Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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The Lancet Vol. 368; No. 9547: P. 1581-1586 (11.04.06) - Tuesday, December 19, 2006
Cicely Marston, PhD; Eleanor King
Seven predominant themes emerged from their research:
*Young people assess potential sexual partners as "clean" or "unclean." Youths may use condoms for short-term, unstable relations but not for longer, stable ones. For stable partners, condom use may be more of a contraception consideration than STD-related.
*Sexual partners have an important influence on behavior in general. Besides condom use decisions, the sexual partner can influence whether sex is perceived as strengthening the relationship, a way to please, or even to retain a boyfriend through paternity.
*Condoms can be stigmatizing and associated with a lack of trust. Youths worry that asking a partner to wear a condom suggests an evaluation their partner is STD-infected. Obversely, condomless sex may signal trust.
*Gender stereotypes are crucial in determining social expectations and behavior. In all the societies studied, men were expected to be highly heterosexually active, while women's chastity, especially at marriage, was prized.
*There are penalties and rewards for sex from wider society. Gender-norm quiescence can raise social status: for men, by having many partners, and for women, by chastity and monogamy.
*Reputations and social displays of sexual in/activity are important. Reputations are key to social control over sexual behavior. Thus, social displays of heterosexuality are important for men, as chastity is for women.
*Finally, social expectations hamper communication about sex. Women might not wish to mention sex, especially early in a relationship, and may avoid saying "yes" directly to sexual activity for fear they might seem inappropriately willing or damage their reputation. Thus, genuine refusal may be hard to communicate.
"This study summarises key qualitative findings that help in understanding young people's sexual behaviour and why they might have unsafe sex; policymakers must take these into account when designing HIV programmes," the researchers concluded. "Considerable overlap exists between current studies, which indicates the need to broaden the scope of future work."
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