HIV and STIs are epidemic in the US and disproportionately affect young women and women of color. HIV/STI prevention concerns social workers as both public health problem and health disparity issue. Prevention focused on condom use has had meaningful but limited success, partly due to norms that limit female power in heterosexual negotiations. Applying a strengths perspective, we considered young women's sexual agency – their capacity to make choices about sex and strive to have them respected – and its implications for HIV/STI prevention. We used existing measures of sexual confidence, efficacy, and satisfaction to create and test a preliminary sexual agency scale, then examined agency's associations with condom use while considering the role of relationship.
A community sample of 179 heterosexually active women (aged 18-25, comprising 66% white participants, 9% African American, 9% Asian American, 6% Latina, 9% multi-racial or “other,” 1% Native American) completed a survey on recent sexual behavior. We assessed aspects of participants' agency such as initiating, regulating, discussing, and enjoying sex with questions like “I cannot discuss sexual matters with a sexual partner (reversed)” and “At times, I find it fun to be the active member during sex while my partner is passive.” Items were combined into a preliminary sexual agency scale.
The first hypothesis, that variables theoretically related to agency would share an underlying structure, was tested with factor analysis. The second, that there would be positive associations between sexual agency and both relationship status and condom use, was tested with bivariate correlation. The third hypothesis, that sexual agency would have different associations with condom use depending on relationship, was tested by comparing correlations within different relationship groups.
Factor analysis results indicated that variables theoretically related to sexual agency were statistically related to one another. Principal components analysis with varimax rotation yielded a 3-factor solution accounting for 49% of variance. Alpha for the 13-item sexual agency scale was 0.67; the mean score on the 1 to 5 scale was 3.7 (SD 0.5).
Sexual agency was positively correlated with relationship steadiness (r=0.25, p<0.001) but was not significantly correlated with relationship exclusivity or condom use. Correlations between relationship exclusivity and steadiness and condom use were negative but not statistically significant.
In non-exclusive relationships, agency was positively though marginally correlated with condom use (r=0.28, p=0.08); in exclusive relationships there was no significant correlation. There were no significant correlations between agency and condom use in any relationship steadiness group.
Conclusions and Implications
Findings suggest that links between agency and condom use are more complex than greater sexual agency being associated with more condom use. Rather, sexually agentic women may tailor their HIV/STI risk reduction techniques to their relationships, perhaps using condoms in non-exclusive relationships but using partner selection or mutual monogamy in other situations. Women's sexual agency is likely to be an emergent property with both individual and relational aspects. Qualitative research on how women enact sexual agency in different relationship contexts could improve our understanding of agency's role in women's sexual health behavior.