Table 3 Summary of theme pattern among respondents in three risk/protection profiles identified in within-case analyses

Risk takers: High risk, low concern

• Emotional Factors: No observed pattern. Relationship Type: No observed pattern.

• Drug and Alcohol Use: Frequent risky sex after drug use or for pleasure seeking but no observed pattern of risk-taking because of substance use. Low frequency in use of condoms if used at all.

• Concern about Pregnancy and STIs: Low concern about risks of pregnancy or disease. Often know they are at risk but not concerned even when having a history of pregnancy or disease. Commonly express fatalistic views of inability to prevent pregnancy or disease as a justification for not using protection.

• Perceived Partner Preferences: Occasional examples of deference to partners who preferred to use protection (e.g. condoms, withdrawal).

N = 12 (7 female, 5 male)

• Communication about Risk: No observed pattern.

• Sexual Arousal: No observed pattern.

• General Attitudes about Risk and Typical Patterns of Risk Engagement and Protection: Have a consistent pattern of risk taking and lack of concern about risk across different types of partners and event circumstances. Only occasional descriptions of protected events.

Kappa = .82

• Perceived Partner Characteristics: Rare discussions of concern about risk and use of protection with certain types of partners perceived to be more risky than the respondent. Dominant pattern of engaging in unprotected sex with all partners regardless of partner characteristics or history of STIs.

• Relationship Trajectory and Risk: No observed pattern.

Risk avoiders: Low risk, high concern

• Emotional Factors: No observed pattern.

• Drug and Alcohol Use: Occasional descriptions of sexual events without use of protection explained by alcohol or drug use. These events are consistently described as exceptions and rare.

• Concern about Pregnancy and STIs: Often very concerned about both pregnancy and STI risk. Often discuss specific consequences of risk behavior, such as having a child when not ready or pain or stigma caused by STIs. Often use multiple strategies to avoid risk including using condoms in addition to other forms of birth control. Express regret for the times they did not use condoms.

• Relationship Type: No observed pattern.

N = 10 (3 female, 7 male)

• Perceived Partner Preferences: No observed pattern.

• Sexual Arousal: Occasional descriptions of sexual events without use of protection explained by being emotionally or physically “in the moment” without access to condoms. These events are consistently described as exceptions and rare.

Kappa = .79

• Communication about Risk: No observed pattern.

• General Attitudes about Risk and Typical Patterns of Risk Engagement and Protection: Emphasize risk avoidance and need for protection across all kinds of events and circumstances. After occasional one-off unprotected events, return to pattern of risk avoidance and protection.

• Perceived Partner Characteristics: Consistent use of protection with all partners. Discussion of avoiding having sex with partners perceived as engaging in risky behavior.

• Relationship Trajectory and Risk: Consistent condom use and use of other forms of protection even when having sex with long-term committed partners.

Risk reactors: medium risk, medium concern

• Emotional Factors: Frequent use of protection with partners without an emotional bond. Change in use of protection after emotional bond developed for increased intimacy and developing pregnancy ambivalence.

• Drug and Alcohol Use: Occasional descriptions of unplanned unprotected sex with partners due to drinking or drug use. Occasional descriptions of unprotected sex events due to lack of concern about risk after substance use. Occasionally these events are first transitions from using condoms consistently to not using condoms at all with a partner. Once transition to unprotected sex, no pattern of drug and alcohol use affecting risk and protection decisions.

• Concern about Pregnancy and STIs: Some concern about pregnancy and STIs despite pattern of engaging in high risk behavior. Tendency to prioritize concern about either STIs or pregnancy while expressing lack of concern about the other issue. Describe being aware and in control of their risks because of a strategy for avoiding risk, such as having sex with a “safe” partner. STI testing (alone, as a pair, or exchanging papers) is often described as a technique for reducing risk and confirmation of “clean” status. Occasionally express a belief in sterility after not becoming pregnant after repeated unprotected sex.

N = 15 (10 female, 5 male)

• Relationship Type: Use of condoms and other projection with new partners, one-night stands, casual partners, etc. Pattern of no protection used with long-term committed partners who are considered “safe” because of an expectation of faithfulness.

• Sexual Arousal: Occasional descriptions of unplanned unprotected sexual events without use of protection due to being emotionally or physically “in the moment” and not wanting to reduce pleasure or feelings of intimacy with a partner. Occasionally these are events in which partners first transition from using condoms to not using condoms. Occasionally these events are first transitions from using condoms consistently to not using condoms at all with a partner. Once transition to unprotected sex, no pattern of sexual arousal affecting risk and protection decisions.

• General Attitudes about Risk and Typical Patterns of Risk Engagement and Protection: Tendency to stop using condoms early in relationships after developing emotional closeness to partner, becoming monogamous, and feeling that their partners were “safe”. Have “rules” for protection but also have rules for breaking rules (e.g. deciding partner is “safe”) or inconsistent application of rules.

Kappa = .67

• Perceived Partner Preferences: Occasional descriptions of use or lack of use of protection due to deferral to partner’s wishes.

• Communication about Risk: Frequent descriptions of unprotected events preceded by discussions of respondent and partner being “clean”. Sometimes discussions occur after unprotected sex.

• Perceived Partner Characteristics: Pattern of use of condoms with partners perceived as engaging in risk behavior or having unknown characteristics. Pattern of transition to unprotected sex with partners with increased familiarity.

• Relationship Trajectory and Risk: Frequent pattern of use of protection with new partners but eventually transitioning to consistent unprotected sex after a discussion of commitment or partners both being “clean”.