Publication
Health Education Population Survey (HEPS) 1996-2003
12. Sexual health
While the incidence of teenage pregnancy has been relatively stable over the past ten years‚ live birth rates among this group are relatively high in Scotland and the UK compared with other countries in Western Europe. It is also increasingly clear that socio-economic disadvantage can be both a cause and a consequence of teenage parenthood (Acheson‚ 1998). At present‚ the major policy focus in sexual health includes reducing the incidence of teenage pregnancy and sexually transmitted infections (STIs)‚ while recognising the need to address broader issues of sexuality and personal relationships in order to achieve this (The Scottish Office‚ 1999). The rising number of reported STIs among young people‚ particularly young women‚ is a growing cause for concern‚ although increased reporting may in part be explained by greater awareness of the symptoms of STIs and the risks of untreated infections‚ as well as willingness to seek treatment. While the extent of HIV infection has not proved as great as predicted‚ Towards a Healthier Scotland highlights the importance of continued vigilance with respect to sustained levels of new HIV infections. Existing research on teenage sexuality in Scotland has been synthesised and published as part of the HEBS Evidence into Action series‚ which draws out the implications for practice‚ policy and research (Burtney‚ 2000). A national strategy for Scotland on sexual health and relationships is currently at the consultation stage.
Health education activities in this area have been primarily targeting young people via sex education in schools‚ encouraging condom use and providing information on STIs and HIV and advice and treatment services.
The Health Education Population Survey assesses self-reported changes in sexual behaviour‚ attitudes toward condom use and information needs on sexual health topics. These questions were asked in the self-completion section of the questionnaire.
12.1 Behaviour change
Questions on behaviour change were asked only in March in 2001 and 2002 but in both March and September in other years. Overall‚ a relatively small proportion (around 15%) of respondents reported changing their lifestyle because of HIV/AIDS and this was strongly associated with age (Table 12.1). Those aged under 35 were most likely to report changing their behaviour‚ and this is consistent with findings from other studies. There does not appear to be any consistent change over time for any age group.
The picture is less clear for differences by social grade‚ although on the whole respondents from social grade C1 tended to be most likely to change their behaviour.
Table 12.1: Percentage changing sexual behaviour because of HIV/AIDS‚ by age/social grade
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
|
All |
13 |
13 |
15 |
– |
– |
15 |
14 |
15 |
|
Age |
|||||||||
16-24 |
31 |
27 |
26 |
– |
– |
16 |
32 |
11 |
|
25-34 |
21 |
21 |
29 |
– |
– |
28 |
19 |
26 |
|
35-44 |
10 |
8 |
12 |
– |
– |
19 |
14 |
18 |
|
45-54 |
7 |
5 |
5 |
– |
– |
9 |
9 |
8 |
|
55-64 |
3 |
6 |
6 |
– |
– |
4 |
6 |
11 |
|
65-74 |
2 |
2 |
1 |
– |
– |
6 |
2 |
6 |
|
Social grade |
|||||||||
AB |
10 |
11 |
12 |
– |
– |
17 |
10 |
14 |
|
C1 |
16 |
14 |
18 |
– |
– |
18 |
19 |
15 |
|
C2 |
13 |
12 |
16 |
– |
– |
10 |
10 |
15 |
|
D |
16 |
13 |
13 |
– |
– |
16 |
12 |
15 |
|
E |
10 |
12 |
10 |
– |
– |
14 |
21 |
12 |
|
Base size: |
1727 |
1735 |
1687 |
– |
– |
774 |
823 |
1529 |
|
Base: respondents answering the self-completion section (March wave only 2001-2002) |
|||||||||
12.2 Motivation
Motivation levels were assessed through attitudes toward condom use. These questions were included in HEPS in March and September 1996 and 1998‚ but only in September in 1997 and only in March in 2001 and 2002 due to shortage of space in the questionnaire. In the period 1996 to 1999 around two-thirds of respondents said that they would not have sex with a new partner without a condom‚ with almost one-half expressing strong support for this statement. This increased significantly to over eight in ten in 2001-2003‚ with over half expressing strong support. The total agreement figure was higher for the key target group of those aged 16-24 and has not changed over time. By 2002 there was no difference in agreement between those aged 16-24 and all respondents (Table 12.2). However‚ there has been some movement for this group in terms of strength of agreement‚ with those aged 16-24 now more likely to agree strongly with this statement.
Table 12.1: Attitudes toward condom use – would not have sex with new partner without a condom
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All |
|
|
|
|
|
|
|
|
Tend to agree |
19 |
18 |
19 |
20 |
– |
28 |
28 |
28 |
Strongly agree |
47 |
49 |
44 |
44 |
– |
56 |
55 |
58 |
16-24 |
||||||||
Tend to agree |
32 |
26 |
23 |
37 |
– |
27 |
15 |
34 |
Strongly agree |
48 |
65 |
57 |
45 |
– |
60 |
65 |
57 |
Base size: all adults |
1698 |
871 |
4663 |
811 |
– |
744 |
823 |
1529 |
Base size: 16-24 |
209 |
109 |
190 |
86 |
– |
114 |
108 |
172 |
Base: respondents answering the self-completion section (September wave only 1997‚ March wave only 2002-2003) |
||||||||
|
Significant changes (p<0.05) |
12.3 Knowledge
Respondents were asked if they had enough information on a series of sexual health topics. These questions were only asked in either March or September from 1996-2002 and at both waves in 2003. The information needs for the most frequently mentioned topics are shown below (Table 12.3). Expressed need for information on each of these topics has fallen significantly since 1996.
Table 12.3: Information needs regarding sexual health topics
% |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
All |
|
|
|
|
|
|
|
|
STIs |
40 |
28 |
35 |
– |
– |
28 |
20 |
30 |
Having an HIV test |
25 |
21 |
20 |
– |
– |
17 |
15 |
20 |
HIV/AIDS transmission |
22 |
16 |
18 |
– |
– |
15 |
14 |
17 |
Emergency contraception |
19 |
15 |
17 |
– |
– |
11 |
10 |
11 |
16-24s |
|
|
|
|
|
|
|
|
STIs |
63 |
60 |
61 |
– |
– |
56 |
58 |
45 |
Having an HIV test |
41 |
27 |
20 |
– |
– |
20 |
28 |
23 |
HIV/AIDS transmission |
24 |
27 |
20 |
– |
– |
20 |
28 |
23 |
Emergency contraception |
41 |
27 |
20 |
– |
– |
20 |
28 |
23 |
Base size: all adults |
850 |
862 |
827 |
– |
– |
774 |
823 |
1529 |
Base size: 16-24 |
105 |
83 |
91 |
– |
– |
114 |
108 |
172 |
Base: respondents answering the self-completion section – only one wave per year 1996-2002 |
||||||||
Younger respondents were consistently more likely to want information on recognising the symptoms of STIs‚ having an HIV test and emergency contraception. Their need to know about HIV transmission stayed at the same level between 1996 and 1998 but by 2002 their need for information on all four topics increased.
The age differences in terms of behaviour change and information needs are perhaps not surprising considering decreasing levels of sexual activity and fewer sexual partners for older age groups (Wellings et al‚ 1994; Hansbro et al‚ 1997; Rainford et al‚ 2000)‚ and are consistent with the findings of previous research. Other analyses of HEPS data show that the youngest age group in this survey was also the most likely to see itself as being at risk from HIV/AIDS relative to older age groups (8% compared to 4% overall) (HEBS‚ 2000). This suggests that those who see themselves as being at greater risk also appear to be more likely to adopt preventative strategies.
Main points
- There were no consistent trends in sexual behaviour change related to HIV/AIDS.
- Attitudes to condom use showed significant positive changes between 1996 and 1999 and 2001 and 2003.
- Younger respondents expressed the greatest need for information regarding STIs‚ HIV testing and emergency contraception‚ and the most concern about sexual health generally.
- There was a declining demand for more information on recognising the symptoms of STIs‚ having an HIV test‚ HIV transmission and emergency contraception. There was no equivalent decrease amongst those aged 16-24 for HIV-related information.