Young Women's Sexual Agency and Its Implications for HIV/ STI Prevention

Background and Purpose

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 and qualitative methods, 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.

Methods

Eighteen 18-25 year old heterosexually active women were recruited via newspaper and online advertisements and paid $20. Seven participants were white, six African American, and five Latina; half were working class or poor and half middle class. Minimally structured one hour interviews were digitally recorded and transcribed. Participants were invited to talk in-depth about their sexual and relational lives. Prompts included “Tell me about your current sexual relationship situation.” Accounts of sexual decision making and enforcement were coded and descriptively summarized; text extracts were examined for patterns across cases. The analytic focus was to describe manifestations of sexual agency within each woman's sexual story and to produce a synthesis of sexual agency's commonalities and variation across individuals.

Results

Women's interviews contained accounts of themselves as active agents making and enforcing sexual choices along with accounts of being acted upon. We delineated three themes in these data: Desire, intimacy, and sexual philosophy.

The desire theme appeared as talk of wanting physical contact, of chemistry with a particular man, and of bodies and sensation. Participants also talked about emotion in accounts of sexual agency, focusing on intimate feelings like love, trust, and comfort and their opposites, loneliness and jealousy. Women spoke fluently about intimacy's role in their sexual choices. Some women spoke of their sexual agency as emanating from a sexual code of conduct: their “sexual philosophy.” This theme involved statements about core values regarding sex, often appearing as talk about what was sexually right or wrong, good or bad, or healthy or unhealthy.

These aspects of sexual agency were meaningful in individual women's accounts and common, though differing in degree and combination, across multiple women's accounts. Desire, intimacy, and philosophy components also interacted with one another within women's sexual stories.

Conclusions and Implications

Each theme observed in women's stories of sexual agency – desire, intimacy, and philosophy – carried with it potential enhancements and detriments to sexual health. This study has implications for sexuality education policy and practice and safer sex interventions. Young women, their male partners, and their communities could benefit from models for women's sexual agency. Such models might stress that young women are entitled to make choices about sex and strive to enforce them, but are not solely responsible for creating positive sexual outcomes. Education and safer sex interventions could work from the perspective of study participants: That sexuality includes both risks and rewards.