Changes in female sexual behaviour with the advent of AIDS and safer sex campaigns were studied. Subjects were drawn from a wide social spectrum of women attending an STD clinic in West London where there is a high prevalence of HIV infection among homosexual men. Between 1982 and 1989, 4224 women answered a self-administered questionnaire: women who reported more than one sexual partner in the previous year fell from 56.9% in 1982 to 51.8% in 1989 (p = 0.003). Anal intercourse showed no change and was reported by 8.8% in 1982 and 9.4% in 1989 (p = 0.8). Oral intercourse increased from 36.9% in 1982 to 44.7% in 1989 (p = 0.001). Condom use for contraception increased from 3.6% in 1982 to 16.2% in 1989 (p less than 0.001). Between 1987 and 1989, 35.6% of 3199 women reported having non-regular partners with no significant trend over this period; these women had earlier coitarche (17.0 years cf 17.9 years), many more partners (p less than 0.0001) and more practised anal (p = 0.007) and oral (p less than 0.0001) intercourse. However, frequent use of condoms doubled from 23.6% in 1987 to 47.6% in 1989. During this period, the prevalence of antibody to HIV (anti-HIV) remained unchanged (0.27-0.37%), but more women declined to be tested. Anonymised testing showed that none of those who refused consent for named testing was anti-HIV positive. It is concluded that significant changes in female sexual behaviour have taken place with the advent of AIDS but there has been no evidence of heterosexual spread beyond the confines of well defined risk behaviours. Risks of the magnitude reported in homosexual men were not found in heterosexual women.
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