Background Successful STI prevention for younger boys should tap into a cultural understanding of boys' romantic and sexual relationships. However, little data exist. We describe developmental changes in boys' relationships, masculinity, sexual behaviour, and STI risk across adolescence.
Methods After IRB approval, thirty-three 14–16-year-old boys were recruited from a teen clinic serving high STI prevalence urban areas, and participated in 3 one-hour qualitative interviews, approximately 6–9 months apart. Urine was tested for gonorrhoea, chlamydia and trichomonas using DNA-based tests. Over 80% were retained at each follow-up. Baseline interviews were coded, then each boy's three interviews were read as a group, looking for changes across the interviews in relationship experience, masculine beliefs, sexual communication and decision-making, sexual experiences, and STI prevention.
Results Mean age was 14.9 years, all were Medicaid-eligible (low income), 90% were African American, and 16/33 were sexually experienced. We observed changes over time in relationships, masculinity, and sexual decision-making. At baseline, boys described girls as having more relationship power, with girls frequently initiating relationships and the decision to have sex. As boys gained experience, they perceived themselves as having more agency, and initiating sex more often. At baseline, we observed low levels of masculine beliefs, with many boys wanting meaningful and emotionally involved relationships, few viewing sex as a conquest, and most worrying about their own relationship and sexual competency. Three trajectories of masculinity emerge. A small number of Players” embodied a subset of masculine beliefs that included sex as a conquest, women as objects, and lack of emotional involvement. “Emotionally distant” was more common; these boys described initially trusting girls, “being burned” by someone they had been close to, and then not investing emotionally so as not to be hurt again. “Caretakers,” also a small minority, emphasised men's role to protect and care for women. Sexual communication, mostly indirect or nonverbal at baseline, became more direct. Despite a baseline interest in sex within relationships, experiences of 1st sex were generally outside of relationships.
Conclusions For STI prevention programs to have relevance to younger boys, they need to tap into developmental changes in the cultural, relational, and behavioural contexts of sex.
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