Written by Emily Nagoski, Ph.D.
Briefly, safer sex is sexual decision-making and behavior that decreases (not necessarily eliminates) risk of STI transmission and unwanted pregnancy.1 The efficacy of prevention interventions, indeed, is measured in terms of rates of STI transmission, unwanted pregnancy, and "sexual debut," which is one of my favorite phrases ever. (The reason sexual debut is an outcome measure is that starting to have sex later in life is strongly and consistently correlated with better sexual health outcomes.)
Attachment style predicts pretty much all the things you might expect:
Weirdly, among adolescents, anxious attachment is globally protective for boys but not for girls, in terms of not-so-good health consequences related to sex. Avoidant attachment protects girls but not boys from those consequences. Secure attachment is better than either insecure attachment style, in both boys and girls.
Secure attachment being associated with the best sexual health outcomes,4 we've got a class disparity on our hands, since poverty negatively impacts attachment for a variety of reasons; kids who grow up poor are more likely to develop insecure attachment styles.5 (The "why" of this is extremely complicated and whole books have been written about it. See, for example, Culture and Attachment: Perceptions of the Child in Context.)
So negative health outcomes are perpetuated by socioeconomic status not just for the straightforward reasons of lack of access to services, education, and other resources, but also because of the emotional differences of living a life of want compared to a life of privilege.
I've mentioned before that human social systems are complex, in the purest sense of the word and that recognizing that complexity will help us to create positive change.
This is an example of that. Just giving people condoms won't help if they don't know how to use them; and even knowing how to use them isn't enough, if they're not motivated to use them. In order to change the decisions people make, you have to address the environment in which they become decision-makers.
Want people to have safer sex and/or less risky sex? End poverty. (Apparently we need more reasons to end poverty, because it's not a self-evidently important goal in itself. We. Are. Morons.)
1. Widman, L., Nesi, J., Kamke, K., Choukas-Bradley, S., & Stewart, J. L. (2018). Technology-based interventions to reduce sexually transmitted infections and unintended pregnancy among youth. Journal of Adolescent Health, 62(6), 651-660.
2. Strachman, A., & Impett, E. A. (2009). Attachment orientations and daily condom use in dating relationships. Journal of sex research, 46(4), 319-329.
3. Starks, T. J., Castro, M. A., Castiblanco, J. P., & Millar, B. M. (2017). Modeling interpersonal correlates of condomless anal sex among gay and bisexual men: An application of attachment theory. Archives of sexual behavior, 46(4), 1089-1099.
4. Pietromonaco, P. R., & Beck, L. A. (2019). Adult attachment and physical health. Current opinion in psychology, 25, 115-120.
5. Delker, B. C., Bernstein, R. E., & Laurent, H. K. (2018). Out of harm's way: Secure versus insecure–disorganized attachment predicts less adolescent risk taking related to childhood poverty. Development and psychopathology, 30(1), 283-296.