Under the perspective of the Theory of Planned Behavior, the objective of this study was to know the gender
differences in the variables involved in the use of effective preventive measures in sexual relations against HIV
in a sample of university students from Spain and Portugal. Furthermore, it is examined whether these factors
produce different predictions concerning the adoption of safe sexual behaviour for young man and women in
each country. The sample consisted of 683 university students, 319 Portuguese (64% female and 36% male)
from the University of Algarve and 364 Spanish students (51% female and 49% male) from the University of
Huelva. Data were obtained by means of a questionnaire. The data revealed that there are gender differences
which apply in both countries, highlighting that the young women have more positive attitudes, greater perceived
behavioural control and intention of condom use than young men. However, they protect themselves less that
their male counterparts: the percentage of females who say using condoms as a contraceptive method is less
than the percentage of males, and especially with their steady partners. The results are discussed in relation to
gender role norms, to have a steady partner or not, gender relations, the associated meaning to sexual relations
for men and women and their implications for the design of sexual educational programmes for them.
Keywords: HIV/AIDS; gender differences; university students; preventive sexual behaviors.
Bajo el enfoque de la Teoría de la Conducta Planeada, el objetivo de este estudio fue analizar las diferencias
de género en cuanto a las variables que están implicadas en el uso efectivo de medidas preventivas en las
relaciones sexuales frente al VIH, en una muestra de estudiantes universitarios de España y Portugal. Además,
se analizó si estas variables provocan diferencias en las predicciones relacionadas con la adopción de conductas
sexuales seguras por chicos y chicas en cada país. La muestra estaba formada por 683 estudiantes universitarios,
319 portugueses (64% mujeres y 36% hombres) de la Universidade do Algarve y 364 estudiantes españoles
(51% mujeres y 49% hombres) de la Universidad de Huelva. Los datos fueron recogidos a través de un cuestionario.
Los datos revelaron que hay diferencias de género que se mantienen en ambos países, destacando que las
chicas tienen actitudes más positivas, una mayor percepción de control del comportamiento y una mayor
intención de uso del preservativo que los chicos. Sin embargo, las chicas se protegen menos que sus homólogos
masculinos: el porcentaje de mujeres que dicen usar el preservativo como un método anticonceptivo es menor
que el porcentaje de hombres, y especialmente con sus parejas estables. Los resultados se discuten en relación
con el papel de las normas de género, con el hecho de tener pareja estable o no, las relaciones de género, el
significado asociado a las relaciones sexuales entre hombres y mujeres y sus implicaciones para el diseño de
programas de educación sexual.
Palabras clave: VIH/SIDA; diferencias de género; estudiantes universitarios; conductas sexuales de prevención.
Gender Differences in HIV-Related Sexual Behavior
among College Students from Spain and Portugal
Alicia Muñoz-Silva1, Manuel Sánchez-García1, Ana Martins2,
and Cristina Nunes2
1Universidad de Huelva (Spain)
2Universidade do Algarve (Portugal)
The Spanish Journal of Psychology
2009, Vol. 12, No. 2, 485-495
Copyright 2009 by The Spanish Journal of Psychology
We would like to thank the anonymous reviewers for comments and suggestions which improved the quality of this paper.
Correspondence concerning this article should be addressed to Alicia Muñoz-Silva. Departamento de Psicología Evolutiva y de la
Educación. Facultad de Ciencias de la Educación. Universidad de Huelva. Campus de El Carmen, s/n. 21007 Huelva (Spain). Phone:
+34-959219208; Fax: +34-959219357. E-mail: email@example.com
HIV affects mainly to young people. So, among adults
15 years and older, young people (15 to 24 years of age)
accounted for 40% of new HIV infections in 2006
(UNAIDS & WHo, 2006). Intravenous drug users sharing
needles or unprotected same-sex relations still constitute
an important means for HIV transmission. However, in
Western Europe the number of HIV infections newly
diagnosed in persons infected through heterosexual contact
increased from 6017 in 2001 to 10722 in 2006 (EuroHIV,
2006, 2007), with the corresponding increase in the number
of infected women. Furthermore, the proportion of women
among newly infected people with a diagnosis of HIV
infection increased from 25% in 1997 to 38% in 2002
(UNAIDS, 2004) and, more recently, the 35% of newly
diagnosed HIV infections in 2006 were female (EuroHIV,
2007). Similarly, in USA, the AIDS epidemic has varied
significantly over the last decade. It has been estimated
that during this period, 40,000 people have been infected
with HIV each year, although the epidemic is now affecting
Afro-Americans disproportionately and a growing number
of women: from 15% before 1995 to 27% in 2004
(UNAIDS & WHo, 2004, 2006).
In the European context, both Spain and Portugal have
high rates of HIV/AIDS. So, whereas the average in Western
and Central Europe for the people aged 15 to 49 was 0.3%
(UNAIDS & WHo 2005), the prevalence rates in 2005 in
Spain were 0.6% and of 0.4% in Portugal (UNAIDS, 2006).
An important difference between these two countries is
the primary exposure categories in each country. So, in
2005, the heterosexual transmission was the most frequent
means for HIV transmission in Portugal (47.7% of cases),
followed by intravenous drug users (40.9%) and same-sex
and bisexual behavior (8.6%) (Ministério da Saude &
Instituto Nacional de Saúde Dr. Ricardo Jorge. Centro de
Vigilância Epidemiológica das Doenças Transmissíveis,
2006). In Spain, the first means of transmision was the
use of intravenous drug (47.8%), followed by the
heterosexual contact (30.5%) and same-sex and bisexual
behavior (15.4%) (Instituto de Salud Carlos III & Ministerio
de Sanidad y Consumo. Vigilancia Epidemiológica del SIDA
en España, 2005). These differences may be due to the
different preventive programmes of each country. In Portugal,
the first years the main focus were intravenous drug users,
later they developed the first sex education school
programmes in 2001, and finally, in 2003, they carried
out prevention programmes aimed at young people sexuality
(Coordenação Nacional para a Infecção VIH/SIDA, 2006).
The ‘Plano Nacional de luta Contra a Sida 2004-2006’
admits these gaps and emphasises the need to tackle the
gender differences and the weakness of women against
HIV/AIDS (Comissão Nacional luta Contra a Sida, 2004).
In contrast, the first strategic plan against AIDS developed
by the Spanish Ministry of Health and Consumption, besides
pointing out the necessity of specific preventive programmes
aimed to women, shows the longer Spanish trajectory in
preventive programmes and measures aimed to children,
adolescents and young people, that are considered a priority
focus as regards prevention. The first national campaign
for preventing HIV/AIDS and other sexually transmitted
diseases among high school and university students was
developed in the academic year 1995/1996 (Secretaría del
Plan nacional sobre el SIDA del Ministerio de Sanidad y
on the other hand, the existence of gender differences
in sexual behavior has been made clear in numerous studies.
Research has demonstrated that young men and women
have different patterns of risk behavior related to sexual
transmission of AIDS and other sexually transmitted diseases
(STDs): young men have more sexual partners (Babikian
et al., 2004; Hynie, lydon, Côté & Wiener, 1998; Kotchick,
Shaffer, Forehand & Miller, 2001; Merakou, Costopoulos,
Marcopoulou & Kourea-Kremastinou, 2002; Murphy,
Rotheram-Borus & Reid, 1998; Newman & zimmermann,
2000; Siegel, Klein & Roghmann, 1999; Wendt & Solomon
1995) while young women use the condom less frequently
in their sexual relations (Babikian et al., 2004; Baele,
Dusseldorp & Maes, 2001; Bazargan, Kelly, Stein, Husaini
& Bazargan, 2000; Gebhardt, Kuyper & Greunsven, 2003;
Kotchick et al., 2001; laraque, Maclean, Brown-Peterside,
Ashton & Diamond, 1997; Merakou et al., 2002; Murphy
et al., 1998; Newman & zimmermann, 2000; Wendt &
Solomon 1995). Thus, young women seem more inclined
to adopt the `monogamy´ preventive strategy, that is
characterised by having fewer partners but not using
condoms consistently (Newman & zimmermann, 2000).
But these young women may be at long-term cumulative
risk as the norm among youth is serial monogamy (Bayés,
Pastells & Tuldra, 1995; Seidman & Rieder, 1994).
Moreover, women are more vulnerable to becoming
infected with AIDS. There are a variety of reasons for this,
such as unequal educational or medical opportunities for
boys and girls and the discrimination or violence against
women, more relevant in less developed countries and
marginalised women (Amaro, Raj & Reed, 2001;
Cummings, Mengistu, Negash, Bekele & Ghile, 2006;
Given that condom use is the main means against HIV,
from a protection approach is basic to analyse the variables
associated with its use. There are various factors related to
condom use among young adults. Different studies highlight
the role of attitudes, subjective social norms and perceived
behavioral control as important variables explaining condom
use intention and behavior. These factors are used together
in the Ajzen´s Theory of Planned Behavior (Ajzen, 1985)
and in several studies that use these variables to explain
the adoption of preventive measures in sexual relations
(Fazecas, Senn & ledgerwood, 2001; Gebhardt et al., 2003).
These variables have also been used separately in several
studies that have drawn on this and other theoretical
frameworks, highlighting the role of attitudes towards
MUñoz-SIlVA, SáNCHEz-GARCíA, MARTINS, AND NUNES
condom use (Bazargan et al., 2000; Bosompra, 2001;
Parsons, Halkitis, Bimbi & Borkowski, 2000; Rosenstock,
Strecher & Becker, 1994) subjective social norms or social
pressure from the environment and people that are important
to the subject (Bosompra, 2001; laraque et al., 1997;
Murphy et al., 1998), and perceived behavioral control,
either in the form of skills for buying, taking or putting
the condom on correctly (Baele et al., 2001), behavioral
skills in negotiating and ensuring condom use with the
partner (Baele et al., 2001; Basen-Engquist et al., 1999;
Bazargan et al., 2000; Gutiérrez, oh & Gillmore, 2000;
Holscheneider & Alexander, 2003; Parsons et al., 2000) or
that guarantee its use even in difficult situations as may
be the case of being sexually excited or under the effect
of drugs (Baele et al., 2001; Bazargan et al., 2000; Parsons
et al., 2000).
Under the perspective of the Theory of Planned Behavior,
the present paper aims to measure gender differences in the
variables –attitudes, social norm, perceived behavioral control,
intention of condom use- involved in the use of effective
preventive measures against AIDS, and specifically in the
condom use, and whether these differences are upheld in a
sample of university students from Spain and Portugal.
Furthermore, we wish to analyse whether these variables
produce different predictions concerning the adoption of safe
sexual behavior for young men and women in each country.
We study the condom use as preventive measure against
AIDS, therefore we ask about its use even when other
contraceptive methods are used. We are also interested in
detailing if the subjects use contraceptive methods different
to the condom, how these methods are related to whether or
not there is a steady partner, and the number of sexual partners
in the past year given that they are other important indicators
of the safe or unsafe sexual behavior of young adults.
The sample consisted of 683 university students, 319
Portuguese (64% female and 36% male) from the University
of Algarve and 364 Spanish students (51% female and 49%
male) from the University of Huelva. The average age of
the Portuguese students was 22.34 (SD = 4.2; median =
21) while for their Spanish counterparts it was 20.94 (SD
= 3.5; median = 20). In both countries a high percentage
of students had had sexual relations (87.6 % for Spanish
students and 86 % for Portuguese students).
The variables were measured with a questionnaire (two
versions: Portuguese and Spanish) drawn up by researchers,
from a revision of different studies (Basen-Engquist et al.,
1999; Krahé & Reiss 1995; oliva, Serra & Vallejo, 1993;
Reinecke, Schmidt & Ajzen, 1996; Sánchez-García, 2001)
to analyse preventive behavior against the transmission of
the AIDS virus in young adults. The response options (except
for the attitude, for which a differential semantic scale was
used) was an 7-point scale: From 1 (strongly disagree) to
7 (strongly agree). All items covered include the expression
“even if we use another contraceptive method.” This
expression does not appear on the tables to avoid repetition.
All the items in the questionnaire (see Table 1) were recoded
so that a higher score meant a more positive attitude towards
condom use, a social norm more in favour of its use, greater
perceived behavioral control or greater intention of use.
Besides the scores in each of the items, we calculated an
index for each variable resulting from the mean of the items
The attitudes towards condom use were assessed using
16 items (= .82). For items 1 to 7 the students expressed
their level of agreement (from 1 – totally disagree, to 7
– totally agree-) with a series of statements. In the
remaining items, students replied to a bipolar 7-point item
based on a semantic difference. For example: `Using the
condom in my sexual relations, even if we use another
contraceptive method, is (or would be) very exciting /
not at all exciting´.
The perceived social norm was assessed using 6 items
( = .75), measuring the opinion that participants felt that
their parents, friends and partner had about condom use
and whether they thought that these people would
recommend its use or not.
The perceived behavioral control was assessed using 8
items ( = .73). Within perceived behavioral control we
distinguished among different aspects: negotiation skills,
ability to ensure its use in especially complicated situations
such as under the effects of alcohol, drugs or in a state of
great excitation, and practical aspects. The condom use
intention was measured using three items ( = .61).
The sexual behavior of the subjects was analysed through
the frequency of condom use, the number of sexual partners
that they had had in the previous year and the contraceptive
methods they used. The frequency of condom use was
measured using a single item: `In general, in your sexual
relations and although you may use another contraceptive
method, how often do you use a condom?´ They responded
to this on a scale from 1 –never- to 7 –always-. The number
of sexual partners was assessed through a question in which
subjects had to say how many sexual partners they had
had in the past twelve months. The possible replies were
`none´, `from 1 to 2´, `from 3 to 5´ or `more than 5´. The
question about the type of contraceptive methods the
participant used had the following options: `Pill´, `Condom´,
`Condom and another. Which?´, `other. Which?´, `None.
Why don’t you use them?´ The question about to have steady
partner had two options: ‘At the moment, do you have
steady partner? (Yes/No)’.
GENDER DIFFERENCES IN HIV-RElATED SEXUAl BEHAVIoR
This investigation used a correlational and transversal
design. The data were obtained from individual questionnaires
administered to the students in their classrooms in the second
semester of 2005/06 academic year. Researchers contacted
university lecturers from different subjects - 20 subjects in
14 different courses from two public universities of Portugal
and Spain - and asked them permission to explain the study
and hand out the questionnaires to their students. The
participants were appropriately informed the thematic of
the survey, they were explained about the voluntary character
of this and they were assured the anonymity and
confidentiality of their answers. Finally, they were asked if
they had understood these instructions and they were
communicated that their negative to participate would never
imply negative consequences for them. No student refused
to answer the questionnaire. They did this at the end of
their classes, and students then filled them and left them
on their desks. They took on average 20 minutes to fill in
Given the nature of our correlational study we used
different statistical tests to analyse the relationship between
the measured variables. To test differences by gender in the
items responses we used Student’s t-tests. Analysis of chi-
square was used to verify the relation between contraceptive
methods and gender, and another hand, contraceptive methods
and to have (or not) a steady partner. To test whether
differences in gender exist within each country in the behavior
of these combined variables predicting condom use intention
and behavior, we conducted two forced entry multiple lineal
regression analysis. All statistical tests were two-tailed and
a P-value < .05 was considered statistically significant. For
all the statistical analyses, SPSS (11.1) was used
As we can see in Table 1, there are differences in gender
which apply in both countries. Both in Spain and Portugal,
women have more favourable attitudes towards the condom
use, even if they use another complementary contraceptive
method, and they perceive less costs than the men (using
the condom interrupts sexual foreplay, makes the partner
feel mistrust or carrying them with you makes the partner
feel that you’re only interested in the sex). The young women
from each country see its use as more romantic and
comfortable. The Spanish women also perceive to a lesser
degree than the men from Spain that the external aspects of
the condom are disagreeable and see its use as being easier,
safer, more useful and a better idea than the Spanish men.
In turn, the Portuguese women perceive the condom as being
more agreeable than their male compatriots and its use gives
them more peace of mind than it does to the men.
No differences in gender are observed in the perceived
social norm, both in general terms and in the social pressure
that subjects perceive from the different people making up
their most significant social contexts: parents, friends and
In relation to perceived behavioral control, we see the
same pattern in both countries: the young women perceive
greater skills for negotiating with the partner to use the
condom, and also greater capacity to ensure its use in
especially complicated situations, while the men perceive
greater control for practical or logistical aspects.
Thus in relation to behavioral skills in negotiating and
ensuring condom use with the partner, both the Portuguese
and Spanish women think to a greater extent than their male
compatriots that, even if they were to use another
contraceptive method, they would not give in if their partner
wanted to have sexual relations without a condom.
Furthermore, the Spanish women think that if they want
to use the condom they would be able to convince their
partner to use it. In the case of condom use in difficult
situations, the women from both countries are more
convinced than the men that they would be capable of using
the condom even if they were under the influence of alcohol
or drugs or were highly excited, even on the point of losing
control. The men, on the other hand, feel themselves more
capable of going to buy them, putting them on correctly
or explaining this to their partner.
The Spanish and Portuguese women also differ from
the men from their respective countries in that they show
greater intention of condom use when having relations with
a person they knew, even if they used another contraceptive
method. Spanish women also have a greater intention of
using the condom than the men when having sexual relations
with a person that they knew was promiscuous.
No differences are found between men and women from
the two countries in the frequency of condom use, as in
both cases they refer to a fairly high frequency of use,
especially in Spain.
To test whether differences in gender exist within each
country in the behavior of these combined variables
predicting condom use intention and behavior, we conducted
two forced entry multiple lineal regression analysis (see
Table 2). In the first model, we analysed the prediction of
the intention of use from the attitudes, perceived social
norms and different variables referring to self-efficacy or
perceived behavioral control. The results indicate that in
both countries, for both young women and men, although
more for the latter, the variables attitude, perceived social
norms and negotiation skills manage to explain a high
percentage of condom use intention. The sole difference
between the countries is that for Spanish men, perceived
self-efficacy in difficult situations also contributes to
explaining intention of use.
MUñoz-SIlVA, SáNCHEz-GARCíA, MARTINS, AND NUNES
GENDER DIFFERENCES IN HIV-RElATED SEXUAl BEHAVIoR
Mean (and standard deviations) of the variables. Comparison according to gender in each country (t-test)
Female Male Female Male
1.1. A young man/woman of my age should always use one
1.2. It interrupts sexual foreplay
1.3. Makes the partner feel mistrust
1.4. May make the partner feel that your are only interested in the sex
1.5. Disagreeable external aspects
1.6. They are easy to use
1.7. I am in favour of condom use
1.8. It’s exciting
1.9. It’s safe
1.10. It’s agreeable
1.11. It’s boring
1.12. It’s useful
1.13. It’s romantic
1.14. It gives peace of mind
1.15. It’s comfortable
1.16. It’s a good idea
2. PERCEIVED SOCIAL NORM
2.1. My friends think you should use one
2.2. My friends would say I should use one
2.3. My parents think you should use one
2.4. My parents would say I should use one
2.5. My partner thinks you should use one
2.6. If we use another contraceptive, my partner doesn’t like me
proposing the use of a condom
5.08 (2.00)4.96 (1.85) 4.54 (2.24) 4.63 (2.01)
3. PERCEIVED BEHAVIORAL CONTROL
3.1. Negotiation skills
3.1.1. I would be able to convince my partner to use it
3.1.2. I would not give in if my partner did not want to use it
3.2. Control in difficult situations
3.2.1. I would be able to use it even if I was under the influence
3.2.2. I would be able to use it even if I was under the influence
3.2.3. I would be able to use it even if I was very excited
3.3. Practical aspects
3.3.1. I would be able to put it on correctly or explain how to do
so to my partner
3.3.2. I could buy them
3.3.3. I would be able to carry them on me, just in case
6.08 (1.20)5.75 (1.32)*5.79 (1.67)5.17 (1.82)**
5.91 (1.40)5.39 (1.70)** 5.43 (1.75) 4.88 (1.92)**
6.21 (1.24) 6.53 (0.88)**6.02 (1.32)6.40 (0.97)**
4. CONDOM USE INTENTION
4.1. If I have relations with someone I know and we use another
contraceptive, I would not use a condom
4.2. If I have relations with someone who has had many partners,
I would always use one even if we used another contraceptive method
4.3. I will always try to use one
5.98 (1.08)5.71 (1.19)*5.57 (1.27)5.13 (1.34)**
5.43 (1.86)4.92 (1.97)*4.85 (2.10)4.17 (2.10)**
6.70 (1.02)6.56 (1.07) 6.41 (1.26)6.06 (1.35)*
5.80 (1.55)5.64 (1.63) 5.46 (1.65)5.14 (1.78)
5. FREQUENCY OF CONDOM USE4.58 (2.15)4.89 (2.17) 5.42 (2.16)5.66 (1.73)
*p < .05; ** p < .01; *** p < .001
In the second model, in line with the proposals of the
Theory of Planned Behavior, we aim to predict condom
use behavior from the intention of use and the different
aspects of self-efficacy or perceived behavioral control. In
this case, the percentages explained of the behavior are
fairly similar for young men and women from both countries,
although there are clear gender differences in the variables
explaining frequency of condom use: for the men the only
explanatory variable is intention of use; while in the women
this behavior is explained by the intention together with
the perception of negotiation skills.
Another variable chosen to study the sexual behavior
of our students was the number of sexual partners. our
data point to differences in Spain between young men and
women over the number of sexual partners. A greater
percentage of Spanish men say they have had `3 to 5´ or
`more than 5´ sexual partners, while the women refer to
less sexual partners in the previous year (2= 19.47; d.f.
= 3; p < .001). No significant differences were found in
the Portuguese sample.
The description of the contraceptive measures used
by the whole sample is shown in Table 3. These results
show that the majority of the university students
interviewed use contraceptive methods, mainly the condom,
followed by the pill. A very low percentage of these young
adults use no contraceptive method at all. The table also
shows that the use of the pill on its own is much more
frequent among the young women from both countries,
but especially among the Portuguese, while using the
condom on its own is much more frequent among the men,
with its combined use with the pill being more probable
amongst the women, in particular the Portuguese. We can
also point to the finding that the condom use is more
widespread among the Spanish students compared to the
Portuguese (all referred differences are significant, with
standardized residuals greater than ±1.96).
one variable that may have a bearing on the type of
contraceptive method chosen is whether the student has a
steady partner or not. In relation to the possible association
existing in our sample between gender and having a steady
partner, data indicate that in both Spain and Portugal a
greater number of women say that they are in a steady
relationship at the time of the interview.
Finally, we analysed the possible differences in gender
in the choice of contraceptive methods between subjects
with or without steady partner in each country (Table 4).
our interest lied in analysing the adoption of preventive
sexual behavior not just against unwanted pregnancies but
also against sexually transmitted diseases. For this reason,
the responses were recoded in two categories: pill and
MUñoz-SIlVA, SáNCHEz-GARCíA, MARTINS, AND NUNES
Summary of Regression Analysis for Variables predicting condom use intention and frequency of condom use among
Portuguese and Spanish female and male
PREDICTIoN oF CoNDoM USE INTENTIoN
Female (N = 203)
Male (N = 114)
Female (N = 183)
Male (N = 172)
Self-efficacy in difficult situations
Self-efficacy, practical aspects
PREDICTIoN oF FREQUENCY oF CoNDoM USE
Female (N = 153)
Male (N = 98)
Female (N = 149)
Male (N = 159)
Intention of use
Self-efficacy in difficult situations
Self-efficacy, practical aspects
p < .05; ** p < .01; *** p < .001.
β = standardized regression coefficients.
R2= proportion of explained variance of the predicted variable.
condom. In the first option we considered the subjects that
replied that they used the pill alone and in the second those
that used the condom, on its own or with another
contraceptive method. The results indicate that there are
differences in gender that are common to both countries,
but only in the group of students with a steady partner.
These differences indicate that Spanish and Portuguese
women with steady partner protect themselves less against
sexually transmitted diseases than their male peers as they
use to a greater extent the pill as the only contraceptive
From the results obtained we can state that the majority
of the university students interviewed in our study have
healthy and safe sexual behavior, given their high frequency
of condom use. on this point, our findings differ from those
obtained by other researchers referring to a greater proportion
of risk behavior among the university population from
several countries (Bradley & Wildman, 2002; Cok, Gray
& Ersever, 2001; Parsons et al., 2000).
However, the findings also show important gender
differences in the sexual behavior. Thus, firstly, although
significant differences do not exist between young men
and women in the frequency of condom use, we find
important discrepancies concerning their use of contraceptive
methods. We found, as other authors have, that the
percentage of women who say using condoms as a
contraceptive method is less than the percentage of men
(Babikian et al., 2004; Baele et al., 2001; Bazargan et al.,
2000; Cerqueira-Santos, Koller & Wilcox, 2008;Gebhardt
et al., 2003; laraque et al., 1997; Murphy et al., 1998;
Newman & zimmerman, 2000; Wendt & Solomon, 1995),
while they use the contraceptive pill to a greater extent,
thereby increasing their vulnerability to sexually transmitted
When analysing the responses that the students gave to
the different items from the questionnaire we also found
several gender differences that were common to both
countries. Both Portuguese and Spanish women have more
favourable attitudes towards condom use, perceiving more
benefits and fewer costs in their use than their male peers.
These results tie in with those obtained by other researchers
GENDER DIFFERENCES IN HIV-RElATED SEXUAl BEHAVIoR
Contraceptive methods used by the Spanish and Portuguese students
Portugal (χ2= 60.55, p < .001)Spain (χ2= 15.24, p < .01)
Female Male Female Male
Condom and other (basically the pill)
df = 4.
Relation between having a steady partner and contraceptive method used in each country
Steady partner No steady partner Steady Partner
(χ2= 8.96, p < .01)(χ2= 3.65, p > .05) (χ2= 5.14, p < .05)
No steady partner
(χ2= .199, p > .05)
Female Male Female Male Female Male Female Male
44 761 18611
(33.3%) (12.3%)(15.4%) (2.7%) (15.5%) (5.9%)(3.8%) (2.1%)
88 50 3336 98 96 2547
(66.7%) (87.7%) (84.6%) (97.3%)(84.5%) (94.1%)(96.2%) (97.9%)
df = 1.
(Campbell, Pepalu & DeBro, 1992; Parsons et al. 2000;
Sacco, Rickman, Thompson, levine & Reed, 1993,). In
addition, they see themselves as more skilful in the
negotiation of condom use with the partner and to ensure
its use in particularly difficult situations, which had also
been found by other researchers (Dekin, 1996; Kvalem &
Træen, 2000; Murphy et al., 1998; Parsons et al., 2000). In
line with the aforementioned point, they also have a greater
intention of using the condom in their sexual relations.
However, as the women from our sample use the condom
as a contraceptive method on a percentage smaller than
their male peers, their attitudes, perceived behavioral control
or greater intention of use has not been translated into a
greater frequency of condom use in sexual relations. This
has also been found by several researchers that have used
these variables in university population (Carrasco, Muñoz-
Silva & Sánchez-García, 2003; Parsons et al., 2000) and
in younger adolescents (Martínez-Donate et al., 2004).
We believe that an important variable that may influence
these results is the fact that in both samples more than half
of the students have a steady partner, and that partner
relations are more frequent among the women than among
the men both in Spain and Portugal. one finding contrasted
by several studies is that in these partner relations it is very
common for other contraceptive methods such as the pill
to be used as the main concern is the prevention of unwanted
pregnancies and not the possibility of becoming infected
with illnesses such as HIV (Bimbela, Jiménez, Alfaro,
Gutiérrez & March, 2002; Cerqueira-Santos et al., 2008;
Gebhardt et al., 2003; Wendt & Solomon, 1995). Thus, as
some authors have suggested (Bimbela et al., 2002; Dias,
Matos & Gonçalves, 2005; Fazecas et al. 2001; Moore,
Rosenthal & Mitchell, 1996; Thorburn, Harvey & Ryan,
2005; Woolf & Maisto, 2008) it is possible that adolescents
and young adults think that having sex without a condom
within a partner relation is an indication of trust in the
partner or love towards him/her, which would make it more
difficult to propose its use. on this point, several authors
(Gebhardt et al., 2003; Hynie et al., 1998; lameiras, Nuñez,
Rodríguez, Bretón y Agudelo, 2005; Manuel, 2005) have
found that for men and women the condom use is associated
more with casual encounters than with steady partner
relations, which may make subjects unwilling to propose
its use when they hope that the relationship will have some
continuity. But the study by Gebhardt et al.(2003) also states
that although young men and women protect themselves
less in their encounters with their steady partners than in
their more sporadic relations, the women are always the
ones who protect themselves less, and especially with their
steady partners. We obtained the same result in our sample:
within the group of subjects with steady partners, the women
use the pill more than the men, who in turn use the condom
to a greater extent. Thus the young women in our study
seem to be using the preventive strategy labelled serial
monogamy to a greater extent. However, we coincide with
several authors (Bazargan et al., 2000; Fazecas et al., 2001;
Newman & zimmerman, 2000) who point out that this
strategy may lead in the long-run to a high risk of HIV
infection, because people may have several steady sexual
partners through their life and be faithful in each one, but
this will not protect the person against the illness as this
may be picked up in any of these relations and from having
unprotected sex on just one occasion.
As different authors (Castañeda, 2000; Cummings et
al., 2006; Dias et al., 2005; Gavey & McPhillips, 1999;
Salgado de Snyder, Acevedo, Díaz-Pérez & Saldívar-
Garduño, 2000; Sherman, Gielen & McDonnell, 2000;
Tschann, Adler, Millstein, Gurvey & Ellen, 2002) have
pointed out, it is possible that while young men may use
or avoid using a condom without discussing it with their
women sexual partner because condom use is under the
physical control of men, for young women, condom use
depends on their male partner’s willingness and the desire
to use a condom may be more complex and challenging,
requiring assertive behavior that may violate gender role
norms. For example, Tschann et al. (2002) have found that,
although there is not a direct relation between gender and
decision making over condom use, men perceive themselves
as having more power and emotional influence than women
in the framework of partner relations, power which is in
turn related to imposing their point of view or desires in
relation to the use or not of the condom. In turn, the results
of several studies (Castañeda, 2000; Quina, Harlow,
Morokoff, Burkholder & Deiter, 2000) underline the
association of women´s skills of sexual communication
for information about the partner’s past HIV-risk behavior
with the adoption of safe sex. It may also be true that the
greater need of the woman to link sexuality and love in
relations (Barrón, Martínez-íñigo, de Paúl & Yela, 1999;
Hatfield, Sprecher, Pillemer, Greenberger & Wexler, 1988;
Kvalem & Træen, 2000) may lead towards a certain
abandonment of preventive aspects so as not to harm the
romanticism of the relationship. These reasons may have a
bearing on the fact that, as we found in the regression
analyses conducted, for young men the condom use intention
is sufficient to ensure implementation of this behavior, while
for women the necessary negotiation skills are also required.
less perceived self-efficacy compared to young men
for buying condoms or knowing how to put them on
correctly, data that has also been found by other researchers
(Martínez-Donate et al., 2004), is another factor that could
also have a bearing on the non-materialization of the attitudes
and intentions of the women in our sample in more effective
preventive behavior against HIV. on this point, several
studies have found that women are less aware of how to
use them correctly and feel more embarrassed about having
to go and buy them (Meekers & Klein, 2002).
We have seen that the gender differences found in our
study are upheld in two samples of university students from
two countries with different patterns of HIV transmission
MUñoz-SIlVA, SáNCHEz-GARCíA, MARTINS, AND NUNES
and different national prevention programmes, and they also
coincide with those found by other researchers analysing
young men and women from different social and cultural
contexts. As a result of this, we believe that these differences
must be taken into account when designing prevention
programmes for adolescents and young adults in general
and university students in particular. If they want to be
effective, condom promotion programmes must address the
characteristics and concerns of the population for which
they are intended (Bazargan et al., 2000; Bimbela et al.,
2002; Campbell et al., 1992; Fazecas et al., 2001; Gebhardt
et al., 2003; Manuel, 2005; Meekers & Klein, 2002). Because
of this and agreeing with the abovementioned authors, we
consider that these programmes must base themselves on
the peculiar meanings that sentimental and sexual relations
have for young adults and from this perspective try and
promote a more healthy sexuality, making them aware of
the dangers of the false sense of security that there is in
monogamy and show them that they can combine the condom
use with enjoyment of sexual relations and demonstrate to
them the means by which the use of condoms may be
incorporated into a satisfactory sexual life. And as women
seem to put themselves in the most vulnerable position, the
messages and programmes aimed at women should be
designed primarily to increase self-efficacy in negotiation
skills with the partner, helping them to assume an assertive
role in the relation, but separating the condom use from
the idea of coldness or lack of trust in the partner, transmitting
instead the idea that the use of protective measures is a
behavior that demonstrates maturity, responsibility, care of
oneself but also of one’s partner, which are very desirable
qualities and values. But in addition to the negotiation skills,
these programmes must give women the confidence to go
and buy condoms themselves and use them correctly, if
necessary with direct instruction on how to use them, as
well as including messages to increase social acceptance
and support from their significant contexts (parents, friends,
teachers,...) to help young women adopt these behavior.
Finally, another important preventive measure may be the
promotion of female condom, in greater extension under
the physical control of women than the male condom.
Although we believe that the contributions of this work
can be very useful, we must acknowledge that it has certain
limitations. We want to emphasize that, despite using an
integrative model like the PBT, there are factors that are
outside the model and that its inclusion would allow us to
improve the predictive power of this. Moreover, as an
anonymous reviewer suggested, an opportunity to improve
this work is to perform some regression analysis not only
by gender or country, but by the type of partner (stable /
casual). It will be interesting to see how far this new variable
may condition the explanatory power of the model, or
explain the differences found between girls and boys, or
even change the weight of the factors that explain the
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Received February 5, 2008
Revision received october 26, 2008
Accepted october 30, 2008
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