Sexual behaviour alone doesn’t explain the differences in STIs among ethnic groups

Patterns of sexual lifestyles and sexually transmitted infections (STI) vary among ethnic groups in Great Britain, concludes a study in this week’s issue of The Lancet.

Kevin Fenton (University College London, UK) and colleagues used data from the second British National Survey of Sexual Attitudes and Lifestyles, involving 12 110 men and women aged 16–44 years resident in Great Britain, to investigate the variations in sexual behaviours and adverse sexual health outcomes among white, black Caribbean, black African, Indian and Pakistani groups. They found variations in the number of sexual partnerships by ethnic group and between men and women. Overall, Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. White women reported higher levels of risk behaviours than other ethnic groups, but were less likely to report STIs than black Caribbean and black African women. White women reported an average of five lifetime partners compared with four reported by black Caribbean women, three by black African women and one by both Indian and Pakistani women. Black African and black Caribbean men reported higher levels of sexual risk behaviour and higher incidence of STIs compared to white, Indian and Pakistani men.

The study found that the main factor influencing an individual’s risk of reporting STIs was the number of sex partners. However, this factor by itself did not fully explain the variations in STI incidence in different ethnic groups. In addition to cultural and demographic influences, other factors likely to influence risk of infection are how people choose sexual partners, the background level of untreated STI in different communities and the speed and completeness of treatment.

Dr Fenton comments: “For the first time we have a clearer understanding of the complex relationship between the sexual lifestyles of Britain’s main ethnic groups and the risk of sexually transmitted infections.

He adds: “Sexual behaviour alone doesn’t explain the differences in STIs among ethnic groups. Cultural factors, age and marriage patterns, and varying levels of infection in different communities are all likely to be important in explaining differences. This study highlights the need for working with communities to develop culturally appropriate approaches to the prevention of STIs that take into account the varied risk experienced by different groups.”

In an accompanying comment Michael Ross (University of Texas, USA) states: “Fenton and colleagues’ study strongly suggests that gender roles and norms might influence the STI risk behaviour of men and women, and that they might exacerbate differences in sexual behaviour within specific ethnic groups. However, the overall pattern that emerges indicates that the expectations about the sexual behaviour of men and women might also transcend group differences.”