Differences in Risky Sexual Behavior According to Sexual Orientation in Korean Adolescents
The current study was a descriptive survey that aimed to examine differences in Korean adolescents’ risky sexual behavior according to their sexual orientation, to inform the development of an educational program to improve adolescents’ sexual health status. Korean adolescents with different sexual orientations showed statistically significant differences in demographic characteristicssuch as economic status (Diamant, Wold, Spritzer, & Gelberg, 2000), smoking rates (Gruskin, Greenwood, Matevia, Pollack, & Bye, 2007; Ryan, Wortley, Easton, Pederson, & Greenwood, 2001), alcohol use (Diamant et al., 2000; Gruskin & Gordon, 2006; Ridner, Frost, & LaJoie, 2006), and experience of violence at school (Kang & Ha, 2012; Kosciw, Greytak, Bartkiewicz, Boesen, & Palmer, 2011; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011); these results support those of previous research. In addition, school violence is a serious issue in Korea. In 2011, the American National School Climate Study found that 81.9% of adolescents in sexual minority groups had been bullied because of their sexual orientation, 63.5% considered school unsafe because of their sexuality, and 29.8% dropped out of school because of safety issues (Kosciw et al., 2011). In addition, the results of a qualitative Korean study involving adolescents from sexual minority groups (Kang & Ha, 2012) found that they had suffered physical or verbal violence and disapproving looks, and school was not a safe environment for this population. The results of the current study demonstrated the severity of school violence against adolescents in sexual minority groups. To resolve school violence and group bullying based on a pessimistic view of young people in sexual minority groups, efforts should be made to change people’s perceptions of homosexuality.
The results also showed that homosexuality and bisexuality were significantly associated with all types of risky sexual behaviour, and adolescents in sexual minority groups were more likely to engage in risky sexual practice relative to heterosexual adolescents. More specifically, after adjusting confounding variables, the results showed that homosexual and bisexual subjects were 1.7 and 1.9 times more likely to engage in sexual intercourse after drinking alcohol, respectively, relative to heterosexual adolescents. Some researchers have posited that the reason for this finding could be that lesbian, gay, and bisexual individuals, who are alienated both economically and socially, smoke and drink heavily to cope with considerable stress resulting from the homophobic and discriminatory attitudes of others (Gruskin & Gordon, 2006; Ryan et al., 2001). Considering that heavy drinking, particularly during adolescence, is a gateway to the use of toxic substances, such as drugs, or inappropriate sexual behavior (Best, Manning, Gossop, Gross, & Strang, 2006; Cavazos-Rehg et al., 2010; Lavikainen, Lintonen, & Kosunen, 2009; Sohn, 2010), adolescents’ drinking is worrisome, as they could commit unintentional violence or engage in inappropriate sexual behavior because of lack of self-regulation (Sohn, 2010). Therefore, sex education programs for adolescents should warn them about dangerous situations that could arise when they are unable to control themselves after drinking. The findings also indicated that heterosexual subjects used condoms more frequently relative to homosexual or bisexual subjects, to avoid unwanted pregnancy. The reason for this finding is likely to be that heterosexual people have a higher chance of unwanted pregnancy, relative to other groups, and therefore attempt to avoid it by using contraception. In the USA, 60-80% of individuals aged 14–17 years use condoms during vaginal intercourse (Fortenberry et al., 2010), whereas only 35–40% of Korean teenagers aged 14–18 years do so (Lee & Kang, 2011). Furthermore, Korean teenagers depend on ineffective methods contraception such as coitus interruptus and the rhythm method (Lee & Kang, 2011). Therefore, education regarding contraception should emphasize the use of effective contraception. Condoms are essential for sexual health, as they protect against STIs and HIV/AIDS as well as unwanted pregnancy. (Kee, Park, Chang, & Go, 2004). It should be noted that teenagers are at high risk of AIDS infection (Joint United Nations Programme on HIV/AIDS, United Nations Children's Fund, World Health Organization, 2008). Therefore, AIDS prevention programs are most effective when provided to teenagers who have recently begun to engage in sexual activity or are very sexually active. In addition to offering theoretical lectures, instructors should provide exercises to educate teenagers in the use of condoms and utilize the effects of peer groups to raise their awareness of healthy sexual practices and improve their sexual health (DiClemente et al., 2004; Lee & Jeon, 2016; Lee, Moon, & Park, 2010). In addition, the results showed that the proportions of homosexual and bisexual subjects who had contracted STDs were higher relative to that of the heterosexual group. Even after adjusting other confounding variables, homosexual and bisexual subjects were 5.0 and 3.7 times more likely, respectively, to contract STDs relative to heterosexual subjects. This appeared to be related the use of condoms only to avoid pregnancy. The chance of contracting an STD in men who always use a condom during sex is approximately 50% (0.57 times) lower relative to that observed for men who do not use condoms consistently (Lee, Lee, Kim, Lee, & Park, 2015). Approximately 7.3% of Korean teenagers with sexual experience have STDs including gonorrhea, syphilis, and HIV/AIDS. (Park & Jeon, 2015). Teenagers’ risk of exposure to STDs is increasing (Cederbaum et al., 2015; Lee et al., 2015; Park & Jeon, 2015). Contracting HIV or other STDs can exert a negative effect on physical and mental health, lead to guilt and shame regarding one’s sexual behavior, and cause individuals tocease all sexual activity or constrain their sexual behavior (Vanable, Carey, Blair, & Littlewood, 2006; Wolitski, Pals, Kidder, Courtenay-Quirk, & Holtgrave, 2009). Consequently, STDs and AIDS not only cause physical problems but also pose a threat to psychological health in members of sexual minority groups, as they induce identity-related stress (Lee et al., 2012). Members of sexual minority groups usually contract STDs because of infrequent condom use, engagement in sexual intercourse with a high number of sexual partners, lower self-efficacy with respect to condom use and communication regarding condoms, and lack of concern regarding STD infection (Jung, 2013; Jung, Lee, Kwon, & Park, 2012; Meyer & Wilson, 2009; Wolitski, & Fenton, 2011). Therefore, we should support experts who are able to provide appropriate medical services and training (Wolitski & Fenton, 2011), endeavor to reduce the spread of HIV and STDs by teaching young people how to manage their sexual behavior through sex education, and attempt to improve the health and wellbeing of sexual minorities. This study was subject to some limitations. As it was a cross-sectional study, we could not infer a causal relationship between sexual orientation and risky sexual behavior in Korean adolescents. Second, the data were based on an anonymous, self-administered, online survey; therefore, it is not possible to exclude cases in which the subject is not honest in responding to sexual orientation. Despite these limitations, the study had some noteworthy strengths. To the best of our knowledge, it was the first study to use a large, nationally representative sample to examine the association between sexual orientation and risky sexual behavior, with a focus on STDs, in Korean adolescents
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