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Safe Sex

For sexually active individuals, the likelihood of contracting a sexually transmitted disease (STD) is best viewed as linked to behavior that varies on a continuum from risky to safer. Safe (or safer) sex is defined as taking precautions to reduce the likelihood of negative consequences of sex—including both STDs and unintended pregnancy. Safer sex is typically thought of in terms of barrier protection methods such as male or female condoms (i.e., protected sex), and a majority of studies on safer sex focus on the use of condoms. There are, however, a variety of strategies that one can use to reduce risk of STDs and unwanted pregnancy. These include engaging in lower risk sexual behaviors (e.g., oral sex rather than anal sex), reducing numbers of sexual partners, refusing unwanted sex, not drinking or using drugs in combination with sex, and not having sex with partners that one knows or suspects may be risky (e.g., injecting drug user, sex worker). Thus, rather than a single behavior, safer sex is perhaps best viewed as a set of behaviors and practices that have the ultimate effect of reducing one's risk. Although the only means to eliminate risk is complete abstinence, for most individuals abstinence is neither realistic nor desirable.

Relationships and Safer Sex

Although defining safer sex is an important starting point, sexual behavior (and thus safer sexual takes place in the context of a relationship—be it intimate or casual. Given that this is the case, a large literature demonstrates that the choice of whether to have protected sex (i.e., sex with a condom) is driven largely by relationship dynamics. For instance, many studies of both heterosexual and gay couples show that couples are more likely to use condoms during sex with casual as compared with main or steady sexual partners. This is presumed to be the case because more casual, lesser known sexual partners are perceived to potentially be a threat or risky whereas better known partners are perceived as safe. In addition, a variety of processes appear to play into these dynamics, depending on the type of relationship.

Main-Steady Relationships

Studies suggest that the most likely time for steady heterosexual and gay couples to use condoms is at the start of a relationship. At that point, the relationship is still new, partners may not know one another well, and the relationship itself may be casual in nature and not serious or monogamous. Over time, however, many gay couples will discontinue condom use, while heterosexual couples replace condom use with hormonal birth control. How much time does this take? One study of heterosexual adolescents and young adults found that typical couples dropped condom use in favor of hormonal birth control only 3 weeks after initiating sexual intercourse. From a safer sex perspective, these young people clearly believe that they are substituting one type of safer sex (condom use with casual partner) with another type (hormonal birth control use with steady partner). The problem for heterosexual couples, of course, is that hormonal methods only protect from unwanted pregnancy and do not protect against STDs. In the case of gay couples, discontinuing condom use leaves them unprotected from STDs. Given that STDs are very common in young people, as are serial monogamy and multiple sexual partners, it quickly becomes clear how STDs are passed within the context of close, steady relationships. In fact, this is thought to be a contributor to the rising rates of HIV/AIDS among African-American and Latina women, who often have their guard down in the context of close relationships. In some cases, such women are unaware of significant risk factors of their male partners, such as bisexuality, multiple partners, and/or injection drug use.

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