WHO GOES TO SEXUALLY-TRANSMITTED DISEASE CLINICS - RESULTS FROM A NATIONAL-POPULATION SURVEY

Objectives: To examine the pattern of attendance at sexually transmitt ed disease (STD) clinics in Britain. To compare the demographic charac teristics, behaviours and attitudes of STD clinic attenders with those of non-attenders, and to assess the extent to which STD clinics are u sed by those with high-risk sexual lifestyles. Design: Random sample g eneral population survey of sexual attitudes and lifestyle. Subjects: 18,876 randomly selected men and women resident in Britain aged 16-59 years. Main outcome measures: Demographic characteristics, pattern of homosexual partnerships, heterosexual partnerships, payment for sex, a bortion, drug injection in the last five years, and attitudes to sexua l behaviours amongst 512 respondents who had attended STD clinic in th e last five years compared with those who had not. Results: 8.3% of me n and 5.6% of women had attended a clinic in their lifetime and 3.4% a nd 2.6% respectively in the last five years. Attendance rates varied s ubstantially with area of residence. 11% of Inner London residents had attended in the last five years. In multivariate analysis, STD clinic attendance for men was most strongly associated with increased number s of heterosexual partners, (OR = 6.01 (4.44-8.15)) and homosexual par tnerships (OR = 9.59 (5.83-15.8)) and more weakly associated with paym ent for sex, non-manual social class, age 25-44, unmarried status and smoking. Clinic attendance for women was most strongly associated with numbers of heterosexual partners (OR = 3.74 (2.76-5.08)) and injectin g drug use (OR 4.39 (1.73-11.1)). A weaker independent association was found with a history of abortion, anal sex, non-manual social class, non-married status and age 16-24. From the total population, 1 in 6 me n and 1 in 7 women in the top 5% of the distribution for numbers of he terosexual partners and 1 in 5 men paying for sex and 1 in 4 of those with a homosexual partner had attended a clinic in the last five years . The probability of attendance increased with multiple risk behaviour s. Of women 64.2% and of men 69.7% attending clinics reported major ri sk markers for STD transmission. Conclusions: STD clinics in Britain a re used by a wide demographic spectrum of the population. The behaviou rs, but not the attitudes, of attenders differed markedly from those o f non-attenders. Clinics are relatively efficient in attracting only t hose with high-risk lifestyles, but, at a population level, the minori ty of those reporting risk-markers for STD transmission attend clinics . These findings suggest that STD clinics are an important focus for s exual health promotion, but that community programmes are also importa nt for reaching non-attenders.