Three essays on sexual behaviour and sexually transmitted disease in the UK

Abstract

This thesis aims to explore the measurement of and the correlation between risky sexual behaviour and chlamydia and gonorrhoea infection in the UK in three chapters. The first of these explores methods of calculating rates of Chlamydia and gonorrhoea infection at UK genitourinary medicine (GUM) clinics. Data from KC60 returns from clinics in the Northwest, Southwest and East Midlands of England are used to provide a numerator for the rates and three methods are tested to derive the denominator: Thiessen polygons, 15 mile boundaries, and 30 minute drive times. The study finds that the rates calculated are relatively insensitive to the method chosen and thus the simplest approach, the Thiessen polygons, is recommended. The analysis also highlights substantial regional differences in GUM service accessibility.

The second chapter uses latent class analysis to derive a measure of risky sexual behaviour with respect to chlamydia and gonorrhoea infection. Data from the National Survey of Sexual Attitudes and Lifestyles II, a nationally representative survey of sexual behaviour in Britain, has been analysed in order to identify patterns of behaviours associated with increased disease risk A 3-class solution is obtained, with individuals classified on the basis of the number of partners they have had in the last 12 months.

The third chapter examines the relationship between the rates of chlamydia andgonorrhoea infection and the measure of risky sexual behaviour. Small areaestimates of risky behaviour are obtained for all wards in England using syntheticregression methods. These are then aggregated in line with the Thiessenpolygons in order to explore the correlation with the rates of chlamydia andgonorrhoea infection. There is a positive correlation for both infections, but farstronger for gonorrhoea than chlamydia (r=0.70 and r=0.41 respectively),suggesting that although risky behaviour may explain some of the observedvariation, further research is need to explore other possible explanations.

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Identifiers

ORCID for Beth Stuart: orcid.org/0000-0001-5432-7437

ORCID for P.R.A. Hinde: orcid.org/0000-0002-8909-9152

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