1. Framing Unintended Sexual Health Outcomes through a Sexual Economics Lens Ehriel F. Fannin, MSN, RN Ruth L. Kirschstein NRSA Predoctoral Fellow University of Pennsylvania School of Nursing

2. Acknowledgements National Institutes of Health Ruth L. Kirschstein NRSA Institutional Research Training Grant on Vulnerable Women, Children, and Families (T32NR007100) PI: Marilyn S. Sommers, PhD, RN, FAAN Center for Global Women’s Health, University of Pennsylvania School of Nursing Director: Marilyn S. Sommers, PhD, RN, FAAN Center for Health Equity Research, University of Pennsylvania School of Nursing Director: Loretta Sweet Jemmott, PhD, RN, FAAN The Alice Paul Center for Research on Gender, Sexuality, and Women, University of Pennsylvania Director: Christine Poggi, PhD

3. Sexual decision-making and negotiation are two of the most significant contributors to the health of women, children, and future populations. 1

4. Unintended Sexual Health Outcomes Sexually transmitted infections (STIs), HIV, and unintended pregnancy Widening disparities in sexual health outcomes 2,3 Vulnerabilities follow patterns of social and economic disadvantage 4

5. Sexual Health Intervention Science Cognitive behavioral models (i.e. the Health Belief Model, the Theory of Reasoned Action, the Theory of Planned Behavior) do not adequately address bias in decision- making, the influence of emotions, or the dyadic negotiation that takes place in sexual relationships. 5,6

6. Behavioral Economics and Sexual Decision Making

7. Sexual Economics and Sexual Negotiation Social exchange is inherent in sexual relationships 7 Sex is a resource that can be leveraged for economic, emotional, social, or hedonistic benefits 8 Exchanges in sexual relationships are influenced by normative expectations and market influences 7,8

8. Aims Examine the contexts in which implicit exchanges of sex for resources occur Identify the types of resources available for exchange

9. Methods Search TermsLimiters Sexual economics Social exchange Sexual exchange Sexual reciprocity Sexual negotiation Compensated sex Transactional sex Sexual networking Exchange relationship LGBT/ married relationships Commercialized sex work Exchange of sex for drugs Total # of Publications Eligible for Analysis: 28 Databases : MEDLINE, PubMed, PsycINFO, Scopus, and Sociological Abstracts

10. Findings Capital/resources available for exchange Approaches to sexual relationships Normative influences relative to sexual exchange Market influences on sexual exchange

11. Capital vs. Resources Capital 9 Economic Emotional Social Sexual Hedonistic Resources 10 Money Material goods Love Information Status Services

12. Approaches to Sexual Relationships Communal approaches to sexual interactions are altruistic, and resources are invested in response to partner needs. 11,12 Exchange approaches to sexual interactions are value maximizing, and resources are invested with expectations of compensation. 11,12

13. Normative Influences Expectations of reciprocity Perceptions of risks and rewards

14. Market Influences Values attributed to capital Supply and demand of sexual partners Equity in capital and negotiating power

15. Implications for Sexual Health Science Innovated frameworks and measures are necessary to address variations in risk assessment, nuanced approaches to sexual relationships, and inequities in sexual negotiation.

16. Future Research Directions Examine the effects of varying types of capital on relationship approach, risk/benefit assessments, and the ability to negotiate sexual decisions with partners Explore cultural differences in normative expectations Determine the influence of reciprocity expectations on sexual violence

17. References 1. World Health Organization. (2010). Developing sexual health programmes: a framework for action. 2. Centers for Disease Control and Prevention. (2010). Sexually Transmitted Disease Surveillance 2009. Retrieved from http://www.cdc.gov/std/stats09/default.htm. http://www.cdc.gov/std/stats09/default.htm 3. Centers for Disease Control and Prevention. (2009). HIV incidence 2008. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/incidence/i ndex.htm. http://www.cdc.gov/hiv/topics/surveillance/resources/slides/incidence/i ndex.htm 4. Finer, L. B. & Kost, K. (2011). Unintended pregnancy rates at the state level. Perspectives on Sexual and Reproductive Heatlh, 43(2), 78-87. 5. Lopez, L. M., Tolley, E. E., Grimes, D. A., Chen-Mok, M. (2011). Theory-based interventions for contraception. Cochrane Database of Systematic Reviews, Issue 3. 6. Brawner, B. M., Davis, Z. M., Fannin, E. F. & Alexander, K. A. (2011). Clinical depression and condom use attitudes and beliefs among African American adolescent females. Journal of the Association of Nurses in AIDS Care.

18. References cont. 7. Vohs, K. D. & Lasaleta, J. (2008). Heterosexual behavior is governed by social exchange and basic economic principles: sexual economics theory. Minnesota Journal of Law, Science, & Technology, 9(2), 785- 802. 8. Baumeister, R. F. & Vohs, K. D. (2004). Sexual economics: Sex as female resource for social exchange in heterosexual interactions. Personality and Social Psychology Review, 8(4), 339-363. 9. Bourdieu, P. (1986). “The forms of capital” in Handbook of Theory and Research for the Sociology of Education, Richardson, J. G. (Ed.). New York, NY: Greenwood. 10. Foa, U. G. & Foa, E. B. (1974). Societal Structures of the Mind. Oxford, England: Charles C Thomas. 11. Clark, M. S. & Mills, J. R. (2011). A theory of communal (and exchange) relationships. In The handbook of theories of social psychology, Van Lange, A. M., Kruglanski, A. & Higgins, T. (Eds.),. London: Sage. 12. Hughes, T. G. & Snell, W. E. (1990). Communal and exchange approaches to sexual relations. Sexual Abuse: A Journal of Research and Treatment, 3(2), 149-161.