Increased STI rates and decreased condom use have become a public health concern in recent years. Aligned with a worldwide trend, condom use rates have decreased in Portuguese and Spanish youth in the last two decades. Throughout Europe, between 2015 and 2019 there was a significant increase in reported rates of chlamydia (9%), gonorrhoea (55%), syphilis (25%), and lymphogranuloma venereum (75%).

Being able to regulate feelings and actions according to distinct needs can be beneficial or detrimental to well-being, depending on the perceived risks posed by a given situation (e.g., taking a risk by accepting a job in a start-up company). People more focused on prevention prioritise safety and risk avoidance over potential gains. In contrast, people more focused on promotion prioritise pleasure and potential gains over risk avoidance. Previous research has shown that when pursuing their sexual goals, people focused on prevention are more aware of health threats and use condoms more than people focused on promotion. In contrast, those focused on promotion tend to undergo more STI testing. The current research asks whether having a prevention priority vs having a promotion priority regarding sex is linked to people’s sexual health knowledge and practices. Some of these findings can be found here  https://psyarxiv.com/w2jgy/ and here https://psyarxiv.com/hx7g6/

The sample included 742 Portuguese and Spanish adults who were single and sexually active. They were recruited to an online survey about relationships and sexual behaviour. Participants’ average age was 31, and most identified as white (78%) and heterosexual (78%). All other demographic characteristics were more balanced across the sample: 56% identified as women, 56% resided in Spain, 62% resided in metropolitan areas, 45% had a university degree, 58% were working, and 45% were coping on their current income.

Participants were categorised in each group based on their responses to the Regulatory Focus in Sexuality Scale. This scale includes items assessing disease prevention (three items, e.g., “Not being careful enough in my sex life has gotten me into trouble at times”) and pleasure promotion motives (six items, e.g., “I am typically striving to fulfil my desires with my sex life”). Responses were mean scored and an index was created by subtracting promotion from prevention scores. Participants with scores above zero were categorised as having a disease prevention priority (“safety-focused participants”, n = 378) and participants with scores below zero were categorised as having a pleasure promotion priority (“pleasure-focused participants”, n = 364).

The authors showed the names of 13 STIs to participants and, for each, asked them if had heard of it, if they had specific knowledge of it, if they have been tested for it, and how frequently they think people should get tested for it. The authors also assessed where participants are usually tested for STIs, and which contraceptive methods (other than condoms) they use.  

Overall, participants had never heard about 28% of the STIs (e.g., cytomegalovirus; trichomoniasis), had only heard about 50% of the STIs (e.g., gonorrhoea, chlamydia), and said they had specific knowledge about 22% of the STIs (e.g., HIV). Also, most participants (69%) had never been tested for any of the STIs and used condoms alone as their contraceptive method (59%). Of participants who had been tested, the most common site was primary care (37%). 

Safety-focused participants indicated that they had only heard about 53% of the STIs (e.g., hepatitis B, gonorrhoea; that is, they did not have specific knowledge about them; compared to 48% in the pleasure-focused group) and a greater proportion of them than pleasure-focused participants used condoms as their only contraceptive method (64% vs 54%). In contrast, pleasure-focused participants had specific knowledge about 25% of the STIs (e.g., genital herpes, chlamydia; compared to 19% in the safety-focused group) and had been tested for 23% of the STIs (e.g., HIV, HPV; compared to 14% in the safety-focused group). A greater share of pleasure-focused participants also had been tested for STIs, either in primary care (43% vs 31% among the safety-focused group) or at free clinics (20% vs 10%) and used the birth control pill (39% vs 31%). 

The authors asked participants to write down reasons that could facilitate the use of condoms and those that could facilitate others’ having condomless sex. The most-mentioned reasons to use condoms were awareness of risk in specific situations (32%), general safety concerns (28%), behavioural control (14%), and pregnancy concerns (10%). When explaining condomless sex, the most-mentioned reasons were lacking behavioural control (33%), perceiving a low risk of becoming infected (22%), lacking sexual education (15%), and wanting more physical sensations (10%). 

Among the safety-focused group, the largest share of mentions attributed condom use to safety concerns (32% of mentions vs 24% in the pleasure-focused group), including responsibility and cautiousness (22% vs 15%; e.g., “When people are aware”). Another reason was behavioural control (16% of mentions vs 12%), especially when people plan their sexual activity beforehand or are in control of the situation (15% vs 11%; e.g., “When people have the time”). 

A greater share of mentions by safety-focused participants than pleasure-focused participants indicated that condomless sex is facilitated when people lack the proper sexual education (18% vs 12%), particularly when people fail to care about protecting their health (12% vs 7%; e.g., “When people are irresponsible”) or fail to know about the health consequences (6% vs 5%; e.g., “Believing people don’t need a condom for oral sex”). In contrast, a greater share of mentions by pleasure-focused participants indicated that condom use is facilitated when people are aware of risks (36% vs 28% among safety-focused participants), particularly when they have sex in high-risk situations (21% vs 13%; e.g., “When having a threesome”). In nearly a quarter of these mentions, condomless sex is said to be facilitated in the heat of the moment or when people have unexpected encounters (24% vs 20% in the safety-focused group; e.g., “When people are really horny”), and want more physical sensations, particularly pursuing more sexual pleasure and excitement (5% vs 3%; e.g., “Because people feel skin on skin and it’s more exciting”).

The authors asked participants to write down the functions and attributes of condoms that can influence people’s decision to use condoms or not. Again, responses were organised into themes and subthemes. Overall, the most-mentioned attributes understood to favour condom use were condoms’ ability to help people avoid health problems (46%) and unplanned pregnancies (27%). A small share of mentions indicated condoms’ tendency to hinder pleasure (13%), and a similar share involved condoms’ ability to enhance pleasure under certain conditions (e.g., increase lubrication, 11%). A greater proportion of mentions by safety-focused participants involved condoms’ ability to prevent health problems (49% vs 44%), whereas a greater proportion of mentions by pleasure-focused participants attributed people’s choice not to use condoms to pleasure reduction (16% vs 9%).

On average, participants had never heard of four STIs, had only heard of six STIs, and had specific knowledge about three STIs. They believed that others used condoms to protect themselves against various health problems and unplanned pregnancies. Furthermore, participants believed that condom use is facilitated when people are uncertain about their partner’s health, acknowledge that certain contexts are riskier to their health, are more responsible with their sexual behaviour, feel more in control of the situation, and are concerned about unwanted pregnancies. In contrast, they believed that condomless sex is facilitated when people are not expecting to have sex, are under the influence of alcohol or other drugs, trust their partner’s sexual health, are less concerned about the consequences of riskier sex, and want to pursue more sexual pleasure. In other words, even though people are aware of some STIs and the protective functions of condoms, they also acknowledge that some conditions favour risk-taking. This indicates that more work needs to be done to improve sexual health literacy and give people better sexual health education. For instance, people should be provided with specific information about the different STIs, how they can be detected and the course of treatment; what to do when there is no condom readily available; and how to enhance self-control. Also, most participants used condoms alone as their contraceptive method and believed that people should be tested frequently for STIs. However, most participants had never been tested for an STI (albeit they turned to their primary care doctor when faced with this need). This suggests a contradiction between the social norms related to condom use and sexual health (e.g., most participants thought   that people should be tested frequently for STIs) and people’s behaviours (e.g., most participants hadn’t been tested). Such contradictions need to be accounted for when examining sexuality and sexual health. 

People’s sexual focus on safety or pleasure shapes their condom use beliefs, sexual health knowledge, and sexual practices. Safety-focused participants had specific knowledge about a smaller share of STIs, but in this group a greater share of mentions involved awareness of the different threats, the need to have control over condom use, the importance of sexual education and responsibility, and the health protective functions of condoms. In contrast, pleasure-focused participants had specific knowledge about a larger share of STIs and got tested for more STIs. A greater share of them also used other contraceptive methods, which possibly allowed them to have more pleasurable sexual experiences despite having less protection against infections. If so, this finding would align with the fact that a greater share of mentions among this group referred to condoms’ tendency to impede sexual pleasure as a factor in condomless sex. Although a greater share of mentions among pleasure-focused participants indicated that being aware of risks helps in the decision to use condoms, a greater share of these participants’ mentions also indicated that being faced with an unpredictable situation, feeling safe with a partner, and wanting to have more pleasure are drivers of riskier sexual activities. These findings were consistent across both countries and after controlling for any a priori demographic differences.

Taken together, the results show the importance of individual motives for sexual health and highlight the potential utility of adopting a regulatory focus framework (that is, paying attention to whether people are safety-focused or pleasure-focused) to develop health messages, campaigns, and interventions to increase sexual health literacy and education. 

Ballester-Arnal, R., Giménez-García, C., Ruiz-Palomino, E., Castro-Calvo, J., & Gil-Llario, M. D. (2022). A trend analysis of condom uses in Spanish young people over the two past decades, 1999–2020. AIDS and Behavior, 26(7), 2299–2313. 

Geretti A. M., Mardh O., de Vries H. J. C., Winter A., McSorley, J., Seguy, N., Vuylsteke, B., & Gokengin, D. (2022). Sexual transmission of infections across Europe: Appraising the present, scoping the future. Sexually Transmitted Infections. Advance online publication. 

Higgins, E. T. (2015). Regulatory Focus Theory. In R. A. Scott, M. C. Buchmann, & S. M. Kosslyn (Eds.), Emerging trends in the social and behavioral sciences: An interdisciplinary, searchable, and linkable resource (pp. 1–18). Wiley. 

Reis, M., Ramiro, L., Camacho, I., Tomé, G., & Gaspar de Matos, M. (2018). Trends in Portuguese adolescents’ sexual behavior from 2002 to 2014: HBSC Portuguese study. Portuguese Journal of Public Health, 36(1), 32–40. https://doi.org/10.1159/000486014

Rodrigues, D. L., Lopes, D., & Carvalho, A. C. (2021). Regulatory focus and sexual health:
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