Elsevier

The Lancet

Volume 358, Issue 9296, 1 December 2001, Pages 1835-1842
The Lancet

Sex at the Millennium
Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours

https://doi.org/10.1016/S0140-6736(01)06883-0Get rights and content

Summary

Background

Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999–2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990–91 (Natsal 1990).

Methods

We did a probability sample survey of men and women aged 16–44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990.

Findings

We interviewed 11 161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3·8 (SD 8·2) for men, and 2·4 (SD 4·6) for women; 2·6% (95% CI 2·2–3·1) of both men and women reported homosexual partnerships; and 4·3% (95% CI 3·7–5·0) of men reported paying for sex. In the past year, mean number of new partners varied from 2·04 (SD 8·4) for single men aged 25–34 years to 0·05 (SD 0·3) for married women aged 35–44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London.

Interpretation

Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes.

Introduction

Population patterns of sexual behaviour are major determinants of conception rates, sexually transmitted infections (STI) and HIV transmission, and other sexual health outcomes. Probability sample surveys have made a major contribution to understanding the diversity of human sexual behaviour.1, 2, 3, 4, 5, 6 In 1990–91, the first National Survey of Sexual Attitudes and Lifestyles (Natsal 1990) was done in Britain and focused on patterns of HIV risk behaviour, partnership formation, and sexual practices.1, 2, 7 The results have been widely used to model the extent of the HIV epidemic in Britain and to plan sexual health services and preventive interventions.6, 8, 9

Since Natsal 1990 was undertaken, there have been substantial changes in public attitudes towards sexual matters, a decline in the intensity of public HIV education, but increased attention on school sex education and teenage pregnancy.10 Surveillance data indicate higher STI incidence rates in 2000 than 1990 suggesting that sexual behaviours may have changed over time.11 Advances in understanding the transmission dynamics of STIs have created demands for population estimates of new variables such as prevalence of monogamy and concurrency, social and sexual mixing (including age, ethnicity, and location), and rates of partner acquisition.12

In 1999–2001 we did a second survey (Natsal 2000) using similar questions to Natsal 1990 but with improved methodology, to provide updated estimates and to assess changes in reported sexual behaviour over time.13 Our results are presented here.

Section snippets

Participants and procedure

We developed a questionnaire for a combination of face-to-face computer-assisted personal interviews carried out by trained interviewers, and computer-assisted self-interview (CASI).13 The CASI component allowed respondents to key in their responses to more sensitive questions into a laptop computer. We have previously shown this method to be highly acceptable in a feasibility study.13 Most questions were identical to Natsal 1990 with some new questions that focused on patterns of partnership

Results

From the 40 523 addresses visited, 16 998 households were identified with an eligible resident aged 16–44 years. At 1425 (3·5%) addresses, eligibility was not known as no contact was achieved (after a minimum of four attempts) or all information was refused. Interviews were completed with 11 161 respondents of whom 4762 were men and 6399 were women. The unadjusted response rate was 63·1%. Response rates were lower in London, and an adjustment taking account of the over-sampling of London, gave

Discussion

Natsal 2000 provides new estimates of patterns of sexual behaviour in Britain at the turn of the millennium, based on computer-assisted interviewing methods. We have found wide variability in sexual lifestyles, by age, gender, relationship status, and residence within and outside Greater London. These behavioural factors are key determinants of the sexual health status of individuals and populations.

Since 1990 there have been important changes in Britain's demographic structure, social

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