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This article discusses the complex process of contraceptive decision-making and how many times methods are chosen according to personal beliefs and the beliefs of health care workers. It makes a case for the development of contraceptive decision aids to improve sustained and correct use of methods and provides information on the future research as well as the role of decision aids.

Introduction Lack of sexual interest is a common sexual difficulty. Estimates of the prevalence of lack of sexual interest vary widely, and the evidence with regard to factors associated with lack of interest is not always consistent. Aims The aims of this study were to identify factors associated with reporting lack of interest in sex among women, and to explore whether these factors differ according to whether or not help was sought. Methods Our data came from the second National Survey of Sexual Attitudes and Lifestyles, a probability survey of 12,110 men and women aged 16–44 years and resident in Britain between 1999 and 2001 (N = 6,942 women). Computer-assisted personal interviewing was used to collect sociodemographic, behavioral, and attitudinal data. Main Outcome Measures (i) Persistent lack of interest in sex (≥6 months or longer in the past year); and (ii) seeking help for persistent lack of interest in sex. We examined data for all women, regardless of their partnership status. Results In this study, 10.7% of women reported lacking interest in sex for a period of 6 months or longer, and of these, 27.9% sought help for this difficulty. Reporting persistent low desire per se (outcome 1), and reporting seeking help for low desire (outcome 2) were associated with not enjoying sex, wanting sex more often, not being “competent” at first intercourse, poor communication about sex with partner, frequency of sex, and attitudes according sex low priority. Increasing age, reporting a birth in the last year, having children under 5 in the house, and reporting no sexual partner in the past year were associated with outcome 1 only. Being married and self-perceived health status were associated with outcome 2 only. Conclusion Identifying the factors associated with seeking help for low sexual interest is useful in understanding risk markers for problematic sexual interest, and in providing useful avenues for therapeutic discussion. Mitchell KR, Mercer CH, Wellings K, and Johnson AM. Prevalence of low sexual desire among women in Britain: Associated factors. J Sex Med 2009;6:2434–2444.

Occupational exposures to bloodborne viruses are very common. Whilst occupational HIV transmissions are rare, the serious physical, psychological and cost implications of potential transmission make this an important public health topic. European and UK guidelines recommend HIV post-exposure prophylaxis (PEP) as a valuable tool of preventing occupational HIV infection. Yet one in five UK healthcare workers did not initiate PEP despite having been exposed to an HIV-positive source patient. The aim of the study is to examine factors associated with PEP uptake behaviour.The study is based on an analysis of the UK Health Protection Agency surveillance database of 'Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers'. Associations between possible predicting factors and PEP-uptake have been examined with univariate analysis and logistic regression modelling.Univariate analysis and logistic regression found significant associations between PEP-uptake and visible blood on the device (p0.0001) and a linear relationship with increasing injury depth (p0.0001). Doctors were significantly more likely to start PEP than nurses (OR 1.88, 1.16; 3.02). Multiple imputation of missing values did not significantly alter these results.PEP-uptake was associated with known transmission risk factors, suggesting awareness of current guidelines. The significant differences in PEP-uptake across occupation categories may be due to differential risk perceptions or other underlying factors. This is the first national study to examine PEP-uptake following occupational exposures to HIV. Further research and exploration of these findings are warranted, to understand the role of PEP-uptake behaviour in preventing occupational HIV transmission.

Background In industrialized countries, the average age of first childbirth is increasing and more women are having no children. An understanding of the reasons for delay might provide strategies aimed at reversing this trend. Study Design A questionnaire survey of 234 nulliparous women aged 34 and over attending a family planning clinic in Scotland in 2006 for contraception to determine fertility intentions; awareness of fertility decline with age; and factors influencing the decision to delay childbearing. Results One hundred and sixteen women (49.6%) definitely/possibly wanted children; 118 women (50.4%) did not. Of those wanting children, 71% were concerned or very concerned about their future fertility. Most were realistic about the time it may take to conceive. Seventy-four percent of women who definitely/may want children gave reasons to do with their relationship/s as the most common reason for delay. The second most common reason was having other distractions in life. Only 34% of those wanting children, and 15% of those who did not, reported that work/training issues caused the delay. Conclusion Most women were aware of the risks of delaying childbirth; however, the most common reason for delay concerned lack of the ‘right’ partner, something which does not lend itself to intervention.

IN late 1988 and early 1989, the Health Education Authority ran an Aids/HIV public education press campaign. The decision to use press advertising was prompted by a growing awareness of the potentially dysfunctional effects, for the maintenance of public concern about Aids, of on/off bursts of high profile advertising followed by periods of apparent inactiv ity. Additionally, it was felt that the press might be best suited to the effective transmission of certain key pieces of information. Efforts to evaluate the campaign therefore paid close attention to the extent to which these goals were attained, and the findings are presented to guide future strategies in terms of optimal choice of media.

A stratified probability sample survey of the British general population, aged 16 to 44 years, was conducted from 1999 to 2001 (N = 11,161) using face-to-face interviewing and computer-assisted self-interviewing. We used these data to estimate the population prevalence of masturbation, and to identify sociodemographic, sexual behavioral, and attitudinal factors associated with reporting this behavior. Seventy-three percent of men and 36.8% of women reported masturbating in the 4 weeks prior to interview (95% confidence interval 71.5%-74.4% and 35.4%-38.2%, respectively). A number of sociodemographic and behavioral factors were associated with reporting masturbation. Among both men and women, reporting masturbation increased with higher levels of education and social class and was more common among those reporting sexual function problems. For women, masturbation was more likely among those who reported more frequent vaginal sex in the last four weeks, a greater repertoire of sexual activity (such as reporting oral and anal sex), and more sexual partners in the last year. In contrast, the prevalence of masturbation was lower among men reporting more frequent vaginal sex. Both men and women reporting same-sex partner(s) were significantly more likely to report masturbation. Masturbation is a common sexual practice with significant variations in reporting between men and women.

Purpose: To describe young people's knowledge and use of contraceptive services over initial stages of England's Teenage Pregnancy Strategy, and to investigate factors associated with use of different services.Methods: A random location sample of young people aged 13-21 years (n = 8879) was interviewed in 12 waves over 2000-2004. Individual data were analysed to investigate factors associated with knowledge and use of contraceptive services and to observe trends over time. Area-level data were analyzed to explore differences in key variables.Results: In all, 77% of young women and 65% of young men surveyed knew a service they could use to obtain information about sex. Amongst those who had had vaginal sexual intercourse, the most common source of contraceptive supplies was general practice for young women (54%) and commercial venues for young men (54%). Young women's use of school-based services to obtain supplies increased significantly from 15.4% in Year I to 24.4% in Year 4, p

Background The labels ‘casual’ and ‘regular’ partners are routinely used in both research and clinical contexts, yet considerable subjectivity surrounds the definition of different types of partnership in both professional and lay contexts, rendering comparison of audit and research findings problematic. We use national probability survey data to distinguish between different types of partnership, and examine the association between the resulting typology and reported STI diagnosis/es. Methods 15,162 people aged 16–74y resident in Britain participated in Natsal-3 undertaken 2010–2012. Computer-assisted-self-interview was used for sensitive questions including those relating to participants’ (max.) three most recent partners (N = 12,167 partners/past year). ANOVA and regression were used to test for differences in partnership duration and perceived likelihood of sex again across 20 ‘Partnership Progression Types’ (PPTs) derived from reported relationship status at first/most recent sex with partners. Multivariable regression examined whether reporting STI diagnosis/es varied by partnership type after adjusting for partner numbers (all past year). Results Four summary partnership types were identified from the 20 PPTs with median[IQR] durations and likelihoods of sex again (%), respectively, of:(1)‘Long-term’ = 175 months [83–323], 96.9% likelihood of sex again; (2)‘Ex-steady’ = 38 months [16–90], 44.9%; (3)‘Now steady’ = 17 months [6–41], 74.4%; (4)‘Currently casual’ = 3 months [0–14], 43.9%. These thresholds neither varied significantly by gender nor sexual identity, but did by age and sexual health clinic attendance. Reporting STI diagnoses varied according to the combination of partnership types experienced, including after adjusting for partner numbers, e.g. AOR for reporting STI diagnoses among men with both ‘currently casual’ and ‘ex-steady’ partners: 6.07 (95% CI: 1.41–26.1) vs. men with only ‘currently casual’ partners. Conclusion Two survey questions enabled identification of four distinct types of sexual partnership in the British population. This typology is a valuable first step in defining partnership type, benefitting both research and practice, especially given recent moves towards more detailed reporting of sexual risk and partner notification outcomes. Disclosure of interest statement AMJ has been a Governor of the Wellcome Trust since 2011. The other authors declare that they have no conflicts of interest.

Background The timing of first sexual intercourse has long been of public health concern and is most commonly defined in terms of chronological age, with ‘early’ sex typically described as that occurring before the legal age of consent. The concept of ‘sexual competence’ at first intercourse attempts to provide a more nuanced assessment of timing, focusing on the contextual attributes of the event, rather than simply age at occurrence. This study examines the prevalence of ‘sexual competence’ at first intercourse, and its correlates, among young people in Britain. Methods The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) is a stratified probability sample survey of 16–74 year olds resident in Britain. Participants were interviewed in 2010–2012 using face-to-face, computer-assisted personal- and self-interviews. Participants were classified as ‘sexually competent’ at first heterosexual intercourse if the event met the following self-reported criteria: use of a reliable contraceptive method, autonomy of decision (not due to external influences), consensuality (both partners ‘equally willing’), and occurrence at the perceived ‘right time’. We examined the prevalence of ‘sexual competence’ by age at first intercourse, among 16–24 year olds. Using multivariable logistic regression, we explored associations between sexual competence and several potential explanatory factors; age at first intercourse, socio-economic position, source of sex education, discussion of sexual matters with parents, and characteristics of first sexual partner/relationship. Results 22.4% (95% CI:17.4–28.4) of women and 36.2% (29.7–43.3) of men who reported first intercourse at age 13–14 were categorised as ‘sexually competent’, rising to 63.7% and 60.4% among those aged ≥18 at first intercourse. In adjusted analyses, lack of sexual competence was independently associated with: first intercourse before 16 (AOR: 1.91 (95% CI: 1.38–2.65) men, 3.00 (2.25–4.00) women), greater area-level deprivation, lower educational level, non-’steady’ relationship at first sex, being unsure of first partner’s virginity status, and among women only: reporting ‘friends’ as main source of sex education, and not discussing sexual matters with parents. Conclusion A substantial proportion of young people in Britain lack ‘sexual competence’ at first intercourse. Though correlated, age at first intercourse does not explain all of the variability in sexual competence, suggesting that chronological age is an overly simplistic indicator of the nature of first intercourse – and supporting the future use of this measure in sexual health/behaviour research. This study also finds that inequalities in sexual health are reflected in the context of first intercourse, indicating that greater efforts are required to reduce the disparities that exist from the onset of sexual activity.

Background Estimates suggest 29% of rapes and 41% of sexual assaults reported to the police involve victims Aims To describe the characteristics of adolescent sexual assault and early mental health sequelae in young people (YP) presenting to the sexual assault referral centres (SARCs) serving a large UK city. Methods Design : Prospective longitudinal cohort study. Study population : We approached all YP aged 13–17 years presenting to a SARC within six weeks of assault. Baseline data collection included psychological evaluation using the Short Moods and Feelings Questionnaire (depressive symptoms), Self-Report for Childhood Anxiety-Related Disorders (SCARED)-short form (anxiety symptoms) and Impact of Events Scale (post-traumatic symptoms). Results 30% of YP consented to take part. Data are available for the first 94 participants (mean [SD] age: 15.16 [1.24] years; 96% female). Those with learning disability and young people of black ethnicity were over-represented compared to the local population (18% vs. 2.5%, and 23% vs . 11%, respectively). 15% had a history of previous non-consensual sex and 44% were known to social services. 39% had sought help for mental health difficulties in the previous year and 37% had previously self-harmed. Participants experienced vaginal rape in 72% of cases, oral rape in 40% and anal rape in 13%. 44% of assaults involved physical violence and 9% involved a weapon. 29% involved alcohol and 14% involved drugs. 36% were stranger assaults, 47% involved an acquaintance and the remainder involved partners or ex-partners (3%), or a relative (5%). Assailants were most commonly aged 15–20 (41%) or 21–30 (22%), with 12% Early psychological outcomes: 73% had significant depressive symptoms, 90% had a high likelihood of post-traumatic stress disorder, 69% met criteria for panic disorder or significant somatic symptoms, and 60% met criteria for generalised anxiety disorder. Conclusions Adolescents accessing SARCs are a vulnerable population and exhibit high levels of psychological morbidity within six weeks of sexual assault. Longitudinal research is critically important for evaluating outcomes over time and to inform interventions and preventive programmes.

Background Adolescent sexual assault victims are a vulnerable group with a high baseline prevalence of mental health problems and low follow-up rates. Little is known about their experience of services following sexual assault. Aims To evaluate experiences of care among adolescents accessing co-ordinated specialist sexual assault services serving a large UK city. Methods Design : Prospective longitudinal cohort study. Study population : Adolescents aged 13–17 years presenting to a sexual assault referral centre (SARC) within six weeks of assault. Participants evaluated care received from different professionals using a questionnaire adapted from the Commission for Health Improvement Experience of Service Questionnaire (CHI-ESQ). Results 30% consented to take part. Data were analysed for the first 64 study participants, evaluating care received from uniformed police (n = 51), specialist sexual offences investigative techniques (SOIT) officers (n = 58) and clinical staff at the SARCs (doctors and crisis workers, n = 64). 97% were police referrals and 3%, self-referrals. 67% had experienced vaginal rape, 32%, oral rape and 12%, anal rape. 90% underwent a forensic medical examination. Commonly held fears before accessing care were that they would be judged, disbelieved, ‘blamed’ or ‘called a liar’. Many participants were apprehensive that the forensic examination would be painful, embarrassing or reveal health problems such as infections. As shown in Figure 1, care given by clinical staff at SARCs was consistently rated higher than police care. Only 49% found uniformed police easy to talk to and only 64% felt safe in their care. Only 63% felt believed by their SOIT officer and only 59% felt they had been given enough information (Figure 1). Conclusions Many participants described positive experiences of systems of care for victims of sexual assault. However, variable experiences of care between services highlight the need for improvement in specific areas. Anxieties about being blamed or judged may prevent adolescents accessing services following sexual assault.

Introduction Recently published national guidance in England recommended that increased use of long-acting reversible methods of contraception could reduce unintended pregnancy rates. Usage rates of long-acting reversible methods of contraception in the UK are currently low. Since these methods require medical intervention, attitudes of professionals are important determinants of prevalence of use. Study Design A questionnaire survey was conducted of 321 health professionals working in general practice which sought practitioner views on safety, efficacy and acceptability of contraceptive methods, and on the feasibility and desirability of prescribing long-acting methods. Results A high proportion of practitioners (80.2%) endorsed the role of LARC in preventing teenage pregnancy, but fewer than half (47.1%) saw them as returning to favor. The combined oral contraceptive pill is still the mainstay of prescriptions. Lack of skill in providing was seen by 60.6% as a barrier to provision of long-acting methods of contraception. Half of respondents (50.3%) thought that irregular bleeding deterred women from using LARC and 20.6% were concerned about high discontinuation rates. Misconceptions about side effects of contraceptive methods were common. Conclusion Investment in professional education and training is needed for health professionals in general practice if the goal of increased provision of long-acting contraceptive methods is to be realized.

Summary Background The aim of this study was to quantify the change in the number of conceptions and abortions among women younger than 18 years in England in relation to the government's national teenage pregnancy strategy. Methods We undertook geographic analysis of data for 148 top-tier local authority areas. The main outcomes were changes in under-18 conceptions, abortions, and births between the 5-year period before implementation of the strategy (1994–98) and the period immediately after implementation (1999–2003). Findings The number of teenage conceptions peaked in 1998, then declined after the implementation in 1999 of the teenage pregnancy strategy. Under-18 conception rates fell by an average of 2·0% (95% CI 1·8 to 2·2) per year between 1998 and 2003, below the rate needed to achieve the target of 50% reduction by 2010. The net change between 1994–98 and 1999–2003 was a fall in conceptions of 3·2% (2·6 to 3·9) or 1·4 per 1000 women aged 15–17 years, a rise in abortions of 7·5% (6·5 to 8·6) or 1·4 per 1000, and a fall in births of 10·6% (9·9 to 11·3) or 2·8 per 1000. The change in the number of conceptions was greater in deprived and more rural areas, and in those with lower educational attainment. The change was greater in areas where services and access to them were poorer, but greater where more strategy-related resources had been targeted. Interpretation The decline in under-18 conception and birth rates since 1998 and evidence that the declines have been greatest in areas receiving higher amounts of strategy-related funding provides limited evidence of the effect of England's national teenage pregnancy strategy. The full effect of local prevention will be clear only with longer observation, and substantial further progress is needed to remedy England's historically poor international position in teenage conceptions.

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.

To date, the focus of sex education research has tended to be on the effect of education on behavioral outcomes. There is little data on the felt needs of young people, how well they are met, and how provision might be improved. Here we report on main source of information about sexual matters, adequacy of knowledge, further needs, and preferred source of additional information, using data from a probability sample survey of people aged 16 to 44 years in Britain (Natsal 2000). A total of 11,161 participants (4,762 men and 6,399 women) were interviewed. The response rate was 65.4%. The results show that despite the assumed worldliness and sophistication of young people about sexual matters, there is a great deal of self-perceived ignorance among them. Parents and schools are the preferred source of further information. We need to enable parents to provide information to their children, especially their sons.

Objective This study aimed to identify factors associated with the use of emergency hormonal contraception (EHC). Methods Data from a probability sample survey of 12,110 men and women aged 16–44 living in Britain were used for this study; 5916 women were selected as potential users of EHC, defined as women reporting at least one male partner in the year prior to the survey. Results Of the 5916 women, 2.3% reported EHC use in the previous year. EHC use was more common among younger, single women, those with more than one sexual partner in the past year and those using condoms for contraception. It was significantly associated with experience of abortion (odds ratio adjusted for age, marital status and number of male partners: 2.40) but not with sexually transmitted infection (STI) diagnosis. Conclusions The use of EHC identifies a group of women at increased risk of unplanned pregnancy and condom use but not STI acquisition. Provision of information on more reliable contraceptive methods is needed to reduce the risk of unplanned pregnancy recurrence.

Background: In the United Kingdom the incidence of sexually transmitted infections (STI) and risky sexual behaviours is increasing. The role of commercial sex in this trend is poorly understood. Little is known about the men who pay for sex. We examined the epidemiology of female commercial sex contacts reported by men in 1990 and 2000. Methods: National probability sample surveys of sexual attitudes and lifestyles (Natsal) of men aged 16–44 resident in Britain in 1990 (n = 6000) and 2000 (n = 4762). Results: The proportion of men who reported paying women for sex in the previous 5 years increased from 2.0% (95% CI 1.6 to 2.5) in 1990 to 4.2% in 2000 (95% CI 3.6 to 4.9). In both surveys, paying for sex was more frequent in men aged between 25 years and 34 years, who were never or previously married, and who lived in London. There was no association with ethnicity, social class, homosexual contact, or injecting drug use. Men who paid for sex were more likely to report 10 or more sexual partners in the previous 5 years; only a minority of their lifetime sexual partners (19.3%) were commercial. They were more likely to meet partners abroad and to report previous STI. Only 15% reported having had an HIV test. Conclusion: The proportion of men who reported paying for heterosexual sex has increased, and these men have multiple commercial and non-commercial partners. Their higher rates of STI and low level of HIV testing suggest the need for prevention interventions for clients as well as sex workers.

Objective: To describe the factors associated with HIV testing among heterosexual black Africans aged 16 - 44 years living in Britain.Design: We analysed data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) - a stratified national probability sample survey conducted between 1999 - 2001. Data from Natsal's main and ethnic minority boost (EMB) samples were analysed. Multivariate analysis was performed using complex survey functions to account for the clustered, stratified, and differential selection probabilities inherent within the survey.Results: A total of 385 ( 216 women and 169 men) black African respondents were included in the study. 44.0% women and 36.4% men reported ever having had an HIV test. In univariate analysis, HIV testing was associated with being born abroad ( OR 3.63), having a new partner(s) from abroad in past 5 years ( OR 2.88), and attending a GUM clinic ( OR 3.27) among men; and educational attainment ( OR 3.50), perception of "not very much'' personal risk of HIV ( OR 2.75), and attending a GUM clinic ( OR 2.91) among women. After adjusting for potential confounders, an increased likelihood of HIV testing was associated with being in the United Kingdom less than 5 years relative to being UK born ( adjusted OR 9.49), and ever attending a GUM clinic (adj OR 5.53), for men; and educational attainment ( adj OR 4.13), and low perception of HIV risk ( adj OR 2.77) for women.Conclusions: Black Africans appear to have relatively high rates of HIV testing reflecting, at least partially, awareness of risk behaviours and potential exposure to HIV. Nevertheless, there remains substantial potential for health gain and innovative approaches are required to further increase timely HIV testing.

Background: Noninvasive molecular tests for bacterial sexually transmitted infections (STIs) provide new opportunities for testing in nonclinical settings. Little information is available on the outcomes when applied to asymptomatic sex survey participants. Objective: The objective of this study was to examine patient treatment preferences and partner notification outcomes among Chlamydia trachomatis-positive cases identified in the 2000 national survey of sexual attitudes and lifestyles (Natsal 2000), and factors associated with providing a urine sample. Methods: The authors conducted a stratified probability sample survey of 11,161 men and women aged 16 to 44 years residing in Britain using computer-assisted self-interviews. Urine testing was performed for C. trachomatis offered to a random half of sexually active respondents aged 18 to 44 using ligase chain reaction. Notification, treatment, and follow up of ligase chain reaction-positive respondents were undertaken. Results: A total of 5105 respondents were invited to provide a urine sample. A total of 3628 (71%) agreed and 3608 samples were successfully tested. Willingness to provide a urine sample was significantly higher among those reporting previous homosexual experience, heterosexual anal sex, and STI diagnosis. Seventy-three respondents (31 men and 42 women) were diagnosed with genital chlamydial infection. Sixty-five (89%) responded to notification of their infection and were recommended for treatment and partner notification. Fifty (77%) respondents preferred to be seen by their general practitioner and 15 (23%) by their local genitourinary medicine clinic. Although physician feedback on treatment and partner notification outcomes was obtained for only half (n = 34) of respondents, follow-up respondent interviews confirmed that a total of 49 (75%) respondents underwent this process. Interpretation: In this community-based survey, the rate of provision of urine samples was high, and those who provided samples were found to be at somewhat greater risk of infection on average. This was accounted for in estimating population chlamydia prevalence. The authors found that treatment and partner notification of newly diagnosed infections can be successfully achieved in STI prevalence studies.

OBJECTIVES: To compare demographic, behavioural and HIV testing characteristics of individuals diagnosed with chlamydia infection in primary care with those in genitourinary medicine clinics, in the absence of a screening programme. The aim was to explore the current and potential contribution of primary care to the control of chlamydia. STUDY DESIGN AND METHODS: We analysed data on individuals who reported one or more chlamydia diagnoses in the past 5 years in a large probability sample survey of the resident, UK general population aged 16-44 years. Estimates were weighted and odds ratios calculated. RESULTS: Women diagnosed in primary care reported fewer sexual partners, and were less likely to have had an HIV test in the past 5 years than their counterparts diagnosed in genitourinary medicine clinics. Age, ethnicity, social class, educational attainment and urbanization of area of residence did not differ between the two groups. Too few men were diagnosed in primary care to allow for such a comparison. CONCLUSIONS: Primary care already diagnoses a large number of women with chlamydia infection, who may perceive themselves as low risk through age or sexual behaviour, yet are likely to comprise a substantial proportion of all infections. Few men are diagnosed in primary care. These groups need to be strategically targeted in the context of a future chlamydia screening programme, which will focus on the screening of younger women at high risk, and in which the role of primary care is still in development.

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.

To describe variations in age differences (ADs) between partners at first heterosexual intercourse and to examine associations between this AD, sociodemographic characteristics, and circumstances of first heterosexual intercourse, by gender.A total of 3277 men and 4734 women aged 25-44 years who reported ever having heterosexual intercourse in a probability survey of the British population to obtain an unbiased sample of ADs at first intercourse. Face-to-face interviews collected sociodemographic data and information on first intercourse. Gender-specific cumulative distributions of ADs categorized respondents reporting relatively younger first partners (below fifth percentile) and those reporting relatively older first partners (above 95th percentile).Relatively older first partners were six years older than men and 10 years older than women. Relatively younger first partners were three years younger than men and one year younger than women. Men and women with relatively older first partners were more likely to have just met their partner (odds ratios adjusted for sociodemographic characteristics [AOR] 1.8, 95% confidence interval [CI] 1.2-2.7, and 3.1, 95% CI 2.1-4.6, respectively); had a more willing first partner (AOR 2.1, 95% CI 1.2-3.8, and 1.6, 95% CI 1.2-2.2, respectively); not used condoms at first sex (AOR 1.9, 95% CI 1.2-3.0, and 1.5, 95% CI 1.1-2.0, respectively); and reported a non-autonomous reason for first sex (AOR 1.6, 95% CI 1.1-2.4, women only). Men with relatively younger first partners were more likely to regret the timing of the first occasion (AOR 2.1, 95% CI 1.0-4.5).First partnerships involving relatively older or younger partners are associated with adverse circumstances of first intercourse. Condoms and other reliable contraception are less likely to be used, and age differences may reflect unequal power relations. Promoting effective communication and negotiation skills may be particularly important for those with relatively older or younger first partners.

Broad spectrum interventions aimed at reaching the general population make use of mass communication approaches such as TV, radio, press, billboard posters, and leaflets. This chapter examines the difficulties inherent in evaluating mass media campaigns. Topics discussed include the scope of interventions, evaluation research, process evaluation, outcome evaluation, selection of indicators/outcome measures, and measuring unintended consequences.

One of the objectives of the first national survey of sexual lifestyles, attitudes, and health in Slovenia was to estimate the prevalence of and risk factors for genital Chlamydia trachomatis infection in Slovenian adults aged 18-49 years.Data were collected over 1999-2001 from a probability sample of the general population by face to face interviews and anonymous self administered questionnaires. Respondents were invited to provide a first void urine (FVU) specimen for polymerase chain reaction testing for C trachomatis infection. We compared the results to the equivalent British survey.1447 individuals contributed FVU specimens (82.6% of survey respondents, 55.3% of those eligible). C trachomatis infection was diagnosed in 3.0% of men and 1.6% of women. Prevalence was highest in men and women aged 18-24 years (4.1% for both). Individuals reporting first heterosexual intercourse before the age of 16, unprotected sexual intercourse with at least one heterosexual partner during the preceding year, concurrent heterosexual relationships during the preceding year, and five or more lifetime heterosexual partners had a higher prevalence. The association was statistically significant only for five or more lifetime partners (adjusted OR 3.0; 95% CI 1.3 to 6.9; p = 0.01).A relatively high prevalence of genital C trachomatis infection among 18-24 year old Slovenians, in the presence of relatively low risk sexual behaviour and low reported incidence rates of chlamydia infection, suggest serious gaps in the diagnosis and treatment of the condition. The results provide support for the introduction of chlamydia screening in Slovenia.

Studies from developing countries1 and sexually transmitted diseases clinics in developed countries2 show that male circumcision appears to protect against some ulcerative sexually transmitted infections (STIs) and decreases the risk of HIV infection.3 We used data from the 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000)—a large scale, stratified, probability sample survey—to estimate the prevalence of male circumcision in Britain and investigate its association with key demographic characteristics, sexual behaviours, and reported STI diagnosis. Natsal 2000 methodology details are published elsewhere.4 For the purposes of this investigation, data from targeted oversampling of black Caribbean, black African, Indian, and Pakistani groups (the Natsal ethnic minority boost) were combined with the main survey data in order to increase the numbers of these respondents included …

Coordination of family planning and GUM services has the potential to boost the effectiveness of both The move towards integration of family planning and genitourinary medicine (GUM) services (that is, the reorganisation of the two specialties, strategically and in terms of setting, in a more client centred approach) has recently been gathering momentum in the United Kingdom. Providers of family planning services are increasingly being urged to adopt a broader remit in respect of their clients’ needs for STI and HIV prevention and treatment,1 as are providers of STI services in respect of their clients’ contraceptive needs. Although fully integrated sexual health services are still comparatively rare, a growing number of family planning services provide STI diagnosis and treatment and a growing number of GUM clinics provide contraceptive services.2,3 The trend may be accelerated as a result of the government’s sexual health strategy,4 in England. The systematic evaluation of three pilot “one stop shops” is likely to provide more robust evidence on the acceptability and effectiveness of integrated services which, if favourable, could provide the impetus to further expansion. In theory, the case for an integrated approach to sexual health service provision is compelling. Control of fertility and of sexually transmitted infection share common characteristics. The choice of contraceptive method may have implications for transmission of infectious agents and the presence of infection has consequences for fertility. The two services also share potential clients. Studies of GUM clinic attenders have shown a high proportion to be at risk of pregnancy5–9 and studies of family planning clinics attenders show sizeable proportions to be at risk of infection.7,10,11 There is also evidence that service users prefer a one stop service providing coordinated sexual health care.7,12,13 Advocates of integration claim that …

Our objective was to assess the feasibility of integrating first void urine (FVU) specimens testing for Chlamydia trachomatis genitourinary infection into a general population sexual behaviour survey. A total of 752 randomly selected respondents aged 18 to 54 were enrolled into the survey. Face to face interviewing with self-administered sensitive questions was used. Overall survey response rate was 77.4%. A convenience sub-sample of 83 respondents were invited to provide FVU specimens for confidential testing for C. trachomatis genitourinary infection. Fifty-five complied. This resulted in 66% FVU specimen participation rate among targeted respondents. Two specimens tested positive by Amplicor polymerase chain reaction. High feasibility study overall response rate indicated good acceptability of the survey. It proved feasible to collect FVU specimens for C. trachomatis testing in the small sub-sample. Consequently, we proceeded with integration of testing for C. trachomatis into the ongoing main survey.

The need for estimates of the extent of sexual function problems in the general population has become more urgent given recent debates surrounding the identification and definition of “sexual dysfunction,” the increased availability of pharmacological interventions, and possible changes in our expectations of what constitutes sexual function and fulfilment.1 We report results from the national survey of sexual attitudes and lifestyles (Natsal 2000). Natsal 2000 was a stratified probability sample survey done between May 1999 and February 2001 of 11 161 men and women aged 16-44 years resident in Britain.2 3 The response rate was 65.4%. A computer assisted self interview asked participants about their sexual lifestyles and attitudes. We asked questions about their experience of sexual problems based on those used in the US national health and social life survey,4 which measured the main dimensions of sexual dysfunction, …

Marital status is often probed in epidemiological, public health, and social surveys, and has been shown to be associated with various health outcomes. However, in the past 25 years there has been a trend towards cohabitation, and higher rates of divorce and remarriage.1 Birth registration data also show that nearly 40% of births are outside marriage, a large proportion of which are to cohabiting couples.2 The way in which data are collected has tended to reflect the increase in cohabitation; “living with partner” tends to be an additional category of marital status, for example, Johnson et al .3 In our recent work (a study to develop a measure of unplanned pregnancy) we wanted to identify both women's marital status and who they were …

Objectives: The 1990–1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999–2001 (Natsal 2000) to update population estimates of risk behaviours, and assess change over time. We examine whether changes in prevalence estimates may partly result from changes in measurement accuracy. Methods: Taking Natsal 2000 (11 161 respondents) and Natsal 1990 (13 765 respondents aged 16–44) we compared the response rate, sample representativeness, reporting of abortion last year (relative to official statistics), and selected attitudes. Among the common birth cohort eligible for both surveys (aged 16–34 Natsal 1990, 26–44 Natsal 2000), we compared reporting of experiences before 1990. Results: The response rate (66.8% Natsal 1990, 65.4% Natsal 2000) and completeness of reporting abortion were unchanged (84% Natsal 1990, 86% Natsal 2000). Attitudes were significantly changed in Natsal 2000 relative to Natsal 1990—for example, increased tolerance of male homosexual sex, OR (95% CI) 2.10 (1.93–2.29) men and 2.95 (2.74 to 3.18) women. In the common birth cohort reporting of heterosexual intercourse before 16 (OR 1.15 (1.02 to 1.29) men, 1.49 (1.31 to 1.69) women), and homosexual experience (OR 1.80 (1.46 to 2.21) men, 2.00 (1.61 to 2.48) women) were significantly increased. Conclusions: The results are consistent with improved reporting accuracy for some sensitive behaviours in Natsal 2000, in line with greater social tolerance and improved survey methodology. However, the evidence is not conclusive, and may not be generalisable to all such behaviours. The increase found in the reported prevalence of STI risk behaviours between Natsal 1990 and Natsal 2000 is likely to be somewhat overstated.

Many European countries developed substantial public education programs, making heavy use of mass media to address the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) epidemic during the 1980s and early 1990s. This chapter reports on an effort to evaluate those somewhat diverse programs cross-nationally. There is some credible evidence for effects of those programs and some evidence that the size of the programs was associated with those effects. Part of the story, however, is the difficulty of evaluating such programs in a single nation or across nations in the urgent context of implementing national programs.ATTRIBUTING OUTCOME TO INTERVENTION

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.

The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour.

Objectives: To examine the factors that influence respondents' willingness to participate in urinary testing for Chlamydia trachomatis in a general population feasibility survey of sexual attitudes and lifestyles. Methods: 199 sexually experienced, 18-44 year old participants, recruited as part of a larger (n=901) methodological study of sexual attitudes and lifestyles, were invited to provide a urine sample for chlamydial infection testing using ligase chain reaction (LCR) techniques. Analysis of the survey data and in-depth qualitative interviews were undertaken to explore the factors that influenced participants' decisions to participate. Results: 143/199 (72%) participants agreed to provide a urine sample. The likelihood of providing a urine sample was reduced if other individuals were present in the home at the time of interview (OR 0.42, 95% confidence interval 0.20-0.90, p=0.03). Trust and rapport with the interviewer, understanding the aims of the test, sense of obligation, and perceived importance of the test were identified as additional influencing factors in the in-depth interviews. Conclusions: Survey respondents' uncertainty or embarrassment at participating in urine testing can be overcome if they are well informed, motivated by the potential health gain, and briefed by trained and confident interviewers.

Teenage mothers and their children face poorer prospects in life than do women who delay motherhood until later in life. Moreover, patterns of early childbearing tend to be repeated in subsequent generations. Therefore, an understanding of the factors associated with early fertility is important for the prevention of adverse consequences. This paper uses data from the National Survey of Sexual Attitudes and Lifestyles to explore these associations. Early sexual intercourse is an important predictor of early fertility, as is poor educational attainment, although it is not clear to what extent pregnancy acts to thwart academic ambitions, or to what extent poor educational performance leads to a need to seek personal fulfilment in other than academic goals. Thus, interventions designed to influence age at first intercourse and to improve educational performance both have potential in terms of impacting on teenage pregnancy rates. Family background also exerts a powerful influence on teenage fertility. Young people for whom one or both parents are absent are more likely to become parents early in life. However, the most important factor of family life determining the chances of teenage motherhood appear to be the quality of communication about sexual matters with the home. In terms of outcomes, teenage mothers are more likely to live in social housing, are less likely to be in paid employment and have larger than average sized families. Certain areas of the country, notably the older, run-down industrial areas, have higher rates of teenage motherhood than the newer, more prosperous areas. Because most of these effects are independent of one another, there is potential merit in intervening to prevent unintended conception at several points in a young woman’s life. Primary preventive efforts are needed to reduce the rates at which teenage pregnancy occurs in this country. Yet, if the cycle of deprivation that means the children of young mothers themselves enter parenthood early is to be broken, then efforts must also be made to mitigate the effects of teenage fertility for both mother and child.

Much useful information can be obtained from a knowledge of people's sexual habits, not least information about AIDS. Such studies should be judged by scientists, not by politicians.

This study investigated anticipation and communication around first sexual intercourse through semi-structured interviews with young people (aged 16 to 29) in England. Ranging from surprise to pre-planning, several different levels of anticipation are explored. The main findings are as follows: communication plays a central role, mediating between the degree of anticipation and the degree to which first intercourse is wanted, protected and enjoyed. First intercourse tends to be characterized by silence, especially during early, spontaneous encounters. Silence does not imply lack of communication—non-verbal communication plays an important role. Where young people are ambivalent, verbal and non-verbal communication may send contradictory messages. The implications of the results for future safer sex campaigns are discussed.

OBJECTIVES: To examine the pattern of attendance at sexually transmitted disease (STD) clinics in Britain. To compare the demographic characteristics, behaviours and attitudes of STD clinic attenders with those of non-attenders, and to assess the extent to which STD clinics are used by those with high-risk sexual lifestyles. DESIGN: Random sample general population survey of sexual attitudes and lifestyle. SUBJECTS: 18,876 randomly selected men and women resident in Britain aged 16-59 years. MAIN OUTCOME MEASURES: Demographic characteristics, pattern of homosexual partnerships, heterosexual partnerships, payment for sex, abortion, drug injection in the last five years, and attitudes to sexual behaviours amongst 512 respondents who had attended STD clinic in the last five years compared with those who had not. RESULTS: 8.3% of men and 5.6% of women had attended a clinic in their lifetime and 3.4% and 2.6% respectively in the last five years. Attendance rates varied substantially with area of residence. 11% of Inner London residents had attended in the last five years. In multivariate analysis, STD clinic attendance for men was most strongly associated with increased numbers of heterosexual partners, (OR = 6.01 (4.44-8.15) and homosexual partnerships (OR = 9.59 (5.83-15.8)) and more weakly associated with payment for sex, non-manual social class, age 25-44, unmarried status and smoking. Clinic attendance for women was most strongly associated with numbers of heterosexual partners (OR = 3.74 (2.76-5.08) and injecting drug use (OR = 4.39 (1.73-11.1)). A weaker independent association was found with a history of abortion, anal sex, non-manual social class, non-married status and age 16-24. From the total population, 1 in 6 men and 1 in 7 women in the top 5% of the distribution for numbers of heterosexual partners and 1 in 5 men paying for sex and 1 in 4 of those with a homosexual partner had attended a clinic in the last five years. The probability of attendance increased with multiple risk behaviours. Of women 64.2% and of men 69.7% attending clinics reported major risk markers for STD transmission. CONCLUSIONS: STD clinics in Britain are used by a wide demographic spectrum of the population. The behaviours, but not the attitudes, of attenders differed markedly from those of non-attenders. Clinics are relatively efficient in attracting only those with high-risk lifestyles, but, at a population level, the minority of those reporting risk-markers for STD transmission attend clinics. These findings suggest that STD clinics are an important focus for sexual health promotion, but that community programmes are also important for reaching non-attenders.

Objective To explore compliance with the UK blood services’ criterion that excludes men who have had penetrative sex with a man from donating blood, and to assess the possible effects of revising this policy. Design A random location, cross sectional survey followed by qualitative interviews. Setting Britain. Participants 1028 of 32 373 men in the general population reporting any male sexual contact completed the survey. Additional questions were asked of a general population sample (n=3914). Thirty men who had had penetrative sex with a man participated in the qualitative interviews (19 who had complied with the blood services’ exclusion criterion and 11 who had not complied). Main outcome measure Compliance with the blood services’ lifetime exclusion criterion for men who have had penetrative sex with a man. Results 10.6% of men with experience of penetrative sex with a man reported having donated blood in Britain while ineligible under the exclusion criterion, and 2.5% had donated in the previous 12 months. Ineligible donation was less common among men who had had penetrative sex with a man recently (in previous 12 months) than among men for whom this last occurred longer ago. Reasons for non-compliance with the exclusion included self categorisation as low risk, discounting the sexual experience that barred donation, belief in the infallibility of blood screening, concerns about confidentiality, and misunderstanding or perceived inequity of the rule. Although blood donation was rarely viewed as a “right,” potential donors were seen as entitled to a considered assessment of risk. A one year deferral since last male penetrative sex was considered by study participants to be generally feasible, equitable, and acceptable. Conclusions A minority of men who have sex with men who are ineligible to donate blood under the current donor exclusion in Britain have nevertheless done so in the past 12 months. Many of the reasons identified for non-compliance seem amenable to intervention. A clearly rationalised and communicated one year donor deferral is likely to be welcomed by most men who have sex with men.

Background The Third British National Survey of Sexual Attitudes & Lifestyles (Natsal 3) builds upon groundbreaking research undertaken for Natsal 1 and Natsal 2 in 1990 and 2000, respectively. Natsal 3 aims to interview 15 000 men and women aged 16–74 years during 2010–2012. However, the first pilot (Pilot 1) for Natsal 3 achieved a response rate of only 38.4%, leading us to explore ways to maximise survey participation. Methods Following Pilot 1, we consulted widely with interviewers, survey methodologists and communications experts to improve documents sent to households in advance of the interviewer calling, and the survey branding. This included simplifying the advance letter language and removing specific references to “sex”; developing a more detailed information leaflet to send with the letter; developing a study logo and respondent website. In Pilot 2, households were randomised to be sent the leaflet with the advance letter or to be given it when the interviewer called. We also examined the effect of the token of appreciation on participation rates by randomising households to receive either a £15 or a £30 voucher for participation. Results The overall response rate increased to 50.3% (218/434 eligible addresses) in Pilot 2. This did not vary by whether or not households received the information leaflet in advance (50.8% and 49.6%, respectively), but interviewers felt that households sent the leaflet were more informed about the study and they were more confident approaching these households. Interviewers preferred the improved advance letter and some respondents reported that the website was a key factor encouraging them to participate. Pilot 2 response rates differed by token of appreciation (47.1% vs 53.4% for £15 vs £30) but the sample size was too small to conclude that the difference was significant, so randomisation continued during the first wave of fieldwork. Response rates in wave 1 before reissuing were 48.4% vs 50.6% for £15 and £30, respectively (p=0.2). Conclusions Despite survey response rates declining generally, Natsal 3 development work has shown that it is possible to attain an adequate response in a population-based survey of sexual behaviour. Careful wording of participant documents, attractive survey branding and a participant website all contributed to increasing response rates. Response rates were slightly higher for the larger token of appreciation but increasing the value was not considered cost-effective.

Britain's first large, national survey of sexual attitudes and lifestyles will allow improved estimates of the magnitude of the HIV epidemic in Britain and should lead to better strategies for prevention.

Erratum to bEthnic variations in sexual activity and contraceptive use: national cross-sectional surveyQ [Contraception 74 (2006) 224–233] Sonia Saxena4, Andrew J. Copas, Catherine Mercer, Anne M. Johnson, Kevin Fenton, Bob Erens, Kiran Nanchahal, Wendy Macdowall, Kaye Wellings Division of Epidemiology Public Health and Primary Care, Department of Primary Care and Social Medicine, Imperial College, London Charing Cross Campus, W6 8RP London, UK Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Mortimer Market, off Capper Street, WC1E 6AU London, UK National Centers for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA National Centre for Social Research, EC1V 0AX London, UK Centre for Sexual and Reproductive Health Research, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK

SUMMARY The mean rate of partner change is a key variable used in mathematical models of the transmission dynamics of sexually transmitted diseases and human immunodeficiency virus. This paper uses data from the British National Survey of Sexual Attitudes and Lifestyles to explore the consistency of responses given by men and women to questions about sexual life style. In common with other surveys of this nature, men report a higher mean number of heterosexual partners than do women. Possible explanations for such a finding are given in this paper and we show that the discrepancies can be reduced by making certain assumptions. The importance of the age mixing of sexual partnerships is highlighted.

The Social Organization of Sexuality: Sexual Practices in the United States , Edward O Lauman University of Chicago Press, pounds sterling39.95, pp 752 ISBN 0 226 46957 3 Sex in America: A Definitive Survey , Robert T Michael, John H Gagnon, Edward O Laumann, Gina Kolata Little, Brown, pounds sterling16.99, pp 288 ISBN 0 316 91191 7 The findings reported in these two books—one a weighty academic tome, the other a lighter version aimed at a lay readership—represent the latest addition to a growing body of research into human sexual behaviour, which has gained its impetus from the need for data to help predict and prevent further spread of HIV. Yet even now, when AIDS has made sexual behaviour a necessary subject for scientific inquiry, there is still a good deal of nervousness about it. The history of the project that resulted in these books reads uncannily like that of the British survey. Planned by an academic team, it originally …