Relationships in which teenage women get most of their spending money from their boyfriends may be "implicitly transactional," according to researchers who examined associations between the economic benefits of relationships and adolescent women's condom use.1 In a sample of sexually active adolescent women who received a clinic‐based HIV prevention intervention in 2002–2006, those whose boyfriend was their primary source of spending money had a significantly elevated risk of reporting six months and again one year later that they never used condoms (incidence rate ratios, 1.5–1.6). In addition, although intervention participants overall had a reduced likelihood of reporting no condom use at the one‐year follow‐up (0.5–0.6), no such association was evident among those who got most of their spending money from their boyfriend.
The study data were drawn from the Horizons project, which enrolled 715 economically disadvantaged black women aged 15–21 who were not trying to become pregnant and who received services at an STD clinic, a public hospital or a family planning clinic in Atlanta. At enrollment and six and 12 months later, participants completed a 40‐minute computer‐assisted interview that covered a vast array of topics, including their background characteristics, STD history, sexual risk behaviors, substance use and relationship characteristics. The researchers used propensity score weighting to eliminate statistical differences between women whose boyfriend was their main source of spending money and those reporting other sources, and they conducted regression analysis to identify predictors of nonuse of condoms at each follow‐up interview.
At baseline, 24% of participants reported that their boyfriend was their main source of spending money; 27% said that they had not used condoms in the past 14 days, and 21% that they had not done so in the past 60 days. Six months later, those who received most of their spending money from their boyfriend were more likely than others to say that they had not used condoms in the past 14 days (incidence rate ratio, 1.6) and in the past 60 days (1.5). The likelihood of both outcomes also was elevated among women who had reported no condom use at baseline (1.8 and 2.1, respectively) and those who still had the same boyfriend six months postintervention (2.1 and 2.0); it increased with relationship length (1.04 and 1.05). Intervention participants were marginally less likely than others to report nonuse of condoms within the past 14 days, but the difference was significant for nonuse within the past 60 days (0.5). Women whose main source of spending money changed from their boyfriend to another source between baseline and the first follow‐up had a reduced risk of reporting nonuse of condoms within the 14 days before the six‐month interview.
One year after the intervention, women who received most of their spending money from their boyfriend had a marginally elevated likelihood of reporting never using condoms during the past 14 days, but were significantly more likely than others to report nonuse within the past 60 days (incidence rate ratio, 1.5). Relationship duration was again positively associated with nonuse of condoms (1.04 for each recall period), as was nonuse at baseline (1.7 and 2.1). Intervention participation was associated with a reduced likelihood of never using condoms during both recall periods (0.6 and 0.5).
Within the subsample of women whose boyfriend was their primary source of spending money, as in the overall sample, nonuse of condoms at baseline predicted elevated odds of nonuse in both the 14 days and the 60 days preceding each follow‐up interview. At six months, Horizons participants were less likely than others to report never using condoms (incidence rate ratio, 0.6 for the past 14 days and 0.4 for the past 60 days); at one year, however, intervention participation was no longer significant.
The researchers note that the sample may not be generalizable and may, because of misreporting, have included women who were not attempting to avoid pregnancy. Despite these limitations, they conclude that resource disparities between partners of the same age appear to be linked to unsafe sexual behaviors and that "safe sex interventions may be undermined if adolescent women receive spending money from their boyfriends." As a result, they encourage clinicians to "remind adolescents of the tangible and intangible resources that they bring to a relationship, provide guidance about when to decline offered gifts, and guide patients to obtain social goods outside of romantic relationships.—D. Hollander