Substance Use As A Predictor Of Risky Sexual Behavior And Sti Risk Among Urban Youth In Ghana

Background: Substance use and risky sexual behavior (RSB) are intertwined public health threats that drive sexually transmitted infection (STI) transmission among young people. Despite escalating drug misuse in urban Ghana, integrated evidence on the drug-RSB-STI triad remains scarce, particularly for opioid substances such as tramadol and for the full spectrum of RSB practices. Objective: This study examined the prevalence of substance use and RSBs, quantified associations between substance use and RSB, and documented the RSB-STI relationship among youth aged 18 to 35 years in Ablekuma North Municipality, Greater Accra, Ghana. Methods: A cross-sectional quantitative design was employed with 383 participants recruited via stratified random sampling across 14 electoral areas. Validated instruments assessed substance use, RSB, and self-reported STI symptoms. Pearson correlation, hierarchical multiple regression, and chi-square tests of independence with odds ratios constituted the primary analytic approaches. Results: Alcohol was the most prevalent substance (51.7%), followed by aphrodisiacs (26.4%), shisha (19.6%), cigarettes (15.9%), and tramadol (14.6%). RSBs were widespread: 50.9% reported condomless sex, 47.5% unplanned sex, 45.2% sex without pregnancy protection, and 19.6% transactional sex. Gonorrhea (18.8%) and chlamydia (14.4%) were the most prevalent STI symptoms; HIV positivity stood at 15.6% among those tested, with 59.4% unaware of their status. Drug abuse strongly predicted RSB ({beta} = .727, p < .001; {Delta}R{superscript 2} = .409). Tramadol users were up to 49.6 times more likely to have sex with casual partners and 31.4 times more likely to engage in transactional sex. RSBs were consistently and significantly associated with HIV, gonorrhea, syphilis, chlamydia, and herpes (all p < .001). Conclusion: Tramadol is an underrecognized and high-magnitude driver of sexual risk in urban Ghana. The high prevalence of RSBs alongside low STI testing and treatment uptake constitutes a compounding public health crisis. Integrated substance-use and sexual health interventions are urgently required.