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Abstract
Research aimed at investigating sexual behaviour and assessing interventions to improve
sexual health has increased in recent decades. The resulting data, despite regional
differences in quantity and quality, provide a historically unique opportunity to
describe patterns of sexual behaviour and their implications for attempts to protect
sexual health at the beginning of the 21st century. In this paper we present original
analyses of sexual behaviour data from 59 countries for which they were available.
The data show substantial diversity in sexual behaviour by region and sex. No universal
trend towards earlier sexual intercourse has occurred, but the shift towards later
marriage in most countries has led to an increase in premarital sex, the prevalence
of which is generally higher in developed countries than in developing countries,
and is higher in men than in women. Monogamy is the dominant pattern everywhere, but
having had two or more sexual partners in the past year is more common in men than
in women, and reported rates are higher in industrialised than in non-industrialised
countries. Condom use has increased in prevalence almost everywhere, but rates remain
low in many developing countries. The huge regional variation indicates mainly social
and economic determinants of sexual behaviour, which have implications for intervention.
Although individual behaviour change is central to improving sexual health, efforts
are also needed to address the broader determinants of sexual behaviour, particularly
those that relate to the social context. The evidence from behavioural interventions
is that no general approach to sexual-health promotion will work everywhere and no
single-component intervention will work anywhere. Comprehensive behavioural interventions
are needed that take account of the social context in mounting individual-level programmes,
attempt to modify social norms to support uptake and maintenance of behaviour change,
and tackle the structural factors that contribute to risky sexual behaviour.