Introduction Risk perception is a key component of behaviour change and underpins effective public health messaging, which for sexual health includes promoting safer sex and STI testing. We examined associations between reported perceived risk of STIs and sexual behaviour in the British general population.
Methods A probability-sample survey undertaken 2010–2012 (Natsal-3) using a combination of computer-assisted personal- and self- interviewing (CAPI/CASI). Participants rated themselves as ‘greatly’, ‘quite a lot’, ‘not very much’ or ‘not at all’ at risk of getting an STI (excluding HIV) given their current sexual lifestyle. We analysed weighted data on risk perception and behaviour from sexually-active individuals aged 16–44 (3391 men, 4966 women), and used multinomial regression to calculate relative risk ratios (RRRs) for rating oneself as greatly/quite a lot or not very much at risk (both compared with not at all at risk).
Results Most participants (64% of men, 73% of women) rated themselves as ‘not at all at risk’ of STIs, 30% of men and 23% of women as ‘not very much at risk’, and 6% of men and 4% of women as ‘greatly/quite a lot at risk’. After adjustment for age, increasing risk perception was associated with reporting risk behaviours in the past year (RRRs for men presented for illustration, associations for women were generally similar): 1 new condomless partner (RRR 5.97 [4.24–8.40] for ‘greatly/quite a lot’ and 2.60 [2.08–3.25] for ‘not very much’, both compared with ‘not at all at risk’), same-sex partners (RRR 19.85 [8.56–46.03] for greatly/quite a lot, 7.11 [3.99–12.66] for ‘not very much’), and concurrent partners (RRR 16.21 [10.27–25.59] for greatly/quite a lot, 5.77 [4.10–8.11] for ‘not very much’). However, these behaviours were also reported by a substantial proportion of those not rating themselves as at risk. For example, 27% of men and 26% of women who self-rated as ‘not very much at risk’, and 10% of men and 9% of women who self-rated as ‘not at all at risk’ reported 1 new unprotected partner in the past year. Similarly, 18% of men and 12% of women who self-rated as ‘not very much at risk’ reported concurrent partnerships in the past year.
Conclusion Most participants did not perceive themselves as being at risk of STIs, however many of these people reported sexual behaviours that are strongly associated with STI acquisition. Health promotion efforts should take account of mismatches between perceived and actual risk.