Elsevier

The Lancet

Volume 365, Issue 9466, 2–8 April 2005, Pages 1246-1255
The Lancet

Articles
Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey

https://doi.org/10.1016/S0140-6736(05)74813-3Get rights and content

Summary

Background

Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain.

Methods

We did a stratified probability sample survey of 11161 men and women aged 16–44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables.

Findings

We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4–20]) and black African (9 [3–20]) men, and in white (5 [2–9]) and black Caribbean (4 [2–7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2·74 [95% CI 1·22–6·15]) and black African (2·95 [1·45–5·99]) men compared with white men, and black Caribbean (2·41 [1·35–4·28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse.

Interpretation

Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions.

Introduction

Variations in the frequency of diagnosed sexually transmitted infections (STIs) by ethnic origin have been recorded in many western industrialised countries and are a major public-health concern.1, 2, 3 In Great Britain, much of the evidence has arisen from studies based on data from genitourinary medicine (GUM) clinics and, more recently, HIV and STI surveillance.4, 5, 6, 7, 8 Findings seem consistent across settings and over time, with generally higher rates of bacterial STIs being reported in black ethnic groups4, 5, 6 and lower rates in Asian groups than in white groups.7, 8 However, studies investigating the relation between ethnic origin and sexual health are often limited by definitions and use of race and ethnic origin as explanatory variables; non-collection of, and adjustment for, data on high-risk sexual behaviour; and failure to take into account the wider socioeconomic determinants of sexual ill-health.9, 10 Concerns have also been raised about the generalisability of data from GUM clinics and the inherent difficulties in extrapolating findings to individuals or groups in the wider community.10

Transmission of STIs is determined by sexual behaviour patterns.11 However, few behavioural studies have been done that have improved our understanding of ethnic variations in sexual health.12, 13 Factors contributing to the variation in frequency of STIs between population subgroups include sexual behaviour, background prevalence of untreated disease, and health-seeking behaviour—especially for STI treatment and screening services. Mathematical models and empirical data indicate that patterns of sexual mixing by ethnic origin, age, country, or sexual activity could be additional complex determinants of STI transmission.14, 15, 16, 17 These factors in turn are affected by educational level and social class (upstream factors) in the socioeconomic and cultural environment.18, 19, 20 Here, we use data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000),21 to investigate ethnic variations in high-risk sexual behaviour and sexual health outcomes in Britain and their associations with key demographic and behavioural factors.

Section snippets

Participants

Natsal 200021 is a stratified probability sample survey of 11161 men and women aged 16–44 years, resident in Great Britain, undertaken between May 1, 1999, and Feb 28, 2001. The method is described in detail elsewhere.21, 22, 23 Briefly, a sample of 40 523 addresses was selected from the small-user postcode address file for Great Britain with a multistage probability cluster design, with over-sampling in London. Interviewers visited all selected addresses and recorded the number of residents

Results

The response rate for the ethnic minority boost was 63% with CASRO (code of standards and ethics for survey research)28 rules—ie, excluding respondents who were ill, away from home, or unable to speak English, and using the observed proportion of ineligible households to adjust the denominator of eligible households. Data from the ethnic minority boost added a further 949 observations to the 11161 sampled in the main survey. 389 participants from the main survey sample did not belong to one of

Discussion

In this national probability survey, we have shown striking variations across ethnic groups in the patterns and distribution of sexual behaviours and in the frequency of reported sexual health outcomes. Our findings also confirm the higher prevalence of adverse sexual health outcomes experienced by black Caribbean and black African communities in Britain, as shown in previous clinic and community-based studies.4, 5, 6 Our results for black Caribbean and black African communities are also

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