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Objectives

Objectives. What do we know about the heterogeneity of sexual behaviour in populations? How is behaviour changing over time? How does behaviour related to STI risk (in individuals and populations)? What does that tell us about prevention programmes?.

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Objectives

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  1. Objectives • What do we know about the heterogeneity of sexual behaviour in populations? • How is behaviour changing over time? • How does behaviour related to STI risk (in individuals and populations)? • What does that tell us about prevention programmes?

  2. Diagnoses of uncomplicated gonorrhoea in GUM clinics by sex and age group, UK: 1995-2000* Males Females *Data are currently unavailable from Scotland for 2000 and from N.Ireland for 1996 & 1997 Source:CDSC

  3. Source:CDC

  4. National Survey of Sexual Attitudes and Lifestyles II SEXUAL BEHAVIOUR IN BRITAIN: PARTNERSHIPS, PRACTICES, AND HIV RISK BEHAVIOURS Lancet 2001; 358: 1835-1842 Anne M Johnson1, Catherine H Mercer1, Bob Erens2, Andrew J Copas1, Sally McManus2, Kaye Wellings3, Kevin Fenton1, Christos Korovessis2, Wendy Macdowall3, Kiran Nanchahal3, Susan Purdon2, Julia Field2 1. Royal Free and University College London 2. National Centre for Social Research 3. London School of Hygiene and Tropical Medicine

  5. National Survey of Sexual Attitudes and Lifestyles II • 1990 2000 • Ages 16-59 16-44 • Sample size 18,876 11,161 • Questionnaire Paper Computer • (PAPI) (CAPI/CASI) • Chlamydia test No Yes • Response Rate 66.8% 65.4%

  6. National Survey of Sexual Attitudes and Lifestyles II The Times 30th Nov 2001

  7. National Survey of Sexual Attitudes and Lifestyles II Number of heterosexual partners in last 5 years Mean = Men 3.8 Women 2.4 Median = Men 1 Women 1 % reporting No. of partners

  8. National Survey of Sexual Attitudes and Lifestyles II Percentage reporting a new sexual partner in last year by gender and age group Percentage

  9. National Survey of Sexual Attitudes and Lifestyles II Mean number of new partners (heterosexual/ homosexual) in last year by gender, age-group and marital status Men Women Mean number of new partners Mean number of new partners Age group Age group

  10. National Survey of Sexual Attitudes and Lifestyles II Regional variability in sexual behaviours - London Outside London Men Women Percentage Percentage

  11. Guardian 30th Nov 2001

  12. National Survey of Sexual Attitudes and Lifestyles II Percentage distribution of heterosexual partners: past 5 years, by gender, 1990 and 2000 Men Women % of those aged 16-44 % of those aged 16-44 Men 1990 Men 2000 Women 1990 Women 2000

  13. Percentage reporting 5 or more heterosexual partners in the last year Percentage Source Natsal 1990. Michael etal AJPH 1998 Men

  14. National Survey of Sexual Attitudes and Lifestyles II Daily Star 30th Nov 2001

  15. National Survey of Sexual Attitudes and Lifestyles II Changes in behaviour over time -1990 2000 Men Women Percentage Percentage

  16. National Survey of Sexual Attitudes and Lifestyles II Changes in behaviour over time -1990 2000 Men Women Percentage Percentage “Unsafe sex” = 2+ partners last year + inconsistent condom use last 4 weeks

  17. Trends in unprotected anal intercourse in serial community samples of gay men in London (n ~ 2000 annually) 1996-2000 % negative Source: J. Dodds et al, BMJ 2000 updated

  18. National Survey of Sexual Attitudes and Lifestyles II Is there evidence for a change in the accuracy of reporting 1990-2000 ? • Could changes in prevalences between surveys in part reflect a change in accuracy of reporting? • Comparison of reported abortion with official statistics suggests little if any under-reporting in either survey, and no change in accuracy over time • We analysed data from the cohort eligible for both surveys (aged 16-34 1990, 26-44 2000) and compared their reporting of behaviours occurring before 1990 Source: Copas et al. STI: Feb 2002

  19. National Survey of Sexual Attitudes and Lifestyles II Changes in reporting between surveys within the common cohort - 1990 2000 Women Men Percentage Percentage * Base: those who first had sex before 20, aged 20-34 (Natsal 1990) and 30-44 (Natsal 2000) Copas et al: STI in press

  20. National Survey of Sexual Attitudes and Lifestyles II Attitudes to sexual behaviour - Natsal 1990 and 2000 Percentage reporting behaviour is sometimes or always wrong Women Men 0 50 100 Percentage Percentage Source: Copas et al ; STI In press

  21. Percentage agreeing premarital sex is always or almost always wrong -Britain and US 1990 Percentage Women Source: Michael et al AJPH 1998

  22. National Survey of Sexual Attitudes and Lifestyles II Conclusions • Increased risky behaviours consistent with: • Changing cohabitation patterns • Rising incidence of STIs • Changes greater in women and in those outside London • Differences between Natsal 1990 and 2000 likely to result from: • True change • Greater willingness to report behaviours due to: • Improved survey methodology • More tolerant social attitudes

  23. Age at first intercourse by generationEurope - Women Median age Birth cohort Source: Hubert et al, Sexual behaviour and HIV/AIDS in Europe

  24. National Survey of Sexual Attitudes and Lifestyles II Contraceptive use at first intercourse Men

  25. National Survey of Sexual Attitudes and Lifestyles II Summary • stabilisation of age at 1st intercourse & sizeable minority reporting onset <16 • sustained increase in condom use at 1st intercourse and decline in non-use of contraception • circumstances of 1st intercourse more favourable as age at onset increases • school sex education associated with later onset of intercourse & increased contraceptive use • outcomes more strongly associated with education-related factors than family background

  26. National Survey of Sexual Attitudes and Lifestyles II Metro 30th Nov 2001

  27. Methods: • In Natsal 2000, we measured: • The frequency of self-reported STIs, • Reported STD clinic attendance • Their relationship to demographic and behavioural variables. • C. trachomatis prevalence -in random half of all sexually experienced respondents who were invited to provide a urine sample for ligase chain reaction (LCR)

  28. Men Women Reported STI acquisition in the past 5 years: percentage

  29. Men Women Age-group specific prevalence of genital C. trachomatis by gender Prevalence

  30. Men Women Prevalence of genital C. trachomatis infection by reported partnerships in the past year Prevalence

  31. 1990 2000 Men Women Percentage Percentage Reported STD clinic attendance in the past 5 years 1990/2000 Exludes those who refused self-completion or did not answer question

  32. % distribution of no of partners and STI diagnosis in last 5 years __% reporting x partners last 5 years __ % diagnosed with STI (excl thrush) last 5 years Source: Natsal 2000

  33. Interpretation: • This population-based survey has demonstrated marked heterogeneity in • distribution of reported STIs, reported GUM attendance, and prevalent chlamydial infection • and their demographic and behavioural determinants. • Results have potentially wide application for chlamydia screening programmes. • Identification of risk factors infection • Level of undiagnosed infection in men

  34. Conclusions • Gains in STI control of 1980s are being eroded • Increased risky behaviour driven by distal (socio-demographic) and proximal (?reduced health promotion) factors • Burden of STIs concentrated in those with multiple partners • Controlling STIs requires intelligence on behavioural & biological determinants

  35. National Survey of Sexual Attitudes and Lifestyles II Percentage reporting a concurrent sexual partner in last year by age and gender Percentage Base: All those with 1+ homosexual or heterosexual partners in last year

  36. Proportion re-attended with an acute STI by age group at initial presentation: Females Kaplan-Meier estimate 12-15 .3 16-19 .2 Proportion re-attended 20-24 25-34 .1 35+ 0 0 1 2 3 Time to re-attendance (years) Source:PHLS :CDSC

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