Persistently high rates of HIV and other STDs have a profound impact on the health of adolescent populations in the United States.¹ Some populations—black youth² and inner-city residents,³ for example—disproportionately suffer the burden of these infections. Social and environmental factors are important determinants of disparities in rates of infection;⁴ key among these factors are the patterns of exposure to STDs created by an individual's sexual network.⁵

A growing body of literature suggests that in addition to individual behavior, characteristics of one's sex partner and sexual network significantly influence an individual's STD risk.⁶ For example, individuals who have nonmonogamous sex partners are at increased risk for STDs relative to those with monogamous partners.⁷ Additionally, adolescents who have older sex partners have a greater risk of infection than individuals whose partners are their own age.⁸

Furthermore, macro-level social and economic forces drive racial differences in sexual network formation in ways that promote and sustain elevated STD rates within black populations in the United States.⁹ Because of racism, racial segregation and poverty, blacks are more likely than others to form partnerships with members of their own race. Because of incarceration, violence and a subsequent imbalance in the sex ratio, sexual networks within black populations are more likely than others to include individuals with varying levels of risk in terms of STD transmission, and more likely to include individuals who have overlapping (nonmonogamous) partnerships. The mechanisms by which these contextual factors influence sex partner selection and dynamics within sexual relationships, however, are not clear.

Over the past several decades, sociologists and psychologists have developed numerous theories to explain sexual behavior, mating patterns and sex partner selection. Most early theories describe motivations for "mate" selection and characteristics that people tend to look for in a lifetime romantic partner in the context of marriage. For example, one theory is that people seek mates who are similar to themselves in characteristics as diverse as height, weight, personality, intelligence and values;¹⁰ another suggests that people seek mates who they believe will provide equity in the exchange of valuable resources in the relationship.¹¹ Distance or propinquity theories suggest that people simply mate with others with whom they tend to come in contact.¹² Critics of these theories contend that their descriptions of the qualities that determine mate selection are vague, and that they fail to differentiate between selection strategies for women and men and selection of partnerships of varying duration (for example, nonmarital sex partnerships).¹³

In response, Buss suggests a more comprehensive theory for understanding sex partner selection, for both short-term and long-term relationships, from a biological perspective based in evolutionary psychology.¹⁴ This theory suggests that sex partner selection is a strategic process motivated by a desire to achieve reproductive success, and that particular selection patterns have developed as an adaptive response to problems our ancestors encountered during evolution. According to Buss, men and women pursue different mating strategies oriented toward reproduction because of the disparity between the levels of parental investment required of each sex due to biological differences: Men are more likely than women to adopt short-term, overlapping sexual partnerships and to seek fertile partners, to increase the probability that they will successfully reproduce. In contrast, women's reproductive success is linked to their ability to access external resources for themselves and their children, and thus women look for partners who can provide these resources through long-term partnerships.

Buss depicts the sex partner selection strategies included in his model as universal, but dependent on contextual factors. Adaptation to these factors is described in relation to the goal of successful reproduction without consideration of other social needs that may influence interactions within sexual relationships. In relation to successful reproduction, factors such as access to economic resources and the sex ratio are important to sex partner selection.¹⁵

Limited research has examined the ways in which contextual factors shape sex partner selection beyond their influence on reproduction. Additionally, research and, in turn, theories that challenge reproduction as the goal of sex partner selection and reflect contemporary motivations and the social environment surrounding at-risk adolescents are sorely lacking. Furthermore, theories that focus on mate selection within the context of long-term marital relationships may not be applicable to adolescents. Thus, to inform an effective public health response to inner-city black adolescents' risk for STDs, our study was designed to gain a better understanding of the psychosocial processes related to sex partner selection in this population.

METHODS

Study participants were recruited during the summer and fall of 2002 from among enrollees in the Baltimore-based Perceived Risk of Sexually Transmitted Diseases (PRSTD) cohort study. The PRSTD cohort consists of adolescents who live in Baltimore and have sought reproductive health services at a public STD or general adolescent health clinic in the eastern region of the city, a lower income area. We employed purposive sampling¹⁶ to recruit participants from among those who had visited a clinic within the previous year, selecting 10 individuals from four key groups: 14–21-year-old men and women with an STD experience and with no STD experience. STD status was determined from PRSTD data that included test results for gonorrhea and chlamydia. Participants were categorized as having had an STD experience if they had tested positive for gonorrhea, chlamydia or both at any time within the previous year.

Eligible adolescents were invited to participate in the study through recruitment letters and phone calls by study team members that summarized project goals (i.e., gaining a better understanding of social factors that influence STD risk in the youths' community) and provided details about participation. A total of 50 adolescents—26 women and 24 men—participated. We experienced a refusal rate of 5%.

Adolescents recruited for the study had been seeking confidential health services at the time of their enrollment in PRSTD; thus, they were not required to provide parental consent. This study was approved by the institutional review board of the Johns Hopkins Bloomberg School of Public Health.

Most participants completed two semistructured in-depth interviews with the same interviewer; four participants completed only one interview. Before each interview, participants were informed of the purpose and format of the interview and were asked to provide written consent. The interview team consisted of four female and four male young adults; interviewers were white and black. All female participants were matched with female interviewers. Most interviews were conducted in a private room at a teaching hospital located near the recruitment clinics; three were conducted at participants' homes, in private rooms with no other household members present.

Interview questions were open-ended, to allow participants to elaborate on topics they considered important. For example, participants were asked "What types of things do you look for in a guy/girl you would have a relationship with," "Tell me about your most recent sexual relationship" and "What did you give/get from this relationship"? Participants were also asked to describe their most recent main and their most recent casual partner—defined, respectively, as "a person that you have sex with and are serious about" and "a person you have sex with but are not serious about and who you may have sex with only once, a few times, or an ongoing casual basis." During the course of the study, the interview guide was adapted to include questions about topics that emerged as significant to the research questions, such as monogamy and economic opportunities.

The interviews were recorded and transcribed, and studied through content analysis.¹⁷ We used Atlas.ti 4.1 software to break the interviews down into the smallest pieces of text that could be interpreted alone, and then coded them according to the concept they reflected. Codes were initially generated from topics covered by the interview guide and were adapted to include salient themes that surfaced during the analysis. Once the interviews were coded, short, informal memos were written on each of the code families that provided information relevant to the research questions for each group of participants. These code families included personal background (priorities and plans, and family and friend dynamics), relationship values (ideal sex or romantic partner and perceptions of monogamy), description of most recent main and casual sex partner, and concerns about HIV and other STDs. Responses related to the research questions were compared across the four groups of participants. The final step in the analysis involved the heuristic review of interviews, during which each interview was reread in its entirety.

RESULTS

All study participants were black, and their average age was 18 (range, 16–21). Forty-six percent of participants were enrolled in school or planned to be enrolled in the next semester. On average, participants had completed 11 years of school (most had had 9–12 years of schooling, and two were in their first year of postsecondary education). Seventy percent said that their mother had completed high school; 34% had children or expected the birth of a child within the next six months. Only two, both female, reported living with their sex partner. Background characteristics were similar among the four study groups and between those who had had an STD and those who had not.

Three main themes related to sex partner selection and sexual relationship dynamics emerged in the in-depth interviews: types of sex partners and desired traits, monogamy and affective needs. We present the findings for each of these themes for women and men.

Types of Partners and Desired Traits

From the perspective of women, there exists only one category or type of sex partner, and these partners are thought of as romantic partners. Women's discussion was exclusively about romantic partners; no women discussed casual partners. Most women suggested that their ideal romantic partner is a "good guy," who is monogamous, has educational and career goals, and is emotionally supportive.

In terms of personality, most women reported that they desire a partner who is respectful, honest and kind. According to these women, a romantic partner demonstrates respect by speaking to them politely in private and public, being honest, being considerate and being monogamous. Many women also expressed a desire for a romantic partner who could add humor and fun to their lives.

For many women, the ideal romantic partner is physically attractive—tall, with characteristics such as strong hands and nice eyes. However, most suggested that the importance of appearance is related more to how a man "keeps himself up" than to innate physical traits. Several women suggested that a man's appearance is symbolic of his physical cleanliness as well as his potential to have a "nice" personality and be a faithful romantic partner. One participant described the symbolic value of appearance for adolescents in her community in the following way:

"It's really based on appearance….I find as young people, people my age, get in relationships, it's really based on appearance, 'cause we don't really know people. [It's] about … how they appear to be, how they seem like they are. He has to appear nice, appear clean, appear nice, you know." —Female, 19 years old

Several women suggested that a sex partner's appearance may be used to evaluate his STD risk. A partner who is "clean" in his physical appearance is also perceived to be "clean" of STD infection. Additionally, a partner who appears to be monogamous and respectful is perceived to have a lower STD risk than others. This evaluation is usually based on the reputation of people the sex partner "hangs with" and the manner in which he initially approached the woman.

Most women expressed a desire for a romantic partner who manages his finances well, and who can pay for gifts such as flowers, jewelry and trips to the salon. These gifts allow a woman to "keep herself up," thereby maintaining a respected image in the community and contributing to her social status. Most of the women in the study worked, and expected romantic partners to be able to "pull their weight" in the cost of shared activities and entertainment, such as going to clubs and restaurants. The two women who lived with their partner and those who had children with their partner expected him to share a portion of the household bills. However, none of the women suggested that they look for a romantic partner who will cover the full cost of household needs such as rent, utilities or food. Economic independence was described as expected and common for women.

Several women suggested that the amount of money a man earns and the manner in which he earns his money are important considerations when selecting a romantic partner. A number of participants said that the status associated with a job is important, and that status differs for legal jobs versus illegal ways of acquiring money, and for jobs requiring different levels of technical training. Several women also reported that it is important for their romantic partner to have a job that matches their own in terms of the amount of money and status it provides.

In contrast, from men's perspective, there are two distinct types of partners, sex-only and romantic, and most men openly described both types as being valid and desirable. Sex-only partners were described as women who may have multiple sex partners; men referred to these women as "friends," "sluts," "hos," "superfreaks" and "chickenheads." "Gold diggers" were described as a special kind of sex-only partner, who are interested in their male partner only for financial gain or status. Relationships with sex-only partners were described as "one-night stands" and "just-friend" relationships.

All male participants described innate physical characteristics that they look for in a sex-only partner, including a pretty smile, a pretty face, long hair and a nice body. In contrast to females, men did not discuss symbolic values associated with such traits. Several men also expressed a desire for a sex partner who is not infected with an STD. Like female participants, males associated a "clean" and "hygienic" appearance with not being infected with an STD. Several men also suggested that STD risk is higher with sex-only partners than with romantic partners.

In contrast to sex-only partners, men described romantic partners as monogamous, and referred to them as "good girls," "main girlfriends" and "girls with a good head on their shoulders." Sexual relationships with romantic partners were described as "girlfriend" and "main" relationships. In the context of romantic partners, men emphasized the importance of characteristics related to personality and financial and educational status more than appearance. These characteristics include employment (without status designation for certain jobs), financial independence, intelligence (school- and street-based), a supportive personality and a positive attitude toward the participant and the relationship (no "fussing" or "nagging"). Most men also described a desire for a romantic partner who demonstrates strength and independence in relationships with family and friends.

Additionally, several men suggested that romantic partners should have the same physical traits described for sex-only partners. For example, one participant mentioned a desire for a romantic partner who is pretty, and who demonstrates strength and independence by taking care of herself and her children without the support of others:

"They have to have a good head on their shoulders. They have to be a nice, outgoing person. They have to be very pretty [and have] intelligence, the right mind and stuff like that. I mean, they got to know what they want. I don't like dumb people. I like people, I mean, I like girls that [are] classy, sophisticated, I mean…like taking care of herself and her child and stuff like that…making sure her child is going to be okay and get a good job."—Male, 16 years old

A few men mentioned a desire for a romantic partner who has not had many sex partners. Most also emphasized a desire for a romantic partner who is similar to them educationally as well as financially. These participants described wanting a romantic partner with a high school education, basic life wisdom or "common sense" and a job.

Monogamy

Although most women suggested that their ideal sex partner would be monogamous, the majority reported experience with a nonmonogamous partner. This same dissonance between ideal and real sex partners was not evident among men, perhaps in part because men clearly distinguished between sex-only partners and romantic partners.

Both women and men said that men commonly have overlapping sex partners. Many women suggested that "boys will be boys," and that maintaining multiple sex partnerships is an accepted behavior for men, but not for women. (Participants' reported actions also reflected this double standard: Only two women, but almost all of the men, reported having had overlapping sex partnerships.) Several women also reported that the family or friends of a nonmonogamous sex partner had collaborated with their partner to conceal his infidelity. A number of women suggested that male peers heavily influence their friends to have more than one sex partner. One woman reported having had a partner whose male friends would arrange for another woman to be present when she was not around. According to this participant, her partner's friends thought he was too young to be in a "married," or monogamous, relationship. Several men suggested that a man who does not take advantage of the opportunity to have multiple sex partners is "whipped," and will be perceived as weak and foolish by his peers.

However, none of the women condoned men's having more than one sex partner. And rather than blame their partner for his unfaithful behavior, many women placed the blame on other women. One participant described this scenario and the sexual double standard in the following way:

"We don't hate the guy; we ready to beat the girl up, you know? We ready to smack her, and she probably don't know nothing about us, or she might do know about us. We ain't ready to beat our boyfriend up 'cause he cheated on us; we ready to beat her up for sleeping with our boyfriend. But a guy, he ready to knock our head off 'cause we cheated on him. He could care less about the guy, he just being a guy. It's okay for men to do this."—Female, 21 years old

Within relationships where men have more than one sex partner, both women and men said that "main girls" or "wifeys" (romantic partners) have more status than "girls on the side" (sex-only partners). Although none of the women suggested that they would want a sex partner who has sexual relationships with other women, several suggested that in a context where multiple sex partnerships for men is common, being a "wifey" at least connotes more respect and status from others in the community than being the "girl on the side." One participant explained:

"A wifey is like somebody, somebody sticks with. Like if y'all been in a relationship…he might be cheating with another girl, but you're the main chick. You know what I'm saying? You still know that [he's thinking], 'That's my wifey, that's my main girl,' and [the other girl is] just on the side….So it's [about keeping your wifey] status."—Female, 19 years old

A few women suggested that a sex partner can demonstrate respect simply by maintaining the idea of monogamy in the relationship even if he has other partners. One participant, who discussed her concern over her current sex partner's fidelity, described this phenomenon in the following way:

"Like as I long as I don't see nothing, hear nothing, like that, then that way I'll feel like I'm being respected. You know, if he is out doing other things, then as long I don't know about it, see it or whatever, then I'll say, 'Well, he respectful as far as I know.'"—Female, 21 years old

Several women discussed the difficulty they encounter in finding "good guys" who will be monogamous, and suggested that there are more women than men available as sex partners. Among the reasons suggested by participants for this imbalance is a high prevalence of incarceration among adolescent men, which women linked to drug trade involvement in the wake of a lack of opportunities yielding financial stability and status for men.

Many women discussed their concern over the STD implications of their sex partner's infidelity. Several described evaluating their sex partner's STD risk on the basis of their perception of his preventive behavior with other partners. This evaluation was based on the level of maturity, respect for their body and trust within the relationship that participants perceived a sex partner to have.

Affective Needs

Women, more than men, suggested that they look to romantic relationships to fulfill a desire for intimacy and emotional support. Several women suggested that being involved in a romantic relationship helps them feel good emotionally and deal with other problems. They also said that having a romantic partner provides them with a sense of emotional security. For example, one participant described this feeling in the following way:

"I'm not too fond of cuddling with my pillow, and TV is only going to do so much, and then it's just like the notion that you always know that it's somebody there for you, that's going to be there for you to stand by your side."—Female, 18 years old

Another participant described the support she gets from her boyfriend as follows:

"He's like my best friend, and like I said, we both love each other. And sometimes when we argue, I just can't stand it, 'cause I just can't stand to be away from him. So it's very important that he's by my side and I feel as though he gives me the love and support that I need."—Female, 21 years old

A number of women described the process of developing an emotional bond with a romantic partner as "catching feelings," and suggested that women "catch feelings" more easily than men. One participant described "catching feelings" this way:

"You can't just sleep with any guy and think it's okay. We [women] catch feelings very quick….We are emotional people. Women, no matter how strong and hard they try to be, women tend to have a very soft spot for people that show us that they care. They might be faking, but we fall in love quick."—Female 21 years old

For several women, the type of emotional support they gain from a romantic partner is different from the social support they experience in relationships with family and friends. These women described strong support systems that consist of maternal figures, including mothers, grandmothers, aunts, older siblings and cousins. A few women also suggested that uncles and cousins serve as male role models and provide emotional support. Yet, even women who described strong social support systems reported that they still look to romantic relationships for the unique type of intimacy and emotional bond these relationships provide.

Several men and women suggested that women who lack strong social support systems are especially likely to seek emotional support and intimacy in sexual relationships and may therefore be more vulnerable in these relationships. For example, one woman said that because her mother, who suffers from drug addiction, is her only form of social support, she participates in sexual relationships with men for emotional benefits:

"Sometimes a woman feels as though if they not getting the care that they need at home, they'll look for it in a man….They'll feel as though just because he had sex with me, that made me feel good….[So] you'll start liking them and liking them, and then they'll just blow you off, and then you'll be hurt again looking for the next man that's going to take care of you."—Female, 18 years old

These participants also recognized dependence on a sex partner as a coping mechanism that some adolescents use to deal with a "stressful life." One participant described the relationship between emotional dependence and sex for adolescent women confronted with a multitude of problems in different domains of their life in the following way:

"Most of them [girls] have problems at home, most of them have problems in school, most of them just got problems period. Who do they look at for love and attention? They deal with the dudes."—Female, 19 years old

In contrast to women, most men described participating in sexual relationships for both physical and emotional benefit. Several described participating in relationships with sex-only partners purely for the benefit of sexual gratification. In the context of romantic partners, many men, like women, described "catching feelings" as a relationship progressed.

Rather than saying that they desire intimacy and emotional support, men often reported looking to sexual relationships to fulfill a desire to "feel wanted." A majority also discussed the lack of a strong social support system. Only a few men reported having a male role model they look up to, or having a strong relationship with an older male such as their father, their stepfather or an uncle. Several suggested that their relationship with their mother is strained because of her partnership with a boyfriend or new husband. Given their lack of relationships with older role models, many men suggested that they look to males close to their age, including siblings, friends and cousins, for guidance and support. These adolescents suggested that men seek relationships with women in part because they need to feel wanted, and both sex-only and romantic partners fulfill this need. For example, one participant discussed his disappointment over his lack of a relationship with his biological father and antagonistic relationship with his mother's current live-in boyfriend. This young man described feeling betrayed by his mother, who often sides with her boyfriend when disputes arise between the boyfriend and the participant. Later in the interview, this participant described his desire to "feel wanted" as follows:

"I mean, like females, they make me feel like I'm wanted. I don't think there's too many people that don't want to be wanted. If not one place, then another, you know? So females make me feel wanted. They make me feel like they're happy to see me, they're happy that I'm around, so I like that. They can even be superfreaks, as long as they're nice." —Male, 17 years old

DISCUSSION

Our findings support several aspects of the sexual strategies theory of Buss—namely, that men and women approach sexual relationships differently, and that whereas women typically seek romantic partners, men seek both sex-only and romantic partners. However, while Buss argues that the reason for this difference is evolutionary, and motivated by reproduction,¹⁸ our findings support a more contextual approach that links sex partner selection and relationship dynamics to social needs, rather than biological ones. In response to a lack of socioeconomic and status-yielding opportunities, many young men reported participating in the informal economy such as the drug trade to earn money and gain social status and respect as a man. This, according to participants, has resulted in an imbalance in the sex ratio, as many young men are incarcerated and therefore not available as sex partners. Additionally, many young men look to multiple sex partnerships as a way to gain status among their male peers.

At the individual level, efforts should be made to increase mentoring opportunities for young men so that they do not rely so heavily on their male peers for guidance, support and, ultimately, approval. Our findings also complement other research conducted among young men in resource-poor inner-city environments such as Baltimore that suggests that hypermasculine behavior within sexual relationships may be a result of young men's inability to fulfill masculine ideals in terms of financial independence.¹⁹ Thus, at the structural level, efforts should be made to increase socioeconomic opportunities for male adolescents in inner cities. Adolescent men in this study also described participating in both romantic and sex-only relationships to fulfill a desire to "feel wanted," indicating a need to explore ways to facilitate social support for these young men.

Although sexual strategies theories assert that women primarily seek mates who can provide them with economic resources that will help them achieve reproductive success, our findings suggest that women in this context are economically independent and are motivated by a desire for emotional rather than material resources. Within sexual relationships, women emphasized a desire for a faithful sex partner, but expressed a sense of fatalism in their ability to find a partner who is monogamous. However, economic dependency was not suggested as a common reason related to young women's tolerance of a nonmonogamous sex partner. This finding complements research conducted with a sample of inner-city black adult women that suggests that women are more likely to seek sexual relationships with men to fulfill psychosocial needs, including emotional intimacy and social status, than for economic support.²⁰ For many women in this study, the social status (if they are the "wifey") and emotional benefits of their sexual relationships appear to outweigh the STD-related risks of an unfaithful partner. Thus, to more fully understand inner-city black women's motivations for sex partner selection and, in turn, their STD-related risk, it is important to further understand the process of gender role socialization and the psychosocial status women may feel that they derive from their participation in heterosexual relationships.

Additional findings of importance with regard to STD prevention interventions include the process by which participants assess the risk associated with different types of sex partners. For example, both women and men initially evaluate sex partners' STD-related risk on the basis of their appearance. It is therefore important for prevention programs to emphasize that a "clean" appearance or whom a person "hangs with" is not an adequate indicator of the STD risk that individual poses. After a period of time, women evaluate STD-related risk more strategically, in terms of their perceptions of their sex partner's monogamy and the amount they trust their partner to practice safer sex with other partners. Hence, STD prevention programs should seek to promote opportunities for ongoing dialogue among women regarding the risks associated with basing the need for safer sex on such perceptions, and the importance of partner communication in addressing the risks of multiple partnerships.