Negotiating HIV and pregnancy prevention and sexual pleasure amongst heterosexual men and women in South Africa.

Heterosexual sex, foremost its gender-power dynamics, is embedded in and informed by the socio-historical context in which it occurs. While safer sexual communication skills are well documented as key to the success of sexual and reproductive health programming and education, communication skills about the positive aspects of sexuality such as sexual pleasure are often limited if not absent. Using data from in-depth qualitative interviews with men and women aged 26-39 from a diverse set of backgrounds in Cape Town, South Africa, this study examines the ways in which gender-power dynamics manifest in negotiations of HIV and pregnancy prevention and sexual pleasure in the intimate spaces of heterosex. Findings fall under three themes: 1) condom negotiation as a replacement for other aspects of sexual communication; 2) self-efficacy in negotiating prevention and negotiating one's own sexual pleasure; and 3) the integral role men play in heterosexual encounters in the facilitation of women's sexual autonomy and women's sexual pleasure. This study contributes to research not only examining the positive and more nuanced realities of heterosex in the South African context, but also argues for the need to integrate positive aspects of sexuality into sexual and reproductive health programming in general.