Birth especially in long-term relationships for the reasons such

control strategies and contraceptive use are an integral part of heterosex for
the prevention of HIV and AIDS as well as women not wanting to get repeatedly
pregnant. One important innovation introduced to prevent HIV and other STDs is
the female condom. It has been accepted as an alternative or supplemental
barrier method to the male condom. However, no studies have tested the efficacy of a relationship-based intervention
on the use of the female condom amongst women and their long-term male sexual
partners. On the other hand, some research has demonstrated an increase in
female condom use within stable and long-term relationships and female condom
use may be particularly effective for the HIV prevention in engagement with
their male sexual partners.

Within heterosexual relationships,
contraceptive practices are heavily dependent on the female partner. Even
though condoms, as one of the limited available male options, that may be used
in the early stages of a relationship, these are set aside when the
relationship starts getting serious (Flood, 2003; Willig, 1995). Condoms’
visibility is portrayed as raising the attention of the risks of unprotected
sexual activity and as having the potential to question the ‘trustworthiness’
of both male and female partners (Flood, 2003; Willig, 1995). On the other
hand, the oral contraceptive pill and implant technologies are highly given a
‘default’ status, because of the potential side effects to women (Oudshoorn,
2003). Therefore, the decision to use a contraceptive method in heterosexual
relationships or change a method is heavily dependent on the factors such as
side effects e.g. weight increase, mental side effects, bleeding disturbances
or fear from the method itself. It may also be related to social and developmental
changes related to a change in the individual’s personal life. These may
include the beginning of a new relationship, unplanned pregnancy or fear from
getting pregnant, specific life changes such as an illness, a planned birth,
ending of a relationship and cost. It has become a culturally inscribed
responsibility for women to manage and deal with contraception use especially
in long-term relationships for the reasons such as women are the ones who get
pregnant, give birth, and take care of the child.

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On the other hand, The Women, Risk and
AIDS Project (WRAP) (Holland et al., 1992a) interviewed young women aged 16 to
21 in London and Manchester and concluded that heterosexual relationships are a
site of inequality where women have less power than men to control the progress
and content of sexual interactions. Their research revealed that young women’s
options regarding safer sex are constrained by the context of differential
power relations in sexual encounters. However, there is little information as
to whether these difficulties continue as women become older or whether
maturity and experience bring empowerment.

There is a universal opinion that
older people are more likely to be monogamous in long-term relationships and
consequently not at a risk of HIV infection. However, where a long-term
relationship is not monogamous, and safer sex is not practiced, risks will
evolve. In fact, estimates of extra-marital sex would appear to specify that
long-term relationships are often not monogamous. Thompson (1983), reviewing 12
surveys dating from 1948 to 1981, indicated that the reported incidence of
extra-marital sex ranged from 20% to 66% in male samples and 10% to 69% in
female samples. Additionally, he reported that an average of 72% of men married
for 2 years or more admitted to extra-marital sex (1981) and that 70% of women
married for more than 5 years had extra-marital relationships (1987).
Furthermore, monogamy seems to be a more serious problem in cohabiting couples.
According to British National Survey of Sexual Attitudes and Lifestyles, 15.3%
of cohabiting men and 8.2% of cohabiting women reported they had more than one
partner in the previous year. Moreover, only 21.8% of married women and 26.2%
of cohabiting women used condoms as a form of contraception, in comparison with
46.7% of single women. These statistics suggest that there is an increased risk
for those older age groups that are likely to be married or have steady
relationships, particularly if safer sex is not performed. 

Holland et al. (1990) reported that
where women insisted on sex being safe, they were mostly able to get men’s
co-operation. However, they needed to be very assertive and this was often very
problematic. Also, Boyle (1991) suggested that some women reported difficulties
around their partners’ inferences that they would be responsible for causing a
reduction in men’s sexual satisfaction.

access to positive conceptions of an active, pleasure-seeking, embodied,
masculine sexuality, put pressures on them to become ‘real men’. Becoming a
‘normal man’ implies the exercise of power over women. Within this masculine
heterosexuality, women’s desires and the possibility of female resistance are
potentially unruly forces to be disciplined and controlled, if necessary by
violence. (Ramazanoglu, 2004, p.12).

This point highlights a major issue
with the ignorance of women’s sexual pleasure and their victimisation in a
heterosexual relationship. In fact, the way in which this competition for
masculinity is played out, protects men from acknowledging fears of an
independent female sexuality and draws women into servicing men’s vulnerability
(Ramazanoglu, 2004). 

Holland et al. (1998) suggested that
ideas of ‘uncontrollable’ male sexuality keep on reinforcing women’s responsibility
for contraception. Pollack (1984) has argued that whilst women have gained
‘responsibility’, this has been offset by a decline in male ‘responsibility’,
therefore, women are now exclusively accountable for any ‘failures’. Also,
Ringheim (1999) has argued that efforts should be made to increase men’s share
of responsibility to reduce the imbalance of gender inequality. However, if men
are encouraged to be more involved in decisions over fertility this may
reinforce rather than decrease inequality since it has the potential to allow
men to be able to exert control over women’s bodies (Lowe, 2003).


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