Polysubstance use and its linkage with risky sexual behavior in university students: significance for policy makers and parents.

Background: Despite the high prevalence of polysubstance use in low income countries, little has been done to investigate the linkage between polysubstance use and risky sexual behaviors.
Objective: To assess the association of polysubstance use with risky sexual behaviors, economic, educational and geographic factors.
Methods: A cross-sectional study on aspects of risky behavior towards HIV-infection was conducted on a sample of 1220 university students. Logistic regression analysis was applied to examine the linkage between polysubstance use and risky sexual behavior--having sex with multiple partners, commercial sex workers and failure to use condom.
Results: About one fourth of study participants reported to use one or more types of substance (mainly cigarette, alcohol and khat) in one year period. Of these students, more than three-fifths started using the substance before joining university and more than two-fifths were polysubstance users. Students from urban areas were more likely to be polysubstance users and to engage in sexual practice. Logistic regression analysis demonstrated a strong association of polysubstance use with male gender, being born and growing up in urban areas, good income, taught in private school, academically senior and born to more educated parents (P < 0.05 each). The majority (42%) of polysubstance users was also practicing sex with multiple partners and commercial sex workers, had sex without condoms and developed active sexually transmitted infection (STI) symptoms (P < 0.0001 for each).
Conclusion: This analysis unveils the strong association of polysubstance use with better socioeconomic circumstances, better education and risky sexual behaviors. Primary prevention strategies should target students in elementary and secondary schools, mainly in the urban setting, and preferably by involving their parents.