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Who has sex with whom? Study of heterosexual partnerships reveals worryingly low condom use
Rates of sexually transmitted infections increase as a result, particularly amongst older people
A
high proportion of people are not using condoms when they have sex with
a new partner, according to a new study of heterosexual partnerships
among British men and women. Among people in their 30s and 40s, and in
partnerships where there is an age difference of five or more years,
condom use is particularly low.
In view of the rising rates of
sexually transmitted infections (STIs), the authors of the study say
that condom use needs to be promoted to all age groups, and not just to
young people.
The research, published online in the
International Journal of Epidemiology
today (Wednesday 12 November), looks at all heterosexual relationships
experienced in the previous 12 months by 11,161 men and women
interviewed for the second British National Survey of Sexual Attitudes
and Lifestyles (Natsal 2). [1]
Dr Catherine Mercer, a lecturer
in the Centre for Sexual Health & HIV Research, University College
London (UK), said: "To the best of our knowledge this is the first
research to take account of all heterosexual partnerships and not just
people's most recent partnerships, which tend to be more established
partnerships such as marriages and cohabitations. Our study ensures
accurate representation of casual partnerships, which are known to be
important in the transmission of STIs. People with large numbers of
partners contribute disproportionately to STI transmission in
populations."
Dr Mercer and her colleagues analysed data from
interviews with 11,161 people, of whom 6,399 were women, carried out
between May 1999 and February 2001. Interviewees were asked about their
three most recent partnerships, and the analysis focused on
partnerships in the past year. Questions included ones on condom use,
age differences in the partnership, where they met and how soon after
meeting they had sex.
Of the 11,161 respondents, 9,598
reported a total of 15,488 heterosexual partnerships in the past year.
A higher proportion of men's partnerships were described as "not
regular" – 39.1% compared to 20% of women's partnerships; while a
higher proportion of women's partnerships were marriages or
cohabitations – 55.2% versus 38.9% of men's partnerships. Men had sex
sooner after first meeting a partner than women, with one in five men
reporting sex within 24 hours of meeting their partner, compared with
one in ten of women.
Condoms were used at last sex in 37.1% of
men's and 28% of women's partnerships. Overall, half of all new
partnerships involved condom use at first sex (55.3%), but this
declined with age; for instance, 68% of men and 67.4% of women aged
16-19 used a condom at first sex, but only 38.1% of men and 28.8% of
women aged 35-44 year-old did.
Dr Mercer said: "For some
people not using condoms may be due to being or trying to become
pregnant, but this is a less likely explanation for partnerships
described as 'not regular', and it is therefore worrying that condom
use was reported at last sex in just half of such partnerships.
However, of greater concern was our finding that half of new
partnerships did not use condoms at first sex, even when this was a
non-regular partner, and condoms were not used in one-third of cases
when first sex was within 24 hours of first meeting."
Rates of
STIs are on the increase. In the UK, the Health Protection Agency
reported a rise of six per cent in the total number of new STIs
diagnosed in 2007 compared to 2006. Other research published this year
reported that STI diagnosis rates in people aged 45 and older attending
clinics in the West Midlands more than doubled between 1996 and 2003
[2].
"Our finding that condom use at first sex declined with
increasing age is of concern," said Dr Mercer. "Although a
disproportionate amount of partnerships are formed among people in
their teens and 20s, the fact is that about 45% of marriages are now
expected to end in divorce, which means that the 'population
attributable risk' of partnership formation by those in their 30s and
40s will increase. Indeed, increasing rates of STIs diagnosed among
those in their 30s and 40s suggest that interventions that promote
consistent condom use with new partners are urgently required, not just
for young people as has been the focus recently, but for people in
their 30s and 40s and older who are increasingly forming new
partnerships."
The researchers also found that where there
was a large age difference between partners of five years or more, and
regardless of whether it was the man or the woman that was older,
partners were less likely to use condoms at first sex compared to
partnerships that were closer in age: 44.1% versus 60.8%.
Dr
Mercer said: "This may reflect unequal power relations, so that younger
people in such partnerships may not have the necessary communication
and negotiation skills to ensure safe sex with older partners. This
finding may have implications for sex and relationship education and
counselling. Improving negotiation skills for women and men may
facilitate communication and, in turn, increase the likelihood of
condom use in such partnerships."
She concluded: "It is
important to understand the characteristics of sexual partnerships to
improve our understanding of STI transmission and to ensure that health
promotion messages are appropriately targeted and delivered. This paper
helps us to better understand the population of partnerships (rather
than the population of individuals) in terms of the large proportion of
partnerships that are casual and why they are at increased risk of
STIs."
###
[1]
Who has sex with whom? Characteristics of heterosexual partnerships
reported in a national probability survey and implications for STI
risk.
International Journal of Epidemiology. Published online under advance access. doi:10.1093/ije/dyn216.
[2] "Trends in sexually transmitted infections (other than HIV) in
older persons: analysis of data from an enhanced surveillance system".
Bodley-Tickell AT, Olowokure B, Bhaduri S et al. Sexually Transmitted
Infections 2008; doi:10.1136/sti.2007.027847.
Contact: Emma Mason (media enquiries only)
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Oxford University Press