Fenton Kevin A, Mercer Catherine H, McManus Sally, Erens Bob, Wellings Kaye, Macdowall Wendy, Byron Christos L, Copas Andrew J, Nanchahal Kiran, Field Julia, Johnson Anne M
Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, University College London, London, UK.
Lancet. 2005;365(9466):1246-55. doi: 10.1016/S0140-6736(05)74813-3.
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.
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.
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.
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.
许多发达国家都报告了性传播感染（STIs）确诊率的种族差异。我们利用英国第二次全国性态度和生活方式调查（2000年全国性态度和生活方式调查）的数据，调查了英国五个种族群体中高危性行为的频率和不良性健康结果。
我们对居住在英国的11161名16 - 44岁的男性和女性进行了分层概率抽样调查，采用计算机辅助访谈。额外的抽样使我们能够对949名加勒比黑人、非洲黑人、印度人和巴基斯坦受访者进行更详细的分析。在控制了人口统计学和行为变量后，我们使用逻辑回归来评估过去5年中性传播感染诊断的报告情况。
我们注意到不同种族群体以及男性和女性之间性伴侣数量存在显著差异。一生中报告的性伴侣数量在加勒比黑人（中位数9 [四分位距4 - 20]）和非洲黑人（9 [3 - 20]）男性中最高，在白人（5 [2 - 9]）和加勒比黑人（4 [2 - 7]）女性中最高。印度和巴基斯坦的男性和女性报告的性伴侣较少，首次性交较晚，确诊性传播感染的患病率也明显低于其他群体。我们记录到，过去5年中，种族与报告的性传播感染之间存在显著关联，与白人男性相比，性活跃的加勒比黑人（比值比2.74 [95%置信区间1.22 - 6.15]）和非洲黑人（2.95 [1.45 - 5.99]）男性感染风险增加，与白人女性相比，加勒比黑人（2.41 [1.35 - 4.28]）女性感染风险增加。在控制了年龄、性伴侣数量、同性恋和海外伴侣以及最后一次性交时的避孕套使用情况后，比值比变化不大。
个人性行为是性传播感染传播风险的关键决定因素，但仅凭这一点并不能解释不同种族群体之间风险的差异。我们的研究结果表明，需要有针对性的、具备文化能力的预防干预措施。
