REASONS FOR SEXUAL PROMISCUITY IN CHEMICALLY DEPENDENT RESPONDENTS AND THEIR AWARENESS AND ACCEPTANCE OF CONDOM USE Brahmam Prakash

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1 REASONS FOR SEXUAL PROMISCUITY IN CHEMICALLY DEPENDENT RESPONDENTS AND THEIR AWARENESS AND ACCEPTANCE OF CONDOM USE Brahmam Prakash 1. Department of Community Medicine, Ail India Institute of Medical Sciences, New Delhi, India

2 INTRODUCTION In a society like ours, talking about subjects like sex, sexuality and sex organs are considered tabooed subject and are not to be discussed openly. The latest WHO estimates reveal that in just another 15 years. India will emerge as an epicentre of AIDS and suffer causalities running into millions if effective steps are not taken urgently to contain the spread of disease. In India hetrosexual intercourse has been found to be responsible for about 80 percent of the HIV infections. (The Indian express; Editorial : The AIDS Trap, 1995). It is estimated that 333 million new cases of curable STDs, one million cases of HIV infections and AIDS and millions of other STDs like herpes, hepatitis B occur every year in the world (WHO, 1992). Is there a connection between drug use and sexual promiscuity? A study by Stall and Colleagues (1986) of Gaymen in San Francisco did find a correlation between the use of drug during sex and the participation in high risk sexual activity. The next question is why might a person continue to engage in sexual practices that have a high probability for contracting a life threatening disease? For some, the state of drug driven sexual excitement may not be attainable in another way. They may be dependent on the drug and sexual behavior or they may be unable to engage in the desired behavior without the drug, others may engage in sexual behavior in exchange for drug. A significant proportion of individuals diagnosed with substance disorders engaged in casual sexual encounters and have multiple sexual partners while failing to use condoms. This behavior puts them at an increase risk of HIV infection (Avins et al, 1994; Fitterling et al 1993; Keighan and Nadeau 1994; Scheidt and Windle 1995; Stiffiman et al 1992; Windle 1989). Alcohol abuse and non intravenous drug use are considered as contributing factors in the failure to use Condom. These studies have not highlighted on reasons for sexual promiscuity. Promiscuity is defined as 'indiscriminate mingling' and sexual promiscuity refers to sexual relations that are not restricted to one sexual partner. It remained the least explored area in the field of drug addiction. The present exploratory study is being taken to improve our understanding about reasons for promiscuity. MATERIALS AND METHODS The study was carried out at Jaitpur- Badarpur area of Delhi, India. The area was divided into three groups i.e. regularized unauthorized and urban village. The author choose this area because it composed of mixed population. A total of 150 respondents were selected from the study areas by resorting to judgement sampling procedure, out-of which 25 refused to participate in the study, 10 missed the appointment and 15 could not fulfill the set criteria. Inclusion criteria consisted of 1) being Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 18 Jan.-June., 2003

3 heterosexual 2) qualify DSM-IV criteria for drug dependence 3) having had more than one sexual partner during last 12 months preceding interview; 4) not having any psychiatric illness ; 5) age group years (WHO, estimate majority of HIV cases fall in this group). 6) gave verbal consent for the study. Finally 100 respondents were interviewed in detail for the purpose of this study. An interview schedule was used for collecting data. Tools for data collection Three scales were used as below: 1. Diagnostic and statistical manual IV (DSM IV) criteria for drug dependence. 2. WHO modified schedule for the assessment of socio-demographic variables. 3. Semi-structured interview schedule. Procedure : Potential subjects were first approached by the local leader / social worker working in that area. Then the author (BP) contacted them to fully explain the purpose and procedure involved in the present study. The interview protocol was developed by the author with the help of professional social worker and psychiatrist of All India Institute of Medical Sciences and included questions about high-risk behavior; reasons for promiscuity and their attitude towards condom use. Before introducing these personal issues, some generalized and usual questions about age, substance use general love life etc initiated the discussion. The interview would take about minutes to complete. RESULTS The following paragraphs describe the socio-demographic profile of the respondents. The analysis showed that majority of the respondents (61%) belonged to the age group of years, while 39% of the respondents were years old. Majority (71%) were Hindu; followed by Sikh 18% and Muslim 11%. Educational status was also reported very low as a large number (80%) were educated upto high school and there is no graduate or postgraduate respondent in the sample. Nuclear type of family was more common (40%). Total monthly income of 60% of respondents was less than Rs.3570 and the mean monthly income was Rs.3570 per month. Furthermore, married respondents were out numbered by unmarried respondents as their percentage were 60% and 40% respectively. Regarding residential background the data shows that majority of our respondents lives in urban area. Various occupational groups were represented however, transport workers (51%) and small businessman (23%) were the two largest groups. Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 19 Jan.-June., 2003

4 TABLE- 1: Distribution of unmarried cases according to their reasons for sexual promiscuity (n=40) Patients have been entered into more than one category wherever applicable. All the addicts were asked the age at which they had their first sexual intercourse. The data shows that majority (52%) reported to have had their first sexual intercourse when they were 25 years or older while 48% reported that they were between years of age at the time of first sexual intercourse. In the sample studied the average age at the time of first sexual intercourse is 20 years. The reasons for sexual promiscuity were classified as shown in table-1. It is important to mention here that marriage in India is universal and takes place at an early age though the legally prescribed minimum age for males and females is 21 years and 18 years respectively. Sex is permitted within marriage only. To check the effect of drug on sexual performance was the most common reason among unmarried respondents (35%). There were 21 cases (26.25%) who reported sexual promiscuity as group activity. About 19% subject indulged in sex activity for achieving fun/ pleasure. The other reasons in this regard includes to satisfy sexual desire (13.75%) and extension of love to partner (6.25%). Among married (n=60), the most common reason for promiscuity was found to be excitement / thrill and variety in sex. About 18% subjects were promiscuous because they could not enjoy sex at home due to unsuitable home conditions. For some (10.97%) subjects promiscuity release sexual inhibitions and help them to become fully responsive for the first time in their life. About 16% subject reported that they had sex with commercial sex worker in the absence of their life partner. The other reasons for promiscuity among married respondents includes; provoked by friends under the influence of drugs/ alcohol (14.64%); and wife was uncooperative in 9.76% cases. Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 20 Jam-June., 2003

5 TABLE- 2: Reasons for promiscuity in married men (including widower) n=60 Patients have been entered into more than one category wherever applicable. Table 3 indicates the source of knowledge about condom. The findings shows that media (TV, radio, poster, magazine etc) was the main source of knowledge in sexually promiscuous drug addicts. Interestingly inspite of wide scale publicity 10% have no knowledge about condom and its role in prevention of sexually transmitted disease, 30% subjects come to know about condom through relatives/ friends. TABLE- 3: Source of knowledge about condom amongst drug addicts (n=100) Majority (63%) of drug addicts did not use condom as they were in intoxicated state during sexual intercourse. An attempt is made to know what are the other reasons besides drug use. They reported that they had limited confidence in condoms as a effective protective means against STDs. Secondly it led to a loss of physical sensation and thirdly it depend upon the wish of the women only 27% used condom during sexual intercourse of which 11 used because their partner insisted. DISCUSSION Promiscuity is a vast phenomenon and the factor that determine it are not only numerous but also complex and interlinked. Sexual desire or libido is thought to be regulated by the limbic system. Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 21 Jan.-June., 2003

6 Conditions that increase brain dopamine stimulate sexual behavior. Drugs that promote dopamine release and formatics or prevent its retake have been associated with increase libido (Buffum 1982). The use of heroin is associated with high-risk behavior of a different sort. It is not usually associated with high risk sexual practices, because it tends to lead to a decrease in all sexual activity with chronic use (Smith et al 1982). Alcohol in small quantity leads to initial euphoria. However, if taken in large quantity, it may lead to poor sexual performance. There is old man saying "Alcohol provokes the desire but takes away the performance". In short alcohol, intake does not lead to improved sexual performance. Sexual promiscuity often is part of the life style of adolescents who abuse drugs. It pose a serious threat to the individual and to society. In India, heterosexual intercourse has been found to be responsible for about 80 percent of HIV infection (Indian Express, 1995). There is currently, no vaccine or cure available for AIDS and the emphasis should be said on the prevention of disease. It is difficult to understand why some addicts are promiscuous while others are not. To check the effect of the drug on sexual performance was the most commonest reason for sexual promiscuity among unmarried drug addicts. This is understandable since drugs impaired sexual performance and opiates are known to day ejaculation in its acute effect. In Indian society children are brought up believing that sexual intercourse is to be reserved for marriage and that sexual promiscuity is a deviation from the acceptable moral standards. It is considered sinful, criminal or immoral in Indian society. Inspite of such belief there were 21 cases (26.25%) who reported sexual promiscuity as group activity. In a study of Teenager by Jeyasing et al earlier found that many promiscuous teenagers sought the accompany of friends while visiting prostitutes. Initially designed for family planning condom is now a universally accepted mean for the control of sexually transmitted disease (Grimes et al 1990). In the sample studies it was found that majority (63%) of the drug addicts did not use condom as they were in intoxicated state during sexual intercourse and they have a high probability for contracting a life threatening disease. In my opinion there should be more counseling centre to educate masses on how to prevent disease. Media was the main source of knowledge about condom use amongst sexually promiscuous drug addicts. The author have also interviewed some of the medical practitioners in Badarpur (Delhi) area to know their view on sexual promiscuity. They were of the view that along with modernization; attitude regarding sex are changing fast and promiscuity is on the increase indicating a weakening of the traditional familial and societal controls on sexual behavior. Large scale migration, an increasing Indian J. Prev. Soc. Med Vol. 34 No. 1 & Jan.-June., 2003

7 number of women taking up jobs outside the home, a decline in the joint family system, and exposure to western media were considered to have contributed to this phenomenon. This study has certain limitations they are- [1] this study has been limited to the analysis of the reasons for promiscuity in drug addict population and their awareness and acceptance of condom use, as revealed by drug addict population and has not covered other factors like family environment, personality traits etc, [2] all the subjects in the present study were male. Thus the result cannot be generalized on female population, [3] the study had been affected by the fact that the data had been collected from the community where general physical examination was not possible to comment on the presence of STD. REFERENCES 1. The Indian Express, Bangalore edition: Editorial: "The AIDS trap," 12 September, Stall R, et al. Alcohol and drug use during sexual activity and compliance with the sex guidelines for AIDS: The AIDS behavioral research project. Health Education Quarterly 13: , Avins AL, Woods WJ, Lindan CP, Hudes ES, Clark W and Hulley SB. HIV infection and risk behaviors among hetrosexuals in Alcohol treatment programs. JAMA 271 : , Word Health Organization. Current and future dimensions of the HIV/ AIDS pandemic - A capsule summary 12, Buffum J. Pharmacosexology: The effects of drugs on sexual function - A review. Journal of Psychoactive Drugs. 14(1-2): 5-44, Smith D et al. A clinical guide to the diagnosis and treatment of heroin related sexual dysfunction. Journal of Psychoactive Drugs. 14(1-2): 91-99, Jeyasingh P, Rammanaiah TBBSV et al. Teenagers with sexually transmitted disease. Indian Journal of Sexually Transmitted Disease. 6 : 12-15, Grimes DA, Cates W Jr, Family planning and sexually transmitted disease: Holmes KK, Mardh P, Sparlung PF, Weisner PJ, eds. Textbook of Venereology. New York McGraw Hill, , Darrow WW. Changes in sexual behaviour and venereal disease. Clin Obstet Gynec.18; , Gibbens TCN and Silberman M. The clients of prostitutes. British J Vener Dis 36: , Datt I. Psycho-social aspects of veneral disease in Teen-Agers. Ind J Dermato , Shillington AM et al. Is there a relationship between "heavy drinking" and HIV high risk sexual behaviors among general population subjects? IntJ Addict 30(11): ,1995. Indian J. Prev. Soc. Med Vol. 34 No. 1 & 2 23 Jan.-June., 2003