Practice Safer Sex

OVERVIEW

There are two main risks associated with sex. When sex is between a male and a female, there is a risk for pregnancy and a risk for sexually transmitted infections. Obviously, there is no risk for pregnancy in sex between two men or two women, but there is still a risk of sexually transmitted infections. Perhaps the easiest and most convenient way to provide greater protection from pregnancy and sexually transmitted infections is to use a condom. There are condoms for both males and females. Male condoms, which are usually made from latex or polyurethane, should be used for vaginal, anal, or oral sex. (Avoid condoms that say they are “natural” or made from lambskin. They may allow the transmission of sexual infections.) Female condoms, which have a ring on each end, are used only for vaginal sex. The condom is held in place by the inside ring. The outside ring stays outside the vagina.

Birth control pills and intrauterine devices (IUD) provide protection from pregnancy, but they offer no protection from sexually transmitted infections. While condoms are sold at pharmacies and other retail locations, your medical provider must write a prescription for birth control pills or insert an IUD into the uterus. Remaining in a monogamous relationship reduces the risk of sexually transmitted infections, but there is always the risk of pregnancy.

WHAT THE EXPERTS SAY

There Are Interventions That Support the Use of Condoms

In a study published in 2014 in Worldviews on Evidence-Based Nursing, researchers from Columbus, Ohio, noted that condoms are a primary means to reduce the incidence of sexually transmitted infections, a major public health concern. The researchers decided to conduct a review of behavioral intervention studies on increasing the use of condoms, ultimately including a total of 13 meta-analyses or systematic reviews that represented 248 studies. The researchers found that behavioral interventions were very successful in promoting condom use and reducing sexually transmitted infections. However, they were not useful in promoting abstinence. The programs worked best when they were designed for specific populations and included skill-building exercises. “The evidence suggests that tailoring content based on ethnicity, culture, and gender—incorporating personal and interpersonal skill building exercises—and exposure to content are important in obtaining effective health outcomes.” 1

Adding an Emotional Component to Safer Sex Education Increases Efficacy 2

Culturally Sensitive Media Messages May Play a Role in Safer Sex

In a study published in 2011 in the Journal of Adolescent Health, researchers from multiple locations in the United States wanted to learn the long-term effects of a mass media intervention that employed “culturally and developmentally appropriate messages” to enhance safer sex, particularly in regard to the prevention of the transmission of the human immunodeficiency virus (HIV) in high risk African American teens. For three years, the researchers coordinated the delivery of television and radio messages in Syracuse, New York, and Macon, Georgia. They focused on channels that were popular with African American teens. The cities of Providence, Rhode Island, and Columbia, South Carolina, served as controls. Over a 16-month period, the researchers recruited 1,710 African-American adolescents between the ages of 14 and 17 years from these four cities. After the teens completed computer-assisted self-interviews lasting about 45 minutes, there were follow-up assessments at 3, 6, 12, and 18 months. The researchers found that the media interventions improved condom-use negotiation among the teens. In addition, the adolescents ages 16 and 17 years who were exposed to the media programs “showed less risky age trajectory of unprotected sex than those in the nonmedia cities.” The researchers concluded that “culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-prevention beliefs, and to reduce HIV-associated risk behaviors among older youth.” 3

Online Focus Groups May Reinforce Safer Sex 4

BARRIERS AND PROBLEMS

It May Be Difficult for Women to Negotiate Safer Sex, Even If They Have a Sexually Transmitted Infection

In a study published in 2012 in the Journal of Clinical Nursing, a researcher from New Zealand investigated the challenges women may encounter in negotiating the use of a condom, even when they have a sexually transmitted disease. The researcher conducted interviews with 12 clinicians with experience in the sexual health field and 26 women with a diagnosis of either herpes simplex or human papilloma virus. Only a small number of the women with sexually transmitted infections had received any safer sex instruction from their clinicians, and they wanted their clinicians to initiate these talks. The women noted that talking about safer sex had become more difficult since their diagnosis. “Women’s dilemmas were whether to disclose the diagnosis as part of insisting on condom use, whether condom use mitigated the obligation to disclose or whether any talk or condom use was avoided as too ‘risky’ to feminine identity.” The women indicated that they wanted their clinicians to offer advice, and they noted that if the women themselves did not raise the topic of safer sex, it was not addressed. Only a small number of women felt that they could initiate the topic. The researcher concluded that “nurses need training in sexual history taking and communication skills to address the gendered complexities of safer sex.” 5

There May Be Financial Pressure for Disadvantaged Teens to Avoid Using Condoms 6

Depressed Young Women Are at Increased Risk for Less Safe Sex

In a study published in 2011 in the Journal of Pediatric & Adolescent Gynecology, researchers from Boston noted that depressed young women are at increased risk for sexually transmitted infections. As a result, the researchers wanted to learn more about this association. Their cohort consisted of 45 depressed young women between the ages of 15 and 22 years. Over a two-week period, 31 of these women reported at least one sex event in which a condom was used. A total of 143 condom use events were reported. During 51 percent of these condom events, the condoms were used incorrectly. The most common error was the failure to hold the condom during withdrawal. The researchers commented that “even if they use condoms, depressed adolescents and young adult women are at increased risk of STIs [sexually transmitted infections] because they frequently use condoms incorrectly.” 7

Women Who Have Sex with Other Women May Not Use Protection 8

NOTES

1. Victoria von Sadovszky, Breana Draudt, and Samantha Boch, “A Systematic Review of Reviews of Behavioral Interventions to Promote Condom Use,” Worldviews on Evidence-Based Nursing 11, no. 2 (2014): 107-17.

2. Rebecca A. Ferrer, Jeffrey D. Fisher, Ross Buck, and K. Rivet Amico, “Pilot Test of an Emotional Education Intervention Component for Sexual Risk Reduction,” Health Psychology 30, no 5 (2011): 656-60.

3. Sharon Sznitman, Peter A. Vanable, Michael P. Carey et al., “Using Culturally Sensitive Media Messages to Reduce HIV-Associated Sexual Behavior in High-Risk African American Adolescents: Results from a Randomized Trial,” Journal of Adolescent Health 49 (2011): 244-51.

4. Michele L. Ybarra, Zachary DuBois, Jeffrey T. Parsons et al., “Online Focus Groups as an HIV Prevention Program for Gay, Bisexual, and Queer Adolescent Males,” AIDS Education and Prevention 26, no. 6 (2014): 554-64.

5. Catherine Cook, “‘Nice Girls Don’t’: Women and the Condom Conundrum,” Journal of Clinical Nursing 21, no. 3-4 (2012): 535-43.

6. Janet Rosenbaum, Jonathan Zenilman, Eve Rose et al., “Cash, Cars, and Condoms: Economic Factors in Disadvantaged Adolescent Women’s Condom Use,” Journal of Adolescent Health 51 (2012): 233-41.

7. Lydia A. Shrier, Courtney Walls, Christopher Lops, and Henry A. Feldman, “Correlates of Incorrect Condom Use Among Depressed Young Women: An Event-Level Analysis,” Journal of Pediatric & Adolescent Gynecology 24, no. 1 (2011): 10-14.

8. Tami S. Rowen, Benjamin N. Breyer, Tzu-Chin Lin et al., “Use of Barrier Protection for Sexual Activity Among Women Who Have Sex with Women,” International Journal of Gynecology and Obstetrics 120 (2013): 42-45.

REFERENCES AND RESOURCES

Magazines, Journals, and Newspapers

Cook, Catherine. “‘Nice Girls Don’t’: Women and the Condom Conundrum.” Journal of Clinical Nursing 21, no. 3-4 (2012): 535-43.

Ferrer, Rebecca A., Jeffrey D. Fisher, Ross Buck, and K. Rivet Amico. “Pilot Test of an Emotional Education Intervention Component for Sexual Risk Reduction.” Health Psychology 30, no. 5 (2011): 656-60.

Fowler, Patrick J., Darnell Motley, Jinjin Zhang et al. “Adolescent Maltreatment in the Child Welfare System and Developmental Patterns of Sexual Risk Behaviors.” Child Maltreatment 20, no. 1 (2015): 50-60.

Kuo, Kelly, Tao Y. Zhu, Shandhini Raidoo et al. “Partnering with Public Schools: A Resident-Driven Reproductive Health Education Initiative.” Journal of Pediatric & Adolescent Gynecology 27 (2014): 20-24.

Lawrence, Ryan E., Kenneth A. Rasinski, John D. Yoon, and Farr A. Curlin. “Obstetrician-Gynecologists’ Beliefs About Safe-Sex and Abstinence Counseling.” International Journal of Gynecology and Obstetrics 114 (2011): 281-85.

Rosenbaum, Janet, Jonathan Zenilman, Eve Rose et al. “Cash, Cars, and Condoms: Economic Factors in Disadvantaged Adolescent Women’s Condom Use.” Journal of Adolescent Health 51 (2012): 233-41.

Rowen, Tami S., Benjamin N. Breyer, Tzu-Chin Lin et al. “Use of Barrier Protection for Sexual Activity Among Women Who Have Sex with Women.” International Journal of Gynecology and Obstetrics 120 (2013): 42-45.

Shrier, Lydia A., Courtney Walls, Christopher Lops, and Henry A. Feldman. “Correlates of Incorrect Condom Use Among Depressed Young Women: An Event-Level Analysis.” Journal of Pediatric & Adolescent Gynecology 24, no. 1 (2011): 10-14.

Sznitman, Sharon, Peter A. Vanable, Michael P. Carey et al. “Using Culturally Sensitive Media Messages to Reduce HIV-Associated Sexual Behavior in High-Risk African American Adolescents: Results from a Randomized Trial.” Journal of Adolescent Health 49 (2011): 244-51.

von Sadovszky, Victoria, Breana Draudt, and Samantha Boch. “Systematic Review of Reviews of Behavioral Interventions to Promote Condom Use.” Worldviews on Evidence-Based Nursing 11, no. 2 (2014): 107-17.

Ybarra, Michele, L. Zachary DuBois, Jeffrey T. Parsons et al. “Online Focus Groups as an HIV Prevention Program for Gay, Bisexual, and Queer Adolescent Males.” AIDS Education and Prevention 26, no. 6 (2014): 554-64.

Web Site

Planned Parenthood. www.plannedparenthood.org .

  This information is not a tool for self-diagnosis or a substitute for professional care.