Sex education

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204 HEALTH PSYCHOLOGY
did not appear to be the case with the women they interviewed. The qualitative data
from the WRAP study provides some insights into the process of negotiation; it also
emphasizes sex as an interaction. In addition, it provides a relationship context for
individual beliefs and cognitions. In line with the WRAP study, Debro et al. (1994)
examined the strategies use by 393 heterosexual college students to negotiate condom
use and concluded that they used reward, emotional coercion, risk information, deception, seduction and withholding sex. Noar et al. (2002) built upon Debro et al.’s work
and developed and validated a measure to quantify negotiation strategies called the
‘condom influence strategy questionnaire’ (CISQ). They conceptualized negotiation
in terms of six strategies: withholding sex, direct request, education, relationship
conceptualizing, risk information and deception and indicate that these factors account
to variance in a range of safer sex variable such as behavioural intentions and actual
condom use.
Therefore qualitative and quantitative research has emphasized the importance of
negotiation which seems to have been taken on board by Health Education Campaigns
with advertisements highlighting the problem of raising the issue of safer sex (e.g. When
would you mention condoms?). However, do interviews really access the interaction?
Can the interaction be accessed using the available (and ethical) methodologies? (It
would obviously be problematic to observe the interaction!) Are qualitative methods
actually accessing something different from quantitative methods? Are interviews
simply another method of finding out about people’s cognitions and beliefs? Debates
about methodology (quantitative versus qualitative) and the problem of behaviour as an
interaction are relevant to all forms of behaviour but are particularly apparent when
discussing sex.
THE BROADER SOCIAL CONTEXT
Beliefs, attitudes and cognitions about sex, risk and condom use do not just exist within
individuals, or within the context of an interaction between two individuals, they exist
within a much broader social context. This social context takes many forms such as
the form and influence of sex education, the social meanings, expectations and social
norms developed and presented through the multiple forms of media, and created and
perpetuated by individual communities and the wider world of gender and inequality.
Psychological theory predominantly studies the individual. However, it is important to
have some acknowledgment and understanding of this broader world. The final part of
this chapter will examine this context in terms of sex education, power relations between
men and women, social norms of the gay community and discourses about sex, HIV and
illness.
Sex education
Education about sex, pregnancy, HIV and contraception comes from a variety of different
sources, including government health education campaigns, school sex education programmes and from an individual’s social world. These three sources of information will
now be examined further.
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Government health education campaigns
Ingham et al. (1991) examined UK campaigns that promoted safe sex and suggested
that slogans such as ‘Unless you’re completely sure about your partner, always use a
condom’, ‘Nowadays is it really wise to have sex with a stranger?’, and ‘Sex with a lot of
partners, especially with people you don’t know can be dangerous’ emphasize knowing
your partner. They interviewed a group of young people in the south of England to
examine how they interpreted ‘knowing their partners’. The results suggest that 27 per
cent of the interviewees had had sex within 24 hours of becoming a couple, that 10 per
cent of the sample reported having sex on the first ever occasion on which they met their
partner, and that over 50 per cent reported having sex within two weeks of beginning a
relationship. In terms of ‘knowing their partner’, 31 per cent of males and 35 per cent
of females reported knowing nothing of their partner’s sexual history, and knowing
was often explained in terms of ‘she came from a nice family and stuff’, and having
‘seen them around’. The results from this study indicate that promoting ‘knowing your
partner’ may not be the best way to promote safe sex as knowledge can be interpreted in
a multitude of different ways. In addition, safer sex campaigns emphasize personal
responsibility and choice in the use of condoms and condoms are presented as a simple
way to prevent contraction of the HIV virus. This presentation is epitomized by government health advertisement slogans such as ‘You know the risks: the decision is yours’.
This view of sex and condom use is in contradiction with the research suggesting that
people believe that they are not at risk from HIV and that condom use involves a complex
process of negotiation.
School sex education programmes
Information about sex also comes from sex education programmes at school. Holland et
al. (1990a) interviewed young women about their experiences of sex education and
concluded that sex education in schools is impersonal, mechanistic and concerned with
biology. The women in their study made comments such as ‘It was all from the book. It
wasn’t really personal’ and ‘Nobody ever talks to you about the problems and the
entanglements, and what it means to a relationship when you start having sex’. It has
been argued that this impersonal and objective approach to sex education is counterproductive (Aggleton 1989) and several alternatives have been suggested. Aggleton and
Homans (1988) argued for a ‘socially transformatory model’ for AIDS education, which
would involve discussions of (1) ideas about sex; (2) social relations; (3) political processes involved; and (4) the problem of resource allocation. This approach would attempt
to shift the emphasis from didactic teachings of facts and knowledge to a discussion of
sex within a context of relationships and the broader social context. An additional
solution to the problem of sex education is a skills training approach recommended by
Abraham and Sheeran (1993). They argued that individuals could be taught a variety of
skills, including buying condoms, negotiation of condom use and using condoms. These
skills could be taught using tuition, role-play, feedback, modelling and practice. They are
aimed at changing cognitions, preparing individuals for action and encouraging people
to practise different aspects of the sequences involved in translating beliefs into behaviour.
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