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Lecture 1

Psychology 2075 Lecture 1: Lecture 1 (midterm 3)


Department
Psychology
Course Code
PSYCH 2075
Professor
Jacob Fisher
Lecture
1

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Reducing the risk: understanding and promoting sexual and reproductive health (with special
focus on STI)
Psychology 2075 Survey
“I have a condom in my wallet, backpack, or purse right now.”
30% males, 20% females
If you and your partner have never had any other sexual partner, you probably don’t have to use
a condom. If you and your partner have had any other sexual partner, you should.
The Challenge: sexual freedom and reproductive health risk
The challenge is one that plays out at the junction of our biological behavior. We live in a world
where we’re reminded frequently of sexual freedom and reproductive health risk. When we want
to know what STI risk is composed of: pathogen prevalence (how much of a bug is out there)
multiplied by our sexual risk behavior.
STI RISK = PATHOGEN PREVALENCE x SEXUAL RISK BEHAVIOR
if we want to know about STI risk, think about how much pathogen is out there and how much
risky behavior an individual engages in. in some areas, there’s a large amount of pathogen but
low risky behavior, in other areas, the vice versa is true.
Sex can lead to pleasure, babies, and infections (bacterial – chlamydia, gonorrhea, syphilis; and viral – HSV, HPV,
HIV)
STI don’t present obvious or evident symptoms of disease. Broadly speaking there are 2
classes of STI 1. 1. Bacterial – curable
- Issue with bacterial STI: people don’t know they have it
- Can be eradicated with antibiotic treatment at any time
- There may damage caused by bacterial STI that may not be fixable
2. Viral – can be prevented with condoms or vaccination and managed, not cured or eradicated
Issue with viral STI: people know they have it but it cannot be cured
Understanding the problem: psychological determinants of sexual and reproductive health risk and
prevention
Most people are informed about
theoretically useful but practically useless
information. Ex. If condoms prevent
most STIs, but you don’t know where to
purchase them, where to carry or store
them, how to use them, or maintain
condom use over time, then your
information has limited applicability.
It’s also the case that well-informed people may not be motivated to act on what they know. It is
incredibly important however, to be motivated, to act on information to practice prevention.
Two sources of motivation:
1. Personal motivation
Theory of reasoned action
A person’s personal motivation to enact STI preventive behavior rest upon a person’s
perception on the outcome of the action multiplied by the individual’s evaluation of the
outcomes

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PERSONAL MOTIVATION = PERSONS PERCEPTION OF OUTCOME OF ACTION x
EVAULATION OF OUTCOMES
2. Social motivation
Expectation that people who’re important to you will either support or resist your action
A well informed individual who believes that the outcome of introducing condoms may be
partner resistance and relationship dissolution, or mother/father/doctor do not support
this action, this individual may be well-informed by unlikely to act on what they know.
This model was formed in context of failure of public health during the aids epidemic. Although
individuals were informed, they did not act on the information that was thrown at them.
Psychologists decided that individuals must be informed, motivated, and coached to act on the
information.
Information-motivation-Behavioral Skills Model
You can be well-informed and well-motivated, but if the STI prevented behaviors are
complicated (plan sex in advance, discretely carry condoms, assertively bring sexual issues up,
and maintain use over time), individuals either have behavioral skills which will permit you to
express your information and motivation in behavioral performance, but if you lack behavioral
skills it doesn’t matter how much you know or how motivated you are to act. Behavioral skills
place an upper limit on the ability to express STI preventive behavior. The model provides
for situations where STI preventive behavior is not as complicated. Whether you’re talking about
initiating condom use, financing a series of HPV vaccinations, or maintaining limited sexual
intercourse over time, these things are not simple.
Information and Reproductive Health Behavior
1. Information
The first rule of reproductive health information provision in Canada, North America and
most of the world, is that the information provided is completely irrelevant to the actual
practice of STI preventive information. This is the criterion of behavioral irrelevance.
Information of anatomy is irrelevant to the actual practice of prevention.
The second issue has to do with whether or not the information is actually
understandable. STI preventive information is irrelevant if non-understandable. Creating
high levels of fear that are not accompanied by things that are easy to enact, that lower
risk and lower fear, simply turns people off and they no longer listen. The specific
approach that’s most useful is to elevate modest amount of anxiety coupled with low
cost, easy to accomplish, prevention recommendations. Provide information that’s
relevant, actionable, and understandable. Information should elevate vigilance and
immediately be coupled with easy to practice behavior. Beware of behavioral
irrelevance, incomprehensible, scary, sexist, and dangerous information. The internet is
the primary provider of incorrect information in the same way that Cosmo magazine was

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in the 80’s. Information from doctors is also misleading; onset of oral contraceptive use
usually accompanies offset of condom use.
Public Health and Primary Care: What we say versus what we get
What people have said when interviewed at an STI clinic:
Have fewer partners
- “I only have one at present and I am perfectly safe”
Get to know your partner
- “I know and love my partner and I am perfectly safe”
Don’t get pregnant
- “Oral contraception is the perfect method of birth control and I have no further worries
about sex”
We are often told that people have learned very well that they should have fewer partners. We
conclude that if we have fewer partners and we’re safer, than if we only have one partner, then
we’re completely safe. The problem is that most of us have one partner AT A TIME. Most of
us have a pattern of serial monogamy of having many partners in a lifetime.
Most people believe that getting to know your partner is a good way to prevent getting an STI.
This is not true. Most people who have an STI are not aware that they have an STI. Imagine
what proportion of people would lie to have sex. There are publications about people who would
lie about anything to get sex. Imagine the risk factors for STI; how likely are we to disclose risk
factors?
Motivation and Reproductive Health Behavior
Emotions
Most people are born with erotophilia.
Attitudes
Most people are positive about “pumping iron”.
Social Norms
Most people believe it’s normative to be sexually active. They understand that in remains
counter-normative to talk about it before you do it.
Behavioral Skills and Reproductive Health Behavior
We understand based on our discussion wrt contraception generalized to STI prevention; much
of what’s involved in STI prevention is the skilled performance of interpersonal behaviors.
Reproductive Health Behavior Sequence
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