Safer Sex Messages Research Articles

Sex and drugs in popular movies: an analysis of the top 200 films

We analyse the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. Films released or set prior to the HIV era (pre 1983), animated, not about humans or G/PG rated, were excluded. Films were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded. There were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use. Sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. The social norm being presented is concerning given the HIV and illicit drug pandemics.

Sex and Drugs in Popular Movies: An Analysis of the top 200 Films

We analyse the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. Films released or set prior to the HIV era (pre 1983), animated, not about humans or G/PG rated, were excluded. Films were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded. There were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use. Sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. The social norm being presented is concerning given the HIV and illicit drug pandemics.

It's not just condoms: Social contexts of unsafe sex in gay men's narratives of post-exposure prophylaxis for HIV

This paper draws on findings from an ongoing prospective cohort study with a quantitative and a qualitative arm to monitor the implementation of guidelines for non-occupational post-exposure prophylaxis in Australia. The aim of the qualitative arm was to explore in-depth details of exposures and participants' understanding of ‘risk’. This paper documents the physical, social and emotional contexts in which unsafe sex leading to post-exposure prophylaxis occurred. It will be argued that unsafe sex happened in spite of participants' knowledge about safe sex and as a consequence of a temporary absence of control. Five themes characterising the social contexts of unsafe sex can be identified in the narratives: issues relating to past, current and potential future relationships, drugs and alcohol, public and private social spaces, stress, and adventure. These contextual categories are not always neatly separated but interact with each other in various ways. Findings suggest that disseminating knowledge of safe sex practices based on condom use alone is not enough. Safe sex messages need to be contextualised to make links between sexual practices and the everyday experiences of those for whom they are intended.

Tailoring safer sex messages to lower-educated young gay men: the impact on cognitions and intention

In order to test whether simplifying information about HIV risk or tailoring arguments that are meant to promote the use of condoms would enhance the effects of safer sex messages on men of lower education, we conducted an experimental study. We recruited 51 lower-educated young Dutch gay men (i.e., men who stopped their training after they had completed general education or lower vocational training). We randomly assigned these men to read a safer sex brochure that is widely distributed among gay men in The Netherlands (the ‘standard message’) or one of three alternative versions. In the alternative messages we (1) reduced the complexity of the information about HIV risk, (2) obtained a closer match between the arguments that are meant to promote the use of condoms and the salient beliefs about safer sex in men of lower SES (among others we gave information about how to cope with situations that these men find difficult to handle), or (3) manipulated both aspects of message content. After exposure to one of the messages, participants completed a self-administered questionnaire that tapped social cognitions about safer sex. We also included 106 higher-educated men in our experiment (i.e., men who had completed high school, college, applied arts and sciences education, or academic and theoretical education). This allowed us to test whether tailoring messages to lower-educated men would have negative effects on higher-educated men. The results showed that simplifying information about HIV risk did not affect knowledge levels. Exposing lower-educated participants to the tailored arguments promoting the use of condoms, however, enhanced these men's intention to engage in protected anal sex. This effect was associated with an increase in men's perception of behavioural control. No negative effects of the manipulations of messages were found in higher-educated participants.This study emphasizes the importance of addressing control issues that are relevant to men of lower SES in order to increase the effectiveness of messages in encouraging preventive action.

Why HIV infections have increased among men who have sex with men and what to do about it: findings from California focus groups.

A resurgence of sexual risk taking, STDs, and HIV incidence has been reported among men who have sex with men (MSM) in several countries. We asked 113 MSM in 12 focus groups conducted in five California cities to identify factors leading to increased risk taking and assess prevention messages to reduce risk in this population. Participants perceived that HIV risk taking has increased because (1) HIV is not the threat it once was due to more effective therapies, (2) MSM communicate less about HIV, and social support for being safe has decreased, and (3) community norms have shifted such that unsafe sex is more acceptable. The prevention messages ranked most likely to motivate risk reduction encouraged individuals to seek social support from friends. Themes ranked least likely to succeed were those that described the negative consequences of HIV or reinforced existing safer sex messages.

Preventing Sexually Transmitted Infections and Unintended Pregnancy, and Safeguarding Fertility: Triple Protection Needs of Young Women

The problems and risks of unprotected sex, unintended pregnancy and sexually transmitted infections are inextricably linked. In this context, the critical yet overlooked problem of infertility also needs to be addressed. Dual protection means concurrent protection against unintended pregnancy and STI/HIV. This paper argues for a more comprehensive notion of “triple protection” to include the safeguarding of fertility. This is intended explicitly to draw out the connection between infertility and STIs—using the “visibility” of fertility and infertility and people's immediate connection with them—and in so doing to bolster STI prevention and control efforts. It could also serve to highlight the connections between infertility and unsafe abortion and delivery practices, which still exist in many developing countries. Understanding differences in perception and weighting of protection concerns by young women and men, whether they wish to start, postpone or avoid pregnancy, is essential for the creation of effective programmes. Building on efforts to promote dual protection, a strategic opportunity exists to include prevention of infertility into safer sex messages and to address the fragmentation of reproductive health and HIV/AIDS programmes.

Urban women's gender scripts: Implications for HIV prevention

Women's and men's gender roles and expectations regarding romantic and sexual encounters have been shifting, and the need to develop HIV preventive strategies has underscored the importance of understanding the contextual dynamics related to sexuality. Urban women's gender scripts were investigated as part of a comprehensive study that evaluated the efficacy of a theory-driven HIV/STI prevention programme. One hundred and thirty ethnically diverse women living in New York City participated in this study. Qualitative analysis was conducted of scripts generated as part of a semi-structured interview. Women's gender scripts were examined via descriptive narratives of their ideal romantic encounters. Results indicate that (a) both traditional and non-traditional gender scripts are evident in women's narratives; (b) distinct flirtation and sexual phases have similar and differing elements that assist in the initiation, progression, and ending of each phase; (c) type of communication used varied by the phase with verbal communication being more prevalent in the flirtation phase, and non-verbal communication used more often in the sexual phase; and (d) safer sex is not included in most women's gender script narratives. The findings have implications for HIV prevention and suggest the need to 're-write' present scripts, expand the repertoire and intent of safer sex messages, and incorporate cues to pre-sexual and sexual romantic encounters that could facilitate safer sex discussion and participation.

MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City

This study assesses patterns of use of methylenedioxymethamphetamine (MDMA or ‘ecstasy’), and the characteristics of users, in a sample of 733 men who have sex with men (MSM) in New York City. Among respondents, 13.7% reported using MDMA in the past 6 months, with mean frequency of use of 6.24 times in that period. MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence, to have more gay/bisexual friends, to have disclosed their sexual orientation to more friends, family members, and coworkers, and to have higher levels of gay community participation and affiliation. Among MDMA users, higher frequency of MDMA use was associated with being younger, having more visits to bars or clubs, more gay/bisexual friends, and having an HIV negative test result or never having been tested. MDMA users thus constitute a group at risk for sexually transmitted diseases, including HIV, and other problems. The data suggest that MDMA use is associated with being more ‘out’, which may be advantageous in helping gay men deal with harmful psychological effects of stigma, but may place individuals in settings that expose them to MDMA. These men have also presumably already been well exposed to safer sex messages within the gay community, thus raising challenges for interventions aimed at prevention, as well as opportunities (e.g. MSM and community specific interventions) that need to be further explored.

Are healthcare providers talking to HIV-seropositive patients about safer sex?

HIV-seropositive men (n = 250) from San Francisco and New York city completed a self-administered survey assessing health care providers delivery of safer-sex messages. 1 out of 4 men had never received safer-sex counseling from their healthcare provider. Men at highest risk for transmitting HIV were no more likely to have been counseled than men at lower risk. Physicians should regularly provide tailored safer-sex messages to all HIV-seropositive patients who have entrusted them with their care. (authors)

Safe sex message fails to get through to young people

Safe sex message fails to get through to young people

Microbicide Research and Development—Where To?

Purpose: Against the backdrop of increasing numbers of HIV infections in women and the limitations of current safer sex messages, several calls have been made for the development of women-initiated methods of prevention as an essential component of the armamentarium to reduce women’s vulnerability of acquiring infection with HIV. An effective microbicide is a critical survival tool in instances and situations where existing proven prevention strategies have failed to be adopted. Method: The results of published N-9 clinical trials in terms of anti-HIV activity, safety data, and anti-sexually transmitted infection (STI) activity are discussed. Results: There is no evidence of efficacy against HIV in three clinical trials, there is scanty evidence for protection against STIs, and there is considerable evidence of dose-related adverse effects. Conclusion: During this time, a vast array of potential microbicides with differing modes of action have been discovered, and some have undergone preclinical and early clinical testing. Effort, time, and resources might be better spent on advancing preclinical and clinical testing of these other candidate microbicides.

Television Teen Drama and HIV/AIDS: The role of genre in audience understandings of safe sex

This study focuses on audience understandings of safe-sex messages ?contained? in television drama. It focuses on the process of audience construction of meaning; on the work that audiences engage in to understand HIV-related television messages. Data consist of 20 focus group discussions conducted subsequent to the viewing of one of two AIDS-related television programmes. Following a Shotterian approach to meaning construction, analyses of audience transcripts indicates that genre is an important hermeneutic tool shaping audience understandings of, and engaement with, health related messages. However, audience emphasis on ?the messag? works against audience engagement with this message. The message is so clearly signalled to viewers that they are able to prepare their defences against the message before it even arrives. The implications for health promotion via mass media generally are discussed.

Educational status and young Dutch gay men's beliefs about using condoms

The higher levels of HIV risk behaviour that have been found in young gay men with lower socio-economic status (SES, among others defined as educational achievement) may result from unequal effects of safer sex interventions. We conducted semi-structured focus group interviews with an educationally diverse sample of 113 young gay men living in The Netherlands. The objective was to bring to light men's salient ('accessible') beliefs about using condoms since information about beliefs might facilitate the formulation of 'personally relevant' safer sex messages that enhance in-depth message processing. We found several educational differences in the areas of knowledge about HIV preventive behaviour, cognitive schemas about the factors involved in HIV transmission, perceived pros and cons of using condoms, perceived social pressure to use condoms and feelings of being in control of protective action. This may suggest that, for intervention efforts to be effective in motivating the diversity of young gay men to engage in safer sex, interventions should convey tailor-made messages that match recipients' educational degree. Several implications for the formulation of such messages are discussed.

How to use a condom: Narratives, sexualities and moralities in safer sex health promotional literature

This paper uses two specific 'moments' in the history of the UK HIV/AIDS health promotion response to illustrate the way in which social narratives and moralities underpin different safer sex messages. Drawing on narrative psychological theory (see Crossley 2000a, Maclntyre 1981, Taylor 1989), it works from the premise that the language and cultural images used in health promotion campaigns are inscribed within predominant narratives and stories. The stories and the meanings thereby set in motion are intrinsic to our making sense of ourselves and others around us. This is because stories constitute manifestations of specific versions of what is 'valuable', 'worthwhile', 'justifiable' and 'moral' for people in any given culture, thereby having the capacity to confer meaning and substance on our lives (Taylor 1989). The case studies examined here are used to illustrate the way in which different health promotional materials offer very different accounts of sexuality that are inextricably related to culturally inscribed visions of 'self' and ways of relating to others. An important part of deconstructing the images and messages offered by HIV/AIDS health promotion campaigns, involves questioning and assessing the suitability of such narratives for contemporary challenges facing the audience for which they are intended. The safer sex promotional materials produced by two very different UK based health related agencies, the Health Education Authority (HEA) and the Terrence Higgins Trust (THT) will be focused on. Chronicles of the HIV/ AIDS epidemic have dubbed these agencies as advocating 'heterosexual' and 'gay' approaches, respectively, to health promotion (e.g. Garfield 1994).

Aids awareness and discourse interpretation

Abstract This paper describes a study which examines how people interpret the safe sex messages presented in posters distributed throughout Australian airports as part of the government’s Travel Safe AIDS awareness campaign. The subjects who participated in the study were all under 25 years old, one of the target groups for the particular campaign. The group was made up of 20 native speakers of English and 20 non-native speakers of English. Both groups of readers largely recognized the intended messages of the texts and, in many cases, learnt something new from them. This was particularly the case with the non-native speakers of English. The paper cautions, however, on drawing the conclusion from the study that all readers will necessarily enter into the intended reading position of the texts, and respond positively to them.

A Qualitative Assessment of Australian Parents' Perceptions of Sexuality Education and Communication

Nineteen focus groups were conducted with parents of secondary students in Australia about important messages they give at home regarding sexual behavior and sexual responsibility. Parents indicated that sexuality is an important part of their children's lives and they want their own children to be better informed than they were as adolescents. They believe it is both unethical and futile to try to dictate the sexual decisions of their children; instead they strive to provide them with the knowledge and skills to make informed choices. Both fathers and mothers clearly value sex within relationships over casual sex, and encourage their children to protect themselves and others when engaging in sexual behavior. They expressed appreciation of school sexuality education programs and said they made it easier to talk about sex at home. There was strong support for safer sex messages in schools and in the media. Most opposed abstinence-until-marriage messages, explaining not only why they wouldn't work but what ...

Ibiza uncovered: changes in substance use and sexual behaviour amongst young people visiting an international night-life resort

Background: Each year more young people travel to international resorts where levels of substance use, sex and associated health risks are unknown. This study measures changes in levels of substance use and sexual behaviour of young people from the UK when on holiday in a youth orientated international resort, Ibiza. Methods: Data were collected through a cross-sectional survey collecting matched information on individuals’ behaviour in the UK and abroad. Questionnaires were administered to 846 individuals aged between 15 and 35 at Ibiza Airport prior to their returning to the UK. Results: Young visitors to Ibiza significantly alter patterns of drug, alcohol and tobacco use. For ecstasy, in the UK 2.9% of users (9/313) used 5 or more days a week, while in Ibiza this rises to 42.6% (127/298). Fewer individuals use amphetamine, ketamine, cannabis, LSD, cocaine and GHB (γ-hydroxybutyrate) in Ibiza although those continuing to use in Ibiza consume at substantially higher rates than when in the UK ( P<0.001). Using multiple drugs over a 1 or 2 week stay was common (31.9%). Most individuals (53.8%) had sex while in Ibiza; 26.2% had sex without a condom and 23.2% had more than one sexual partner. Overall, 7.3% of individuals went to hospital or to see a doctor while in Ibiza with male ( P<0.001), older ( P<0.05) and staying for shorter times ( P<0.005) being the key risk factors. Conclusions: While the potential for substance related ill health is dramatically elevated in Ibiza, harm minimisation measures in such resorts remain scarce. Equally, although holiday companies attract a sexually active cohort, safe sex messages are either absent or ineffective. Coordinated information campaigns to protect the health of young people are urgently needed and will require European cooperation across both public and private organisations.

Part 2

In this second part of the trilogy, I review the concepts of panic, the Theory of Cognitive Dissonance, and how internally inconsistent opinions and attitudes can be made consistent (or consonant). The theory explains, in some measure, how AIDS has been socialized into our thinking about identity, and goes beyond a medical condition. The pervasive identification of gay men with HIV and AIDS has resulted for many in an over-identification with fears of contagion and on a societal level in a fear of all gays as pools of contagion. The conversion of dissonance to consonance has taken many forms; within the gay community it has resulted in the rejection of the “100% safe-100% of the time” safe-sex message, and the adoption (for many) of a new form of deviant label-someone who is not in conformity with the social norm of gay community sexual behavior. However, we shall see that this so-called norm is a sham-that many gay men do not, as a rule, practice safe(r) sex on a consistent basis. This information indicates that the educational efforts of the last decade have at best lost their potency, and at worst were less than efficacious to begin with. The dissonant messages have also informed both the construction of the gay community and its interpretation of what it means to be gay. The result has been a tri-lateral perception of HIV and AIDS as either a medical, political or a social phenomenon. This fragmented understanding has exacerbated the already polarized ASOs and GSOs in that each has determined its ideology based on a particular interpretation of HIV and AIDS. This polarization has been operationalized by the GSOs and ASOs primarily in the manner by which they define their target markets, and more importantly, in the manner by which they exclude certain gays from participation. At the extreme, some gay men feel entirely left out of the community, and are consequently unable to convert their dissonance regarding being gay into consonance, if only by developing some associational ties with the community. The central question of the sustainability of the gay movement is thus partly answered by restating the nature of the fractures in the community. Kiesler's determinants regarding change relate directly to the sustainability question-can GSOs and ASOs, given their pluralistic ideologies and constituencies, break free of the constraints that are posed by these determinants? Would the adherents and conscious constituents defect from their organizations, and form new ones (thus reifying the fractures that already exist)? On the other hand, is there a sense of community and identity that will function as a bonding agent to encourage coalition building and social reorganization? The matter may turn on the issue of selective rewards: can a coalition of ASOs and GSOs provide staff, volunteers and clients sufficient motivation for making the inevitable compromises? Given the selective nature of the rewards, as they now stand, the probability of being able to so do is remote. The influence of the non-gay community, as well as the attitudes and beliefs of the majority of gays who do not belong to any gay organizations, hampers success.

Third-Person Perception and Optimistic Bias Among Urban Minority At-Risk Youth

Recent third-person perception articles suggest that optimistic bias is the mechanism underlying the perceptual bias but fail to empirically test the assumption. A small inverse relationship between third-person perception and optimistic bias was found among the youth surveyed: 51% of the students exhibited third-person perceptions, believing they were less influenced by televised safer-sex messages than were their peers. These students were less optimistic about their chances of becoming HIV infected than their peers; 34% exhibited first-person perceptions, believing they were more influenced by the messages than were peers, and were more optimistic than were their peers concerning HIV infection. Most students (89%) exhibited some degree of optimistic bias regarding their chances of avoiding HIV infection in the future. The findings effectively link the two literatures within a sample neglected by previous studies: urban, minority, at-risk youth. The study advances knowledge of third-person perceptions by suggesting underlying social-psychological mechanisms.

Socializing influences and the value of sex: The experience of adolescent school girls in rural Masaka, Uganda

In order to explore the socializing influences which have shaped rural adolescent schoolgirls' views and values about sex in a high HIV prevalence area of Uganda, detailed qualitative data was obtained over a one year period from 15 schoolgirls (aged 14-17), chosen for their willingness to participate actively in a series of role plays, focus group discussions (FGD) and one-to-one interviews. Findings suggest that the girls have been subjected to a wide range of influences, including parents, social functions, other young children, nature, their ssengas, peers, school, and various media, such as pornography. There was disagreement about the relative values of sex and virginity. Some were determined to retain their virginity, but the majority felt that sex benefits them socially and personally. Peer pressure was a major factor shaping many girls' opinions, while traditional influences are in decline. Because of the small sample size, care should be taken in generalizing from the findings. However, the data suggest that sex has a high value for at least a substantial minority of adolescent girls in rural Masaka, Uganda. Policy makers and health educators should therefore consider how best to devise safe sex messages that are both relevant and applicable to this especially vulnerable group.