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Sexual health clinic attendance and non-attendance in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)
  1. Clare Tanton1,
  2. Rebecca S Geary1,2,
  3. Soazig Clifton1,
  4. Nigel Field1,
  5. Katie L Heap1,
  6. Fiona Mapp1,2,
  7. Gwenda Hughes3,
  8. Anne M Johnson1,
  9. Jackie A Cassell4,
  10. Pam Sonnenberg1,
  11. Catherine H Mercer1
  1. 1 Institute for Global Health, University College London, London, UK
  2. 2 Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Department of HIV and STIs, National Infection Service, Public Health England, London, UK
  4. 4 Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
  1. Correspondence to Dr Clare Tanton, Institute for Global Health, University College London, 3rd Floor, Mortimer Market Centre, London WC1E 6JB, UK; c.tanton{at}


Objectives In Britain, sexual health clinics (SHCs) are the most common location for STI diagnosis but many people with STI risk behaviours do not attend. We estimate prevalence of SHC attendance and how this varies by sociodemographic and behavioural factors (including unsafe sex) and describe hypothetical service preferences for those reporting unsafe sex.

Methods Complex survey analyses of data from Britain’s third National Survey of Sexual Attitudes and Lifestyles, a probability survey of 15 162 people aged 16–74 years, undertaken 2010–2012.

Results Overall, recent attendance (past year) was highest among those aged 16–24 years (16.6% men, 22.4% women), decreasing with age (<1.5% among those 45–74 years). Approximately 15% of sexually-active 16–74 year olds (n=1002 men; n=1253 women) reported ‘unsafe sex’ (condomless first sex with a new partner and/or ≥2 partners and no condom use, past year); >75% of these had not attended a SHC (past year). However, of non-attenders aged 16–44 years, 18.7% of men and 39.0% of women reported chlamydia testing (past year) with testing highest in women aged <25 years. Of those aged 16–44 years reporting unsafe sex, the majority who reported previous SHC attendance would seek STI care there, whereas the majority who had not would use general practice.

Conclusion While most reporting unsafe sex had not attended a SHC, many, particularly younger women, had tested for chlamydia suggesting engagement with sexual health services more broadly. Effective, diverse service provision is needed to engage those at-risk and ensure that they can attend services appropriate to their needs.

  • sexual health clinic
  • attendance
  • sexual behaviour
  • probability survey
  • United Kingdom
  • surveys and questionnaires
  • unsafe sex
  • general practice
  • prevalence

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • CT and RSG are joint first authors.

  • Handling editor Jonathan Ross

  • Contributors This paper was conceived by RSG, SC, CT, GH, PS and CHM. RSG wrote the first draft of the article, CT wrote further drafts with contributions from SC, NF, FM, GH, AMJ, JC, PS and CHM. KLH, CT and RSG carried out the statistical analysis, with support from CHM and SC. AMJ, PS and CHM, initial applicants for Natsal-3, wrote the study protocol and obtained funding. CT, SC, NF, AMJ, PS and CHM designed the Natsal-3 questionnaire, applied for ethics approval and undertook piloting of the questionnaire. CT, SC and CHM managed data. All authors interpreted data, reviewed successive drafts and approved the final version of the article.

  • Funding The study was supported by grants from the Medical Research Council (G0701757); and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health. Soazig Clifton was funded to undertake independent research supported by the National Institute for Health Research (NIHR Research Methods Programme, Fellowships and Internships, NIHR-RMFI-2014-05-28). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests AMJ has been Governor of the Wellcome Trust since 2011.

  • Ethics approval Oxfordshire Research Ethics Committee A (reference: 09/H0604/27).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Natsal-3 dataset is publicly available from the UK Data Service:; SN: 7799; persistent identifier: 10.5255/UKDA-SN-77991-1.

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