Journal of Primary Prevention

, Volume 27, Issue 6, pp 619–640 | Cite as

Eroticizing Creates Safer Sex: A Research Synthesis

  • Lori A. J. Scott-SheldonEmail author
  • Blair T. Johnson

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.


eroticization condoms HIV prevention meta-analysis research synthesis 



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.


  1. References marked with an asterisk indicate studies included in the meta-analysis.Google Scholar
  2. Adelman, M. B. (1992). Sustaining passion: Eroticism and safe-sex talk. Archives of Sexual Behavior, 21, 481–494.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. *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.PubMedGoogle Scholar
  5. *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.PubMedCrossRefGoogle Scholar
  6. *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.Google Scholar
  7. *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.Google Scholar
  8. *Brown, I. S. (1983). Symbolic arousal and attitudes toward fertility control (Doctoral Dissertation, University of Georgia, 1983). Dissertation Abstracts International, 44, 1620–1621.Google Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. Centers for Disease Control and Prevention (2004). HIV /AIDS surveillance report, 2003. Retrieved July 30, 2005, from Scholar
  13. *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.PubMedCrossRefGoogle Scholar
  14. *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.PubMedCrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. Ekstrand, M. L. (1992). Safer sex maintenance among gay men: Are we making any progress? AIDS, 6, 861–868.Google Scholar
  19. *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.PubMedCrossRefGoogle Scholar
  20. *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.CrossRefGoogle Scholar
  21. 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.Google Scholar
  22. Figueroa, J. P. (2004). An overview of HIV/AIDS in Jamaica: Strengthening the response. Western Indian Medical Journal, 53, 277–282.Google Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.Google Scholar
  27. Hedges, L. V., & Olkin, L. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.Google Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. Johnson, B. T. (1993). DSTAT 1.10: Software for the meta-analytic review of research literatures. Hillsdale, NJ: Erlbaum.Google Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. 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.Google Scholar
  34. 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.Google Scholar
  35. *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.PubMedGoogle Scholar
  36. *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.PubMedCrossRefGoogle Scholar
  37. Kirby, D. (2002). The impact of schools and school programs upon adolescent sexual behavior. Journal of Sex Research, 39, 27–33.PubMedGoogle Scholar
  38. *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.Google Scholar
  39. *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.CrossRefGoogle Scholar
  40. *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.CrossRefGoogle Scholar
  41. *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.CrossRefGoogle Scholar
  42. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage.Google Scholar
  43. 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.PubMedCrossRefGoogle Scholar
  44. *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.Google Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. *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.PubMedCrossRefGoogle Scholar
  47. 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.Google Scholar
  48. 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.PubMedCrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. *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.Google Scholar
  51. *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.CrossRefGoogle Scholar
  52. 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.Google Scholar
  53. 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.Google Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. *Rosser, B. R. S. (1990). Evaluation of the efficacy of AIDD education interventions for homosexually active men. Health Education Research, 5, 299–308.Google Scholar
  56. *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.CrossRefGoogle Scholar
  57. Sanchez-Meca, J., Marin-Martinez, F., & Chacon-Moscoso, S. (2003). Effect-size indices for dichotomized outcomes in meta-analysis. Psychological Methods, 8, 448–467.PubMedCrossRefGoogle Scholar
  58. *Sanderson, C. A. (1999). Role of relationship context in influencing college students’ responsiveness to HIV prevention videos. Health Psychology, 18, 295–300.PubMedCrossRefGoogle Scholar
  59. 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.Google Scholar
  60. Shoumilina, T. (2001). Russia's HIV epidemic spreads to heterosexuals. UNAIDS coordinator discusses current challenges. AIDS Alert, 16, 21–22.PubMedGoogle Scholar
  61. 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.CrossRefGoogle Scholar
  62. *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.CrossRefGoogle Scholar
  63. *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.Google Scholar
  64. *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.Google Scholar
  65. 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.PubMedCrossRefGoogle Scholar
  66. UNAIDS (2004). AIDS epidemic update: 2004. Retrieved July 30, 2005, from Scholar
  67. 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.PubMedCrossRefGoogle Scholar
  68. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  1. 1.Center for Health and BehaviorSyracuse UniversitySyracuseUSA
  2. 2.Center for Health, Intervention, and PreventionUniversity of ConnecticutStorrsUSA

Personalised recommendations