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Impediments to safer heterosexual sex: a review of research with young people D. Wight



MRC Medical Sociology Unit , 6 Lilybank Gardens, Glasgow, UK Published online: 25 Sep 2007.

To cite this article: D. Wight (1992) Impediments to safer heterosexual sex: a review of research with young people, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 4:1, 11-23, DOI: 10.1080/09540129208251616 To link to this article:

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AIDS CARE, VOL. 4, NO. 1, 1992


Impediments to safer heterosexual sex: a review of research with young people D. WIGHT

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MRC Medical Sociology Unit, 6 Lilybank Gardens, Glasgow, UK

Abstract This article reviews the existing British literature on the micro-social details of young people’s heterosexual encounters, emphasizing the cultural factors which impede the adoption of health education advice. Most of the findings cited come from qualitative projects that relied primarily on detailed interviews or group discussions. Six issues are highlighted: difficulties in talking about sex; the gender-role expectations brought to an encounter; the primary function of condoms as contraceptives; problems in buying, carrying and using condoms; how the stage of a particular relationship affects behaviour, and gendered power relations. Several important issues are not addressed in the existing literature. The survey data on sexual behaviour suggest that HIV has had little impact on sexual activity, apart from a reported increase in condom use. Qualitative studies reveal the moral categories, gender-role expectations, power inbalances and other cultural factors that prevent a high level of knowledge about HIV transmission from being translated into safer heterosexual behaviour. Their findings provide important insights into how realistic and practical safer sex messages are. They suggest that to promote health in respect to HIV it is necessary not only to advocate specific precautionary behaviour, such as using condoms, but also to address wider cultural issues relating to the taboos around the discussion of sex and the empowerment of women. Introduction The only means available to governments to combat the spread of HIV remains to change‘ people’s behaviour, nearly always attempted through exhortation. HIV/AIDS health education messages usually imply that sexual behaviour is the outcome of mutual, rational decision making. However, the assumption that health-related behaviours result from conscious, rational choice has been subjected to considerable criticism (see Hunt ?i Martin, 1988; RUHBC, 1989; Blaxter, 1989); it seems a particularly unwarranted assumption in respect to sexual behaviour. This article will review the existing British literature on the micro-social details of young people’s heterosexual encounters, emphasizing the cultural factors which impede the adoption of health education advice. Most of the findings cited come from small scale, qualitative projects in diverse areas of Britain. The appended table of research details shows how arbitrary are the locations of recent HIV-related studies in respect to the prevalence of HIV, the only exceptions being

Address for correspondence: Dr Daniel Wight, MRC Medical Sociology Unit, 6 Lilybank Gardens, Glasgow G12 SQQ, UK.

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studies in Dundee (Abrams et al., 1990a; Scott & Griffin, 1989) and, possibly, two that included London (Holland et al., 1990, 1991; RUHBC, 1990). None of the current literature refers to recent research in Edinburgh. Furthermore, even the quantitative surveys have not used standardized questions which precludes strict comparisons that might overcome the geographical limitations of individual studies. The applicability of qualitative research findings beyond the sample, let alone beyond the geographical location of the study, is always open to debate. However, in so far as they are comparable, the findings from recent research cited here do not suggest differences in beliefs or values between different regions of Britain. Where there are contrasting findings they can be attributed to variation in the recruitment of respondents or the sexual experiences that they were asked to report. The only findings that contrasted markedly with other projects (in particular Holland et al., 1990, 1991) were those of Kent et al. (1990). In this research it was up to the respondents to choose which of their first sexual encounters with a sexual partner would be described in detail, so there might well have been a bias towards those encounters which were more consensual and which had a more affective component. Six issues have been highlighted for this article: difficulties in talking about sex; the gender-role expectations brought to an encounter; the primary function of condoms as contraceptives; problems in buying, carrying and using condoms; how the stage of a particular relationship affects behaviour, and gendered power relations. The research findings on these topics are followed by a section highlighting those issues that the existing literature has not addressed. The focus on condoms in this review is not intended to perpetuate the notion that authentic sex is penetrative, or that safer sex can be equated with condom use. The reason for concentrating on condoms is that research findings suggest that the public’s view of ‘safer sex’ is primarily wearing a condom and secondly reducing the number of sexual partners (Spencer et al., 1988; Holland et al., 1991; Kitzinger, 1991). It seems that apart from lesbians and gay men very few people associate ‘safer sex’ with non-penetrative sex (Spencer et al., 1988; Kitzinger, 1991), and heterosexuals regard non-penetrative sexual activity as preliminary to penetrative intercourse (Kent et al., 1990; Holland et al., 1991). The term ‘sexual intercourse’ will be used in its most widely understood sense (Spencer et al., 1988; Holland et al., 1991) to mean penetrative vaginal intercourse, whether or not protected. A much more inclusive version of this literature review is available elsewhere (Wight, 1990). Communication There is a gap between clinical-sounding sexual terminology and vulgar colloquialisms (Lee, 1983; Spencer et al., 1988) perpetuated by the taboo against the explicit discussion of sexual behaviour in the media. It should not be surprising, then, to learn that in a sexual encounter there tends to be very little verbal communication during the transition from sexual intercourse being a possibility to it becoming a reality (Kent et al., 1990). In fact ambiguity is often deliberately maintained: Much of the lead up, over however long a time, seems to be about keeping the potential there, but ambiguous, in case further progress is rejected by either partner. (Kent et al., 1990:4). Much of the communication seems to be non-verbal and coded. For instance, mutual agreement to change location (even, for example, from bed to floor) is frequently taken by both partners to mean agreement to have sexual intercourse. This muteness explains people’s accounts that sex ‘just happened’ (Ingham et al., 1991). The inhibition to talk frankly about

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sexual behaviour means that to do so can be perceived as a sexual act in itself (see Gagnon & Simon, 1974) and is frequently interpreted as an invitation to have sexual intercourse, as several researchers have personally experienced. The lack of communication about sex has two serious consequences in relation to HIV transmission. It makes it almost impossible for potential sexual partners to ‘get to know’ each other’s sexual histories before having sex, and it greatly constrains the negotiation of sexual behaviour. Qualitative research suggests that only a minority discuss their partner’s sexual history before their first ever sexual intercourse, the information learnt often only amounts to whether or not they are virgins, and it almost never involves details of condom use (Ingham et al., 1991). Those who do discuss each other’s sexual past do so for reasons to do with their relationship rather than through fear of infection, so it is unsurprising that they learn little to inform them of their partner’s HIV status. Nevertheless, this does not stop them from assuming low risk on the basis of being acquainted. Predictably, the shorter the period a couple have known each other before intercourse the less knowledge they have of each other’s sexual histories. Ingham et al. (1991) learnt several strong reasons for not asking about one’s partner’s sexual history; for some young women trusting their boyfriends means being sure that their sexual behaviour together will remain confidential: for a boyfriend to reveal his previous sexual history would immediately destroy that trust. The attempt to maintain ambiguity about one’s sexual intentions, and the general absence of explicit talk about sexual behaviour, means that contraception is often only discussed after first intercourse (Kent et al., 1990). T o talk about safer sex options involves far more explicit reference to genitals and different sexual behaviours, and even proposing the use of a condom other than for contraception is extremely problematic. It can imply either that one is oneself, or’(more likely) that one thinks one’s partner might be, bisexual (Wallman & Sachs, 1988; Wilton & Aggleton, 1991), promiscuous, an intra-venous drug user (Scott & Griffin, 1989), the previous partner of any of these people or a carrier of some STD other than HIV (Holland et al., 1991).

Gender-role expectations brought to the encounter Gender stereotyping is very influential, particularly on the first occasion of sexual intercourse (Kent et al., 1990; Holland et al., 1991). Partly because they were usually older, men were presumed to be more experienced and more knowledgable (which contrasts with Spencer, 1984), and many young women therefore expected their partner to take the initiative in their sexual behaviour. Kent et al. found that many of their female respondents prefer this and prefer the man to be on top of them in sexual intercourse, on the first occasion. The corollary of the male initiating role is that women are considered to be the decision makers in a negative way (Spencer, 1984; Kent et al., 1990). It is up to the women to decide how far things will go, the assumption being that ‘men see sex as a process of attrition, as wearing a girl down until she says yes’ (Holland et al., 1991). The boys see their actions as governed by a set of social patterns which are amoral and followed by almost all boys, whereas girls’ behaviour is seen as much less of a group phenomenon, with each girl following her own personal moral code. (Spencer, 1984: 14).

It is important to note that several informants in Kent et d ’ s study (both female and male) expressed unease at the limitations of the gender roles they were expected to fulfil. Many of

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their interviewees said that neither partner had taken the lead in initiating sexual intercourse but that it had been a mutual progression (Kent et al., 1990). Apart from setting the limits to how far sexual behaviour proceeds, women are also expected to be decision makers in the use of contraception. Young men feel it is up to the young women to recognize her personal needs for protection, to choose which contraception to use or to decide whether or not to have unprotected sex (Morton-Williams, 1976; Scott & Griffin, 1989). It is often forgotten that in the 1960s most girls felt ‘that birth control is the man’s business’ (Schofield, 1965: 107), but within a decade the widespread availability of the pill shifted the prime responsibility for choosing, obtaining and using birth control from men and women. Lack of contraceptives used sometimes to be a defensive ploy to strengthen a woman’s veto of sex. A disadvantageous consequence of the pill is that many men abnegate all reponsibility for contraception presuming that women will be using it (Spencer, 1984). Ironically the powerful social constraints on women carrying condoms (discussed below) might actually restore to women refusing sexual advances the rationale that they have no protection, that is if the male partner acknowledges a risk of HIV transmission. Primary purpose of condoms Since condom use is one of the main ways in which the public are encouraged to respond to HIV/AIDS, several AIDS-related surveys have investigated this. They find that approximately three quarters of sexually active 16-21 year-olds have used a condom at some point, but only a third reported having used one during their last sexual intercourse (Bowie & Ford, 1989; Ford & Morgan, 1989; MEL, 1989; Abrams er al., 1990b). Of particular concern to health promoters is the finding that this proportion was lower amongst those with a higher rate of sexual partners, so amongst those who had had four or more partners in the previous 12 months only 17% reported having used a condom for their last sexual intercourse (Bowie & Ford, 1989). It is important, however, to consider why condoms are used. Are they used primarily as contraceptives, as a protection against venereal diseases in general (which is how they have been perceived in the United States until recently: Chng, 1983; De Jong, 1989), or are they used specifically to prevent HIV transmission? Unfortunately there is very little survey data on this important issue. Only the RUHBC investigated it and found that 72% of 18-21 year-olds who reported having used condoms at the time of the survey said they did so as protection against infection (RUHBC, 1990). However, they were not asked whether this was the exclusive purpose of of the condoms, and since the questions were clearly posed in relation to AIDS they probably wished to be seen to be concerned about HIV. All the recent qualitative studies in Britain confound the RUHBC survey’s finding and show that condoms are used primarily as contraceptives (Scott & Griffin, 1989; Ingham et al., 1991; Kent et aZ., 1990; Frankham & Stronach, 1990; Holland er al., 1991). Young people seem aware that condoms can protect against pregnancies, HIV and other sexually transmitted diseases, but few use them for other purposes than contraception (Scott & Griffin, 1989). Since it appears that condoms are still used primarily to prevent conception it seems appropriate to study what is known about their use in that context. Today the condom is rarely the preferred form of contraception (Bury, 1984; Scott & Griffin, 1989). For teenagers the pill had become the most popular method prior to the risk of HIV, primarily because of its efficacy and the fact that it does not intrude on the act of



sexual intercourse (Bury, 1984). Unfortunately AIDS-related surveys have not accompanied questions on condom use with questions about other contraceptive methods, so it is difficult to assess the impact of HIV/AIDS on the popularity of the pill. Qualitative studies suggest it is still preferred to condoms (Scott & Griffin, 1989; Holland et al., 1991). Inter-uterine devices and the diaphragm are little used by young people, and probably the third most widely practised means of avoiding conception is withdrawal, particularly amongst inexperienced young teenagers (Bury, 1984). Condoms are probably still the most widely used contraceptive in young people’s first sexual intercourse (Bury, 1984). However, the more inexperienced people are and the more casual their relationship the less likely they are to use any form of contraception.

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It is a continuing irony of contraceptive usage at any age that the more unstable the relationship, the less likely is contraception to be used. (Bury, 1984: 41). The fact that this occurs at all ages is worth emphasizing given the way teenage sexuality is regarded by many as self-evidently problematic (see Macintyre & Cunningham-Burley, 1989). Several reasons have been identified for non-use of contraceptives in early sexual encounters, such as thinking conception was not possible, not expecting to have sexual intercourse, believing it wrong to use contraceptives, the unavailability of contraceptives in the circumstances, one’s partner objecting or contraceptives reducing fun (Zelnik & Kantner, 1979). If young men do not consider a relationship serious, or do not fear that they would be held responsible for a pregnancy, they are much less likely to take precautions (Morton-Williams, 1976; Spencer, 1984; Wellings, 1984). Some young women have great difficulty in accepting their need for contraception because they are reluctant to admit and accept their own sexuality (McGlew et al., 1983).

Problems with condoms: buying, carrying and using Beyond the general reasons for the non-use of contraceptives mentioned above there are specific problems which inhibit the use of condoms. First there are problems with buying: principally the embarrassment of asking for condoms in public, often from someone of the opposite sex (Morton-Williams, 1976; Spencer, 1984; Scott & Griffin, 1989; Abrams et al., 1990a). Machines in toilets (for men) and family planning clinics (for women) are preferred to supermarkets or record shops as sources of condoms, and the vast majority of young people (particular women) prefer to buy from someone of their own sex (Abrams et al., 1990a). A further difficulty in procuring condoms is that they are mostly available in daytime hours, in contrast to the period when they are normally required (Scott & Griffin, 1989). A second difficulty with condoms is carrying them around. While the majority of young people questioned felt it should be acceptable for everyone to carry condoms, embarrassment prevented many people from doing so. Their main concerns were fear of being caught in possession of condoms either by peers or parents, and people’s perception of women who carry condoms around with them (Scott & Griffin, 1989; Abrams et al., 1990a). If a woman takes contraceptive precautions for a casual date it contravenes the romantic code that sexual activity only occurs when a woman is ‘carried away’ by love (McRobbie, 1978), a code that made it preferable for some to ‘fall’ pregnant through unpremeditated sex than to go on the pill and be labelled as promiscuous (Bostock & Leathar, 1982; see also Spencer, 1984). The same applies today with precautions against HIV transmission: for a woman to carry condoms it is assumed she is both pre-meditating and self-initiating a sexual encounter, either of which can label her as ‘a slag’ (see Cowie &

16 D. WIGHT Lees’, 1987, analysis of how the ‘slag’ category denies sexuality to respectable women). Scott & Griffin identified a worrying double-bind:

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Some male respondents said they would not sleep with a girl if she was carrying condoms because she was probably promiscuous. Some girls felt men who carried condoms were only after one thing. (Scott & Griffin, 1989: 11). In some youth subcultures it appears that the eliding of unrepressed female sexuality with worthlessness and dirt (Cowie & Lees, 1987: 108) might have been given added potency by the further association of a fatal condition: AIDS. Furthermore, a bitter irony may be that for a woman to carry condoms to use outside a steady relationship is regarded as belonging to this powerful polluting category of ‘slags’. More problematic than buying or carrying condoms is actually using them: in fact some men do not use condoms even though they are carrying them (Scott & Griffin, 1989). Most of those questioned had negative views of condoms, referring to the awkwardness of putting them on ‘half way through‘, their unreliability, the decreased sensitivity and the embarrassment of removing them after use (Morton-Williams, 1976; Scott & Griffin, 1989). The main reasons given for not using a condom even when one had been carried were drunkenness, ‘losing control and not caring’ and being worried about one’s partner’s response to the idea (Scott & Griffin, 1989). Stages in a relationship The negotiation of sexual encounters tends to change with increasing familiarity between the partners. In Kent et al.’s study (1990) initial sexual intercourse with a particular individual was often described retrospectively as important because it was the culmination of a steadily developing relationship, and confirmed that it was serious. Physical pleasure was not a prime reason for having intercourse, though the possible bias in this research towards more affective relationships (mentioned above) should not be overlooked. Clearly safer sex alternatives to penetrative intercourse can not substitute for the symbolic significance of that act. Indeed, during the largely non-verbal communication immediately prior to sexual intercourse such ‘alternatives’ as mutual masturbation are ‘perceived as the final stage indicating that intercourse was about to happen. These activities are seen as a prelude, not alternative, to intercourse” (Kent et al., 1990:7). Once sexual intercourse has occurred between two partners it is highly likely to be repeated, since it is particularly difficult to say no having once said yes. Verbal communication is eased once there is no longer any need to maintain ambiguity, and it may become possible to discuss physical pleasure and to override some of the constraints of stereotyped gender roles. If a sexual relationship continues the woman is likely to go on to the pill, if she had not been using it before (Frankham & Stronach, 1990). The condom is often associated with young people, pre-marital sex and ‘one night stands’, largely because of its suitability for sporadic sexual encounters (Morton-Williams, 1976; Holland et al., 1991). It is not surprising, therefore, that some young women contrast the condom with the pill which they associate with ‘grown up status and grown up sex’ (Holland et al., 1991). Kent et al. (1990) found that half their interviewees used condoms when they first had sexual intercourse with a particular partner, but this figure fell to a third for subsequent intercourse. The HIV risks of moving from condoms to the pill do not seem to arise ‘as the partner is now ‘known’ (and usually was assumed to be in the first place)’ (Kent et al., 1990: 4). Holland et al. (1990) emphasize how moving from condom use to the pill within a steady relationship often



symbolizes serious commitment, which makes long term condom use problematic. Furthermore, once there is implicit trust between partners, and this trust includes assumptions of monogamy, then persisting with condom use can be interpreted as undermining the steady relationship (Holland et al., 1991). Another important finding of the Women, Risk and AIDS Project (WRAP) is that whatever degree of explicitness and understanding about sexual behaviour a woman might establish within one relationship, with another partner the negotiation of sex is likely to be quite different (Holland et al., 1991).

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Gendered power relations

Some researchers argue that the factors discussed above concerning the negotiation of sexual behaviour ‘cannot be understood without taking account of the gendered power relations which construct and constrain choices and decisions’ (Holland et al., 1991). It is the effect of these power relations on condom use that is the prime focus of the WRAP study. There are various levels at which gender inequalities might operate. If young women’s predominant experience of relations between the sexes is of men’s authority over women, then this might well shape their behaviour in a sexual encounter. If women anticipate that men will, if necessary, exercise their power to get their way (whether by refusing to have intercourse with a condom, by threatening to end the relationship or destroy the woman’s reputation, or by rape) then they might well not pursue their own interests, recognizing that they are unlikely to succeed (Holland et al., 1990, 1991). Economic factors also frequently disadvantage women in their negotiations over sexual behaviour. The convention of men taking women out, premised on their higher earning capacity, coupled with their greater access to cars and restrictions on women’s mobility at night, means that men have greater power to determine the location of their meeting. Evidently this can be contrived to make sexual activity more probable (Kent et al., 1990) and to make the woman’s departure alone particularly difficult. Some women have an immediate motive to try and retain their boyfriends simply to be able to go out at night. In the longer term they will be concerned to ‘find a husband’ before they are ‘left on the shelf. A woman’s economic and social status is still largely determined by her husband, whereas a man’s is determined by his job. Consequently young women have far more to lose if they assert their wishes to the point of ending a relationship (Leonard, 1980). Another dimension of the gender inequalities that shape the negotiation of sex is the expectation, widely held by both sexes, that the man’s sexual pleasure is paramount in a sexual encounter (Fine, 1988; Wilton & Aggleton, 1991). The privileging of men’s gratification means that for a woman to ask her partner to use a condom ‘is a potentially subversive demand’ (Holland et al., 1991). An alternative view is that the management of men’s sexual desire is an habitual pursuit for women, and although men make demands which women have to negotiate many women may be accomplished and successful in doing so. Issues still to be addressed

The qualitative studies of heterosexual behaviour in relation to HIV/AIDS go a long way towards explaining why attitudes and knowledge about AIDS do not necessarily predict behaviour. They address the symbolic dimensions of sexual behaviour, showing how people’s actions are often constrained by implicit social meanings. The latter probably have greater weight as a consequence of the general aversion to explicit conversation about sex. Detailed investigations of sexual encounters show how the behavioural outcome is frequently the

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18 D. WIGHT result of a complex interaction of social factors, is sometimes contingent, and is rarely the subject of explicit decisions. It seems that for many people (and certainly most men) if there is negotiation over a sexual encounter it is concluded when the woman agrees to have sex: it does not start at that point. It is therefore understandable if AIDS health education advice is rarely followed. Although pioneering qualitative research on sexual behaviour has greatly contributed to our understanding of the area, it inevitably leaves many issues to be explored. Little is known about whether there are ‘typical’ sexual careers through which young women or men progress, and if there are, how they have been affected by the advent of HIV. Does it discourage early sexual activity and encourage the more rapid formation of monogamous relationships? Does this in turn affect family formation, or is reproduction more immediately affected by the danger of unprotected sex? How quickly do young women and men gain confidence in their sexual behaviour (if ever), and what are the consequences of insecurity in one’s sexual identity, in terms of seeking sexual encounters and negotiating them? There is great scope to explore how the development of young people’s sexual experience relates to major transitions in their lives: leaving school, moving from YTS to employment, moving in and out of employment, leaving one’s parents home to live independently and so on. Young people’s perceptions and use of condoms are comparatively well researched, but greater knowledge raises further questions. For instance, what are the criteria used to judge when a relationship is stable enough for a couple to move from using condoms to the pill, and is it at this stage that monogamy becomes assumed and therefore sexual intercourse outside the relationship would be concealed and would not prompt a return to safer sex? Another important question to investigate is why a minority of young people do not dislike using condoms. Is this a consequence of early positive experiences with condoms, the support of sexual partners, the lack of other sexual experiences, preferred practices in foreplay, a greater concern to take precautions or none of these? A particularly intangible question to resolve is the extent to which women dislike condoms because of their own physical displeasure or because they have internalized their male partners’ views. Young women’s perceptions of female and male sexuality are becoming better understood, primarily from a feminist perspective. However there is a glaring absence of literature on young men’s perceptions of their own and women’s sexuality. Are young men ambivalent about female sexuality, do they have images of passivity co-existing with ideas of rapacity, with different notions predominating according to their degree of self-confidence or their fantasies? Or are these two traditional constructs of female sexuality irrelevant to the 1990’s? It is widely assumed that the predominant concept of male sexuality amongst both women and men is the essentialist notion of spontaneous, biological and inevitable sex drives. However, little research has investigated this assumption and, if it were substantiated, explored when men consider it is or is not legitimate to succumb to these urges. If a biological notion of the male sex drive were widely held, it would seem particularly fruitful to study prejudices surrounding masturbation, since this is a logical alternative to imposing one’s libido on the opposite sex. It has been argued (Holland et al., 1991) that young men’s apprehension about sex and fear of sexual inadequacy is not subject to discussion amongst young women, since it is not considered a natural aspect of male sexuality. If this is so-and it may be that Holland et al. simply failed to identify such discourse-the absence of any ‘counter culture’ amongst young women warrants further research. The predominant focus on feminist issues in studies of sexual encounters has meant that individual behaviour is intepreted as part of a framework of patriarchal relations. Although this is difficult to contest at a macro level, it seems important to acknowledge the possibility, within individual relationships, of young men’s lack of confidence, fear of



ridicule and readiness to defer to women’s initiatives at least in private. Similarly, while women’s lack of vocabulary to talk about sexual behaviour has been noted (Holland et al., 1991), one cannot assume that the crudities of boys’ discourse enables them to discuss sex seriously. There is still much to be learnt about which factors enable someone to change hidher sexual behaviour (hopefully in the direction of safer sex). The recent history of behaviour change amongst gays suggests that a clearly perceived threat and strong collective identity are important, which bodes ill for heterosexual change. However, it is not known if other conditions are necessary for a change in sexual behaviour, such as confidence in one’s sexual identity, an ability to talk explicitly about sexual pleasure or perhaps a change in sexual partners.

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The survey data on sexual behaviour suggest that HIV has had little impact on sexual activity, apart from a reported increase in condom use (Wight, 1990). A minority still have unprotected sex with several different partners. The research that goes furthest in investigating why the high levels of knowledge about HIV/AIDS are not necessarily translated into safer sex practices are the qualitative studies of micro-social sexual behaviour. Group discussions and detailed interviews elicit the cultural context of sexual behaviour, revealing the moral categories, gender-role expectations, power inbalances and other factors that shape and give meaning to our actions. T o protect one’s self-esteem, for instance, ambiguity about one’s sexual intentions is maintained as long as possible, thereby precluding prior discussion of safer sex. Trusting one’s partner to be discreet about one’s sexual relations also precludes learning about hidher previous sexual history. Another consequence of the lack of communication about sex is that partners frequently do not use any contraceptive during their first sexual intercourse; since condoms are used primarily as contraceptives rather than contra-infection, this has important consequences for safer sex. Even if the difficulties of buying, carrying and using condoms can be overcome, if a sexual relationship is perceived as long term the woman is likely to go onto the pill, symbolizing serious commitment. Overlying all these issues is the extent to which women’s choices are constrained by their power relations with men and the privileging of men’s sexual gratification. Although only interim findings are available from the most detailed studies of sexual encounters, they already provide important insights into how realistic and practical safer sex messages are. The findings suggest that to promote health in respect to HIV it is necessary not only to advocate specific precautionary behaviour, such as using condoms, but also to address far wider cultural issues. The most important cultural factors constraining safer heterosexual behaviour can be loosely grouped under two headings. First is the taboo against the serious discussion of sexual behaviour, both amongst same sex groups and across the sexes. The second is the extent to which women are able to exercise their own interests in sexual encounters unconstrained by the conventions of feminine sexuality. T o tackle such entrenched aspects of our culture might be deemed as unrealistic as advocating sudden widespread condom use, and would certainly be more contentious politically. However, it should not substitute shortterm health promotion campaigns, but, rather, complement, them. Given the constraints to safer heterosexual sex in the immediate future, a long-term strategy of addressing wider cultural issues, particularly through comprehensive sex education (Bury, 1991), may be essential to promote sexual health.


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References ABRAMS, D., ABRAHAM, C., SPEARS,R. & m s , D. (1990a) AIDS invulnerability: relationships, sexual behaviour and attitudes among 16-19 year-olds in: P. AGGLETON,P. DAVIES& G. HART(Eds) AIDS: Individual, Cultural and Policy Dimensions (Lewes, Falmer Press). ABRAMS, D., et al. (1990b) Personal communication with C. Abraham. BLAXTER, M. (1989) Behaviour change in the context of HIV/AIDS. Paper prepared for ESRC Steering Group. BOSTOCK, Y. & LEATHAR,D. (1982) The role of mass media advertising campaigns in influencing attitudes towards contraception among 16-20 year olds, British Journal of Family Planning 8, pp. 59-63. BOWIE,C. & FORD,N. (1989) Sexual behaviour of young people and the risk of HIV infection, Journal of Epidemiology and Community Health, 43( l), pp. 61-65. BURY,J. (1984) Teenage Pregnancy in Britain (London, Birth Control Trust). BURY,J. (1991) Teenage sexual behaviour and the impact of AIDS, Health Education Journal, 50 ( l ) , pp. 43-49. CHNG,C.L. (1983) The male role in contraception: implications for health education, The Journal of School Health, Much, pp. 197-201. COWIE,C. & LEES,S. (1987) Slags and Drags in: FEMINIST REVIEW (Ed.): Sexuality: A Reader (London, Virago). DEJONG,W. (1989) Condom promotion: The need for a special marketing program in America’s inner cities, Amm‘can Journal of Health Promotion, 3(4), pp. 5-10. FINE,M. (1988) Sexuality, schooling, and adolescent females: the missing discourse of desire, Harvard Educational Review, 58(1), pp. 29-53. FORD,N. & MORGAN, K. (1989) Heterosexual lifestyles of young people in an English city, Journal of Population and Social Studies, l(2) (Bangkok, Thailand). FRANKHAM, J. & STRONACH, I. (1990) Making a drama out of a crisis: an evaluation of the Notfolk action against AIDS health education play ‘Zove Bites” (Centre for Applied Research in Education, University of East Anglia). GAGNON, J. & SIMON,W. (1974) Sexual Conduct: The Social Sources of Human Sexuality (London, Hutchinson). HOLLAND, J, RAMAZANOGLU, C., SCOTT, S, SHARPE,S. & THOMSON, R. (1990) Sex, gender and power: young women’s sexuality in the shadow of AIDS, Sociology ofHealth and Illness, 12(3), pp. 336-350. C., SCOIT, S, SHARPE,S. & THOMSON, R. (1991) Between embarrassment and trust: HOLLAND, J, RAMAZANOGLU, young women and the diversity of condom use in: P. AGGLETON, P. DAVIBS& G. HART(Eds) AIDS: Responses, Intervention and Care (Basingstoke, Falmer Press). C.J. (1988) Health-related behavioural change-a test of a new model, Psychology and HUNT, S.M. & MARTIN, Health, 2, pp. 209-230. INGHAM,R., WOODCOCK, A. & STENNER,K. (1991) Getting to know you.. .young people’s knowledge of their partners at first intercourse, Journal of Community and Applied Social Psychology, 1, pp. 117-132. KENT,V., DAVIES,M., DEVERELL,K. & GOTTESMAN,S. (1990) Social interaction routines involved in heterosexual encounters: prelude to first intercourse. Paper presented at 4th Conference on Social Aspects of AIDS, South Bank Polytechnic, London (7 April). KITZINGER, J. (1991) Safer sex. Unpublished working paper, AIDS Media Research, University of Glasgow. LEE, C. (1983) The Ostnch Position: Sex, Schooling and Mysttfiation (London, Writers and Readers Publishing Co-op).

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Leonard (1980)

McRobbie (1978)

McGlew et al. (1983)

Bostock & Leathar (1982) Cowie & Lees (1987)

1987 and 1988

1987 and 1988

Spencer et al. (1988)


Bowie & Ford (1989)

MEL (1989)



Spencer (1984) Abrams et al. (1990a)



Date of research

Schofield (1965)


Detailed interviews

Survey: interview and self-complete Surveys: interview and self-complete

Single sex group discussions Group discussions and detailed interviews Group discussions Self-complete questionnaire

Ethnography, detailed interviews, questionnaires Detailed interviews

Detailed interviews

Interview survey

Principal methods 2,m

Final size









54 couples





16 and 18





Primarily early 20s



Appendix. Research details ~

Quota sampling in selected wards Street contact: quota samples determined by age, sex, social class, ethnicity Quota sampling by gender, age, social class, sexual orientation etc

Primarily boys Postal, using school roles

First time clients at family planning clinic Representative in socio-economic terms Two Islington schools

Clustered representative samples Through priests and Marriage Register Youth club girls

46 out of quota 25 refusals

ca. 70%


(far higher for young women)




Response rate /bias

Sample characteristics



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London, Birmingham, Leeds and Ipswich

West Midlands


Dundee and Kircaldy

Edinburgh and Strathclyde Region London










RUHBC (1990)

Holland et al. (1990, 1991) Ingham et al. (1991)

Kent et al. (1990)

Ford & Morgan (1989) Scott & Griffin (1989)

Computer assisted telephone interviewing

Detailed interviews


1987-1 990 repeated monthly

Questionnaire survey Detailed interviews

Detailed interviews

Questionnaire survey Eight single sex group discussions





I?;“ 1,051






16-2 1



16-2 1

Random digit dialling

Diverse range of contacts

Diverse range of contacts

Through various institutions

Quota sampling in selected areas Representative in socio-economic terms

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ca. 80%

Low participation probable bias toward more sexually active Possible bias towards more consensual sexual encounters









? I






2 Central Scotland and Metropolitan London

and London Hampshire and Berkshire


8 Manchester




Impediments to safer heterosexual sex: a review of research with young people.

This article reviews the existing British literature on the micro-social details of young people's heterosexual encounters, emphasizing the cultural f...
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