ArticleLiterature Review

Re-examining the Effectiveness of Monogamy as an STI-Preventive Strategy.

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The utility of monogamy (in practice) as a strategy for preventing sexually transmitted infections (STIs) was investigated. By reviewing recent literature surrounding monogamous relationships and sexual behaviors, the authors determined that monogamy might not prevent against STIs as expected. First, the authors elucidate the ways in which public health officials and the general public define and interpret monogamy and discuss how this contributes to monogamy as an ineffectual STI prevention strategy. Second, the authors provide evidence that individuals' compliance with monogamy is likely to be low, similar to rates of compliance with other medical advice. Lastly, the authors draw upon recent research findings suggesting that when people label themselves as monogamous, they are less likely to engage in safer sex behaviors than people who have an explicit agreement with their partner to be non-monogamous. Future research and clinical directions to promote sexual health and destigmatize sexual behaviors are considered. Copyright © 2015. Published by Elsevier Inc.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... However, sugar dating women were also more than six times more likely to have been tested for STIs. One explanation for the large discrepancy in testing rates is that, like other individuals in CNM relationships, sugar dating women may be more aware of the risk of contracting an STI, particularly when having unprotected sex with multiple partners (Conley et al., 2015;Lehmiller, 2015). By contrast, non-sugar dating women may perceive their sexual behaviors as less risky, and therefore do not feel the need to be tested. ...
... By contrast, non-sugar dating women may perceive their sexual behaviors as less risky, and therefore do not feel the need to be tested. It is worth emphasizing, however, that many people in monogamous relationships do unwittingly acquire STIs from their partners due to the high prevalence of infidelity, which often occurs in the absence of condom use or subsequent STI testing (Conley et al., 2015;Lehmiller, 2015). Additionally, other factors, such as adherence to traditional gender role norms, education level, socio-economic status, and individual differences in propensity to engage in risky sexual behavior (Gaither & Sellbom, 2003;Hardee et al., 2014;Madiba & Ngwenya, 2017) may very well play a role in both inclinations for STI testing and condom use, regardless of whether or not women have ever been involved in sugar dating or not. ...
Full-text available
Article
Sugar dating is a form of dating typically characterized by wealthier, older men providing financial support to younger, less financially secure women in exchange for companionship and sexual intimacy. The goals of the current study were to (1) quantitatively assess the sexual practices of sugar dating women in their arrangements with sugar daddies, including time spent on sexual activity, average number of current partners, and relative perceptions of relationship power, (2) examine how perceptions of power within arrangements relate to condom use with sugar daddies, and (3) compare samples of sugar dating and non-sugar dating women on both condom use consistency by partner type and rates of STI testing and diagnoses. Overall, condom use for all women was highest with casual sexual partners and lowest with romantic partners, with sugar dating women’s condom use with sugar daddies in between. Consistent with social exchange theory, perception of power within sugar dating arrangements predicted condom use with sugar daddies, such that women who felt they held more power reported more consistent condom use. Further, sugar dating women were twice as likely to have been diagnosed with an STI but were more than six times as likely to have been tested for STIs.
... Thus, some potential reasons for stigma may include beliefs about promiscuity, or perceived likelihood of having sexually transmitted infections (STIs), given that increased promiscuity may be suggestive of greater likelihood of having an STI. This line of reasoning is supported by previous research that suggests that monogamous relationships are overwhelmingly perceived by the public to prevent the spread of STIs (Aral and Leichliter, 2010;Conley et al., 2012aConley et al., , 2015Moors et al., 2013) and previous research that suggests that CNM relationships are perceived to be riskier because people believe CNM offers less protection from STIs . However, previous research has not examined the associations between discriminatory attitudes (i.e., social distance) and perceptions about the likelihood of having STIs or beliefs about promiscuity across varying CNM orientations and among targets of varying relationship orientations. ...
... Therefore, with infidelity occurring in a reliable minority of American marriages and monogamous romantic relationships, it would seem that concern about CNM relationships and STI risk is somewhat overblown while concern for STI risk within monogamous relationships may be underappreciated. This idea is consistent with recent findings suggesting that monogamy might be less effective at preventing STIs than expected (Conley et al., 2015). ...
Full-text available
Preprint
Previous research suggests that both monogamous and consensually non-monogamous (CNM) participants rate monogamous targets more positively. However, this pattern of stigma towards CNM relationships and the “halo effect” surrounding monogamy is at odds with the view that people typically favor members from their own groups over members of other groups. In the current research, we sought to re-examine the halo effect, using a more direct measure of stigma (i.e., desired social distance), in a methodological context that differentiates between the three most common types of CNM relationships. A convenience sample (N = 641) of individuals who self-identified as monogamous (n = 447), open (n = 80), polyamorous (n = 62), or swinger (n = 52) provided social distance ratings in response to these same relationship orientations in a counterbalanced order. Congruent with prior findings, CNM participants favored monogamous targets over CNM targets as a broad category (replicating the halo effect). However, results indicated this effect dissipated when participants were asked to differentiate between relationships they identify with, and other CNM relationships. Furthermore, supplementary findings suggest that monogamous targets were perceived to be the least promiscuous and were associated with the lowest perceived sexually transmitted infection (STI) rates, while swinger targets were perceived as the most promiscuous and were associated with the highest perceived STI rates. Consequently, our results imply social distance is partly attributable to the perception of STI risk, but not perceptions of promiscuity.
... Thus, some potential reasons for stigma may include beliefs about promiscuity, or perceived likelihood of having sexually transmitted infections (STIs), given that increased promiscuity may be suggestive of greater likelihood of having an STI. This line of reasoning is supported by previous research that suggests that monogamous relationships are overwhelmingly perceived by the public to prevent the spread of STIs (Aral and Leichliter, 2010;Conley et al., 2012aConley et al., , 2015Moors et al., 2013) and previous research that suggests that CNM relationships are perceived to be riskier because people believe CNM offers less protection from STIs . However, previous research has not examined the associations between discriminatory attitudes (i.e., social distance) and perceptions about the likelihood of having STIs or beliefs about promiscuity across varying CNM orientations and among targets of varying relationship orientations. ...
... Therefore, with infidelity occurring in a reliable minority of American marriages and monogamous romantic relationships, it would seem that concern about CNM relationships and STI risk is somewhat overblown while concern for STI risk within monogamous relationships may be underappreciated. This idea is consistent with recent findings suggesting that monogamy might be less effective at preventing STIs than expected (Conley et al., 2015). ...
Full-text available
Article
Previous research suggests that both monogamous and consensually non-monogamous (CNM) participants rate monogamous targets more positively. However, this pattern of stigma toward CNM relationships and the "halo effect" surrounding monogamy is at odds with the view that people typically favor members from their own groups over members of other groups. In the current research, we sought to reexamine the halo effect, using a more direct measure of stigma (i.e., desired social distance), in a methodological context that differentiates between the three most common types of CNM relationships. A convenience sample (N = 641) of individuals who self-identified as monogamous (n = 447), open (n = 80), polyamorous (n = 62), or swinger (n = 52) provided social distance ratings in response to these same relationship orientations in a counterbalanced order. Congruent with prior findings, CNM participants favored monogamous targets over CNM targets as a broad category (replicating the halo effect). However, results indicated this effect dissipated when participants were asked to differentiate between relationships they identify with, and other CNM relationships. Furthermore, supplementary findings suggest that monogamous targets were perceived to be the least promiscuous and were associated with the lowest perceived sexually transmitted infection (STI) rates, while swinger targets were perceived as the most promiscuous and were associated with the highest perceived STI rates. Consequently, our results imply social distance is partly attributable to the perception of STI risk, but not perceptions of promiscuity.
... Thus, some potential reasons for stigma may include beliefs about promiscuity, or perceived likelihood of having sexually transmitted infections (STIs), given that increased promiscuity may be suggestive of greater likelihood of having an STI. This line of reasoning is supported by previous research that suggests that monogamous relationships are overwhelmingly perceived by the public to prevent the spread of STIs (Aral and Leichliter, 2010;Conley et al., 2012aConley et al., , 2015Moors et al., 2013) and previous research that suggests that CNM relationships are perceived to be riskier because people believe CNM offers less protection from STIs . However, previous research has not examined the associations between discriminatory attitudes (i.e., social distance) and perceptions about the likelihood of having STIs or beliefs about promiscuity across varying CNM orientations and among targets of varying relationship orientations. ...
... Therefore, with infidelity occurring in a reliable minority of American marriages and monogamous romantic relationships, it would seem that concern about CNM relationships and STI risk is somewhat overblown while concern for STI risk within monogamous relationships may be underappreciated. This idea is consistent with recent findings suggesting that monogamy might be less effective at preventing STIs than expected (Conley et al., 2015). ...
Full-text available
Preprint
Abstract: Previous research suggests that both monogamous and consensually non-monogamous (CNM) participants rate monogamous targets more positively. However, this pattern of stigma towards CNM relationships and the “halo effect” surrounding monogamy is at odds with the view that people typically favor members from their own groups over members of other groups. In the current research, we sought to re-examine the halo effect, using a more direct measure of stigma (i.e., desired social distance), in a methodological context that differentiates between the three most common types of CNM relationships. A convenience sample (N = 641) of individuals who self-identified as monogamous (n = 447), open (n = 80), polyamorous (n = 62), or swinger (n = 52) provided social distance ratings in response to these same relationship orientations in a counterbalanced order. Congruent with prior findings, CNM participants favored monogamous targets over CNM targets as a broad category (replicating the halo effect). However, results indicated this effect dissipated when participants were asked to differentiate between relationships they identify with, and other CNM relationships. Furthermore, supplementary findings suggest that monogamous targets were perceived to be the least promiscuous and were associated with the lowest perceived sexually transmitted infection (STI) rates, while swinger targets were perceived as the most promiscuous and were associated with the highest perceived STI rates. Consequently, our results imply social distance is partly attributable to the perception of STI risk, but not perceptions of promiscuity. Preprint can be found at: https://osf.io/ct6bh/ Pre-registration for project (including hypotheses, measures and method, and analytic plan) can be found at: https://osf.io/ndytw *This manuscript has been accepted in its current form by Frontiers and will be in press soon. **This manuscript has also received the OSF pre-registration challenge award.
... Provided that neither partner is HIV positive or has an STI, monogamy is substantially low risk. However, testing and safer sex practices are not irrelevant to monogamy (Conley, Matsick, Moors, Ziegler, & Rubin, 2015;Swan & Thompson, 2016). Monogamous individuals who are HIV positive and/or have STIs may or may not be aware of their status, and may or may not convey this to their partners. ...
... Yet for all these divergences, our findings also aligned with some previous work on relationship structure. The present study reinforces existing challenges to the assumption that monogamy is an effective and ideal strategy for addressing sexual risk, including but not limited to HIV/STI transmission (Conley et al., 2015;Swan & Thompson, 2016). ...
Full-text available
Article
People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of “concurrent sexual partnerships.” Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as “Other, Non-Hispanic” were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming.
... Remaining sexually exclusive with a partner (sexual monogamy) is perceived by many as an effective strategy to promote sexual health and safety-including public health officials, researchers, and the general public [1][2][3]. Sexual monogamy is often the cornerstone of sexual health programs, and alternative types of partnering are perceived as responsible for the spread of sexually transmitted infections (with the exception of abstinence) [2,3]. However, recent research has revealed an interesting twist to these popular conceptions of sexual safety: People engaged in consensually non-monogamous relationships are more likely to practice safer sex strategies than people engaged in ostensibly sexually monogamous relationships [3, 4•]. ...
... Remaining sexually exclusive with a partner (sexual monogamy) is perceived by many as an effective strategy to promote sexual health and safety-including public health officials, researchers, and the general public [1][2][3]. Sexual monogamy is often the cornerstone of sexual health programs, and alternative types of partnering are perceived as responsible for the spread of sexually transmitted infections (with the exception of abstinence) [2,3]. However, recent research has revealed an interesting twist to these popular conceptions of sexual safety: People engaged in consensually non-monogamous relationships are more likely to practice safer sex strategies than people engaged in ostensibly sexually monogamous relationships [3, 4•]. ...
Full-text available
Article
Purpose of Review Interest in consensually non-monogamous (CNM) relationships—in which partners have explicitly agreed that pursuing other romantic or sexual partners is permitted—has grown both among the American public and among researchers and practitioners. Yet, little is known about the prevalence of CNM relationships or factors related to engagement in these relationships. Recent Findings In this review, we synthesize the past 5 years of research on CNM relationships to provide insight on (1) definitions of differing CNM relationships, (2) how many people are engaging in or have previously engaged in CNM relationships, and (3) which social identities and individual differences are associated with CNM engagement. Summary Engagement in CNM relationships has been linked to positive aspects of sexual health such as open conversations about sexual needs and risk, and greater condom use. Researchers and practitioners should further address perceptions of and approaches to relationships outside the standard of monogamy.
... For example, polyamorous relationships are sometimes perceived more favorably than open or swinging relationships (Balzarini et al., 2018;Grunt-Mejer & Campbell, 2016;Matsick et al., 2014), arguably because polyamory partners are perceived to favor emotional connections over casual sex. As monogamy is perceived as one of the most effective strategies to prevent the spread of STIs (Conley & Piemonte, 2020;Conley et al., 2015), CNM individuals are also perceived to be reckless with their sexual health when compared to monogamous individuals. For example, CNM individuals are perceived as more promiscuous and more likely to have an STI (Balzarini et al., 2018;Conley et al., 2013) but also more likely to use condoms . ...
Full-text available
Article
Studies have shown that romantic partners in consensual non-monogamous (CNM) relationships are targets of stigmatization. However, little is known about the underlying mechanisms and the conditions under which such stigmatization occurs. In two experimental studies (combined N = 772), we asked participants to read the description of two partners in a relationship (monogamous vs. open relationship vs. polyamorous) and make a series of judgments about those partners. Overall results showed that CNM (vs. monogamous) partners were perceived as less trustworthy and as having more sexual health concerns (Studies 1 and 2), and as being less committed and less sexually satisfied (Study 2). Results from a conditional mediation analysis (Study 2) further showed that participants with negative attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having less conservation and more openness to change values, which was then associated with more stigmatization. In contrast, participants with positive attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having more openness to change values, which was then associated with less stigmatization. Taken together, these results extended the literature focused on prejudice, discrimination, and stigmatization of minority groups and highlighted key elements that can be used to buffer stigmatization.
... While monogamy has long been held as the benchmark for happy, healthy, and sexually satisfied relationships in the western world (Waite & Gallagher, 2000) especially as compared to those who are divorced, unmarried, single, or widowed (Blanchflower & Oswald, 2004), research has been accumulating that requires more nuanced assessments and comparisons with other relationship styles, including CNM (Conley et al., 2012(Conley et al., , 2013b(Conley et al., , 2013c(Conley et al., , 2015(Conley et al., , 2018Moors et al., 2017). Previous research found that older CNM persons, even those who are not married (including divorced, separated, widowed, or never married), fare at least as well in happiness, health, and marital happiness, in some cases exceptionally well, compared with their counterparts in the general U.S. population (Fleckenstein & Cox, 2015). ...
Full-text available
Article
The primary objective of this cross-sectional study was to examine the associations of self-reported health, happiness, marital happiness, frequency of sexual activity, and number of partners from a multinational survey of individuals who are consensually non-monogamous (CNM) or open to being CNM, completed in 2012 with 4062 respondents. We compared data from this survey with the 2010–2014 US General Social Surveys (GSS). This study explored these variables and their predictors by gender (including 612 non-binary-gendered CNM individuals), marital status, number of partners, sexual frequency, age, education, and income and were broken down by behavioral sexual orientation, marital status, and other relevant categories. Respondents in our CNM sample generally reported being as healthy (sometimes healthier; e.g., all respondents M–W Z = 7.66, p < .001, η2 = 0.007), happy (frequently happier; e.g., multiple-partnered Z = 15.43, p < .001, η2 = 0.069), happy in their marriages (in some cases happier; e.g., multiple-partnered females Z = 2.61, p = .009, η2 = 0.067), and reported having more frequent sexual activity (e.g., all Z = 29.54, p < .001, η2 = 0.094) with more partners (e.g., all Z = 60.75, p < .001, η2 = 0.393) compared to corresponding individuals within the GSS. This study contributes to knowledge about commonalities and differences between the general population and those who are CNM regarding health, happiness, and happiness in marriage, including differences in optimal number of sexual partners and sexual frequency.
... Another possible mechanism is the perception that CNM relationships are more exposed to sexually transmitted infections. Indeed, research shows that monogamy is equated with protection against these infections and is even advocated as a preventive technique (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). Moreover, Balzarini et al. (2018) found that the perceived likelihood of having an infection was predictive of greater social distance toward open and polyamorous relationships, whereas perceptions of promiscuity were not. ...
Full-text available
Article
We built upon a recent study by Rodrigues, Fasoli, Huic, and Lopes (2018) by investigating potential mechanisms driving the dehumanization of consensual non-monogamous (CNM) partners. Using a between-subjects experimental design, we asked 202 Portuguese individuals (158 women; Mage = 29.17, SD = 9.97) to read the description of two partners in a monogamous, open, or polyamorous relationship, and to make a series of judgments about both partners. Results showed the expected dehumanization effect, such that both groups of CNM partners (open and polyamorous) were attributed more primary (vs. secondary) emotions, whereas the reverse was true for monogamous partners. Moreover, results showed that the dehumanization effect was driven by the perception of CNM partners as less moral and less committed to their relationship. However, these findings were observed only for individuals with unfavorable (vs. favorable) attitudes toward CNM relationship. Overall, this study replicated the original findings and extended our understanding of why people in CNM relationships are stigmatized.
... The stable relationship culture presupposes that men and women are protected against the risk of acquiring sexually transmitted infections by being monogamous (Maia et al., 2008). However, it has been suggested that people who consider themselves monogamous are less likely to develop safer sexual behaviors, which may facilitate the acquisition of infections in a possible extramarital relationship (Conley et al., 2015). ...
Full-text available
Article
The objective of the present study was to determine the prevalence, epidemiological and socioeconomic profile and risk factors associated with HIV-1 infection in elderly patients diagnosed with HIV/AIDS in the state of Piauí, Brazil. A total of 805 individuals seen at the Central Laboratory of Public Health of Piauí were included. The subjects were classified into two groups: a group of individuals 18 to 59 years old and a group of those 60 years or older. These individuals were tested for HIV-1 infection (ELISA), which was monitored by TCD4+/CD8+ lymphocyte count (flow cytometry) and viral load quantification (branched DNA method), and for coinfections with HBV, HCV and HTLV-1/2 (ELISA and PCR). They also answered an epidemiological questionnaire on socio-demographic, epidemiological and clinical characteristics. The frequency of HIV-1 infection in elderly patients was 3.7% (30/805). The majority of patients were male (66.6%), had a primary school education level (90%), were married (40%) and had a family income of 1 to 4 times the minimum wage (63.3%). The main behavioral risk factors associated with these individuals included lack of condom use (100%) and a history of Sexual Transmitted Diseases – STI (53.3%), surgery (63.3%) or blood transfusion (40%). The elderly patients also had a higher frequency of HIV-HTLV-1/2 co-infection (13.3%). Identifying the main characteristics related to HIV infection in the elderly is important to show that these individuals are also susceptible to HIV-1 infection and must be made aware of risk behaviors.
... Trust within a relationship provides a safety net where women's perceived vulnerability to HIV and other sexually transmitted infections is decreased (Crosby, 1999). Similarly, perceived mutual monogamy inhibits safe sex practices such as condom use (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). Qualitative studies with women experiencing IPV also confirm that monogamy is important and believed to be practiced by both partners (Hearn, O'Sullivan, El-Bassel, & Gilbert, 2005). ...
Article
Background: Vulnerability to human immunodeficiency virus (HIV) infection is a significant public health issue for women experiencing intimate partner violence (IPV). Despite the increased risk of human immunodeficiency virus infection, women only represent 4.6% of pre-exposure prophylaxis (PrEP) users in the United States. IPV may present additional difficulties to PrEP access. In this qualitative study, we examined how IPV and the relational context shaped women's decisions, attitudes, and engagement in the PrEP care continuum. Methods: We conducted semistructured interviews with 19 women residing in Connecticut who participated in a prospective cohort study. We purposively recruited our sample to include women who reported physical and/or sexual IPV in the past 6 months, and used a grounded theory approach to analyze the qualitative data. Results: Our findings suggest multiple ways that the relational context can affect women's decisions, attitudes, and engagement in the PrEP care continuum. We identified five aspects of women's relationships that can shape women's interest, intentions, and access to PrEP: 1) relationship power struggles, 2) infidelity, 3) trust and monogamy, 4) male partner's reactions, and 5) "season of risk" (i.e., PrEP use only during times of perceived human immunodeficiency virus risk). Collectively, these findings suggest that women experiencing IPV might face additional relational challenges that need to be adequately addressed in settings administering PrEP. Conclusions: Communication on sexual risk reduction strategies should address relational factors and promote women's autonomy. Future research on long-acting and invisible forms of PrEP may help to circumvent some of the relational barriers women experiencing IPV may face when considering PrEP care.
... Research has been fairly consistent in showing that people in romantic relationships are less likely to use condoms, as compared to single people (Costa et al., 2016;Reece et al., 2010;Sanders et al., 2010;Sheeran et al., 1999;Štulhofer, Baćak, Ajduković, & Graham, 2010; but see also Ssewanyana et al., 2015). This has been explained by the belief that monogamy is an effective way to prevent the dissemination of STIs (Conley et al., 2015). Indeed, a monogamous relationship agreement indicates that neither partner is allowed to have sex or affective relationships outside their primary relationship (Cohen, 2016;Conley et al., 2017;Rubel & Bogaert, 2015). ...
Article
Attitudes toward condoms and self-control are reliable predictors of consistent condom use. However, safer sex behaviors depend on whether people are single or romantically involved. For the latter, it also depends on whether people are non-consensually non-monogamous (NCNM) or consensually non-monogamous (CNM). A cross-sectional study with 512 Portuguese heterosexual users of the Second Love website (77.0% men; Mage = 37.64, SD = 7.37; 47.8% romantically involved) examined if attitudes toward condom use were associated with safer sex behaviors – condom use negotiation and condom use frequency – and if this association was mediated by the perception of greater sexual self-control. For single participants we focused on casual partners, and for romantically involved participants we focused on both extradyadic casual partners and the primary partner. Results showed that perceived sexual self-control mediated the association between attitudes and condom use negotiation with casual partners. However, for condom use frequency there was only evidence of mediation for romantically involved (and not single) participants. Lastly, results showed mediations for both safer sex behaviors with the primary partner, but only for CNM (and not NCNM) participants. These findings highlight the importance of sexual self-control and the need to acknowledge relationship agreements.
... It should be noted that although CNM participants are widely perceived as being less sexually safe or trustworthy, recent studies have found that individuals in CNM relationships may engage in stronger safer sex practices, utilize them more consistently, and get tested for sexually transmitted infections (STIs) more frequently than either monogamous or ostensibly monogamous but sexually unfaithful individuals (Conley, Matsick, Moors, Ziegler, & Rubin, 2015;Conley, Moors, Ziegler, & Karathanasis, 2012;Lehmiller, 2015). Furthermore, Lehmiller (2015) found that despite CNM participants reporting more sex partners than monogamous ones, the self-reported rate of STI infections did not differ between the two groups, ostensibly due to the higher quality and reliability of CNM participants' safer sex practices. ...
Full-text available
Thesis
Polyamory is a type of consensual non-monogamy (CNM) in which participants engage in multiple simultaneous romantic and often sexual relationships with the knowledge and consent of all involved. CNM practitioners in general, and polyamorous people in specific, appear to be highly stigmatized due to their relational practices, and to frequently encounter CNM-related discrimination, harassment, and violence (DHV). Conceptualizing this dynamic via minority stress theory predicts that this stigma and DHV will lead to negative mental health outcomes for polyamorous individuals. However, recent research has begun to identify possible sources of resilience and strength within polyamorous populations, which may ameliorate these negative effects, as well as enhance satisfaction with CNM and quality of life. This study investigated these hypotheses in a sample of 1,176 polyamorous American adults utilizing structural equation modeling (SEM). Two structural models were proposed and tested, one for polyamorous resilience and one for polyamorous strengths. Four constructs were assessed as potential resilience and strength factors: mindfulness, cognitive flexibility, a positive CNM identity, and connection to a supportive CNM community. Results indicate that CNM-related minority stress was positively related to increased psychological distress, such as higher self-reported depression and anxiety symptoms. Mindfulness was found to have both direct and moderating effects on the relationship between minority stress and psychological distress, such that higher mindfulness attenuated the negative impact of minority stress. Cognitive flexibility also displayed direct and moderating effects, but in the opposite than predicted direction. Regarding polyamorous strengths, mindfulness was found to positively impact overall satisfaction with CNM as well as life satisfaction. In addition, greater connection to a supportive CNM community correlated with having a more positive sense of CNM identity, which in turn was related to higher satisfaction with CNM. Overall satisfaction with CNM was related to greater life satisfaction. Clinical and research implications of these findings are discussed, with an emphasis on improving cultural competence for clinicians working with this unique and under-served population.
... Explicit, nonjudgmental questions regarding the sexual behaviors, safer sex practices, and testing practices of other members of the sexual health network may also be beneficial to ensure more accurate risk assessment. 32 Other CNM-inclusive healthcare practices may include secure sharing of test results with members of the patient's sexual health network, identifying multiple emergency contacts, and exploring needs for long-term highly effective birth control, preexposure prophylaxis, and/or HPV vaccines depending on the gender of their partners and specific risk factors and needs. ...
Full-text available
Article
Background: Individuals engaged in consensual non-monogamy (CNM) face broad and potentially harmful experiences of sexual stigma in society, yet no published empirical literature has examined the experiences of this population within the healthcare system. Aim: The present investigation sought to explore positive and negative experiences of CNM individuals within the healthcare system, as well as specific needs of these patients regarding inclusive healthcare practices. Methods: 20 CNM-identified adults from a non-profit organization serving CNM individuals completed a brief survey and participated in 1 of 3 focus groups of 70 minutes duration centered on their healthcare needs and experiences. Outcomes: CNM patients report challenges in addressing their healthcare needs related to lack of provider knowledge, inadequate preventative screenings, and stigmatizing behaviors that impact their health and trust in the healthcare system. Clinical implications: Healthcare providers must monitor and work to avoid assumptions and pathologization of individuals who engage in CNM, creating an open, accepting environment to work collaboratively with CNM individuals to meet their unique sexual health needs. Strength & limitations: Although the present sample is diverse with respect to sexual and gender identity and socioeconomic status, it may not represent the experiences of CNM individuals outside of the midwestern United States and those who do not identify as polyamorous. Conclusion: CNM individuals frequently experience sexual stigma in interactions with the healthcare system that interferes with receipt of sensitive, medically accurate care relevant to their unique needs and experiences. Vaughan MD, Jones P, Taylor BA, et al. Healthcare Experiences and Needs of Consensually Non-Monogamous People: Results From a Focus Group Study. J Sex Med 2019;16:42-51.
... Monogamy was, and remains, a centerpiece of public health approaches to STIs, including HIV (Gostin, 2013;Kelly & Kalichman, 1995). Now, however, the great span of contexts of the experiences of normative sex have fully exposed the limits of monogamy (as an ideal for sexual relationships and as public health policy) (Balzarini, Shumlich, Kohut, & Campbell, 2018;Conley, Matsick, Moors, Ziegler, & Rubin, 2015). The historical moment thus seems appropriate for more in-depth interrogation of trust and sexual trust in relation to sexual health and well-being. ...
Article
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
... Monogamy, in particular, is thought to be the gold standard for preventing STDs within AOUM education (Santelli et al., 2017) and more generally (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). Because non-monogamous sex is perceived 1 3 as inherently riskier, we also associate collective sex environments (and non-monogamy more generally) with greater risk for STDs-this is the issue to which we now turn. ...
... The notion of having one person meet all of one's sexual needs appears to be uncomfortable for many, and unrealistic for others. Yet, the dominant discourse around sexuality and sexual health (implicitly) prioritizes monogamy as the optimal way to engage in partnering and sex (Aguilar, 2013;Conley et al., 2015a;Moors et al., 2017). Thus, there is a disconnect between the ways in which sexual and romantic norms unfold in the real world and how they are conceptualized in research. ...
... Future research should compare and contrast CUR tactics in casual and committed relationship contexts. It is well established that as relationships become more serious, partners tend to stop condom use because concerns for STI/HIV transmission risk decrease (Manlove et al., 2011), despite the potential for continued STI risk if partners are not monogamous (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). ...
Article
Although there is a growing literature on men's condom use resistance (CUR) tactics (e.g., direct requests, deception), little research exists on women's CUR tactics. This study investigated young women's (ages 18 to 21) self-reported use of CUR tactics since age 14 and related individual difference factors. Participants included 235 sexually active heterosexual women from a nationwide convenience survey sample who completed a newly adapted women's version of the Condom Use Resistance Survey. Consistent with the limited previous research, women were most likely to use risk-level reassurance (37.9%) and seduction (33.2%) tactics. A higher frequency and quantity of alcohol consumption, particularly prior to sex, lower perceived risk of sexually transmitted infections (STIs), and a history of STI diagnosis were associated with having previously used a greater number and variety of CUR tactics. This highlights the need for CUR prevention and intervention programming for women. Future research should specifically examine women's rationale for using CUR tactics and utilize longitudinal and experimental methods to further elucidate directional and causal relationships among individual-level risk factors, CUR, and negative sexual health outcomes.
... Monogamy is considered to be and promoted as an effective strategy for STI prevention (Misovich, Fisher, & Fisher, 1997). Apart from the mutual monogamy (monogamy by both partners) that is a prerequisite for its effectiveness, individuals' interpretation of monogamy undermines its real-life effectiveness (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). From a behavioral perspective, both consensual nonmonogamy and nonconsensual nonmonogamy (infidelity) can be considered as sexual concurrency. ...
Article
Swingers are couples practicing consensual extradyadic heterosexual relations. This subculture is defined by venues, and online communities. This study aimed to assess swingers' lifestyle, sexual health, history of testing for sexually transmitted infections (STI), and review risk factors for sexual risk behavior and STI transmission. An online survey was distributed through venues, chat- and dating websites. Most of 480 swingers starting the survey completed it (n = 392, 81.6%). Women (n = 146) reported more frequent swinging (p = 0.013), same-sex contacts (p < 0.001), and more sex under influence of alcohol (p < 0.001). Men (n = 334) reported more anal sex (p = 0.002), and condomless vaginal sex (p = 0.004). Of respondents tested, 25.7% ever received an STI diagnosis. Using logistical regression, being male, older, single, and party drug use were associated with sexual risk behavior (p = 0.009). Higher frequency of swinging was associated with an STI diagnosis (p = 0.036).Swingers were sexually active, reported factors associated with sexual risk behavior, and were more diagnosed with an STI compared to the general population. Many swingers were tested for STI. Nonetheless implementation of tailored testing strategies should be considered given their elevated risk for STI acquisition.
... Individuals with trauma symptoms may be hypervigilant to cues of partner disapproval and forgo condom use (Stoner et al., 2008). It is important to highlight that condom use is important whether youth consider themselves in an ''exclusive'' relationship or not; condoms protect against STIs, highly prevalent at this age and serial monogamy appears to further elevate risk for STIs, in part by making condom use less likely (Conley, Matsick, Moors, Ziegler, & Rubin, 2015). Contrary to hypotheses, substance use did not mediate the relation between child maltreatment history and any of the outcomes examined but did predict the number of sexual partners. ...
Article
Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of each form of maltreatment were coded. At age 16, potential mediators (trauma symptoms and substance use) were assessed. At age 18, risky sexual behavior (more than four partners, unprotected sex, unassertiveness in sexual refusal) was assessed. Neglect significantly predicted unprotected sex. Substance use predicted unprotected sex and four or more partners but did not mediate the effects of maltreatment. Trauma symptoms predicted unprotected sex and mediated effects of emotional maltreatment on unprotected sex and on assertiveness in sexual refusal and the effects of sexual abuse on unprotected sex. Both neglect and emotional maltreatment emerged as important factors in risky sexual behavior. Trauma symptoms appear to be an important pathway by which maltreatment confers risk for risky sexual behavior. Interventions to reduce risky sexual behavior should include assessment and treatment for trauma symptoms and for history of child maltreatment in all its forms.
... 78 Although this may seem counterintuitive, couples who self-identify as monogamous are not necessarily sexually exclusive 79 and may be less likely to use safe sex practices with their primary partner. 80,81 The more common consensually nonmonogamous identities include swinging and polyamory. "Swingers" maintain social and emotional monogamy but allow for sexual nonmonogamy. ...
Article
Few topics generate such controversy and emotional reactivity as the nature of human mating behavior. Unfortunately, and potentially to the detriment of good patient care, sexual medicine practitioners have largely avoided this matter. An understanding of the scientific literature can empower practitioners to more effectively confront the inevitable monogamy and nonmonogamy challenges present in research and clinical practice. To review and summarize relevant scientific literature as a context to evaluate the more common myths and misunderstanding relating to the practice of monogamy and nonmonogamy in humans. This review also is intended to promote a discussion of the ways human mating strategies may impact sexual function and dysfunction for the individual and couple. A review of English written peer-reviewed evolutionary, anthropological, neuropsychiatric, zoological research, and other scholarly texts was conducted. Work published between 2000 and 2016 concentrating on evolutionary theory, long- and short-term mating strategies in primates and most specifically in humans, and consensual nonmonogamy was highlighted. Main outcomes included a brief explanation of evolutionary theory and a review of relevant literature regarding long- and short-term mating behaviors and consensual nonmonogamy. Serial sexual and social monogamy is the norm for humans. Across time and cultures, humans have adapted both long- and short-term mating strategies that are used flexibly, and sometimes simultaneously, based on unique personal, social, and environmental circumstances. Human mating behavior is individualistic, the result of numerous biopsychosocial influences. The clinician cannot assume that an individual presenting as a patient maintains a monogamy-valued view of his or her intimate relationship. Patients may experience conflict between the cultural monogamous ideal and their actual sexual behaviors. This conflict may be critical in understanding a patient's sexual concerns and in treatment planning. Awareness of these issues will aid the practitioner in sexual medicine.
Article
Consensually non-monogamous (CNM) romantic and sexual relationships tend to be stigmatized. The present research examined this stigma across two studies. First, we qualitatively explored the specific ways that people in CNM relationships report experiencing stigma using thematic analysis and identified the following four themes: Expressions of discomfort/disapproval of CNM, Loss of resources/threatening behaviors, Character devaluation, and Relationship devaluation (Study 1; N = 372). Second, we examined the relationship between experienced stigma and psychological well-being for people in CNM relationships, using the framework of minority stress theory. We found that experienced stigma was positively associated with psychological distress and that this association was partially statistically mediated by anticipated stigma and internalized stigma (Study 2; N = 383). Overall, this research strives to achieve a better understanding of the processes and potential consequences of stigma toward CNM relationships and individuals.
Article
Despite the cultural imperative in Western societies for individuals to practice monogamy, a considerable proportion of individuals report having engaged in consensual non-monogamous (CNM) relationships at some point in their life. To what extent are CNM relationships socially accepted? Through 34 semi-structured interviews conducted with Canadian parents who are polyamorous or in open relationships and their partners, we explore the participants’ representations of consensual non-monogamy, both the way they believe others to be reading them with regard to the way they do intimate relationships and the way they perceive themselves. Results show that parents involved in CNM relationships perceive others to hold negative assumptions about them with regard to their sexuality, the stability of their romantic relationships and the family environment they provide for their children. We also note that being a parent is seen by participants as exacerbating the negative reactions they face, and that gender influences, to some extent, these reactions. Ultimately, this study contributes to a better understanding of social changes related to sexuality and intimate relationships.
Article
Background: There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. Methods: A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. Results: A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16-24 years, 5.5% in 25-34 years, 7.8% in ≥35 years, ptrend=0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR=5.74, 95% CI: 1.20-27.44), followed by dating apps (aOR=2.99, 95% CI: 1.36-6.58), friends/family (aOR=2.99, 95% CI: 1.34-6.69) and social venues (e.g. bar) (aOR=2.73, 95% CI: 1.18-6.30). Group sex was strongly associated with STI positivity (aOR=6.24, 95% CI: 2.41-16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Conclusion: Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.
Article
Historically, sexually concurrent relationships have been associated with increased risk for sexually transmitted infections (STIs), including HIV. Due to socio-structural factors, African Americans (AAs) have higher rates of STIs compared to other racial groups and are more likely to engage in sexually concurrent (SC) relationships. Current research has challenged the assumption that SC is the only risky relationship type, suggesting that both SC and sexually exclusive (SE) relationships are at equal risk of STI and HIV acquisition and that both relationship types should engage in safer sex practices. This study aimed to compare sex practices and behaviors among AA men and women in SC and SE relationships (N = 652). Results demonstrate differences in sexual practices and behaviors between SC and SE men and women. Overall, SC and SE women report condom use with male partners less frequently than SC and SE men. SC men were more likely to report substance use during sex compared to SC and SE women. Pre-exposure prophylaxis (PrEP) use did not differ across groups. SE men were less likely to report STI testing and diagnosis compared to SC women. Findings support the need to focus on culturally and gender-specific safer sex interventions among AAs.
Article
Monogamy is current public policy for preventing sexually transmitted diseases (STDs). To evaluate whether monogamy is serving its intended purposes, the Centers for Disease Control’s (CDC’s) definition of monogamy is considered. This definition does not convey to the public the fact that monogamy must be practiced very strictly to be effective and implies that serial monogamy is a safe practice. Benefits and drawbacks of employing (different versions of) monogamy to reduce STD transmission are considered. Although certain forms of monogamy are efficacious in reducing STDs, these versions of monogamy have not been adopted by the public and widely practiced forms of monogamy are not effective in practice. Finally, this review considers whether the public policy of monogamy helps society achieve its sexual health goals, explicating strengths and weaknesses of monogamy advice versus other tactics that might be utilized to curb STDs.
Article
Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e., non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM). Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; Mage = 42.24, SD = 9.65, range: 23-76 years). All individuals were in a romantic relationship (Mlength = 13.47 years, SD = 9.39). Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months), and relationship agreement. Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (> 49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age. Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behavior to prevent sexually transmitted infections, especially among older and NCNM individuals.
Article
Drawing on qualitative in-depth interviews with people in the USA who have formed consensually non-monogamous relationships, this article introduces the term relational panopticism and uses empirical data to demonstrate the theoretical concept. Three primary themes in the data illustrate the origin, expression, and enforcement of relational panopticism: (1) encounters with institutions; (2) encounters with personal networks; and (3) coping and resistance strategies. Focusing on the daily reproduction of compulsory monogamy and the ways in which people in non-monogamous relationships negotiate and resist that reproduction, this study reveals how marginalized romantic and sexual relationship configurations are received and negotiated in interaction with family, peer groups, and institutions.
Full-text available
Presentation
Stigmatization of Polyamory: Perceptions, Predictors, and Clinical Implications
Article
Here, we present the current challenges in women's reproductive health and the current state-of-the-art treatment and prevention options for STI prevention, contraception, and treatment of infections. We discuss how the versatile platform of electrospun fibers can be applied to each challenge, and postulate at how these technologies could be improved. The void of approved electrospun fiber-based products yields the potential to apply this useful technology to a number of medical applications, many of which are relevant to women's reproductive health. Given the ability to tune drug delivery characteristics and three-dimensional geometry, there are many opportunities to pursue new product designs and routes of administration for electrospun fibers. For each application, we provide an overview of the versatility of electrospun fibers as a novel dosage form and summarize their advantages in clinical applications. We also provide a perspective on why electrospun fibers are well-suited for a variety of applications within women's reproductive health and identify areas that could greatly benefit from innovations with electrospun fiber-based approaches.
Article
We proposed that the premise that monogamy is the exemplary form of romantic partnership underlies much theory and research on relationship quality, and we addressed how this bias has prompted methodological issues that make it difficult to effectively address the quality of nonmonogamous relationships. Because the idea that consensually nonmonogamous (CNM) relationships are functional (i.e., satisfying and of high quality) is controversial, we included a basic study to assess, in a variety of ways, the quality of these relationships. In that study, we found few differences in relationship functioning between individuals engaged in monogamy and those in CNM relationships. We then considered how existing theories could help researchers to understand CNM relationships and how CNM relationships could shed light on relationship processes, and we proposed a model of how CNM and monogamous relationships differ. Finally, in a second study, we determined that even researchers who present data about CNM are affected by the stigma surrounding such relationships. That is, researchers presenting findings favoring polyamory were perceived as more biased than researchers presenting findings favoring monogamy.
Article
The increased media and public curiosity on the topic of consensual non-monogamy (CNM) presents an interesting case, given that these types of relationships are highly stigmatized. In the present review piece, we first situate common themes of benefits that people believe are afforded to them by their CNM relationships within the current state of the literature to provide insight into unique and shared (with monogamy) relationship benefits. This approach helps uncover relationship benefits and theoretical advances for research on CNM by highlighting some of the key features of CNM relationships that people find rewarding, including need fulfillment, variety of activities, and personal growth and development. Second, we discuss common misconceptions about CNM and stigma toward CNM. Finally, we conclude with future directions and recommendations for scholars interested in pursuing research on CNM.
Full-text available
Article
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Full-text available
Article
A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be "casual" sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information-motivation-behavioral skills model of preventive behavior.
Full-text available
Article
Since 1982, more than US$1 billion have been spent through federally sponsored abstinence-only-until-marriage (AOUM) programs, including nearly $800 million between 2001 and 2006, during the presidency of George W. Bush. With this increased funding has come pressure to evaluate the impact of AOUM programs. In 1998, a federally funded evaluation of AOUM programming was commissioned to assess its impact on young people. Because the abstinence policies and the evaluation of their success derive from the federal government, the authors identify the troubling potential of "embedded science." Using a recent example of research in the field of abstinence-only education (Maynard et al., 2005), the authors identify a number of practices and consequences of embedding research science within existing public policy. They find that when evaluation research is overly embedded, it tends to be dominated by political ideologies, information is omitted, and critique is virtually absent.
Full-text available
Article
The scientific community underlines that one of the main challenges for couples is the effect of time on sexual desire. Some studies suggest that although some dimensions associated with intimacy tend to increase during the relationship, sexual desire and the related constructs tend to decrease. Some researchers have recently suggested that couples' relationships with high degrees of sharing and fusion might be particularly detrimental for the sustenance of sexual desire. However, the authors found no empirical or theoretical studies that investigate the relations between intimacy and desire. Recovering the concept of differentiation as a possible influencing variable between intimacy and desire, this article develops reflections on this theme, which is of paramount relevance for the couple viability.
Full-text available
Article
Human Papillomavirus (HPV) is the most common STI among youth in the U.S. As alternative school students are at higher risk of acquiring STIs compared to regular high school students, this study examined HPV knowledge and risk perception among Latino youth attending 9 alternative high schools in Houston, Texas. HPV knowledge measures assessed prevalence, health consequences, symptoms, transmission, and risk reduction strategies. Three measures assessed perceived risk. The sample included 414 youth (58.4% female) with a mean age of 16.6 years (SD = 1.86); 63.8% were sexually experienced. Most (76.0%) were U.S.-born to parents from Mexico, Central or South America (70.8% of mothers and 77.8% of fathers, respectively); 61.7% had parents with less than a high school education. Results indicate that youth answered 1 out of 5 HPV knowledge items correctly (mean = 1.3, SD = 1.45); 35.8% identified skin-to-skin contact during sex as the most common mode of HPV transmission, and 72.5% selected condoms as an effective HPV risk reduction strategy followed by avoiding multiple partners (55.8%), abstinence (47.5%), monogamous relationships (26.8%) and HPV vaccination (22.3%). Only twenty-seven youth (6.5%) perceived themselves to be at high risk for contracting HPV. Regression analyses examining the association between demographic variables, sexual behavior, HPV knowledge, and HPV risk perception, showed significant associations for mothers' place of birth only - youth whose mothers were born outside of the U.S. had significantly lower HPV knowledge than those with American-born mothers (p < 0.007). Findings indicate the need for enhanced educational efforts among Latino alternative school youth regarding the prevalence of HPV and effective risk reduction strategies.
Full-text available
Article
The public health advice to "either know your partner well, or use condoms" may have led to higher levels of risky sexual behaviour between well-acquainted individuals whose HIV status is unknown. This study assessed the extent to which college students believe that knowing their partner well eliminates the need to practice safer sex, and measured the relationship between such beliefs and the performance of necessary safer sexual practices, such as using condoms during sexual intercourse. Endorsement of beliefs that partner knowledge made safer sex unnecessary was common, and agreement with these beliefs correlated significantly and negatively with levels of AIDS preventive behaviours and behavioural intentions, especially among women. In conclusion, the public health dictum to "know your partner" has been widely internalized, and may be contributing to risky sexual behaviour. Consideration should be given to rejecting explicitly the "know your partner" advice, and to re-educating the public regarding the necessity of consistently practising safer sex with any individual whose HIV status is unknown.
Full-text available
Article
To determine the prevalence of sexual infidelity and disclosure among undergraduates and to identify the characteristics of those engaging in infidelity. Analysis of responses from an online survey of 1341 undergraduate. Approximately 27% of males and 20% of females reported having oral, vaginal, or anal sex outside a partner-perceived monogamous relationship. Men over the age of 20, binge drinkers, fraternity members, male NCAA athletes, or the nonreligious were most likely to engage in these behaviors. Implement educational strategies to encourage undergraduates in committed relationships to reconsider their STI risk and to protect themselves via condom usage.
Full-text available
Article
The most commonly cited descriptions of the behavioral characteristics of habituation come from two papers published almost 40 years ago [Groves, P. M., & Thompson, R. F. (1970). Habituation: A dual-process theory. Psychological Review, 77, 419-450; Thompson, R. F., & Spencer, W. A. (1966). Habituation: A model phenomenon for the study of neuronal substrates of behavior. Psychological Review, 73, 16-43]. In August 2007, the authors of this review, who study habituation in a wide range of species and paradigms, met to discuss their work on habituation and to revisit and refine the characteristics of habituation. This review offers a re-evaluation of the characteristics of habituation in light of these discussions. We made substantial changes to only a few of the characteristics, usually to add new information and expand upon the description rather than to substantially alter the original point. One additional characteristic, relating to long-term habituation, was added. This article thus provides a modern summary of the characteristics defining habituation, and can serve as a convenient primer for those whose research involves stimulus repetition.
Full-text available
Article
An integrative model of change was applied to the study of 872 Ss (mean age 40 yrs) who were changing their smoking habits on their own. Ss represented the following 5 stages of change: precontemplation, contemplation, action, maintenance, and relapse. 10 processes of change were expected to receive differential emphases during particular stages of change. Results indicate that Ss (a) used the fewest processes of change during precontemplation; (b) emphasized consciousness raising during the contemplation stage; (c) emphasized self-reevaluation in both contemplation and action stages; (d) emphasized self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) used counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers responded as a combination of contemplaters and people in action would. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. (14 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Full-text available
Article
The Sociosexual Orientation Inventory (SOI; Simpson & Gangestad 1991) is a self-report measure of individual differences in human mating strategies. Low SOI scores signify that a person is sociosexually restricted, or follows a more monogamous mating strategy. High SOI scores indicate that an individual is unrestricted, or has a more promiscuous mating strategy. As part of the International Sexuality Description Project (ISDP), the SOI was translated from English into 25 additional languages and administered to a total sample of 14,059 people across 48 nations. Responses to the SOI were used to address four main issues. First, the psychometric properties of the SOI were examined in cross-cultural perspective. The SOI possessed adequate reliability and validity both within and across a diverse range of modem cultures. Second, theories concerning the systematic distribution of sociosexuality across cultures were evaluated. Both operational sex ratios and reproductively demanding environments related in evolutionary-predicted ways to national levels of sociosexuality. Third, sex differences in sociosexuality were generally large and demonstrated cross-cultural universality across the 48 nations of the ISDP, confirming several evolutionary theories of human mating. Fourth, sex differences in sociosexuality were significantly larger when reproductive environments were demanding but were reduced to more moderate levels in cultures with more political and economic gender equality. Implications for evolutionary and social role theories of human sexuality are discussed.
Full-text available
Article
Abstinence from sexual intercourse is an important behavioral strategy for preventing human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and pregnancy among adolescents. Many adolescents, including most younger adolescents, have not initiated sexual intercourse and many sexually experienced adolescents and young adults are abstinent for varying periods of time. There is broad support for abstinence as a necessary and appropriate part of sexuality education. Controversy arises when abstinence is provided to adolescents as a sole choice and where health information on other choices is restricted or misrepresented. Although abstinence is theoretically fully effective, in actual practice abstinence often fails to protect against pregnancy and STIs. Few Americans remain abstinent until marriage; many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents. Although abstinence is a healthy behavioral option for teens, abstinence as a sole option for adolescents is scientifically and ethically problematic. A recent emphasis on abstinence-only programs and policies appears to be undermining more comprehensive sexuality education and other government-sponsored programs. We believe that abstinence-only education programs, as defined by federal funding requirements, are morally problematic, by withholding information and promoting questionable and inaccurate opinions. Abstinence-only programs threaten fundamental human rights to health, information, and life.
Article
The Community Preventive Services Task Force (Task Force) recommends group-based comprehensive risk reduction delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). The recommendation is based on sufficient evidence of effectiveness in: reducing a number of self-reported risk behaviors, including engagement in any sexual activity, frequency of sexual activity, number of sex partners, and frequency of unprotected sexual activity; increasing the self-reported use of protection against pregnancy and STIs; and reducing the incidence of self-reported or clinically documented STIs. Direct evidence of effectiveness for reducing pregnancy and HIV is, however, limited. The Task Force finds insufficient evidence to determine the effectiveness of group-based abstinence education delivered to adolescents to prevent pregnancy, HIV, and other STIs. Evidence was considered insufficient because of inconsistent results across studies.
Article
Consensual non-monogamy (CNM) refers to romantic relationships in which all partners agree to engage in sexual, romantic and/or emotional relationships with others. Within the general framework of CNM, subtypes of relationships differ in the extent to which partners intend for love and emotional involvement to be a part of their multiple relationships (that is, some relationships may prioritise love over sex with multiple partners, or vice versa). The present study examined whether individuals were more likely to stigmatise relationships that: (i) focus on loving more than one person (which is characteristic of polyamory), (ii) focus on having sex without love (which is characteristic of swinging lifestyles), or (iii) involve having sex without love without a partner’s participation (which is characteristic of open relationships). In the present research, participants were assigned to read a definition of one of the three CNM relationship types (i.e. a swinging, polyamorous or open relationship) and to indicate their attitudes towards individuals who participate in those relationships. Results show that swingers were overwhelmingly perceived more negatively (e.g. less responsible) than individuals in polyamorous relationships and that people in open relationships were sometimes perceived more negatively (e.g. less moral) than people in polyamorous relationships. Overall, findings suggest that people are more uncomfortable with the idea of strictly sexual relationships (i.e. swinging relationships) than relationships involving multiple romantic/emotional attachments (i.e. polyamorous relationships).
Article
Improving and promoting condoms may be a more effective tactic than monogamy, drugs or vaccines in fighting AIDS and other sexually transmitted diseases.
Article
In the context of recent debates about same-sex marriage, consensually nonmonogamous (CNM) relationships have recently begun making their way into media discussions. In the current research, we investigated whether stigma is attached to these nonnormative romantic relationships and, conversely, whether halo effects surround monogamous relationships. In Study 1 we analyzed open-ended responses to the question “what are the benefits of monogamy?”. The most commonly mentioned benefits included the promotion of commitment and health (especially the prevention of sexually transmitted infections [STIs]). In Study 2, descriptions of CNM relationships were strongly stigmatized and a substantial halo effect surrounded monogamous relationships. Specifically, monogamous relationships were rated more positively than CNM relationships on every dimension (both relationship-relevant and arbitrary relationship-irrelevant factors) that we examined and across diverse social groups, including CNM individuals themselves. In Study 3, we conducted a person perception study in which participants provided their impressions of a monogamous or a CNM relationship. The monogamous couple was rated overwhelmingly more favorably than the CNM relationship. Finally, in Study 4, we replicated the findings with a set of traits that were generated with regard to relationships in general (rather than monogamous relationships, specifically) and with a broader set of arbitrary traits. Across all studies, the results consistently demonstrated stigma surrounding CNM and a halo effect surrounding monogamy. Implications for future research examining similarities and differences between monogamous and CNM relationships are discussed.
Article
In our target article, “The Fewer the Merrier: Assessing Stigma Surrounding Consensual Nonmonogamous Relationships,” we documented a robust stigma toward consensual nonmonogamous relationships and a halo surrounding monogamous relationships. In the present piece, we respond to six commentaries of our target article with the aim of promoting future research and policy change. First, we address questions and concerns raised by commentators using existing data and found that regardless of perceived relationship happiness, sexual orientation, or gender (of experimental targets), individuals in consensual nonmonogamous relationships were more negatively viewed on a variety of qualities (both relationship-specific and nonrelationship specific) compared to those in monogamous relationships. Second, we suggest productive future research avenues with regards to implications for social change, and strengthening methodology used in consensual nonmonogamous research. Finally, we consider common ground among the commentators as an avenue to promote coalition building through the examinations of prejudice toward individuals in nonnormative romantic relationships. We conclude that this is only the beginning of a fruitful line of research and argue that the stigma toward departures from monogamy is robust and, of course, worthy of additional research.
Article
In this qualitative research, I first use hegemony theory to describe the cultural forces that position monogamy as the only privileged form of committed sexual relationship coupling available to undergraduate heterosexual men. I then interview 40 heterosexual male students for their experience with monogamy and cheating, finding that the hegemonic mechanisms of subordination and stratification that stigmatize nonmonogamy consequently result in an absence of consideration of the problems associated with monogamy. I use cognitive dissonance theory to explain participants’ desires for simultaneously wanting monogamy and nonmonogamy, calling this dissonance ‘the monogamy gap.’ Data suggest that participants who cheat do so not because of lost love, but instead cheating represents an attempt to rectify conflicting desires for monogamy and recreational sex.
Article
The future course of the HIVlAIDS epidemic depends on the ratio of secondary to primary infections early in the epidemic. If this ratio, here called the reproductive rate of infection, exceeds unity then the epidemic can be expected to flourish ; otherwise it will eventually abate. Estimates of the reproductive rate of HIV infection, obtained via a Bernoulli process model of the sexual transmission of HIV, indicate that decreasing the infectivity of the virus, through the consistent use of condoms, for example, is more effective at reducing the reproductive rate of infection than is limiting the number of sexual partners, regardless of the initial prevalence of HIV infection in the population under consideration.
Article
The lifespan sexual history of many Americans can be modeled as a series of long-term monogamous relationships coupled with some number of brief affairs. Implicit in this model is the assumption that these monogamous relationships arise as a natural consequence of the search for a single partner with whom to share one's life, and therefore cannot be eliminated. Hence the only opportunity to reduce the number of sexual partners is by decreasing the number of short-term relationships. In contrast, condoms can be used in all relationships, regardless of the expected duration. But which is more effective at reducing the risk of HIV infection, the consistent use of condoms or decreasing the number of short-term sexual partners? This article employs a Bernoulli process model of HIV transmission to evaluate the infection risks associated with various sexual behavior patterns in an attempt to answer such questions.
Article
Drawing on qualitative in-depth interviews with bisexual-identified practitioners of polyamory in the UK, this article shows that love, intimacy and friendship are salient themes in polyamory discourses. An exploration of the question of how respondents define polyamory with regard to different ‘styles of non-monogamy’ reveals that the boundaries of polyamory are contested within the movement that has formed around this concept. The prevalent definition of polyamory as ‘responsible non-monogamy’ usually goes hand in hand with a rejection of more sex- or pleasure-centred forms of non-monogamy, such as ‘casual sex’, ‘swinging’, or ‘promiscuity’. The author argues that the salience of the relational ideologies of love and intimacy hampers the potential of polyamory to ground a truly pluralistic sexual ethics.
Article
There are a number of philo- sophical and practical reasons for using information-based ap- proaches to changing health- related behavior. The idea that people will change their behavior when they are informed about the logic of doing so is consistent with the Western worldview, which places individualism, enlighten- ment, and reason at the center of its value system. Knowledge-based behavior change is, in theory, inter- nalized. Thus, the new behaviors will last longer, display a greater resistance to extinction, and gener- alize across more situations than will new behaviors arising from other forms of social influence (e,g., reward, coercion, and compliance with authority figures). Behaviors based on these other influences may be relatively situation specific and require surveillance for com- pliance.
Article
This research involved comparisons of the condom use behaviours of people who are in monogamous relationships but who have engaged in extradyadic sex (i.e. committed infidelity) to those who are in consensually nonmonogamous (CNM) relationships. Consensual nonmonogamy is the practice of openly having multiple sexual or romantic partners simultaneously, with the full knowledge and consent of all participating partners. Participants in CNM relationships used condoms more correctly in their last instance of intercourse than those who were committing infidelity.
Article
Background Headache associated with sexual activity is a well-known primary headache disorder. In contrast, some case reports in the literature suggest that sexual activity during a migraine or cluster headache attack might relieve the pain in at least some patients. We performed an observational study among patients of a tertiary headache clinic.MethodsA questionnaire was sent to 800 unselected migraine patients and 200 unselected cluster headache patients. We asked for experience with sexual activity during a headache attack and its impact on headache intensity. The survey was strictly and completely anonymous.ResultsIn total, 38% of the migraine patients and 48% of the patients with cluster headache responded. In migraine, 34% of the patients had experience with sexual activity during an attack; out of these patients, 60% reported an improvement of their migraine attack (70% of them reported moderate to complete relief) and 33% reported worsening. In cluster headache, 31% of the patients had experience with sexual activity during an attack; out of these patients, 37% reported an improvement of their cluster headache attack (91% of them reported moderate to complete relief) and 50% reported worsening. Some patients, in particular male migraine patients, even used sexual activity as a therapeutic tool.Conclusions The majority of patients with migraine or cluster headache do not have sexual activity during headache attacks. Our data suggest, however, that sexual activity can lead to partial or complete relief of headache in some migraine and a few cluster headache patients.
Article
In this article, we critically examine the social institution of monogamy. First, we discuss the lack of an adequate and consistent definition of the construct of monogamy and consider how common monogamy is. Next, we address perceived benefits of monogamy and whether those ostensible benefits are supported by empirical evidence. We conclude that evidence for the benefits of monogamy relative to other relationship styles is currently lacking, suggesting that, for those who choose it, consensual non-monogamy may be a viable alternative to monogamy. Implications for theories of close relationships are discussed.
Article
We examined risk factors for HIV and changes in condom use among heterosexual adults (N = 987) over three waves of data from the AIDS in Multi‐Ethnic Neighborhoods (AMEN) cohort survey (1988–89, 1989–90, 1991–92). We found that respondents had maintained increases in condom use reported at Wave 2, but the overall picture is one of condom use having plateaued (and possibly decreased; see sales data). The self‐report condom use data parallel national data on condom sales for 1990 to 1992. Changes in condom use between Waves 2 and 3 were unrelated to social class, race / ethnicity, and age. Men and people without primary sexual partners were the most likely to report gains in condom use from Wave 2 to 3. At‐risk people did not show changes in condom use with primary sexual partners. People with multiple sexual partners at Waves 2 and 3 also did not change in condom use. However, people who acquired risk by Wave 3 showed significant increases in occasional condom use. The results call for renewed efforts to facilitate condom use (and HIV testing) among the chronically at risk and those at‐risk individuals who enter “monogamous” relationships.
Article
This investigation examined reasons for (un)faithfulness. Driven by interdependence theory, data from 220 undergraduates at a southwestern U.S. university indicate that men have more relational alternatives than women and individuals’ relational investments tied to relational stage as well as length of relationship. Significant predictors of infidelity among men and women are quality of alternatives, believing that sex occurs early in a relationship, and having been cheated on (applied to men only). Quality of alternatives predicted cheating among seriously dating individuals, whereas marrieds reported the strongest predictor of cheating as being cheated on. Fear of sanctions related to cheating but not to commitment. Legal sanctions motivated monogamy for men but not women. Participants reported over 500 reasons to remain faithful and over 1,000 reasons to cheat.
Article
In four studies, we documented the symbolic meanings of the progression of contraceptive use in close relationships. In Study 1A, participants perceived a couple in which one partner suggests changing contraceptive method from condoms to the pill (a normative transition script) as having a more positive relationship than a couple in which one partner suggests changing from the pill to condoms (a counternormative transition script). In Study 1B, participants believed that couples who followed a counternormative transition script had higher likelihood of infidelity/STDs and a lower degree of closeness than couples who followed a normative transition script. In Study 2A, the association of counternormative transition with perceptions of greater infidelity and lower closeness was demonstrated among a group of college students imagining their own relationship partners suggesting the transition. In Study 2B, participants who imagined that their partner suggested a counternormative transition reported more negative emotions than did participants who imagined that their partner suggested a normative transition. These findings suggest that the symbolic meaning of condoms and birth control pills may contribute to the relative lack of safer sex behaviors in close relationships.
Article
In this article, we review the major research advances made during the 1990s in the study of sexuality in marriage and other close relationships. More specifically, we provide a critical review of the empirical findings from the last decade on such sexual phenomena as sexual behavior, sexual satisfaction, and sexual attitudes within the context of marriage, dating, and other committed relationships. After highlighting the major theoretical and methodological advances of the 1990s, we focus on the research literatures of: (1) frequency and correlates of sexual activity in marriage; (2) sexual satisfaction, including its association with general relationship satisfaction; (3) sexuality in gay and lesbian committed relationships; (4) trends in sexual behavior and attitudes in dating relationships; and (5) the role of sexuality in dating relationships. We also incorporate brief reviews of the past decade's research on sexual assault and coercion in marriage and dating and on extramarital sex. We end our decade review with recommendations for the study of sexuality into the next decade.
Article
Given the prevalence and harm of sexually transmitted infections (STIs), there is a need to examine safer sex strategies in the context of romantic relationships and extradyadic sexual encounters. Sexual infidelity is associated with a variety of detrimental psychosocial outcomes; however, little research has addressed the sexual health ramifications of sexually unfaithful partners and members of other high-risk nonmonogamous lifestyles. To determine whether sexually unfaithful individuals or "negotiated nonmonogamous" individuals are more likely to engage in sexual health risk reduction behaviors during extradyadic encounters and with their primary partner. Data were collected via an anonymous Internet-based study. Several hundred sexually unfaithful individuals and individuals with a negotiated nonmonogamy agreement completed a sexual health questionnaire. Self-reported measures of risk reduction behaviors within the primary relationship and risk reduction behaviors during the extradyadic encounter were assessed. Sexually unfaithful participants demonstrated significantly lower rates of protective sexual health behaviors both within their primary partnerships and during their extradyadic sexual encounters. Sexually unfaithful participants were also less likely to engage in frequent STI testing, and less likely to discuss safer sex concerns with new partners. These data add to the literature on the negative effects of sexual unfaithfulness. Understanding rates of nonengagement in safer sex strategies will be helpful to those who lead efforts to increase condom use and other preventive STI measures.
Article
Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group. Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews. Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates. Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.
Article
We examined the ambiguity of monogamy as a safer-sex goal in a sample of young, inner- city women (N = 447), of whom 58 percent were African- American and 42 percent European-American. It was our premise that women may be misperceiving and underestimating their risk due to differences in their definition and beliefs about monogamy, and thus are not changing their behavior. When compared to long-term monogamous women (self-reporting one partner in the past year), serially monogamous women (reporting two or more partners in the past year) perceived themselves at greater risk but did not report more frequent use of condoms. It is possible that a suggestion of monogamy may be subject to multiple interpretations and thus could be providing women with a false sense of safety. Risk reduction should be defined in specific behavioral terms.
Article
The concept of concurrent partnerships, while theoretically appealing, has been challenged at many levels. However, non-monogamy may be an important risk factor for the acquisition and transmission of sexually transmitted infections (STI). One's own non-monogamy is a risk factor for transmitting STI to others, partners' non-monogamy is a risk factor for acquiring STI and, most importantly, mutual non-monogamy is a population level determinant of increased STI spread. This study describes the levels, distribution and correlates of non-monogamy, partners' non-monogamy and mutual non-monogamy among adult men and women in the USA. Data from the National Survey of Family Growth (NSFG) Cycle 6 were used. NSFG is a national household survey of subjects aged 15-44 years in the USA. Cochran-Mantel-Haenszel tests and χ(2) tests were used in the analysis. Among sexually active adults, 17.6% of women and 23.0% of men (an estimated 19 million) reported non-monogamy over the past 12&emsp14;months in 2002. An estimated 11 million Americans (1 in 10) reported partners' non-monogamy and an estimated 8.4 million (7% of women and 10.5% of men) reported mutual non-monogamy. All three types of non-monogamy were reported more frequently by men than women. Younger age, lower education, formerly or never married status, living below the poverty level and having spent time in jail were associated with all three types of non-monogamy in general. The three types of non-monogamy may be helpful in tailoring prevention messages and targeting prevention efforts to subgroups most likely to spread infection.
Article
New sex partners put adolescents at increased risk for sexually transmitted infections (STIs), even when these sex partners are nonoverlapping. Although the risk of partner change is well described, little is known about its antecedents. We prospectively examined associations between relationship characteristics, partner change, and subsequent STI during intervals of "serial monogamy." As part of a longitudinal study, 332 adolescent women were interviewed and tested for gonorrhea, chlamydia, and trichomonas every 3 months for up to just over 6 years. Interviews covered partner-specific relationship characteristics and sexual behaviors. The quarterly interval, a 3-month period bracketed by interviews and STI testing, was the unit of analysis. We examined associations among relationship factors, partner change, and subsequent STI using a series of mixed regression models, controlling for age, STI at Time 1, and condom nonuse. Age, lower relationship quality, and lower levels of partner closeness to friends and family predicted partner change from Time 1 to Time 2. In turn, partner change was associated with acquisition of a new STI at Time 2. Although relationship factors did not exert a direct effect on STI at Time 2, they improved partner change-STI model fit. Similar patterns were seen with each organism. Relationship factors drive partner change, which in turn contributes to STI acquisition. STI prevention research may need to focus on the relationship antecedents to partner change, in addition to the partner change itself.
Article
This study investigated 832 college students' experiences with hooking up, a term that refers to a range of physically intimate behavior (e.g., passionate kissing, oral sex, and intercourse) that occurs outside of a committed relationship. Specifically, we examined how five demographic variables (sex, ethnicity, parental income, parental divorce, and religiosity) and six psychosocial factors (e.g., attachment styles, alcohol use, psychological well-being, attitudes about hooking up, and perceptions of the family environment) related to whether individuals had hooked up in the past year. Results showed that similar proportions of men and women had hooked up but students of color were less likely to hook up than Caucasian students. More alcohol use, more favorable attitudes toward hooking up, and higher parental income were associated with a higher likelihood of having hooked up at least once in the past year. Positive, ambivalent, and negative emotional reactions to the hooking up experience(s) were also examined. Women were less likely to report that hooking up was a positive emotional experience than men. Young adults who reported negative and ambivalent emotional reactions to hooking up also reported lower psychological well-being and less favorable attitudes toward hooking up as compared to students who reported a positive hooking up experience. Based on these findings, suggestions for psychoeducational programming are offered. Additionally, directions for future research are provided.
Article
The Transtheoretical Model of Behavior Change was examined for its applicability to contraceptive and condom use adoption and maintenance using N = 248 heterosexually active college-age men and women. The model posits that individuals do not go directly from old behaviors to new behaviors to new behaviors, but progress through a sequence of stages: precontemplation, contemplation, preparation, action, and maintenance. The stages of change offer a temporal dimension that provides information regarding when a particular shift in attitudes, intentions, and behavior may occur. The model also postulates a set of or outcome variables--the pros and cons of change and self-efficacy. The results demonstrated that individuals were furthest along in the stages of change for general contraceptive use, followed closely by condom use with other (e.g., casual) partners, and then condom use with main partners. Although no sex differences were found for the stages for the three separate contraceptive behaviors, males and females differed on the pros and cons and levels of self-efficacy when engaging in intercourse with the two types of partners. MANOVA/ANOVA results indicated that the relationship between stages and other constructs follows predicted patterns suggesting that the transtheoretical model may provide a useful framework or paradigm for understanding contraceptive and condom use behavior.
Article
AIDS is increasing almost four times as fast among women, yet lesbians and bisexual women are among the least studied, least understood and most elusive populations affected by the AIDS epidemic. This paper reports the results of community-level HIV prevention research designed: (a) to examine the knowledge, perceptions, social contingencies and political constraints affecting the HIV risk taking of lesbians and bisexual women; and (b) to offer them context specific HIV prevention education. The study was a peer educator-based intervention project situated in San Francisco's women's bars, dance clubs, and sex clubs to reach socially and sexually active lesbians and bisexual women in natural settings. Between June 1992 and May 1993, ethnographic interviews were conducted with 626 women attending the bars and clubs; group presentations at these locales reached 1,315 women. The structure of the intervention was effective in prompting interest in HIV prevention information and intent to change behavior. The resultant cultural analysis details risk behaviors lesbians and bisexual women participate in, myriad constraints they face in trying to enact safer behaviors, gaps in knowledge, difficulties comprehending the relevance of HIV prevention, and risk reduction strategies commonly employed.
Article
Data from the National AIDS Behavioral Survey were used to examine the social distribution of extramarital sex and risk for human immunodeficiency virus (HIV) infection among married individuals in the United States. Of 1686 married respondents living across the United States, 2.2% reported extramarital sex; of 3827 married respondents living in 23 urban areas with large Hispanic or African-American populations, 2.5% reported having sexual partners outside marriage. The data indicate that the correlates of extramarital sex varied by race/ethnicity. Low levels of condom use were found among people reporting extramarital sex (8% to 19% consistent users).
Article
Two hundred thirty-seven college students involved in heterosexual relationships were surveyed to determine the effects of relationship type and use of forms of contraception other than condoms on condom use. Findings indicated that in the context of a short-term, monogamous relationship, the use of another form of birth control was associated with decreased condom use. In addition, 20% of the participants reported that they had wanted to use a condom for disease prevention on at least one occasion but had decided not to do so because they were using another form of contraception. Implications for preventive health are discussed.
Article
Two hundred ten heterosexual undergraduates in dating relationships were surveyed about reasons for not using condoms every time for vaginal and anal sex and for increasing or decreasing condom use during their relationships. Half of the respondents reported consistent condom use in the first month of their relationships, while only 34% reported consistent condom use in the past month. Subjective assessments of partner safety and the belief that sufficient measures were being taken to avoid pregnancy were important reasons for condom nonuse. Study results suggest that interventions should emphasize the importance of objectively assessing HIV/STD risk before reducing condom use within relationships. Interventions also need to provide additional information on the riskiness of heterosexual anal sex.
Article
Previous reviews of the literature on medication compliance have confirmed the inverse relationship between number of daily doses and rate of compliance. However, compliance in most of these studies was based on patient self-report, blood-level monitoring, prescription refills, or pill count data, none of which are as accurate as electronic monitoring (EM). In this paper, we review studies in which compliance was measured with an EM device to determine the associations between dose frequency and medication compliance. Articles included in this review were identified through literature searches of MEDLINE, PsychInfo, HealthStar, Health & Psychosocial Instruments, and the Cochrane Library using the search terms patient compliance, patient adherence, electronic monitoring, and MEMS (medication event monitoring systems). The review was limited to studies reporting compliance measured by EM devices, the most accurate compliance assessment method to date. Because EM was introduced only in 1986, the literature search was restricted to the years 1986 to 2000. In the identified studies, data were pooled to calculate mean compliance with once-daily, twice-daily, 3-times-daily, and 4-times-daily dosing regimens. Because of heterogeneity in definitions of compliance, 2 major categories of compliance rates were defined: dose-taking (taking the prescribed number of pills each day) and dose-timing (taking pills within the prescribed time frame). A total of 76 studies were identified. Mean dose-taking compliance was 71% +/- 17% (range, 34%-97%) and declined as the number of daily doses increased: 1 dose = 79% +/- 14%, 2 doses = 69% +/- 15%, 3 doses = 65% +/- 16%, 4 doses = 51% +/- 20% (P < 0.001 among dose schedules). Compliance was significantly higher for once-daily versus 3-times-daily (P = 0.008), once-daily versus 4-times-daily (P < 0.001), and twice-daily versus 4-times-daily regimens (P = 0.001); however, there were no significant differences in compliance between once-daily and twice-daily regimens or between twice-daily and 3-times-daily regimens. In the subset of 14 studies that reported dose-timing results, mean dose-timing compliance was 59% +/- 24%; more frequent dosing was associated with lower compliance rates. A review of studies that measured compliance using EM confirmed that the prescribed number of doses per day is inversely related to compliance. Simpler, less frequent dosing regimens resulted in better compliance across a variety of therapeutic classes.
Article
112 college students reported the frequency of their sexual encounters and were divided into four categories: none, infrequent (less than once a week), frequent (one to two times per week), and very frequent (three or more times per week). Participants also described their overall sexual satisfaction. Saliva samples were collected and assayed for salivary immunoglobulin A (IgA). Individuals in the frequent group showed significantly higher levels of IgA than the other three groups, which were comparable. Data on length of relationship and sexual satisfaction were not related to the group differences.
Article
Penile-vaginal intercourse (PVI) but not other sexual behavior is associated with better psychological and physiological function. I examined the relationship of sexual behavior patterns to blood pressure (BP) and its reactivity to stress (public speaking and verbal arithmetic). For a fortnight, 24 women and 22 men used daily diaries to record PVI, masturbation, and partnered sexual behavior in the absence of PVI. Persons who reported PVI (but no other sexual activities) had better stress response (less reactivity and/or lower baseline levels) than persons reporting other or no sexual behaviors. Persons who only masturbated or had partnered sex without PVI had 14 mmHg more systolic BP reactivity than those who had PVI but not the other behaviors. Many variables were examined but failed to confound the observed relationships. The magnitude of the sexual behavior effect on BP reactivity is greater than of other factors in the literature. These findings add to the research corpus on the benefits of PVI (differentiated from other sexual activities).
Article
Achieving optimal outcomes in the treatment of hypertension--a prevalent and largely asymptomatic disease--necessitates that patients take their medications not only properly (medication adherence) but also continue to do so throughout long-term treatment (persistence). However, poor medication-taking behavior is a major problem among patients with hypertension, and has been identified as one of the main causes of failure to achieve adequate control of blood pressure (BP). In turn, patients with hypertension who have uncontrolled BP as a result of their poor medication-taking behavior remain at risk for serious morbidity and mortality (eg, stroke, myocardial infarction, and kidney failure), thereby accounting for a significant cost burden through avoidable hospital admissions, premature deaths, work absenteeism, and reduced productivity. Improving medication-taking behavior during antihypertensive therapy therefore represents an important potential source of health and economic improvement. Whereas many factors may contribute to poor medication-taking behavior, the complexity of dosage regimens and the side effect profiles of drugs probably have the greatest therapy-related influence. Central to any strategy aimed at improving outcomes for patients with hypertension, therefore, are efficacious antihypertensive agents that facilitate good medication-taking behavior through simplified dosing and placebo-like tolerability, along with the development of programs to detect poor medication adherence and to support long-term medication persistence in daily practice.
Article
This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a program group that was eligible to participate in one of the four programs or a control group that was not. The findings show no significant impact on teen sexual activity, no differences in rates of unprotected sex, and some impacts on knowledge of STDs and perceived effectiveness of condoms and birth control pills