MAKING SENSE OF SEX, SUBSTANCE USE, AND PREVENTION
MAKING SENSE OF SEX, SUBSTANCE USE, AND PREVENTION
40 CONSENT AND COMFORT
44 TALKING ABOUT SUBSTANCE USE
48 CONCLUSION
50 METHODOLOGY
52 RESOURCES
54 APPENDIX
56 RESPONDENTS
MESSAGE FROM SHAMIN
Young people are more aware than ever of their actions. But they still don’t have enough safe, judgment-free spaces to talk openly and make informed decisions. That’s one of the key reflections this fourth edition of the Sex Lives Report brings forward.
Putting this research together wasn’t easy. Many organizations still avoid talking about substance use among young people, which often leads to silence around something already present in their lives. Substance use, its connection to sexual experiences, and its impact on mental health is not something we can keep avoiding. It needs to be addressed directly. The more we understand what young people are going through, their questions, doubts, and the challenges of simply being young in a constantly changing world, the better we can respond and support them in making safer, healthier choices.
So even after hearing a few “no’s,” we remained firm with this theme. Our goal was to understand how substances, whether legal or illegal, interact with young people’s sexual practices, looking at why they use them,
how they use them, and what happens after, including next-day effects that are often left out.
Today, the LetsStopAIDS Sex Lives Report is a credible initiative that reflects the realities of young people across Canada. But this is not just about data. What matters is what we do with it. We use these insights to shape our programmes and support others doing this work, including youth and their families.
As the world rethinks how to respond to HIV and other health challenges, LetsStopAIDS remains clear: real progress depends on youth leadership. Young people should not be observers; they are essential to shaping health strategies and driving the change the world needs to see.
Shamin Mohamed Jr. Founder & President LetsStopAIDS
Making Sense of Sex, Substance Use, & Prevention
In 2026, LetsStopAIDS focused on understanding the structural and societal barriers that continue to affect HIV awareness and testing across Canada.
Specifically, LetsStopAIDS explored why young people remain resistant to treatment, and how substance use before or during sexual activity, particularly alcohol and cannabis, can shape young people’s experiences of consent, risk perception, relationships, and their engagement with harm prevention practices.
In partnership with Ipsos Canada and San Patten Associates, LetsStopAIDS surveyed 1,111 sexually active youth across Canada aged 18–24* to explore the dynamic relationship between substance use and sexual behaviour.
*Survey conducted August 2–17, 2025. See page 56 for detailed respondent demographics.
Previous Sex Lives Reports have highlighted the need for sex-positive, comprehensive sex-ed, alongside ongoing challenges related to HIV awareness, testing, and condom negotiation.
Building on this work, the 2026 report re-examines trends in condom use as well as STI and HIV testing, diagnosis, and treatment. By understanding these trends and exploring their intersection with substance use and sex, the report aims to inform education, prevention, and harm-reduction strategies that reflect young people’s lived realities.
In the sections that follow, the findings push past assumptions to highlight key trends that can inform youth-centred and evidencebased STI and HIV prevention programming across Canada.
Condom use remains inconsistent
Only 1 in 2 respondents used a condom during their last sexual encounter.
Despite the high effectiveness of condoms in preventing STI and HIV transmission and unplanned pregnancy when used correctly, youth are still not using them consistently. Only 1 in 2 respondents used a condom during their last sexual encounter.
Similar to the 2024 Sex Lives Report data, 69% of sexually active Canadian youth reported never or inconsistently using condoms, with 1 in 4 youth (26%) never using a condom, a slight increase from 21% or 1 in 5 in 2024.
Condom Use:
All the time vs. Never
This trend may be due to a mix of factors such as*:
• Relationship and trust dynamics that influence condom decisions.
• The perceptions of STI and HIV risk.
• The association that condoms reduce pleasure.
• Barriers to accessing condoms, including cost.
• No perceived risk of pregnancy.
* Factors collected from Sex Lives Report 2024 Data
STI AND HIV TRENDS
Detection & diagnosis on the rise
At the time of this survey, 9% of youth surveyed indicated that they had been diagnosed with an STI or HIV in the last six months. Among this group of respondents, 22% were diagnosed with chlamydia, 21% were diagnosed with gonorrhoea, and 18% were diagnosed with HIV – a 10 percentage increase in HIV diagnosis among youth who had tested positive for an STI or HIV, since 2022.
Distribution of diagnoses among youth who have tested positive for STIs or HIV
Hepatitis
HIV
Syphilis
Herpes simplex virus
HPV
Prefer not to answer
1 - The four-year trend accounts for a relevant change taking place from 2022 to 2025.
More than half of Canadian Youth Have Yet to be Tested
Testing is one of the clearest pathways to prevention. While testing rates have improved, rising youth-HIV diagnoses raise important questions about what barriers remain and whether enough is being done to ensure young people have the tools to overcome them.
This year’s report indicates a 10% increase in HIV and STI testing compared to the 2024 Sex Lives Report.
Have you been tested for HIV in the past?
Have you been tested for other STIs in the past?* *not includingHIV
Compared to 2024, more youth are getting tested — but over half of sexually active Canadian youth have still never been tested.
Why aren’t youth getting tested?
I didn’t know I was supposed to be testing regularly
I have not been sexually active
I
Among youth who have not sought testing, common reasons for not getting tested regularly (every 6 months to a year) include uncertainty whether testing was necessary and challenges accessing healthcare.
These responses point to both knowledge gaps and structural barriers, underscoring the need for accessible and comprehensive sex-ed.
Among youth who have been tested for STIs ,
4 in 5 were tested through healthcare providers.
This demonstrates that good access to these primary health services are important ways to improve rates of testing, but also that there is room for other low-barrier testing methods to be promoted and to be made more available.
What kind of STI test did you take?*
37% General health clinic 11%
Ordered from pharmacy/drugstore 5% Self test
2%
Test at community organization
Family doctor
Health clinic specializing in STI or HIV 1% Other
* “Prefer not to answer” responses are excluded from the data shown.
Discussions about STI & HIV Testing
Our research shows that most young people first hear about STI and HIV testing through teachers, online platforms, or peers. This highlights the importance of up-to-date and reputable resources on testing such as CATIE, Teen Health Source, Action Canada for Sexual Health and Rights, and local public health units.
9 in 10 agree that STIs and HIV should be discussed with every new partner.
This includes family doctors and sexual health clinics — demonstrating primary health services improve rates of testing. However, to optimize rates, there must also be alternative low-barrier methods of testing and increased availability.
From which information source(s) did you first hear about STI and HIV testing?
Website, Social Media, etc.
Doctors/Healthcare Professionals
Friends/Peers
General Health Clinic or Hospital
Parents/Guardian
Sexual Partners
STI/HIV Specialized Clinics
Youth Serving Organizations
Community Organizations
Counselor/Therapist
ChatGPT/Other Chatbots
Other/Prefer not to answer
I have not heard about HIV testing
Many young people recognize the importance of open communication about STIs and HIV — 89% agree that these topics should be discussed with every new partner. At the same time, most acknowledge that these conversations can feel stigmatizing (72%) or challenging (65%).
3 in 5 sexually active Canadian youth report that STI and HIV testing was not brought up by their providers.
Do you recall any healthcare providers bringing up the topic of STI and HIV testing with you?
When should we be having discussions about testing?
When asked at what age young people should learn about STI and HIV testing, youth preferred learning sooner rather than later.
2 in 3
youth who discussed testing with a healthcare provider, were first introduced to STI and HIV testing between the ages of 13 and 18.
Age at which healthcare providers first discussed STI and HIV testing
Doctor, I have a question...
Youth Continue to Face Gaps in Treatment
1 in 4 youth revealed not receiving treatment after an STI or HIV diagnosis.
Although this is a slight improvement since 2024, it remains higher than it should be. Ensuring youth have access to treatment is critical, not only for their own health but also to prevent transmission to others.
Advancements in HIV care now allow people diagnosed with HIV to achieve a viral load low enough that they cannot transmit HIV to others during sexual contact. This is known as Undetectable = Untransmittable (U=U). Treatment is a key component of both personal and public health.
who received an STI/HIV diagnosis did not receive treatment. 27%
Why youth aren’t seeking treatment
Young people did not seek treatment due to both system-level barriers and knowledge gaps.
Can’t afford it.
Zara — Surrey, BC
I didn’t need it.
Amira — Winnipeg, MB
It’s very difficult to get treatment.
Mateo — Red Deer, AB
I didn’t think my symptoms were serious enough to require treatment at the time.
Micah — Regina, SK
Real respondents testimonials Pseudonyms used
When asked why they did not access care, many expressed uncertainty about whether treatment was necessary, while others cited challenges accessing healthcare services.
These responses reinforce the need for healthcare systems that are accessible and affordable, alongside clear, nonjudgmental guidance from healthcare providers and educators. Strengthening comprehensive sex-ed across all stages of care is essential to ensure young people understand when and how to seek treatment.
SUBSTANCE USE AND SEX
Substance Use and Sex Among Youth Today
This year’s Sex Lives Report examines the significance of substance use, including alcohol, cannabis, nicotine, tobacco, and other drugs, in relation to sex among youth. We sought to understand patterns, perceptions, relationships, and risk behaviours associated with substance use.
Although nearly half of young people have mixed substance use and sex, the reality is far more nuanced than many might think.
Among the 47% of young Canadians who have combined substance use with sex, the most commonly cited substances were alcohol, cannabis, nicotine, and tobacco.
Lean (also known as purple drank, sizzurp, or drank)
Ketamine (also known as Special K)
Erection drugs (e.g., Viagra, Cialis, TriMix)
Tranquilizers or benzos (e.g., Valium, Xanax)
Amphetamine / Speed
Crack, Freebase
Non-medical steroids
Other
Prefer not to answer
GHB or GBL (also known as Gina, G, Water)
1 in 2 Canadian youth have not combined substance use with sex, and among them, 73% would not consider doing so.
Many young people shared that using substances would feel ‘unnatural’, interfere with genuine connection, or compromise their sense of safety and wellbeing. Others expressed concerns that substance use could impair their ability to give or receive consent and reduce their control over safety.
Most Youth Avoid Substance Use During Sex
51% have never used substances leading up to, or during sex
47% have used substances leading up to, or during sex
I feel like sex itself is good enough, substances create illusions and not real feelings.
I want to be completely aware and sober when having sex in case something were to happen.
Je ne veux pas gâcher l’expérience et je suis conte la consommation de ce genre de substances.
While some youth choose not to combine substance use and sex, we must clearly communicate the risks and harm reduction strategies so that all youth can make informed decisions and set boundaries when they feel unsure or unsafe.
Reese — Thunder Bay, ON
Jade — Whitehorse, YT
Jordan — Montréal, QC
Frequency of Mixing Substance Use & Sex
For youth who engage in substance use and sex, substances are not a consistent part of their sexual experiences but may arise in select moments.
Among youth who did combine substance use and sex,
4 in 5 reported using substances only occasionally (ie. either once or ‘once in a while’), suggesting that substance use in sexual contexts is less frequent than might be assumed.
Furthermore, 38% of youth reported that combining substance use with sex was spontaneous and unplanned. Education should prepare young people to use harm reduction strategies in both spontaneous and planned situations where substance use and sex are combined.
Frequency of mixing substance use and sex
21% Only once 60% Once in a while, not every time 15%
Regularly, most times 2% Every time 1% Other 1% Prefer not to answer
SUBSTANCE USE AND SEX
Motivations Behind Combining Substances and Sex
Among those who do mix substance use with sex,
3 in 4 youth did so to enhance their experience.
Health providers and educators should acknowledge the importance of pleasure, self confidence, and healthy coping skills while promoting safe sex.
So why do some young people choose to use substances before or during sex?
Exploring Risk and Pleasure
How safely are youth navigating substance use and sex?
Among sexually active Canadian youth who combine substance use with sex,
3 in 5 are aware that doing so can increase risk and feel okay with that.
Somewhat disagree 5% Strongly disagree
4% Don’t know
Although using substances such as alcohol and cannabis can decrease inhibition and affect decision-making, this does not necessarily mean all youth are neglecting safety.
thought about preventing STIs and HIV or other risks at least once during their experience 64%
Among youth who used substances before or during sex, 64% reported thinking about STI and HIV prevention or other harm reduction strategies at least once during their experience. Additionally, 70% reported using some form of HIV prevention strategy, such as condoms, PrEP, or PEP. This suggests that many are actively considering and implementing safer sex practices even when substance use is involved.
However, 28% reported never thinking about STI and HIV prevention during their experience, 24% said they worried less about STIs and HIV, and 31% worried less about using condoms. Some youth also reported feeling safe in other ways, with only 1 in 10 indicating difficulty giving or receiving consent.
While these findings highlight that the majority of youth are attentive to STI and HIV prevention when combining substance use and sexual activity, the data also points to the ongoing need for accessible sexual health education and resources that address substance use, prevention, and personal safety.
Thinking about the times you combined sex with substance use, which of these statements apply to you?
I worried less about using condoms
I worried less about HIV and STIs
It led me to be in more risky situations
I felt regret or disconnection from what happened
I had difficulty giving or receiving consent
I had less control over sexual activities
I felt paranoid or anxious
It led me to be in scary situations
I wasn’t always in control of or fully aware of the substances I’ve taken
It brought up triggers about previous experiences
It led to physical injury during sex
It put me at greater risk of adverse effects mixing substances or overdose
Prefer not to answer
The Morning After Feeling
1 in 5 reported negative experiences — feelings of guilt, regret, and disappointment — were often linked to gaps in memory, clarity around consent, and partner pressure.
So how do youth feel the day after?
Overall, while the majority of young people described their experiences as neutral or positive, a notable minority reported negative effects.
...with my current partner there is never any regret or negative feelings. But with my past abuser it made me feel very stupid and ashamed.
There was maybe once when I didn’t feel okay about it the next day because I wasn’t in total control of what had happened...
I don’t remember everything, but I don’t feel regretful.
... I don’t like getting too drunk or high because I want to just be a bit tipsy or buzzed but still be able to consent...
Our findings show that most youth feel more comfortable discussing substance use with sexual partners or peers, than with doctors, parents, or teachers.
Talking about substance use can be challenging, especially when disclosing illegal or socially stigmatized behaviours. Therefore creating familiar, non-judgmental environments is essential for youth.
Parents/Guardians
Counselor/Therapist
ChatGPT/Other Chatbots
Friends/Peers
TALKING ABOUT SUBSTANCE USE
Survey respondents shared a wide range of questions and curiosities about combining substance use and sex. These reflected interests spanning health and safety, relationship dynamics, and consent.
Many questions point to gaps in young people’s knowledge that may leave them unprepared to keep themselves safe if they choose to mix substances and sex. This signals a crucial need for comprehensive sex-ed and conversations around pleasure, consent, and informed choices, taking into account that sometimes youth combine substance use and sex.
Consent and Decision Making
• Does using substances make it harder to give or get clear consent?
• [What are] signs that I shouldn’t be having sex under the influence, even if I am with a committed partner I trust?
• How does it affect continuous consent?
• How much can we trust whether fully conscious consent was given especially in situations where the sexual partners aren’t in a committed relationship?
Practical Guidance
• Are there safer harm reduction practices for people who choose to mix sex and substances?
• Are there safer ways to explore sex and substances together?
Emotional and Relational Dynamics
• Why do people use them?
• What is the thought process behind the very first attempt? Are you mentally okay for wanting to experiment? Am I not fun enough if I don’t ever want to?
• [How does it] affect emotional connection during intimate moments?
Health and Physical Effects
• Is it dangerous? What are the risks?
• What do the side effects feel like?
• Does it increase the chances of getting HIV?
• Can it increase the chances of unsafe sex?
• Is it actually better?
• Does it make [sex] hurt less?
CONCLUSION
The findings from our 2026 report illustrate how young people experience and navigate the intersection of sex, substance use, pleasure, safety, and stigma.
Year after year, the report highlights persistent systemic and knowledge gaps in youth sexual health, underscoring the importance of equipping young people with the resources and support they need to engage with topics like substance use, consent, as well as STI and HIV disclosure, prevention, and testing.
How can we help youth?
We believe that meaningful change begins by placing youth at the centre of decision making. Through active listening to youth voices and acknowledging their lived experiences, we can better understand the barriers they face when accessing care, having open conversations, and finding support that feels safe and relevant.
Strengthening low-barrier services alongside enhancing the sex-ed curriculum can help close these gaps, reduce stigma, and empower young people to navigate their sexual health with confidence.
METHODOLOGY
How and with whom was the survey conducted?
Sex Lives Report 2026 survey was conducted by LetsStopAIDS from August 2 to 17, 2025 among a sample of 1,111 sexually active Canadians aged 18 to 24 and was hosted by Ipsos. The survey questions were designed based on research conducted on similar topics and followed the format of previous surveys conducted by LetsStopAIDS. The questionnaire was carefully pilot tested with a reference group before the survey was deployed. Respondents had options to not answer or withdraw from survey at any point in time and were assured of anonymity. Participants were screened so only those who reported ever having sex were included in the survey results. The survey was conducted in English and French and included an additional boost of 100 Canadians who self-identify as being part of the 2SLGBTQI+ community. The data should be interpreted contextually and with caution due to the nature of the quota sample from a pooled population.
Quotas and weighting were employed to ensure that the sample’s composition reflects that of the Canadian population aged 18 to 24 according to census parameters. Weights have been applied using general population characteristics among those 18 to 24. A credibility interval is a range of values used in Bayesian statistics that represents the degree of belief or probability that a parameter falls within this range. In this case, the credibility interval for a sample of n=1,111 is ±3.6 percentage points, 19 times out of 20. In some cases, responses may not add up to 100% due to rounding or due to the question allowing for multiple responses to be selected.
How was respondents’ data protected?
LetsStopAIDS, Ipsos Canada, and San Patten and Associates are committed to protecting the privacy and confidentiality of personal information collected. Steps were taken by Ipsos to ensure only de-identified data was shared with LetsStopAIDS and San Patten and Associates, including ensuring no personally identifiable information was shared. Further, analysis was conducted only at an aggregate level for sub-groups with a quantifiable sample base. All survey data is stored on secured servers located in Canada.
View our data:
Sex Lives Report 2026 data and previous datasets are available on an open-source platform.
To go to the platform, please scan the QR code or visit SexLivesReport.ca.
Additional questions?
If you have any additional questions about the methodology, analysis, or survey question wording you may contact slr@LetsStopAIDS.org.
If you or someone you know needs help with substance use, mental health, sexual health, or HIV, here is a brief list of resources. Find more resources available online compiled by The Government of Canada and your province.
*If you are in an emergency situation, call 9-1-1 or go to your local emergency department.
• Suicide Crisis Helpline - call 9-8-8
• Kids Help phone - call 1-800-668-6868 or Text 686868
• Your local Canadian Mental Health Association Branch
• Drug Rehab Services - call 1-877-254-3348
• National Overdose Response Service - call 1-888-688-NORS(6677)
• Alcoholics Anonymous
• Sexual assault resources in your province
• Action Canada for Sexual Health and Rights Access Line - call 1-888-642-2725
• HIV Self Testing programs such as the I’m Ready Program
• CATIE Where to? Resource - visit whereto.catie.ca to find Harm reduction, HIV and STI testing and treatment locations near you
• You can talk to a family doctor, psychologist, mental health nurse, or social worker. You may also want to talk to another trusted professional, such as a counselor or spiritual leader.
LEGEND (PRIMARY CATEGORY)
STIMULANTS - Accelerate CNS activity (“Uppers”)
DEPRESSANTS - Slow down CNS activity (“Downers”)
HALLUCINOGENS - Alters perception and reality
EMPATHOGENS - Increase feelings of empathy and connection
CANNABINOIDS - Interacts with the body’s cannabinoid receptors
OTHERS/ MISCELLANEOUS - Substances with unique or localized effects
Source: Consolidated and synthesized from widely accepted pharmacological classifications used by international and national public health authorities, including the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC), and leading national health institutes like the National Institute on Drug Abuse (NIDA).
RESPONDENTS*
Gender Identity
LetsStopAIDS is Canada’s Youth-HIV charity dedicated to fostering youth leadership and enhancing awareness on HIV and sexual health. We focus on research, knowledge exchange initiatives and community engagement globally.
Since 2004, LetsStopAIDS has engaged over 200,000 young people through 10 global projects, supported by 15,000 volunteers. 21 years later, and we continue to inspire young people to take action within their local communities.
To learn more and get involved with LetsStopAIDS or make a charitable donation, please visit LetsStopAIDS.org or contact us at +1 (416) 231-2333.
LetsStopAIDS Sex Lives Report: Making Sense of Sex, Substance Use, and Prevention
Survey Design
Ipsos Canada (Sanyam Sethi, Vice President, Ipsos Public Affairs Canada
Meghan Miller, Director, Ipsos Public Affairs Canada), San Patten and Associates (San Patten, Tariq Bhanjee, Caterina Tess Kendrick), Alex MacLeod, and Dr. Gerson Scheidweiler
Data Collection
Ipsos Canada
Data Analysis
Ipsos Canada and San Patten and Associates (San Patten, Tariq Bhanjee, Caterina Tess Kendrick)
Initial Report Writing
San Patten and Associates (San Patten, Tariq Bhanjee, Caterina Tess Kendrick)
Final Booklet Report Writing
Alex MacLeod, Dana Won, Daniel Opert, Dr. Gerson Scheidweiler
Creative Direction
Dana Won
Design and Layout
Neo-Aldwin Torres
Director of Video Campaign
Dan LeMoyne
Director of Photography
Susannah Haight
Photo Subject
Diego Dominguez de Garay
Editorial Support
Shamin Mohamed Jr., San Patten and Associates (San Patten, Tariq Bhanjee, Caterina Tess Kendrick), Ipsos Canada, LetsStopAIDS Volunteer Research Analysts (Zara Ahmed, Swarna Arunchalam, Jordan Chow)
A special thank you to The PrEP Clinic for supporting the video campaign associated with this report. A big thank you to studio.b and Breathe Entertainment.
