Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Sexual agency versus relational factors: a study of condom use antecedents among high-risk young African American women

Richard A. Crosby A B G , Ralph J. DiClemente C D E F , Gina M. Wingood C D , Laura F. Salazar C D , Sara Head A , Eve Rose C and Jessica McDermott-Sales C

A College of Public Health, University of Kentucky, 121 Washington Avenue, Lexington, KY 40506, USA.

B Rural Center for AIDS/STD Prevention, Indiana University, 801 East 7th Street, Bloomington, IN 47405, USA.

C Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, 1516 Clifton Avenue, GA 30322, USA.

D Emory Center for AIDS Research, 1518 Clifton Avenue, Atlanta, GA 30322, USA.

E Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Epidemiology, and Immunology, 2015 Uppergate Drive, Atlanta, GA 30322, USA.

F Emory University School of Medicine, Department of Medicine, Infectious Diseases, 1440 Clifton Avenue, Atlanta, GA 30322, USA.

G Corresponding author. Email:

Sexual Health 5(1) 41-47
Submitted: 23 June 2007  Accepted: 30 October 2007   Published: 22 February 2008


Background: The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. Methods: A cross sectional study of 713 young, African American women (aged 15–21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Results: Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. Conclusion: The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.

Additional keywords: adolescent females, sexual behaviour, sexually transmissible infection.


[1]  Centers for Disease Control and Prevention. A heightened national response to the HIV/AIDS crisis among African Americans. Atlanta: Department of Health and Human Services; March 2007.

[2]  Centers for Disease Control and Prevention. HIV/AIDS Among African Americans. Fact Sheet. Available online at [verified 5 March 2006].

[3]  Southern States AIDS/STD Directors Work Group. Southern States Manifesto: HIV/AIDS & STDs in the South – A call to action. Southern States AIDS/STD Directors Work Group; 2003.

[4]  Wasserheit JN 1992 Epidemilogical synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 19 61 72

[5]  Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2005. Atlanta: US Department of Health and Human Services; November 2006.

[6]  Berman SM , Hein K . Adolescents and STDs. In: KK Holmes, PF Sparling, P Mardh, et al. (eds). Sexually Transmitted Diseases. New York: McGraw Hill; 1999. pp. 129–42.

[7]  Weinstock H Berman S Cates W 2004 Sexually transmitted diseases among American youth: incidents and prevalence estimates, 2000. Perspect Sex Reprod Health 36 6 10

[8]  DiClemente RJ Salazar LS Crosby RA 2005 Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective – a commentary. Public Health 119 825 36 doi:10.1016/j.puhe.2004.10.015

[9]  DiClemente RJ , Crosby RA . Sexually transmitted diseases among adolescents: risk factors, antecedents, and prevention strategies. In: GR Adams, M Berzonsky (eds). Blackwell Handbook of Adolescence. Oxford: Blackwell Publishers Ltd; 2003. pp. 573–605.

[10]  Crosby RA DiClemente RJ Wingood GM Sionéan C Cobb BK Harrington K et al 2000 Correlates of unprotected vaginal sex among African American female teens: the importance of relationship dynamics. Arch Pediatr Adolesc Med 154 893 9

[11]  Crosby RA Salazar LF DiClemente RJ Yarber WL 2004 Correlates of having unprotected vaginal sex among detained adolescent females: an exploratory study of sexual factors. Sex Health 1 151 5

[12]  Wingood GM DiClemente RJ 1998 Partner influences and gender-related factors associated with non-condom use among young adult African American women. Am J Community Psychol 26 29 51 doi:10.1023/A:1021830023545

[13]  Kalichman SC Rompa D 1995 Sexual sensation seeking and sexual compulsivity scales: reliability, validity, and predicting HIV risk behavior. J Pers Assess 65 586 601 doi:10.1207/s15327752jpa6503_16

[14]  Cabral RJ Pulley L Artz LM Brill I Macaluso M 1998 Women at risk of HIV/STD: the importance of male partners as barriers to condom use. AIDS Behav 2 75 85 doi:10.1023/A:1022363408723

[15]  Turner CF Ku L Rogers SM Lindberg LD Pleck JH Sonenstein FL 1998 Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 280 867 71 doi:10.1126/science.280.5365.867

[16]  Pullerwitz J Gortmaker S DeJong W 2000 Measuring sexual relationship power in HIV/STD research. Sex Roles 42 637 60

[17]  DiClemente RJ Lodico M Grinstead OA Harper G Rickman RL Evans PE et al 1996 African-American adolescents residing in high-risk urban environments do use condoms: correlates and predictors of condom use among adolescents in public housing developments. Pediatrics 98 269 78

[18]  Wingood GM DiClemente RJ 1998 Gender related correlates and predictors of consistent condom use among young adult African American women: a prospective analysis. Int J STD AIDS 9 139 45

[19]  Begley E Crosby RA DiClemente RJ Wingood GM Rose E 2003 Older partners and STD prevalence among pregnant African American teens. Sex Transm Dis 30 211 3 doi:10.1097/00007435-200303000-00006

[20]  DiClemente RJ Wingood GM Crosby RA Sionean C Cobb BK Harrington K et al 2002 Sexual risk behaviors associated with having older sex partners: A study of African American female adolescents. Sex Transm Dis 29 20 4 doi:10.1097/00007435-200201000-00004

[21]  Miller KS Clark LF Moore JS 1997 Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Fam Plann Perspect 29 212 4 doi:10.2307/2953397

[22]  Crosby RA DiClemente RJ Holtgrave DR Wingood GM 2002 Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non-viral STIs. Sex Transm Infect 78 228 31 doi:10.1136/sti.78.4.228

[23]  Crosby RA Yarber WL Sanders SA Graham CA 2005 Condom discomfort and associated problems with their use among university students. J Am Coll Health 54 143 8 doi:10.3200/JACH.54.3.143-148

[24]  Crosby RA Graham CA Yarber WL Sanders SA 2004 If the condom fits, wear it: A qualitative study of young African American men. Sex Transm Infect 80 306 9 doi:10.1136/sti.2003.008227

[25]  Weir SS Roddy RE Zekeng L Ryan KA 1999 Association between condom use and HIV infection: a randomised study of self reported condom use measures. J Epidemiol Community Health 53 417 22

[26]  Crosby RA DiClemente RJ Holtgrave DR Wingood GM 2002 Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against non-viral STIs. Sex Transm Infect 78 228 31

[27]  Warner L Newman DR Austin HD Kamb ML Douglas JM Jr Malotte CK et al 2004 Condom effectiveness for reducing transmission of gonorrhea and Chlamydia: the importance of assessing partner infection status. Am J Epidemiol 159 242 51 doi:10.1093/aje/kwh044

Export Citation