On the other hand, the level of early sexual debut among both males and females was alarmingly high in our study compared to a Chinese study in which sexual debut before age 18 among youths was rare [ 10 ]. The RDS procedure was begun by selecting initial participants who were non-randomly selected members of the target population.
Dissemination of reliable SRH information among youths through possible mass media, especially among males, is an urgent issue.Sexual debut was defined as sexual intercourse involving vaginal or anal penetration for the first time. Figure 2 Full size image Discussion The levels of exposure to SRH information and risky sexual debut among poor youths in suburban communities of Mandalay City, Myanmar were unfavorable. Marital status was categorized as never married versus ever married. Changing risky sexual behaviors is an important strategy for preventing STI and HIV transmission among drug users [ 19 ]. All proposed youths had a right to participate in the study using informed consent. Nowadays, early and risky sexual debut among youths is increasing worldwide along with higher adverse RH consequences [ 5 ]. Variables having a p-value less than 0. However, to date, no epidemiological research has examined high-risk sexual behaviors inconsistent condom use, having multiple sexual partners and having a history of sexually transmitted infections among MA users. Altogether, a total of 3, youths were identified living in those 10 communities of Mandalay City. This topic is particularly important in Myanmar, which is recognized as one of the key MA production countries in the Southeast Asia region. Migrating to a new environment may play an important role in initiation and continuation of illegal substance and risky sexual behavior. This methodology is similar to that used to examine multiple indicators of high-risk sexual behavior [ 10 ] and drug dependence symptoms [ 38 ]. Unwillingness to have sex at sexual debut was defined as youths who were forced to have sex or those who had to have sex not for pleasure but for money to survive at their first intercourse. However, the studies investigating risky sexual behaviors among drug using populations focus on separate risk behavior measurements, such as only considering inconsistent condom use as the outcome variable. The details of the recruitment and interview procedures have been described elsewhere [ 33 , 37 ].
Many youths are also sexually active by this age. There are four broad suburban areas on the outskirts of Mandalay City. However, the Myanmar government cannot put much effort into controlling stimulant drug use because of the burden of opiate drug use that has long been a concern.
The rate of premarital sex in our study was higher than that in studies conducted in Nigeria and Eastern Ethiopia; however the rate of condom non-use at sexual debut and having sex with a non-regular partner was similar to our study [ 1123 ].
Condom use was measured on a scale from 1 to 5 always, almost, sometimes, never, and do not remember. Location was categorized as resident versus migrant, and employment status as unemployed versus employed. The generalized estimating equation GEE model approach was therefore applied to accommodate these interrelationships.
Unwillingness to have sex at sexual debut was defined as youths who were forced to have sex or those who had to have sex not for pleasure but for money to survive at their first intercourse. Marital status was categorized as never married versus ever married.
These key populations also often use MA [ 8252627 ].
Results A large proportion of MA users engaged in high-risk sexual behaviors inconsistent condom use: males,