Efforts to improve sexual health need robust information about sexual behaviour. Researchers from the London School of Hygiene and Tropical Medicine (UK) analysed data from 59 countries. They conclude that sexual health strategies must go beyond individual risk reduction and address social and economic determinants of behaviour.

The analysis revealed the huge regional variation in sexual behaviour but also showed that there has been less change in behaviour over the past two decades than was thought:

• There is no universal trend towards sex at a younger age. However, a shift towards later marriage in most countries has led to an increase in premarital sex, more so in developed countries and for men. Sexual activity in single people tends to be sporadic.
• Most people are married (or live together in partnerships) and most sex happens in stable partnerships. Marriage does however not always safeguard sexual health. 
• Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the last year is more common for men and in industrialised countries.
• Condom use has increased almost everywhere, but rates remain low in many developing countries.
• School-based sex education improves awareness of risk and ways to reduce it. It increases the intention to practise safer sex and delays rather than hastens the onset of sexual activity.

Regional variations in sexual behaviour do not correlate with sexual health status. Higher rates of partner change in industrialised countries are offset by higher levels of condom use and better access to treatment results in better health. The authors explored the main reasons for the variations:

• Some of the variations can be explained by demographic and structural changes. The age structure and ratio of men to women in a population can limit or extend opportunities to form new partnerships. 
• There is a striking gender difference in sexual behaviour. Multiple partnerships are more common for men than for women. This is in line with a double standard in most societies that makes non-exclusive relationships more acceptable for men than for women.
• Poverty, deprivation and unemployment work with gender inequity to promote partner change, multiple partners and unprotected sex.
• Possibly the most powerful influences on human sexuality are the social norms that govern its expression. Morals, taboos, laws, and religious beliefs used by societies worldwide limit and radically determine the sexual behaviour of their citizens.

The authors highlight the need to base interventions on evidence rather than myths or moral stances. Approaches focusing exclusively on expectation of individual behaviour change are unlikely to produce substantial improvements in sexual health. Comprehensive multi-level behavioural interventions are needed that reflect the social context. These should attempt to modify social norms and tackle the structural factors that contribute to risky behaviour. Examples include mainstreaming HIV and sexual health in development projects; empowering sex workers through business and IT training; and integrating sexual health education into microfinance schemes. However, the success of these strategies requires decision-makers to accept the reality of sexual practices.

Source(s):
‘Sexual behaviour in context: a global perspective’, The Lancet 368, pages 1706-1728, by Kaye Wellings, Martine Collumbien, Emma Slaymaker, Susheela Singh, Zoë Hodges, Dhaval Patel and Nathalie Bajos, 2006 (PDF) Full document.
DFID R4D project record: Research and capacity building in reproductive and sexual health and HIV/AIDS in developing countries Full document.

Funded by: Partly supported by UK Department for International Development's (DFID) Research Programme Consortium (RPC - HD3, MIS Number: 733637011) for research and capacity building in sexual and reproductive health and HIV in developing countries

id21 Research Highlight: 11 May 2007

Further Information:
Kaye Wellings
London School of Hygiene and Tropical Medicine
London
WC1B 7HT
UK

Contact the contributor: kaye.wellings@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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