Sexual behaviour in Britain at the millennium

November 29, 2001

N.B. Please note that if you are outside North America the embargo for Lancet Press material is 0001 hours UK Time Friday 30th November 2001. Three articles and a Commentary in this week's issue of THE LANCET detail and analyse the results of the UK National Survey of Sexual Attitudes and Lifestyles (Natsal 2000), and provide a comparison with the last survey done a decade ago (Natsal 1990). Natsal 2000 involved a detailed survey of over 11,000 men and women aged 16-44 years across the UK. The three papers each focus on a specific topic: partners, practices, and HIV risk behaviours; early heterosexual experience; and sexually transmitted infections and prevalent genital Chlamydia trachomatis infection.

Partners, practices, and HIV risk behaviours

Anne Johnson from University College London, UK, and colleagues report how patterns of heterosexual and homosexual partnership varied substantially in Natsal 2000 by age, residence in Greater London, and marital status. In the past 5 years, average numbers of heterosexual partners were around four for men, and around two for women. 2.6% of both men and women reported homosexual partnerships; and 4.3% of men reported paying for sex. In the past year, the average number of new partners varied from around two for single men aged 25-34 years to 0.05 for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990; for men and women there were increases in: reported numbers of heterosexual partners ever and in the past 5 years; homosexual partnerships ever and in the past 5 years; concurrent partnerships, oral-genital contact and heterosexual anal sex in the past year; and consistent condom use in the past 4 weeks.

The investigators comment that the benefits of greater condom use in Natsal 2000 compared with Natsal 1990 were offset by increases in reported partners. Changes between the two surveys were generally greater for women than men and for respondents outside London.

Early heterosexual experience

Kaye Wellings from the London School of Hygiene and Tropical Medicine, UK, and colleagues report that 30% of men and 26% of women aged 16-19 had heterosexual intercourse before 16 years of age; these percentages were substantially lower for women aged more than 30 years in the survey, and for men aged over 35 years. They also report a sustained increase in condom use. Non-use of contraception increased for people who were younger at first intercourse (reported by 18% of men and 22% women aged 13-14 years at occurrence). Early age at first intercourse was significantly associated with pregnancy under 18 years. Low educational attainment was associated with motherhood at younger than 18 years, but not abortion.

Sexually transmitted infections and prevalent genital Chlamydia trachomatis infection

Kevin Fenton from University College London and the UK Public Health Laboratory Service and colleagues report the data for the incidence of sexually transmitted infections (STIs). They found that 10.8% of men and 12.6% of women reported ever having an STI. C trachomatis was found in 2.2% of men and 1·5% of women with age-specific prevalence being highest among men aged 25-34 and women aged 16-24 years. Non-married status, age, and reporting partner concurrency of two or more sexual partners in the past year were independently associated with infection with C trachomatis. The investigators conclude that the results have potentially wide application for proposed chlamydia screening programmes which should proactively seek to include men.

In an accompanying Commentary (p 1828), Ralph DiClemente from Emory University, Atlanta, USA, considers the clinical and public-health implications of Natsal 2000. He comments that sexual-health-promotion programmes are important in community settings in addition to the school environment. He concludes: "From an economic and social standpoint, STI and unintended pregnancy continue to exact a significant toll on individuals and, ultimately, on society. This toll can be measured in terms of projected costs of certain infections, such as chlamydia infections, and in terms of health outcomes, such as the number of ectopic pregnancies and the rate of infertility. The real concern, however, is that in an era when an STI, HIV-1 infection, can result in a fatal illness, AIDS, the impact of sexual risk behaviour is now being measured in terms of deaths. This shift makes the potential impact of sexual-health-promotion programmes all the more important, and means that the design, implementation, and evaluation of these programmes deserve high priority."
MEDIA BRIEFING: Authors of the three Natsal papers will present their findings at an embargoed media briefing; this will take place at 0930 H on Thursday 29 November at the Medical Research Council, 20 Park Crescent, London W1B 1AL. Further details available from the MRC Press Office (T) +44 (0)20 7637 6011.

Contact: Natsal authors c/o MRC Press Office, 20 Park Crescent, London W1B 1AL; T) +44 (0)20 7637 6011; F) +44 (0)20 7436 2665; E)

Dr Ralph J DiClemente, Department of Behavioural Sciences and Health Education, Rollins School of Public Health and Department of Pediatrics and Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA; T) +1 404 727 0237; F) +1 404 727 1369; E)


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