title: Perceptions of sexual risk behavior among Palestinian youth in the West Bank: a qualitative investigation.
abstract: BACKGROUND
  Young people in the Middle East and North Africa (MENA) are profoundly affected by violence, high unemployment, and economic hardship. Experiences of community-level violence and personal trauma increase the likelihood that young people will engage in risky behaviors that include smoking, drug use, and unsafe sex. Little is known about the sexual behavior of young people in the region, particularly in the occupied Palestinian territory (oPt). Our aim in this study was to gain an insight into the perceived prevalence and patterns of sexual behavior among Palestinian youth.
  
  
  METHODS
  The study was based on ten focus groups and 17 in-depth interviews with young people aged 16-24 years as part of the formative phase of a cross-sectional representative study of risk behaviors in the West Bank, including Jerusalem, in 2012. The sample was selected using a combination of purposive and convenience sampling. Qualitative analysis was used to code detailed notes of focus groups and interviews.
  
  
  RESULTS
  Based on participants' reports, different types of sexual activity outside marriage were not uncommon, even in conservative communities. The most reported sexual activity was non-penetrative sex: oral and anal intercourse, and virtual sex. Some young people had sexual intercourse with sex workers; they went to brothels in Israel and to brothels operating clandestinely in the West Bank, including East Jerusalem. Most respondents were of the opinion that young people did not usually use protection during sexual intercourse. Many reported that youth engage in different types of sexual activity outside marriage for several reasons: to challenge the culture, financial constraints and inability to marry, basic human need, personal pleasure, suppression, to kill boredom, and to prove manhood.
  
  
  CONCLUSIONS
  In contrast with the conservative social context of the occupied Palestinian territory (oPt), the findings suggest that sexual activities outside marriage may be more common than is currently assumed. Sexual behavior in the oPt is a concern because of the low awareness of the potential health consequences. The results draw attention to the need to incorporate sexual reproductive health into the national agenda and ensure that it is included in the programs of national institutions.
authors.forename: Salwa G
authors.initials: SG
authors.lastname: Massad
authors.forename: Rita
authors.initials: R
authors.lastname: Karam
authors.forename: Ryan
authors.initials: R
authors.lastname: Brown
authors.forename: Peter
authors.initials: P
authors.lastname: Glick
authors.affiliation: Al Quds University, Abu-Dis, Palestine. mshaheen2009@gmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shaheen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Linnemayr
authors.forename: Umaiyeh
authors.initials: U
authors.lastname: Khammash
mesh_terms: D000293:Adolescent; D018912:Arabs / Q000706:statistics & numerical data*; D003075:Coitus; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008877:Middle East / Q000453:epidemiology; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012907:Smoking / Q000453:epidemiology; D012938:Social Perception; D019966:Substance-Related Disorders / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence; D055815:Young Adult