This meta-analytic review examined the effectiveness of sexual risk reduction interventions in 21 studies (N=5,015) that integrated a safer sex eroticization component. Compared to controls, intervention participants exhibited lower sexual risk on 6 dimensions: HIV-related knowledge, attitudes toward condoms, condom use, overall behavioral risk, communication with sexual partners, and sexual frequency. Additional analyses examined pre- to post-test outcomes and showed significant improvement in condom use in the intervention compared to the control groups. Overall, findings suggest that eroticizing safer sex leads to more risk-preventive attitudes, which in turn facilitates less risky sexual behavior.
Similar content being viewed by others
References
References marked with an asterisk indicate studies included in the meta-analysis.
Adelman, M. B. (1992). Sustaining passion: Eroticism and safe-sex talk. Archives of Sexual Behavior, 21, 481–494.
Albarracín, D., McNatt, P. S., Klein, C. T. F., Ho, R. M., Mitchell, A. L., & Kumkale, G. T. (2003). Persuasive communications to change actions: An analysis of behavioral and cognitive impact in HIV prevention. Health Psychology, 22, 166–177.
*Antunes, M. C., Stall, R. D., Paiva, V., Peres, C. A., Paul, J., Hudes, M., et al. (1997). Evaluating an AIDS sexual risk reduction program for young adults in public night schools in São Paulo, Brazil. AIDS, 11, S121–S127.
*Antunes, M. C., Peres, C. A., Paiva, V., Stall, R., & Hearst, N. (2002). Differences in AIDS prevention among young men and women of public schools in Brazil. Rev Saúde Pública, 36, 88–95.
*Black, K. J. (1989). The effect of a ``safer sex'' film as mediated by erotophobia and gender on attitudes toward condoms and willingness to use them (Doctoral Dissertation, University of Georgia, 1989). Dissertation Abstracts International, 50, 1597.
*Brondino, M. J. (1997). Message framing effects on risky decision making in the context of AIDS prevention programming (Doctoral Dissertation, University of South Carolina, 1997). Dissertation Abstracts International, 58, 6277.
*Brown, I. S. (1983). Symbolic arousal and attitudes toward fertility control (Doctoral Dissertation, University of Georgia, 1983). Dissertation Abstracts International, 44, 1620–1621.
Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.
Calzavara, L., Burchell, A. N., Major, C., Remis, R. S., Corey, P., Myers, T., et al. (2002). Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada. AIDS, 16, 1655–1661.
Carballo-Dieguez, A., & Bauermeister, J. (2004). ``Barebacking'': Intentional condomless anal sex in HIV-risk contexts. Reasons for and against it. Journal of Homosexuality, 47, 1–16.
Centers for Disease Control and Prevention (2004). HIV /AIDS surveillance report, 2003. Retrieved July 30, 2005, from http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf
*Choi, K. H., Lew, S., Vittinghoff, E., Catania, J. A., Barrett, D. C., & Coates, T. J. (1996). The efficacy of a brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men. AIDS, 10, 81–87.
*Cohen, D. A., Dent, C., MacKinnon, D., & Hahn, G. (1992). Condoms for men, no women: Results of brief promotion programs. Sexually Transmitted Diseases, 19, 245–251.
Conley, T. D., & Collins, B. E. (2005). Differences between condom users and condom nonusers in their multidimensional condom attitudes. Journal of Applied Social Psychology, 35, 603–620.
Crepaz, N., Hart, T. A., Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior. Journal of the American Medical Association, 292, 224–236.
Dilley, J. W., McFarland, W., Woods, W. J., Sabatino, J., Lihatsh, T., Adler, B., et al. (2002). Thoughts associated with unprotected anal intercourse among men at high risk in San Francisco 1997–1999. Psychology & Health, 17, 235–246.
Ekstrand, M. L. (1992). Safer sex maintenance among gay men: Are we making any progress? AIDS, 6, 861–868.
*Ehrhardt, A. A., Exner, T. M., Hoffman, S., Silberman, I., Leu, C. S., Miller, S., et al. (2002a). A gender-specific HIV/STD risk reduction intervention for women in a health care setting: Short- and long-term results for a randomized clinical trial. AIDS Care, 14, 147–161.
*Ehrhardt, A. A., Exner, T. M., Hoffman, S., Silberman, I., Yingling, S., Adams-Skinner, J., et al. (2002b). HIV/STD and sexual strategies among women family planning clients in New York: Project FIO. AIDS and Behavior, 6, 1–13.
Essien, E. J., Meshack, A. F., Peters, R. J., Ogungbade, G. O., & Osemene, N. I. (2005). Strategies to prevent HIV transmission among heterosexual African-American men. BMC Public Health, 5.
Figueroa, J. P. (2004). An overview of HIV/AIDS in Jamaica: Strengthening the response. Western Indian Medical Journal, 53, 277–282.
Fisher, W. A. (1984). Predicting contraceptive behavior among university men: The role of emotions and behavioral intentions. Journal of Applied Social Psychology, 14, 104–123.
Guttmacher, S., Liberman, L., Ward, D., Freudenberg, N., Radosh, A., & Des Jarlais, D. (1997). Condom availability in New York City public high schools: Relationships to condom use and sexual behavior. American Journal of Public Health, 87, 1427–1433.
Harper, G. W., Hosek, S. G., Contreras, R., & Doll, M. (2003). Psychosocial factors impacting condom use among adolescents: A review of theoretical integration. Journal of HIV /AIDS Prevention and Education for Adolescents and Children, 5, 33–69.
Hedges, L. V. (1994). Fixed effects models. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 285–299). New York: Russell Sage Foundation.
Hedges, L. V., & Olkin, L. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.
Herek, G. M., Gonzalez-Rivera, M., Fead, F., & Welton, D. (2001). AIDS educational videos for gay and bisexual men: A content analysis. Journal of the Gay and Lesbian Medical Association, 5, 143–153.
Hocking, J., Keenan, C., Catton, M., Breschkin, A., Guy, R., & Hellard, M. (2004). Rising HIV infection in Victoria: An analysis of surveillance data. Australian and New Zealand Journal of Public Health, 28, 217–219.
Johnson, B. T. (1993). DSTAT 1.10: Software for the meta-analytic review of research literatures. Hillsdale, NJ: Erlbaum.
Johnson, B. T., Carey, M. P., Chaudoir, S., & Reid, A. E. (2006). Sexual risk reduction for persons living with HIV: Research synthesis of randomized controlled trials, 1993 to 2004. Journal of Acquired Immune Deficiency Syndromes, 41, 642–650.
Johnson, B. T., Carey, M. P., Marsh, K. L., Levin, K. D., & Scott-Sheldon, L. A. J. (2003). Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985 – 2000. Archives of Pediatric and Adolescent Medicine, 157, 381–388.
Johnson B. T., & Eagly A. H. (2000). Quantitative synthesis of social psychological research. In H. T. Reis & C. M. Judd (Eds.), Handbook of research methods in social and personality psychology (pp. 496–528). New York: Cambridge University Press.
Johnson, W. D., Hedges, L. V., Ramirez, G., Seeman, S., Norman, L. R., Sogolow, E., et al. (2003). HIV prevention research for men who have sex with men: A systematic review and meta-analysis. Journal of Acquired Immune Deficiency Syndrome, 30, S118–S130.
*Kegeles, S. M., Hays, R. B., & Coates, T. J. (1996). The Mpowerment project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health, 86, 1129–1136.
*Kegeles, S. M., Hays, R. B., Pollack, L. M., & Coates, T. J. (1999). Mobilizing young gay and bisexual men for HIV prevention: A two-community study. AIDS, 13, 1753–1762.
Kirby, D. (2002). The impact of schools and school programs upon adolescent sexual behavior. Journal of Sex Research, 39, 27–33.
*Knight, C. L. (1994). HIV prevention and heterosexual college students: The impact of video instructions on the ``safer'' sexual behaviors of sexually active men (Doctoral Dissertation, Western Michigan University, 1994). Dissertation Abstracts International, 56, 512.
*Krause, B. J., Goldsamt, L., Bula, E., Godfrey, C., Yee, D. S., & Palij, M. (2000). Pretest assessment as a component of safer sex intervention: A pilot study of brief one-session interventions for women partners of male injection drug uses in New York City. Journal of Urban Health, 77, 383–395.
*Kyes, K. B. (1990). The effect of a ``safer sex'' film as mediated by erotophobia and gender on attitudes toward condoms. Journal of Sex Research, 27, 297–303.
*Kyes, K. B., Brown, I. S., & Pollack, R. H. (1991). The effect of exposure to condom script on attitudes toward condoms. Journal of Psychology & Human Sexuality, 4, 21–36.
Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.
Logan, T. K., Cole, J., & Leukefeld, C. (2002). Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin, 128, 851–885.
*Lowenherz, J. (1991). Effects of safe sex persuasive communications varying explicitness and fear versus health promotion videos. (Doctoral Dissertation, Hofstra University, 1991). Dissertation Abstracts International, 52, 3892.
Mansergh, G., Marks, G., Colfax, G. N., Guzman, R., Rader, M., & Buchbinder, S. (2002). ``Barebacking'' in a diverse sample of men who have sex with men. AIDS, 16, 653–659.
*Miller, S., Exner, T. M., Williams, S. P., & Ehrhardt, A. A. (2000). A gender-specific intervention for at-risk women in the USA. AIDS Care, 12, 603–612.
Mullen, P. D., Ramirez, G., Strouse, D., Hedges, L. V., & Sogolow, E. (2003). Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States. Journal of Acquired Immune Deficiency Syndrome, 30, S94–S105.
Oncale, R. M. S, & King, B. M. (2001). Comparison of men's and women's attempts to dissuade sexual partners from couple using condoms. Archives of Sexual Behavior, 30, 379–397.
Pinkerton, S. D., Cecil, H., Bogart, L. M., & Abramson, P. R. (2003). The pleasures of sex: An empirical investigation. Cognition and Emotion, 17, 341–353.
*Ploem, C. (1992). The effects of two AIDS risk-reduction interventions on women's AIDS-related knowledge, attitudes, and practice of safer sex (Master's thesis, University of New Brunswick, 1992). Masters Abstracts International, 31, 1379.
*Ploem, C., & Byers, E. S. (1997). The effects of two AIDS risk-reduction interventions on heterosexual college women's AIDS-related knowledge, attitudes and condom use. Journal of Psychology & Human Sexuality, 9, 1–24.
Reichert, T. (2003). Sex in advertising research: A review of content, effects, and functions of sexual information in consumer advertising. Annual Review of Sex Research, 13, 241–272.
Reichert, T., Heckler, S. E., & Jackson, S. (2001). The effects of sexual social marketing appeals on cognitive processing and persuasion. Journal of Advertising, 30, 13–27.
Robinson, B. E., Bockting, W. O., Rosser, B. R. S., Miner, M., & Coleman, E. (2002). The sexual health model: Application of a sexological approach to HIV prevention. Health Education Research, 17, 43–57.
*Rosser, B. R. S. (1990). Evaluation of the efficacy of AIDD education interventions for homosexually active men. Health Education Research, 5, 299–308.
*Roser, B. R. S., Bockting, W. O., Rugg, D. L., Robinson, B. E., Ross, M. W., Bauer, G. R., et al. (2002). A randomized controlled intervention trial of a sexual health approach to long-term HIV risk reduction for men who have sex with men: Effects of the intervention on unsafe sexual behavior. AIDS Education and Prevention, 14, 59–71.
Sanchez-Meca, J., Marin-Martinez, F., & Chacon-Moscoso, S. (2003). Effect-size indices for dichotomized outcomes in meta-analysis. Psychological Methods, 8, 448–467.
*Sanderson, C. A. (1999). Role of relationship context in influencing college students’ responsiveness to HIV prevention videos. Health Psychology, 18, 295–300.
Scott-Sheldon, L. A. J., Marsh, K. L., Johnson, B. T., & Glasford, D. E. (2006). Condoms + pleasure = safer sex? A missing addend in the safer sex message. AIDS Care, 18, 750–754.
Shoumilina, T. (2001). Russia's HIV epidemic spreads to heterosexuals. UNAIDS coordinator discusses current challenges. AIDS Alert, 16, 21–22.
Smoak, N. D., Scott-Sheldon, L. A. J., Johnson, B. T., Carey, M. P., and the SHARP Research Team (2006). Do sexual risk reduction interventions inadvertently increase the overall frequency of sexual behavior? Answers from a meta-analysis of 174 studies with 116,735 participants. Journal of Acquired Immunodeficiency Syndrome, 41, 374–384.
*Struckman-Johnson, C., Struckman-Johnson, D., Gilliland, R. C., & Ausman, A. (1994). Effect of persuasive appeals in AID PSAs and condom commercials on intentions to use condoms. Journal of Applied Social Psychology, 24, 2223–2244.
*Tanner, W. M. (1990). The effects of viewing films and writing fantasies on attitudes toward condoms and willingness to use them (Doctoral Dissertation, University of Georgia, 1990). Dissertation Abstracts International, 52, 1128.
*Tanner, W. M., & Pollack, R. H. (1988). The effects of condom use and erotic instructions on attitudes toward condoms. Journal of Sex Research, 25, 537–541.
Tsantes, A., Nikolopoulos, G., Masgala, A., & Paraskeva, D. (2005). Assessing the secular trends in the transmission of HIV in Greece. Sexually Transmitted Infections, 81, 230–232.
UNAIDS (2004). AIDS epidemic update: 2004. Retrieved July 30, 2005, from http://www.unaids.org/wad2004/report.html
van Griensven, F., Thanprasertsuk, S., Jommaroeng, R., Mansergh, G., Naorat, S., Jenkins, R., et al. (2005). Evidence of a previously undocumented epidemic of HIV infection among men who have sex with men in Bangkok, Thailand. AIDS, 19, 521–526.
Weinhardt, L. S., Carey, M. P., Johnson, B. T., & Bickham, N. L. (1999). Effects of HIV counseling and testing on sexual risk behavior: A meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89, 1397–1405.
ACKNOWLEDGMENTS
This research was supported by National Institutes of Health grant R01-MH58563 to Blair T. Johnson. We thank the following study authors and associates who provided additional intervention details or data: Gregory M. Rebchook, Ph.D., Beatrice J. Krauss, Ph.D., B. R. Simon Rosser, Ph.D., Catherine Sanderson, Ph.D., and Cathy Struckman-Johnson, Ph.D. We thank Marcella B. Boynton, MA, Page Jerzak, Ph.D., Jessica M. La Croix, BA, I-Ching Lee, MS, Kerry L. Marsh, Ph.D., and Allecia E. Reid, BA, for assistance in preparing and in organizing the study data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scott-Sheldon, L.A.J., Johnson, B.T. Eroticizing Creates Safer Sex: A Research Synthesis. J Primary Prevent 27, 619–640 (2006). https://doi.org/10.1007/s10935-006-0059-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10935-006-0059-3