Role of the COVID-19 Pandemic on Sexual Behaviors and Receipt of Sexual and Reproductive Health Services Among U.S. High School Students — Youth Risk Behavior Survey, United States, 2019–2021

Results

From 2019 to 2021, the prevalence of lifetime HIV testing decreased significantly by 3.68 percentage points, from 9.4% to 5.8% (Table 2). Among currently sexually active students, the prevalence of STD testing during the past 12 months decreased significantly by 5.07 percentage points, from 20.4% to 15.3%; condom use at last sexual intercourse did not significantly change. Among currently sexually active students reporting opposite sex or both sexes sexual contacts during their lifetime, the prevalence of IUD or implant use at last sexual intercourse increased significantly by 4.11 percentage points, from 4.8% to 8.9%, and no contraceptive method use increased significantly by 2.74 percentage points, from 10.7% to 13.4%. Among currently sexually active students reporting opposite sex or both sexes’ sexual contacts during their lifetime, shot, patch, or birth control ring use and use of birth control pills (all at last sexual intercourse) did not significantly change over time.

Among female students, STD testing and HIV testing significantly decreased by 8.58 percentage points and 4.24 percentage points, respectively: IUD or implant use significantly increased by 4.76 percentage points (Table 2). Among male students, HIV testing significantly decreased by 3.10 percentage points. In 2021, male students were less likely to report STD testing than female students (12.7% versus 17.6%). In 2021, male students were more likely to report condom use than female students (57.7% versus 47.3%). In 2021, compared with female students’ report of contraceptive method used (self or partner), male students were less likely to report they or their partner used no contraceptive method (15.2% versus 11.3%) and shot, patch, or birth control ring (4.6% versus 2.3%) at last sexual intercourse.

Lifetime HIV testing significantly decreased by 2.96 and 3.05 percentage points for students aged ≤15 and 16–17 years, respectively, but did not significantly change for students aged ≥18 years (Table 3). STD testing during the past 12 months decreased significantly by 12.22 percentage points, from 25.4% to 13.2% for students aged ≥18 years but did not significantly change for students aged ≤15 or 16–17 years. Among students aged 16–17 years, IUD or implant use at last sexual intercourse increased significantly by 6.29 percentage points, from 4.7% to 11.0% but did not significantly change for students aged ≤15 or ≥18 years. Among high school students aged ≤15 years, no contraceptive method used at last sexual intercourse increased significantly by 8.01 percentage points, from 12.4% to 20.5%, but did not significantly change for students aged 16–17 or ≥18 years.

In 2021, students aged 16–17 years, compared with students aged ≤15 years, were more likely to report HIV testing (7.2% versus 3.5%), STD testing (18.2% versus 8.4%), IUD or implant use (11.0% versus 1.9%), and use of birth control pills (23.1% versus 11.7%), and less likely to report no contraceptive method use (11.1% versus 20.5%). In 2021, compared with students aged ≤15 years, students aged ≥18 years were more likely to report HIV testing (10.3% versus 3.5%), IUD or implant use (10.5% versus 1.9%), and use of birth control pills (25.3% versus 11.7%), and less likely to report condom use at last sexual intercourse (46.4% versus 55.1%) and no contraceptive method use (13.1% versus 20.5%).

Lifetime HIV testing decreased significantly for Black (PD = –6.47), Hispanic (PD = −3.15), and White students (PD = −3.17) (Table 4). Among sexually active White students, STD testing decreased significantly by 6.86 percentage points and did not significantly change for Black and Hispanic students. IUD or implant use increased significantly by 5.75 percentage points for Hispanic students. Among White students, no contraceptive method use increased significantly by 2.71 percentage points and did not significantly change for Black and Hispanic students. In 2021, compared with White students, Hispanic and Black students were less likely to use birth control pills (24.9%, 15.7%, 11.0%, respectively) and more likely to report no contraceptive method use (9.5%, 19.0%, 21.4%, respectively). In 2021, compared with Hispanic students, White students were less likely to report shot, patch, or birth control ring use (3.9% versus 2.2%) and more likely to report HIV testing (4.8% versus 6.6%) and STD testing (12.5% versus 19.5%).

HIV testing significantly decreased for students reporting opposite sex only (PD = –2.96), same sex only (PD = −8.49), and both sexes sexual contacts (PD = −5.97) (Table 5). STD testing decreased significantly by 4.57 and 18.00 percentage points among students reporting opposite sex only and same sex only sexual contacts, respectively. IUD or implant use significantly increased by 8.14 percentage points among students reporting sexual contacts of both sexes and did not significantly change for students reporting opposite sex only contacts. In 2021, compared with students reporting opposite sex sexual contacts, students reporting both sexes sexual contacts were more likely to report HIV testing (9.7% versus 14.7%), STD testing (14.4% versus 23.4%), and no contraceptive method use (11.8% versus 23.7%), and less likely to report condom use at last sexual intercourse (55.5% versus 40.3%). In 2021, compared with students reporting same sex only contacts, students reporting both sexes sexual contacts were more likely to report STD testing (9.7% versus 23.4%) and condom use (18.3% versus 40.3%). In 2021, students reporting same sex only sexual contacts were less likely to report condom use than students reporting opposite sex only sexual contacts (18.3% versus 55.5%).