National Survey of Australian Secondary Students and Sexual Health
The following are the key findings of the National Survey of Australian Secondary Students and Sexual Health released in April 2014.
They are arranged under the key themes of knowledge, behaviour and health. These findings help inform PDHPE programs in schools.
HIV knowledge remains relatively high and comparable to the levels found in 2008. 93% of students knew that HIV could be transmitted by sharing needles, more than 80% of students knew that the contraceptive pill does not protect against HIV and that using condoms during sex offers some protection from HIV. Of interest was the differences in knowledge around HIV transmission with regards to sexual partners - 95% of students knew that a woman could get HIV from having sex with a man, 90% knew that a man could get HIV from having sex with a woman and 85% knew that men could get HIV from having sex with men. The poorest knowledge of HIV was related to the spread of the virus by other means, 73% of students knew that a pregnant woman could pass on HIV to her baby, 74% of students knew that coughing or sneezing could not transmit HIV and only 31% of students knew that HIV cannot be transmitted by mosquitos.
There has been little improvement in student knowledge of sexually transmissible infections (STI) other than HIV. The highest levels of student knowledge were around the symptoms, or asymptomatic nature, of STIs. The majority of students knew that someone could still pass on a sexually transmissible infection without having any obvious symptoms (89%). The lower levels of knowledge were in relation to Chlamydia and Herpes.
The depth of knowledge about human papilloma virus (HPV) was poor. It was the first time that questions on HPV have been asked; in most cases more than half the sample reported being ‘unsure’ of correct answers to HPV knowledge questions. On most of the HPV knowledge questions, young women demonstrated better knowledge than young men, 63% of female students had heard of the HPV virus compared with 45% of the male students. In general having heard of HPV increased a student’s ability to provide correct responses. Of those students reporting they had heard of HPV before, young women demonstrated better knowledge than young men. This undoubtedly reflects the longer period of time that the HPV vaccine has been offered to young women. Among all students surveyed, 52% of young women reported being vaccinated against HPV compared with 68% of those young women who had heard of HPV. There was a large degree of uncertainty surrounding the vaccination, with many young women and men unsure of whether or not they had been vaccinated against HPV. This lack of knowledge about HPV, and uncertainty about vaccination status, is significant being these students are the first cohort to be vaccinated against HPV-related cancers. Greater education and information in both promoting and delivering the vaccine is necessary.
Student knowledge of Hepatitis vaccination and whether they had been vaccinated themselves was poor. Students were unsure of whether they had been vaccinated for hepatitis A (51%), B (34%) or C (49%). There was a general lack of understanding of the disease with a considerable proportion of students incorrectly claiming they had been vaccinated against hepatitis C (36%) when no such vaccine exists. More could be done in the area of Hepatitis C transmission with only 66% of students knowing that injecting drugs can put a person at risk of Hepatitis C and 64% knowing that Hepatitis C can be transmitted by tattooing and body piercing.
Students who have ever had sexual intercourse
The number of students that have experienced sexual intercourse specifically remained similar to past surveys (35% in 2002, 40% in 2008 and 35% in 2014). The percentage of students having ever had experienced sexual intercourse increased by year group (23% of Year 10, 34% of Year 11, and 50% of Year 12).
Over 60% of students surveyed believed that either ‘most’ or ‘all’ young people their own age use condoms when they have sex. This belief was close to the reported use (59% used a condom at the last sexual encounter). Of those sexually active students 43% reported ‘always’ using condoms when they had sex in the previous year. A considerable proportion (39%) of sexually active students reported they only used condoms ‘sometimes’ when they had sex and a notable 13% ‘never’ used condoms when they had sex in the previous year.
Student condom use has remained stable between 2002, 2008 and 2014 surveys. The majority of students (67%) reported that a condom was available at the last time they had sex. Young men (70%) were more likely to report a condom was available at the last sexual encounter compared to young women (65%). Of those students who reported having access to a condom at their last sexual encounter, a large proportion of students reported having used it (89% of males and 84% of females).
Being unprepared and not expecting sex (‘it just happened’, 27%), trusting a partner (31%) and knowing a partner’s sexual history (32%) were the most common reasons stated for failing to use a condom at the last sexual encounter. Over a quarter of sexually active students who did not use a condom the last time they had sex reported it was because they didn’t like them (30%).
Fewer students (20%) reported the reason for not using a condom as ‘we both have been tested for HIV/STIs’.
A quarter of sexually active students reported ever having experienced unwanted sex. Young women (28%) were more likely than young men (20%) to have experienced sex when they did not want to, a gender difference that has remained stable across since 2002. There were no significant differences in rates of unwanted sex by year level. Most students reported having wanted to have sex at their last sexual encounter. Females (8%) were more likely than males (5%) to report that their last sexual encounter involved unwanted sex. There has been a substantial increase from 2008 to 2014 in the reasons behind unwanted sex. Students cited being too drunk (49% up from 17%) or pressure from their partner (53% up from 18%) as the most common reasons for having sex when they did not want to. Over a quarter of students (28%) reported being frightened as the reason for having unwanted sex. Gender differences in the reasons for unwanted sex were obvious with a larger proportion of males (22%) than females (9%) having unwanted sex because their friends thought they should and a larger proportion of females (34%) than males (15%) having unwanted sex because they were frightened. This highlights the importance of education on communication skills, peer pressure, consent and ethical behaviour in regards to sexual activity.
The majority of students reported positive feelings after having sex. Almost half of sexually
active students reported that they felt ‘extremely’ good (46%), happy (43%), fantastic (41%) or loved (44%) after their last sexual encounter. Differences were found between the positive and negative feelings for females after their last sexual encounter as compared to males. A higher proportion of males (52%) than females (42%) reported feeling ‘extremely’ good after sex. A lower number of female students report feeling ‘not at all’ upset than their male counterparts (74% vs 88%) and ‘not at all’ used (68% vs 82%) after their last sexual encounter..
When responding about their most recent sexual encounter, the majority of sexually active students (55%) reported their most recent sexual encounter was with their current steady girlfriend or boyfriend. A smaller number of students (37%) stated that they had sex with someone that they have known for a while, up by 10% from the previous survey and 8% of students reported having had sex with someone that they had not met before. A larger number of males (12%) than females (5%) reported their most recent sexual encounter was with someone of the same sex. Of most significance is the steady incline for males having a same sex encounter at the most recent sexual experience up from 2% in 2002, to 8% in 2008, to 12% in 2014. A higher number of males (23%) than females (10%) reported their most recent sexual partner as being ‘under 16 years’ of age. A large majority of students (73%) reported that their last sexual encounter was either at their own or their partners house. Other locations included a friend’s house (13%), outside (5%), in a car (4%) or other (5%). There were no significant gender differences in regards to the location of the last sexual encounter.
Before they had sex, 81% of students were most likely to discuss having sex. Topics discussed included using a condom (69%), avoiding pregnancy (50%) and how to gain sexual pleasure without having intercourse (40%). Less frequently discussed by students before they had sex was how to avoid becoming infected by HIV (23%) and STIs (28%). In comparison to 2008 sex related discussions during the last sexual encounter have remained relatively the same. Compared to their year 12 counterparts, year 10 students were significantly more likely to engage in discussion with their last sex partner about avoiding pregnancy (54% vs 48%), avoiding HIV (31% vs. 17%), STIs (36% vs. 24%), sexual pleasure without intercourse (47% vs 38%), using a condom (78% vs. 62%) and having sex (87% vs 79%).
Sexually active students most commonly used a condom (58%) and/or the contraceptive pill (39%) the last time they had sex. Use of the withdrawal method increased between 2008 (9%) and 2014 (15%) and more males (17%) than females (10%) reported using no contraception the last time they had sex. Despite this, emergency contraception was not widely used with only 4% of students having accessed it. A small proportion (5%) of sexually active students reported that they had experienced sex that resulted in pregnancy.
Students who have never had sexual intercourse
The majority of students who had not had sexual intercourse (60%) reported ‘ever’ having a girlfriend or boyfriend and one in five reported currently having a girlfriend or boyfriend. When asked how important a number of reasons were for not having sexual intercourse a higher proportion of females than males reported reasons that were ‘extremely important’: “I do not feel ready to have intercourse” (64% vs 32%), “I am proud I can say no and mean it” (62% vs 37%), “Important to be in love the first time” (57% vs 34%), and “Current (or last) partner is not willing” (52% vs 41%).
Overall, for both males and females, parental disapproval (17%) and religious (19%) or cultural (17%) beliefs played less of a role in the decision to not have sexual intercourse. Half of the students who had not had sexual intercourse reported that it was ‘extremely likely’ that they would engage in sex prior to marriage (50%). More than half of students reported that they felt ‘not at all’ upset (54%), guilty (75%), regretful (63%), or embarrassed (51%) in relation to not having experienced sexual intercourse. Over 60% of students reported ‘no pressure’ from partners or friends to become sexually active.
Since 2008 there has been a decline in the number of students who reported that they had drunk alcohol (80% vs 60% in 2014). A large proportion of students surveyed (40%) reported that they ‘never drink alcohol’. Year 12 students were more likely to drink alcohol (76%) than students in year 11 (57%) and year 10 (51%). Students were asked how often they drank alcohol and just over a third of students (36%) reported drinking alcohol ‘once per month or less’. A lower proportion (4.2%) of students in years 10 and 11 were less likely to drink alcohol ‘one day a week’ than their counterparts in year 12 (10%). Of those students who drank alcohol more males than females reported consuming 7 drinks or more on a day when they have an alcoholic drink (21% vs 11%).
Cigarette and Marijuana use
The vast majority of students (81%) have never smoked cigarettes with only 4% reporting that they smoke regularly, and 14% reporting only occasional smoking. A small proportion of students (15%) reported using marijuana occasionally with only 3% reporting that they used marijuana regularly. A significant number of students (82%) reported never having smoked marijuana. There is a strong correlation between marijuana and cigarette use with 61% of students who smoke cigarettes (occasionally or regularly) also using marijuana occasionally or regularly.
Drug use and sexual behaviour
Over three quarters of sexually active students (83%) reported that they were NOT drunk or high the last time they had sex. However, males in year 10 (27%) were more likely to report being under the influence of alcohol or drugs the last time they had sex than any other sample group.
Over 50% of all students reported receiving a sexually explicit written text message and 42% had received a sexually explicit photo of someone else. Almost half of the students surveyed (43%) reported having sent a sexually explicit written text message and just over a quarter reported that they sent a sexually explicit photo of themselves (26%). A reasonably low proportion of students had sent sexually explicit photos or videos of someone else (14% of males vs 5% of females). The use of the internet, technology and social media, and related behaviours, were higher amongst those who reported being sexually active as compared to the total sample group.
Social networking sites were used at least once a day by 87% of all students and only 2% of students reported that they did not use any forms of social networking. Many students reported that they regularly used YouTube (82%) and Instagram (49%), with a significant number of students (91%) reporting Facebook as the most commonly used social networking site. More males than females reported using social media for sexual reasons (31% vs 16%).
Students were asked to indicate how often they had been exposed to a series of Internet/mobile communication behaviours which involved potential bullying and are commonly considered to constitute ‘cyberbullying’. For all ‘cyberbullying’ examples the vast majority of young people reported that it had not happened to them in the last couple of months. The most common bullying behaviours reported as occurring every few weeks or more were receiving prank mobile phone calls (10%) and being deliberately ignored or left out of things over the Internet (9%).
The research indicates students increasing use of the Internet, technology and social media as a source of sexual health information and recognises the large role this plays in the negotiation and development of sexual relationships. These behaviours can be seen as a strength which can give students access to reliable and confidential information on topics where questions can often be difficult to ask. School programs designed to improve the sexual health of young people cannot work against this trend and should work to enable young people to develop critical enquiry skills and knowledge and understanding of ethical behaviours.
Between 2008 and 2014, there has been a decline in students’ confidence in talking to their parent or carer about sex related matters. Approximately 42% of students reported that they felt either ‘confident’ or ‘very confident’ talking to their parent or carer about sexually transmissible infections including HIV and decisions concerning contraception down from 55% in 2008. Slightly fewer students (38% vs 48%) felt that they were confident or very confident talking to their parent or carer about sex. Of some significance were the students who felt ‘not at all confident’ in talking to their parent or carer about sex (20%), HIV and STIs (17%), and decisions concerning contraception (15%).
A large majority of students (88%) had sought information regarding sexual health. Students most commonly used the school sexual health program (43%) or an Internet website (44%) for information on sexual health. A smaller, but still significant amount of students consulted either their mother (36%) or a female friend (41%). Just over a quarter of students nominated doctors and teachers as a common source of information for sexual health. Generally, it was more common for females (90%) to seek advice regarding sexual health than it was for young men (84%). The most common source used by males was internet websites (39%) as compared to females who used a female friend as a source of information (51%). Female students were more likely than males to consult their doctor (33% vs. 25%), their mother (43% vs. 27%) and female friends (51% vs. 27%) for sexual health information. In contrast, males were more likely than young women to confide in their father (23% vs. 16%) for advice regarding sexual health. It is clear that school programs continue to be highly valued as an information source for young people. While the use of the Internet continues to play a significant role in accessing sexual health information
This article has been reproduced with the permission of the authors Anthony Smith, Paul Agius, Sue Dyson, Anne Mitchell and Marian Pitts from the Australian Research Centre in Sex, Health and Society.
Copies of the full report are available at no cost from:
ARCSHS Australian Research Centre in Sex, Health and Society,
La Trobe University Level 1, 215 Franklin St, Melbourne 3000 Australia.