Skip to main content

Advertisement

SpringerLink
Log in

Avoidance, Anxiety, and Sex: The Influence of Romantic Attachment on HIV-Risk among Pregnant Women

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Most unprotected sex occurs in close relationships. However, few studies examine relational factors and sexual risk among high-risk populations. Romantic Attachment Theory states that individuals have cognitive working models for relationships that influence expectations, affect, and behavior. We investigated the influence of attachment avoidance and anxiety on sexual beliefs (e.g., condom use beliefs, self-efficacy), behavior (e.g., condom use, multiple partners, unprotected sex with risky partners), and sexually transmitted infections (STIs) among 755 high-risk, young pregnant women (ages 14–25) recruited from urban prenatal clinics. Attachment anxiety predicted sexual beliefs, condom use, and unprotected sex with risky partners controlling for demographic variables. Sexual beliefs did not mediate the relationship between attachment orientation and sexual behavior. Current relationship with the father of the baby did mediate the effect of attachment anxiety on multiple partners and STIs. Results indicate the importance of including general relational factors, such as attachment, in HIV prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ainsworth, M. D. S. (1982). Attachment: Retrospect and prospect. In C. M. Parkes, & J. Stevenson-Hinde (Eds.), The place of attachment in human behavior (pp. 3–30). New York: Basic Books.

    Google Scholar 

  • Baron, R. M., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistic considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  CAS  Google Scholar 

  • Basen-Engquist, K., Masse, L. C., Coyle, K., Kirby, D., Parcel, G. S., Banspach, S., et al. (1999). Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents. Health Education Research, 14, 25–38.

    Article  PubMed  CAS  Google Scholar 

  • Begley, E., Crosby, R. A., DiClemente, R. J., Wingood, G. M., & Rose, E. (2003). Older partners and STD prevalence among pregnant African American teens. Sexually Transmitted Diseases, 30, 211–213.

    Article  PubMed  Google Scholar 

  • Bogaert, A. F., & Sadava, S. (2002). Adult attachment and sexual behavior. Personal Relationships, 9, 191–204.

    Article  Google Scholar 

  • Bost, K. K., Cox, M. J., Burchinal, M. R., & Payne, C. (2002). Structural and supportive changes in couples’ family and friendship networks across the transition to parenthood. Journal of Marriage and the Family, 64, 517–531.

    Article  Google Scholar 

  • Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.

    Google Scholar 

  • Brennan, K. A., & Shaver, P. R. (1995). Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Personality and Social Psychology Bulletin, 21, 267–283.

    Article  Google Scholar 

  • Brennan, K. A., & Shaver, P. R. (1998). Attachment styles and personality disorders: Their connections to each other and to parental divorce, parental death, and perceptions of parental caregiving. Journal of Personality, 66, 835–878.

    Article  PubMed  CAS  Google Scholar 

  • C’de Baca, J., Lapham, S. C., Skipper, B. J., & Watkins, M. L. (1997). Use of computer interview data to test associations between risk factors and pregnancy outcomes. Computers and Biomedical Research, 30, 232–243.

    Article  PubMed  CAS  Google Scholar 

  • Ciesla, J. A., Roberts, J. E., & Hewitt, R. G. (2004). Adult attachment and high-risk sexual behavior among HIV-positive patients. Journal of Applied Social Psychology, 34, 108–124.

    Article  Google Scholar 

  • Collins, N., & Read, S. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58, 644–663.

    Article  PubMed  CAS  Google Scholar 

  • Cooper, M., Shaver, P. R., & Collins, N. L. (1998). Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology, 74, 1380–1397.

    Article  PubMed  CAS  Google Scholar 

  • Cooper, M. L., Shapiro, C. M., & Powers, A. M. (1998). Motivations for sex and risky sexual behavior among adolescents and young adults: A functional perspective. Journal of Personality and Social Psychology, 75, 1528–1558.

    Article  PubMed  CAS  Google Scholar 

  • Cox, M.J., Paley, B., Payne, C. C., & Burchinal, P. (1999). The transition to parenthood: Marital conflict and withdrawal and parent-infant interaction. In M. Cox & J. Brooks-Gunn (Eds.), Conflict and cohesion in families:Causes and consequences. The advances in family research series (pp. 87–104). Mahwah, NJ: Lawrence Erlbaum.

  • Crosby, R. A., DiClemente, R. J., Wingood, G. M., Sionean, C., Cobb, B. K., & Harrington, K. (2000). Correlates of unprotected vaginal sex among African American female adolescents: Importance of relationship dynamics. Archives of Pediatric Adolescent Medicine, 154, 893–899.

    CAS  Google Scholar 

  • Des Jarlais, D. C., & Turner, C. V. (1998, 1998). Audio-CASI versus interviewer obtained survey from participants in syringe exchange programs. Paper presented at the North American syringe exchange convention, Baltimore, Maryland.

  • DiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Cobb, B. K., Harrington, K., et al. (2002). Sexual risk behaviors associated with having older sex partners: A study of black adolescent females. Sexually Transmitted Diseases, 29, 20–24.

    Article  PubMed  Google Scholar 

  • Dulude, D., Belanger, C., Wright, J., & Sabourin, S. (2002). High-risk pregnancies, psychological distress, and dyadic adjustment. Journal of Reproductive and Infant Psychology, 20, 101–124.

    Article  Google Scholar 

  • El-Bassel, N., Witte, S. S., Gilbert, L., Sormanti, M., Moreno, C., Pereira, L., et al. (2001). HIV prevention for intimate couples: A relationship-based model. Families, Systems and Health, 19, 379–395.

    Google Scholar 

  • El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., et al. (2003). The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. American Journal of Public Health, 93, 963–969.

    PubMed  Google Scholar 

  • El-Bassel, N., Witte, S. S., Gilbert, L., Wu, E., Chang, M., Hill, J., et al. (2005). Long-term effects of an HIV/STI sexual risk reduction intervention for heterosexual couples. AIDS and Behavior, 9, 1–13.

    Article  PubMed  Google Scholar 

  • Feeney, B. C., & Kirkpatrick, L. A. (1996). Effects of adult attachment and presence of romantic partners on physiological responses to stress. Journal of Personality and Social Psychology, 70, 255–270.

    Article  PubMed  CAS  Google Scholar 

  • Feeney, J. A., Kelly, L., Gallois, C., Peterson, C., & Terry, D. J. (1999). Attachment style, assertive communication, and safer-sex behavior. Journal of Applied Social Psychology, 29, 1964–1983.

    Article  Google Scholar 

  • Feeney, J. A., & Noller, P. (2003). Attachment and sexuality in close relationships. In P. Florsheim (Ed.), Adolescent romantic relations and sexual behavior: Theory, research, and practical implications (pp. 137–162). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Feeney, J. A., Noller, P., & Callan, V. J. (1994). Attachment style, communication and satisfaction in the early years of marriage. In K. Bartholomew, & D. Perlman (Eds.), Attachment processes in adulthood. Advances in personal relationships. PA, US: Jessica Kingsley Publishers, Ltd.

    Google Scholar 

  • Feeney, J. A., Noller, P., & Patty, J. (1993). Adolescents’ interactions with the opposite sex: Influence of attachment style and gender. Journal of Adolescence, 16, 169–186.

    Article  PubMed  CAS  Google Scholar 

  • Feeney, J. A., Peterson, C., Gallois, C., & Terry, D. J. (2000). Attachment style as a predictor of sexual attitudes and behavior in late adolescence. Psychology and Health, 14, 1105–1122.

    Article  Google Scholar 

  • Florsheim, P., Sumida, E., McCann, C., Winstanley, M., Fukui, R., Seefeldt, T., et al. (2003). The transition to parenthood among young African American and Latino couples: Relational predictors of risk for parental dysfunction. Journal of Family Psychology, 17, 65–79.

    Article  PubMed  Google Scholar 

  • Fortenberry, J. D., Tu, W., Harezlak, J., Katz, B. P., & Orr, D. P. (2002). Condom use as a function of time in new and established adolescent sexual relationships. American Journal of Public Health, 92, 211–213.

    PubMed  Google Scholar 

  • Fraley, R. C., & Davis, K. E. (1997). Attachment formation and transfer in young adults’ close friendships and romantic relationships. Personal Relationships, 4, 131–144.

    Article  Google Scholar 

  • Furman, W., & Shaffer, L. (2003). The role of romantic relationships in adolescent development. In P. Florsheim (Ed.), Adolescent romantic relations and sexual behavior (pp. 3–22). Mahwah, New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Gallo, L. C., & Smith, T. W. (2001). Attachment style in marriage: Adjustment and responses to interaction. Journal of Social and Personal Relationships, 18, 263–289.

    Article  Google Scholar 

  • Gentzler, A. L., & Kerns, K. A. (2004). Associations between insecure attachment and sexual experiences. Personal Relationships, 11, 249–265.

    Article  Google Scholar 

  • Goldman, A., & Greenberg, L. S. (1992). Comparison if integrated systemic and emotionally focused approaches to couple therapy. Journal of Consulting and Clinical Psychology, 60, 962–969.

    Article  PubMed  CAS  Google Scholar 

  • Greenberg, L. S., & Johnson, S. M. (1986). Affect in marital therapy. Journal of Marital and Family Therapy, 12, 19–23.

    Article  Google Scholar 

  • Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.

    Article  PubMed  CAS  Google Scholar 

  • Hensley, W. E. (1996). The effect of a ludus love style on sexual experiences. Social Behavior and Personality, 24, 205–212.

    Article  Google Scholar 

  • Ickovics, J. R., Niccolai, L. M., Lewis, J. B., Kershaw, T. S., & Ethier, K. A. (2003). High postpartum rates of sexually transmitted infections among teens: Pregnancy as a window of opportunity for prevention. Sexually Transmitted Infections, 79, 469–473.

    Article  PubMed  CAS  Google Scholar 

  • Johnson, S. M., Hunsley, J., Greenberg, L. S., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Journal of Clinical Psychology:Science and Practice, 6, 67–79.

    Article  Google Scholar 

  • Kalichman, S. C., Sarwer, D. B., Johnson, J. R., & Ali, S. A. (1994). Sexual coercion, domestic violence, and negotiating condom use among low-income African American women. Journal of Psychology and Human Sexuality, 6, 93–106.

    Article  Google Scholar 

  • Kershaw T. S., Ethier K. A., Milan S., Lewis J. B., Niccolai L. M., Meade C., Ickovics J. R. (2005). The influence of pregnancy, STD, and HIV susceptibility patterns on sexual risk reduction for adolescent females. Journal of Community Psychology, 33, 313–331.

    Article  Google Scholar 

  • Kershaw, T. S., Ethier, K. A., Niccolai, L. M., Lewis, J. B., & Ickovics, J. R. (2003). Misperceived risk among female adolescents: Social and psychological factors associated with sexual risk accuracy. Health Psychology, 22, 523–532.

    Article  PubMed  Google Scholar 

  • Kershaw, T. S., Ickovics, J. R., Lewis, J. B., Niccolai, L. M., Milan, S., & Ethier, K. A. (2004). Sexual risk following a sexually transmitted disease diagnosis: The more things change the more they stay the same. Journal of Behavior Medicine, 27, 445–461.

    Article  Google Scholar 

  • Kershaw, T. S., Niccolai, L. M., Ethier, K. A., Lewis, J. B., & Ickovics, J. R. (2003). Perceived susceptibility to pregnancy and sexually transmitted disease among pregnant and nonpregnant adolescents. Journal of Community Psychology, 31, 419–434.

    Article  Google Scholar 

  • Kershaw, T. S., Niccolai, L. M., Ickovics, J. R., Lewis, J. B., Meade, C. S., & Ethier, K. A. (2003). Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: Implications for prevention of repeat pregnancy. Journal of Adolescent Health, 33, 359–368.

    Article  PubMed  Google Scholar 

  • Ketterlinus, R. D., Lamb, M. E., & Nitz, K. (1991). Development and ecological sources of stress among adolescent parents. Family Relations: Interdisciplinary Journal of Applied Family Studies, 40, 435–441.

    Google Scholar 

  • Latkin, C., Vlahov, D., & Anthony, J. (1993). Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users. Addiction, 38, 517–526.

    Article  Google Scholar 

  • Lenoir, C. D., & Ellen, J. M. (2004). What you don’t know can hurt you: Perceptions of sex partner concurrency and partner reported behavior. Journal of Adolescent Health, 34, 113.

    Google Scholar 

  • Meade, C. S., & Ickovics, J. R. (2005). Systematic review of sexual risk among pregnant and mothering teens in the USA: Pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Social Science and Medicine, 60, 661–678.

    Article  PubMed  Google Scholar 

  • Mikulincer, M., & Florian, V. (1999). The association between spouses’ self-reports of attachment styles and representations of family dynamics. Family Process, 38, 69–83.

    Article  PubMed  CAS  Google Scholar 

  • Mikulincer, M., Florian, V., Cowan, P. A., & Cowan, C. P. (2002). Attachment security in couple relationships: A systemic model and its implications for family dynamics. Family Process, 41, 405–434.

    Article  PubMed  Google Scholar 

  • Miller, W. B., & Pasta, D. J. (2001). Motivational antecedents to contraceptive method change following a pregnancy scare: A couple analysis. Social Biology, 48, 256–277.

    PubMed  CAS  Google Scholar 

  • Misovich, S. J., Fisher, J. D., & Fisher, W. A. (1997). Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes. Review of General Psychology, 1, 72–107.

    Article  Google Scholar 

  • Niccolai, L. M., Ethier, K. A., Kershaw, T. S., Lewis, J. B., & Ickovics, J. R. (2003). Pregnant adolescents at risk: Sexual behaviors and sexually transmitted disease prevalence. American Journal of Obstetrics and Gynecology, 188, 63–70.

    Article  PubMed  Google Scholar 

  • Niccolai, L. M., Ethier, K. A., Kershaw, T. S., Lewis, J. B., Meade, C. S., & Ickovics, J. R. (2004). New sex partner acquisition and sexually transmitted disease risk among adolescent females. Journal of Adolescent Health, 34, 216–223.

    Article  PubMed  Google Scholar 

  • Sanford, K. (1997). Two dimensions of adult attachment: Further validation. Journal of Social and Personal Relationships, 14, 133–143.

    Article  Google Scholar 

  • Schachner, D. A., & Shaver, P. R. (2004). Attachment dimensions and sexual motives. Personal Relationships, 11, 179–195.

    Article  Google Scholar 

  • Sikkema, K. J., Heckman, T. G., Kelly, J. A., Anderson, E. S., Winett, R. A., Solomon, L. J., et al. (1996). HIV risk behaviors among women living in low-income, inner-city housing developments. American Journal of Public Health, 86, 1123–1128.

    Article  PubMed  CAS  Google Scholar 

  • Simpson, J. A., Rholes, W. S., & Phillips, D. (1996). Conflict in close relationships: An attachment perspective. Journal of Personality and Social Psychology, 71, 899–914.

    Article  PubMed  CAS  Google Scholar 

  • Sionean, C., DiClemente, R. J., Wingood, G. M., Crosby, R., Cobb, B. K., Harrington, K., et al. (2002). Psychosocial and behavioral correlates of refusing unwanted sex among African-American adolescent females. Journal of Adolescent Health, 30, 55–63.

    Article  PubMed  Google Scholar 

  • Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology (pp. 290–312). San Francisco: Josey-Bass.

    Google Scholar 

  • Tracy, J. L., Shaver, P. R., Albino, A. W., & Cooper, M. (2003). Attachment styles and adolescent sexuality. [References]. In Florsheim Paul (Ed.), Dept of Psychology; U Utah (2003) Adolescent romantic relations and sexual behavior: Theory, research, and practical implications (pp. 137–159). Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.

    Google Scholar 

  • Turner C. F., Ku L., Rogers S. M., Lindberg L. D., Pleack J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science, 280, 867–873.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, and Center for Interdisciplinary Research on AIDS, Yale University, 60 College St., New Haven, CT, 06510, USA

    Trace S. Kershaw, Jessica Lewis & Jeannette Ickovics

  2. Department of Psychology, University of Connecticut, Storrs, CT, USA

    Stephanie Milan

  3. Emory University, Atlanta, GA, USA

    Claire Westdahl

  4. Centering Pregnancy and Parenting Association, Chesire, CT, USA

    Sharon Schindler Rising

  5. Macalester College, St. Paul, MN, USA

    Rachel Fletcher

Authors
  1. Trace S. Kershaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Milan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claire Westdahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharon Schindler Rising
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rachel Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeannette Ickovics
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Trace S. Kershaw.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kershaw, T., Milan, S., Westdahl, C. et al. Avoidance, Anxiety, and Sex: The Influence of Romantic Attachment on HIV-Risk among Pregnant Women. AIDS Behav 11, 299–311 (2007). https://doi.org/10.1007/s10461-006-9153-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-006-9153-z

Keywords

Search

Navigation