N. K., & Swaminathan, S. 2004. A study of condom acceptability among men in an urban population in South India. AIDS and Behavior, 8(2): 215-220. Traeen, B., Stulhofer, A., & Landripet, I. 2011. Young and Sexual in Norway and Croatia: Revisiting the Scandinavian Versus Mediterranean Gendered Pattern of Sexual Initiation. International Journal of Sexual Health, 23(3): 196-209. Yilmaz, H. B., Kavlak, O., & Atan, S. U. 2010. Sexual activity, knowledge and contraceptive usage by gender among university students in Turkey. European Journal of Contraception and Reproductive Health Care, 15(6): 433-440. Good sexual health promotes a better sense of sexual wellbeing and leads to healthier lives

Reckitt Benckiser Turner House 103–105 Bath Road, Slough, Berkshire SL1 3UH United Kingdom T +44 (0) 1753 217800 F +44 (0) 1753 217899 www.durex.com ISSN 1755–3075

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