" Condoms are just not sexy": A Qualitative Study of College Students' Sexually Transmitted Infection Risk Perception and Approaches for Risk Management.

Background: For five years in a row, sexually transmitted infections (STIs) have been rising steeply in the United States of America (US). Compared to the rates in 2014, chlamydia, gonorrhea, and syphilis (primary and secondary) have increased by 19%, 63%, and 71%, respectively. College-aged young adults (18 – 24 years) account for the highest rate of STIs compared to other age groups. Despite the work by researchers, college students continue to engage in sexual risk behaviors at a high rate. There is a need to explore different ways of creating interventions to reduce sexual risk behaviors. The purpose of this study was to explore STI risk differently by exploring college students’ perceptions and approaches for managing their STI risk behaviors. Methods: A qualitative study was conducted with college students (N=42) aged 18 – 24 years. Participants were recruited from STUDYfinder (a university-hosted online system for students to participate in research) and flyers distributed around the university campus. Data was collected using a demographic form and a semi-structured interview guide. Transcribed individual in-depth interviews were analyzed using a thematic analysis. Result: Participants identified poor condom use, multiple sexual partners, sex under the influence of alcohol, and casual sexual encounters as behaviors that increase their risk for STIs. Steps taken to manage STI risk behaviors include communication with sexual partners, vaccination, and proactive STI testing. Some identified supporting themes include The pleasure of the moment, Hook-ups and Highs, Knowing better but not doing better, and Testing as a way out. Conclusion/Implications: Although college students understand the adverse consequences of STI risk behaviors, they still engage in these behaviors. The steps taken by college students to manage STI risks could be used as building blocks to create tailored STI risk reduction interventions as opposed to interventions that seek to teach new knowledge and skills.