“First, I… then, we…”: exploring the sequence of sexual acts and safety strategies reported during a sexual encounter using a modified timeline followback method

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Assessments of sexual safety often rely on questions about the occurrence of condom use within a designated timeline, assuming that penile–vaginal intercourse (PVI) occurred once at the conclusion of the event. An investigation of all sexual acts and safety strategies that occur during a single event may present a more nuanced picture of sexual risk.


Behaviourally, bisexual women (N=45) were recruited due to the potential diversity of their sexual behaviour and safety strategies. A modified timeline follow-back method, the SEQUENCE Calendar, was designed to capture information about the participants’ most recent sexual event with a male partner, including the order of each sexual act during the sexual event. Interviews took between 1 and 3 h. These acts were compiled into narratives and the behavioural sequences were reviewed and coded.


Participants reported an average of 7.9 (SD=4.3) sexual acts. Over a third (35.9%, N=14) of the participants who reported PVI indicated engaging in genital contact after PVI and over 15% (N=6) of these participants reporting PVI at two different time points, separated by sexual behaviour. Additional potential for infection outside of condom use and PVI was also identified.


Sexual interactions are comprised of multiple acts that occur in a variety of permutations. Understanding the complexity of people's sexual encounters has potential to inform the ways we measure condom use and consider sexual safety.

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