Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison

American Journal of Public Health, Volume 88, Issue 5: Pages 749-754, May 1998.

Michael RT, Wadsworth J, Feinleib J, Johnson AM, Laumann EO, Wellings K.

Harris School of Public Policy Studies, University of Chicago, IL 60637, USA.


OBJECTIVES: The purpose of this study was to characterize sexual behavior and opinions about sex in the United States and Britain; implications are discussed for effective public health policy regarding sexually transmitted diseases (STDs) in the United States.

METHODS: Large-scale national probability surveys conducted in the 2 countries detailed sexual behavior, opinions, and the prevalence of STDs.

RESULTS: In comparison with that of Britain, the US population has greater variability in sexual behavior, less tolerant opinions about sexual behavior, and a higher STD prevalence and lower condom usage amongmen.

CONCLUSIONS: The survey data show compelling evidence from both countries of a strong association between number of sex partners and STD risk. In the United States relative to Britain, there is both greater dispersion in sexual behavior and a greater incidence of unconditional opposition to certain sexual practices. The former implies a need for strong public health policy to address the risks of STDs, but the latter implies strong opposition to that policy. This disjuncture between public health need and feasibility may contribute to the high US rate of STDs.

PMID: 9585739 [PubMed - indexed for MEDLINE]

CIRP logo Note:

This article is of interest because it compares the sexual behavior in America, where most men are circumcised, with the sexual behavior in Britain, where most men have intact penises. This article shows that men in the U.S. are much less likely to use condoms.


The incidence of HIV is estimated to have peaked in Britain between 1982 and 1984 with an intense epidemic in homosexual men and a limited spread to injection drug users. Probably as a result of behavior change, a declining incidence followed; thus, the prevalence observed in Britain has never reached the intensity of high-risk populations in the United States. In the United States, no such peak occurred early in the epidemic. Regarding the known transmission mechanisms of all AIDS cases as of 1996, 50% of US and 59% of British cases involved transmission between men who have sex with men, 26% of US and 10% of British cases involved injection drug users (with another 6% in the United States and 2% in Britain involving both of the preceding 2 groups), and 9% of US and 20% of British cases involved heterosexual contacts. 17,18,20


  1. Centers for Disease Control and Prevention. HIV/AIDS Surveill. 1996;8(2).
  2. Centers for Disease Control and Prevention. HIV/AIDS Surveill. 1997;9(1).
  1. Report of an Expert Group. The incidence and prevalence of AIDS and prevalence of other severe HIV diseases in England and Wales for 1995 to 1999: projections using data to the end of 1994. Commun Dis Rep CDR Rev. 1996;6:R1-R24.

Robert T. Michael and Joel Feinleib are with the Harris School of Public Policy Studies, University of Chicago, Ill. Edward 0. Laumann is with the Sociology Dept, University of Chicago. Anne M. Johnson is with the University College, London Medical School, England. Kaye Wellings is with the London School of Hygiene and Tropical Medicine. At the time this paper was written, Jane Wadsworth was with the Imperial College School of Medicine at St. Mary's, London; Jane Wadsworthdied in July 1997.

Requests for reprints should be sent to Robert T. Michael, PhD, Harris School of Public Policy Studies, University of Chicago, 1155 E60th St, Chicago, IL 60637.

This paper was accepted January 15, 1998.

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