Framing Unintended Sexual Health Outcomes

through a Sexual Economics Lens

Ehriel F. Fannin, MSN, RNRuth L. Kirschstein NRSA Predoctoral Fellow University of Pennsylvania School of Nursing

Acknowledgements

National Institutes of Health Ruth L. Kirschstein NRSA Institutional Research Training Grant on Vulnerable Women, Children, and Families (T32NR007100)PI: Marilyn S. Sommers, PhD, RN, FAAN

Center for Global Women’s Health, University of Pennsylvania School of NursingDirector: Marilyn S. Sommers, PhD, RN, FAAN

Center for Health Equity Research, University of Pennsylvania School of NursingDirector: Loretta Sweet Jemmott, PhD, RN, FAAN

The Alice Paul Center for Research on Gender, Sexuality, and Women, University of PennsylvaniaDirector: Christine Poggi, PhD

Sexual decision-making and

negotiation

are two of the most significant

contributors to the health of

women, children, and future

populations.1

Unintended Sexual Health Outcomes

Sexually transmitted infections (STIs), HIV, and unintended pregnancy

Widening disparities in sexual health outcomes2,3

Vulnerabilities follow patterns of social and economic disadvantage4

Sexual Health Intervention Science

Cognitive behavioral models

(i.e. the Health Belief Model, the Theory of Reasoned Action, the Theory of Planned

Behavior)

do not adequately address bias in decision-making, the influence of

emotions, or the dyadic negotiation that takes place in sexual relationships.5,6

Behavioral Economics and Sexual Decision Making

Sexual Economicsand Sexual Negotiation

Social exchange is inherent in sexual relationships7

Sex is a resource that can be leveraged for economic, emotional, social, or hedonistic benefits8

Exchanges in sexual relationships are influenced by normative expectations and market influences7,8

Aims

Examine the contexts in which implicit exchanges of sex for resources occur

Identify the types of resources available for exchange

Methods

Search Terms Limiters

Sexual economicsSocial exchangeSexual exchangeSexual reciprocitySexual negotiationCompensated sexTransactional sexSexual networkingExchange relationship

LGBT/ married relationships

Commercialized sex work

Exchange of sex for drugs

Total # of Publications Eligible for Analysis:

28

Databases : MEDLINE, PubMed, PsycINFO, Scopus, and Sociological Abstracts

Findings

Capital/resources available for exchange

Approaches to sexual relationships

Normative influences relative to sexual exchange

Market influences on sexual exchange

Capital vs. Resources

Capital 9

Economic Emotional

Social Sexual

Hedonistic

Resources 10

MoneyMaterial goods

LoveInformation

StatusServices

Approaches to Sexual Relationships

Communal approaches to

sexual interactions are altruistic, and resources are

invested in response to

partner needs.11,12

Exchange approaches to

sexual interactions are

value maximizing, and resources are

invested with expectations of

compensation. 11,12

Normative Influences

Expectations of reciprocity

Perceptions of risks and rewards

Market InfluencesValues attributed to capital Supply and demand of sexual partnersEquity in capital and negotiating power

Implications for Sexual Health Science

Innovated frameworks and measures are necessary to address variations in risk assessment, nuanced approaches to

sexual relationships, and inequities in sexual negotiation.

Future Research Directions

Examine the effects of varying types of capital on relationship approach, risk/benefit assessments, and the ability to negotiate sexual decisions with partners

Explore cultural differences in normative expectations

Determine the influence of reciprocity expectations on sexual violence

References1. World Health Organization. (2010). Developing sexual health

programmes: a framework for action.2. Centers for Disease Control and Prevention. (2010). Sexually

Transmitted Disease Surveillance 2009. Retrieved from http://www.cdc.gov/std/stats09/default.htm.

3. Centers for Disease Control and Prevention. (2009). HIV incidence 2008. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/incidence/index.htm.

4. Finer, L. B. & Kost, K. (2011). Unintended pregnancy rates at the state level. Perspectives on Sexual and Reproductive Heatlh, 43(2), 78-87.

5. Lopez, L. M., Tolley, E. E., Grimes, D. A., Chen-Mok, M. (2011). Theory-based interventions for contraception. Cochrane Database of Systematic Reviews, Issue 3.

6. Brawner, B. M., Davis, Z. M., Fannin, E. F. & Alexander, K. A. (2011). Clinical depression and condom use attitudes and beliefs among African American adolescent females. Journal of the Association of Nurses in AIDS Care.

References cont.

7. Vohs, K. D. & Lasaleta, J. (2008). Heterosexual behavior is governed by social exchange and basic economic principles: sexual economics theory. Minnesota Journal of Law, Science, & Technology, 9(2), 785-802.

8. Baumeister, R. F. & Vohs, K. D. (2004). Sexual economics: Sex as female resource for social exchange in heterosexual interactions. Personality and Social Psychology Review, 8(4), 339-363.

9. Bourdieu, P. (1986). “The forms of capital” in Handbook of Theory and Research for the Sociology of Education, Richardson, J. G. (Ed.). New York, NY: Greenwood.

10. Foa, U. G. & Foa, E. B. (1974). Societal Structures of the Mind. Oxford, England: Charles C Thomas.

11. Clark, M. S. & Mills, J. R. (2011). A theory of communal (and exchange) relationships. In The handbook of theories of social psychology, Van Lange, A. M. , Kruglanski, A. & Higgins, T. (Eds.),. London: Sage.

12. Hughes, T. G. & Snell, W. E. (1990). Communal and exchange approaches to sexual relations. Sexual Abuse: A Journal of Research and Treatment, 3(2), 149-161.