Teen girls whose primary source of spending money comes from their boyfriends are less likely to use condoms, according to a new study published in the Journal of Adolescent Health.
Researchers from Johns Hopkins School of Medicine obtained data from an HIV prevention study that included 715 African-American teen girls in the Atlanta area.
Almost a quarter of the females (ages 15 to 22) attending family-planning centers said their primary source of spending money was from their boyfriends, rather than from their parents or grandmothers or jobs. The teens were 10 percent more likely not to have used condoms in the previous 60 days.
Few girls reported using other methods of contraception, researchers said, and girls whose boyfriends owned cars were also about 50 percent more likely to not use condoms than those whose boyfriends did not own cars.
"After matching the groups on over 75 characteristics, the teens whose primary source of spending money was their boyfriend were still 50 percent more likely not to use condoms, and they were less likely to respond to the HIV prevention intervention," said Janet Rosenbaum, lead author of the study and research faculty at the Maryland Population Research Center in College Park.
Women with less relationship bargaining power -- and hence limited ability to insist on safe sex -- are particularly at risk of condom nonuse, the authors wrote.
In a way, these girls are trading unsafe sex for money, Rosenbaum said, even though most of them reported being in long-term and monogamous relationships.
"Medical interventions alone will not cure or solve the problem of nonuse of condoms," said Dr. Paula Hillard, professor of obstetrics and gynecology at Stanford School of Medicine. "We need societal changes and changes in the messages we provide to adolescent girls. … We need to provide alternative messages about power and self-efficacy that will counter the tendency to succumb to coercive relationships and unsafe sex."
To counter these societal norms, Rosenbaum said clinicians must consider teens' economic circumstances when conducting safe sex interventions.
"Teens may act unwisely in order to meet their material needs and wants," Rosenbaum said. "Interventions and clinicians may need to concentrate not just on safe sex behavior but also on helping teens to evaluate their needs versus wants."
Plan B, the emergency contraception pill that can be taken up to 72 hours after having unprotected sex to prevent pregnancies, has made headlines as experts debate whether young teens should have access to it. But even with access, experts said, this would only be a drop in the bucket when it comes to preventing teen pregnancies altogether, particularly in the most underserved communities.
One solution would be to increase their trust of contraceptive methods that could not be detected or easily sabotaged by their partners such as intrauterine devices (IUD/IUS) or contraceptive injections to prevent pregnancy, at least, Rosenbaum said.
"Increased access to contraception including Plan B is always helpful for disadvantaged populations, but it's not enough," Rosenbaum added.
"The best solution would be economic empowerment for these girls and their families, so that they do not rely on their boyfriends for spending money and use condoms consistently. "