News
Sexual behaviours: health and well-being
Researcher CIS‑Iscte
Several reports show that condom use has decreased significantly in recent years, including in Portugal and Spain, and instead, the number of STIs has skyrocketed worldwide.
What did this project set out to investigate?
We wanted to know how people's motivations are going to be informed by their sexual behaviours. People have two fundamental motivations for meeting their needs. Some are more likely to take risks in pursuit of gain, while others are more likely to seek risks and protect their safety. These two motivations also differ according to the areas of our lives. Those most likely to take risks are the people "on promotion"; those most predisposed to protect their health/safety are people "on prevention". A vast amount of literature shows that people "on promotion" tend to gamble more, line up with greater financial risk, change jobs more efficiently, etc., while people "on prevention" tend to be more cautious and prefer to maintain the security and conditions they have so as not to incur possible losses. We transposed this to sexual behaviour and set out to understand whether people "on promotion" are more willing to take risks with their sexual behaviour, while people "on prevention" would be more willing to protect their sexual health. This was the focus of the project. In terms of behaviour and indicators of sexual health and well-being, we analysed the frequency of STI testing, the frequency of condom uses and perceptions related to condom use in different sexual activities. We also looked at affection – positivity or negativity – in the face of sexual experiences without a condom. We also looked at other types of indicators, namely the kind of sex education that people had, whether it was in schools, with parents, with friends, or on social media pages, to try to understand how motivations for pleasure-seeking or safety can determine or be associated with different types of sexual behaviours.
What methodologies were used in this study?
Mostly, they were quantitative, in which we asked people in what situations and conditions they considered prone to the use of condoms, as well as what functions they attributed to their use. We also used experimental methodologies. In these, we presented a scenario to people and analysed how they differed in their intentions to use condoms. The only inclusion criterion was to be over 18 years old and to have started sexual activity, and anyone from Portugal or Spain could participate in this universe. The project also compared Portugal and Spain throughout the four significant data collection moments. Another great moment of data collection was for the longitudinal study. We made a collection at a specific time, and three months later, we collected it again, with precisely the same people, to assess temporal causality, that is, to find out if people's motivations tend to determine their behaviours three months later.
Have you detected discrepancies between Portugal and Spain?
We did not find any significant differences between the two countries. We have achieved a good balance in terms of demographic characteristics, although, in general, there are more people with a high level of education living in metropolitan areas. There is, therefore, a group of people who tend not to be covered by these questionnaires – due to difficulties in accessing the internet or computer, for example – and these are some of the limitations we have in generalising our results. The experimental study was carried out in the United States, and this helps to have validation against other cultures and social contexts, giving more robustness to the results.
They identify two types of profiles – one of people who are more "on promotion" and the other who are more "on prevention" – but can't the same person alternate this behaviour throughout life?
This is a good question, but the literature has no definitive answer. The way we look at this is related to a trait that we have developed since childhood based on the experiences we have in our social environment. If we have parents who lead us to experiment and take risks, we will probably develop more motivations for promotion. If, on the other hand, we have parents who always say, "Don't do this", we tend to internalise this caution, and we are likely to adopt prevention motivations and are more alert to possible dangers everywhere. But in specific contexts, we can adapt to different motivations. It is expected that even a person "on promotion" if they are going to get tested for an STI and receive a positive diagnosis will be able to restrict their behaviour and momentarily adopt a more preventive behaviour. However, this has not yet been adequately studied.
What stands out from the results obtained? Were recommendations made from this investigation?
We have different types of outcomes, but in general, we found that people who are more focused on promotion have adequate knowledge about a higher number of STIs – and this knowledge came from conversations with peers or doctors. For these people, the use of condoms is seen as a barrier to pleasure, so they tend not to use them as often. However, the fact that people "on promotion" put themselves more at risk also leads to them being tested more frequently for a more significant number of STIs. On the other hand, people who are more focused on "prevention" already know that there are many STIs, usually seeking information from more academic sources. Still, they tend to be tested less often. This behaviour is probably related to the fact that they are more aware of the possible risks that sexual activity may have and use condoms more often. However, they also tend to feel less sexually satisfied. This is an important point that has to be worked on in the future, as people "on prevention" are protecting their health, but they are losing their sexual well-being component.
People have two fundamental motivations for meeting their needs. Some are more likely to take risks in pursuit of gain, while others are more likely to seek risks and protect their safety.
Is there not, then, an 'ideal' behaviour?
There are benefits and consequences to each of the modes of operation. Suppose we can intervene and develop awareness campaigns in which we give tools to both types of profiles to increase the components of their sexual health and well-being. In that case, we will improve everyone's quality of life.
What are the outputs of the project?
This project has three scientific articles published (1), two under review, and one to be written. The project also included a publicity article, which was published on the website of the "la Caixa" Foundation (2).
In all studies, we are careful to see if there are differences in demographic characteristics, and regardless of any difference that may exist in our sample from the outset, the results are consistent. That allows us to look at this phenomenon in a very robust way. The findings of the Prevent2Protect project can be very quickly used in screenings or communication campaigns to know the best message to convey to people according to their profile. For example, for a person who is more focused on prevention, a campaign focused on pursuing pleasure may have less impact because it is not aligned with their fundamental motivations. Still, if the message is "Stay safe and seek pleasure," the message may resonate more.
Is there a field of progression for this research?
We would like to have awareness campaigns with the same message but focused on both profiles so that they are comprehensive and impactful. It is a study that we still have to do, and that is why we are planning for the future: to develop an intervention for the improvement, in the sense of sexual pleasure for everyone, always with personal responsibility and the integration of the use of condoms as a customary practice of sexuality. For people "on prevention," this practice is more common, but we want to give them tools to get more sexual pleasure. For people "on promotion," this practice is not so common, but we want to provide them with tools to get pleasure while using condoms.
Several reports show that condom use has decreased significantly in recent years, including in Portugal and Spain, and instead, the number of STIs has skyrocketed worldwide. It may have to do with the fact that the most feared STI is HIV, which no longer has the negative charge it had a few years ago. Today, it is a disease that can be managed with access to medication. As such, people tend to take away from its gravity and may not feel as much need to protect themselves. We need to rethink the way we talk about STIs and condom use and include this need for protection as part of positive sexual health.
How was the Prevent2Protect team formed? And what funding did it support?
This is a project of CIS-Iscte researchers Marília Prada, Margarida Vaz Garrido, Diniz Lopes, me and the scholarship holder Ana Catarina Carvalho. We collaborated with international researchers Rhonda Nicole Balzarini from Texas State University and Richard O. de Visser from Brighton & Sussex Medical School. The "la Caixa" Foundation – Social Research Call 2020 funded the project.
1 Articles published in scientific journals: Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices Condom use beliefs differ according to regulatory focus: A mixed‑methods study in Portugal and Spain Focusing on safety or pleasure determine condom use intentions differently depending on condom availability and STI risk.
2 Dissemination article published in Social Observatory "la Caixa": Knowledge for safe health in Portugal and Spain.