Nathalie Beltzer

Changes in sexual behaviours: from secular trends to public health policies.

Objective:To explore the relative contribution of secular trends and public health policies to changes in sexual behaviour. Design:Three random probability surveys of the sexual behaviour of people aged 18–69 years were conducted in 1970, 1992 and 2006 in France. Methods:Data of the 2006 survey (n = 12 364) were compared with those from two surveys carried out in 1970 (n = 2625) and 1992 (n = 20 055). Results:Over the last decades, median age at first intercourse has decreased by 4 years for women (22.0 in the 1930s vs. 17.6 in the 2000s) and 1 year for men (18.1 vs. 17.2). Lifetime number of sexual partners increased for women (1.8 in 1970 vs. 4.4 in 2006), but not for men (11.8 vs. 11.6). At the same time, the proportion of respondents, especially women, who reported nonpenetrative sexual practices and considered sexual intercourse essential to well being was on the increase. These changes are mainly attributed to an increase in womens social status. A marked increase in condom use was observed following the first AIDS/HIV prevention campaigns in the 1980s. Conclusion:Public health interventions that are synergistic with trends in social norms are likely to be more effective than those that run counter to them. In France, sexual health and HIV prevention policies aimed at harm limitation appear to have chimed with secular trends. The evidence of greater diversification of sexual practices offers potential to increase the range of safer sex messages used in public health interventions.

Les modèles d'analyse des comportements à risque face à l'infection à VIH : une conception trop étroite de la rationalité

Moatti (Jean-Paul), Beltzer (Nathalie), Dab (William) - Les modeles danalyse des comportements a risque face a linfection a VIH : une conception trop etroite de la rationalite Les recherches en sciences sociales sur la prevention de linfection a VIH ont etabli des liens entre des connaissances et des croyances sur le SIDA dune part, des attitudes individuelles et collectives face aux personnes infectees et au risque de transmission dautre part ; mais elles ont egalement mis en evidence lambiguite de ces relations avec les comportements declares. Comme dans de nombreux autres domaines de la prevention sanitaire, les recherches ont confirme quune amelioration du niveau dinformation sur le risque nest clairement pas une condition suffisante pour provoquer des modifications de comportements individuels tendant a diminuer celui-ci. En matiere danalyse des determinants de lexposition au risque de transmission sexuelle du VIH, la litterature internationale est demeuree jusqua present dominee par le recours a des modeles psychosociologiques preexistants (Health Belief Model ou « modeles de croyances pour la sante », theorie de lapprentissage social, etc.), qui ont notamment servi de reference a lintervention « communautaire » de prevention mise en œuvre avec un certain succes dans la communaute homosexuelle et bisexuelle de San Francisco. Larticle developpe une critique des limites de ces modeles en termes dexplication et de prediction des comportements face au risque de transmission du VIH, et sefforce de demontrer quils reposent implicitement sur une conception reductrice de la rationalite individuelle qui assimile celle-ci a la seule exposition nulle au risque et a la recherche de la securite absolue. Une confrontation de ces modeles psychosociologiques avec la theorie de lutilite esperee, modelisation classique en micro-economie des comportements des agents face au risque et a lincertitude, ainsi quune application empirique de cette theorie aux donnees de lenquete ACSF, permet de souligner dautres logiques sous-jacentes a la persistance dexpositions individuelles au risque de transmission sexuelle du VIH ; et dillustrer le fait que des strategies de non changement, ou de changement «intermediaire», ne donnant aucune garantie reelle de protection face au risque VIH, puissent neanmoins saverer comme les plus coherentes avec les rationalites effectives des individus. En conclusion, larticle suggere quelques pistes pour des analyses moins mecanistes des comportements qui seraient susceptibles de mieux tenir compte du contexte specifique et de la dynamique temporelle dans laquelle sinscrivent les expositions au risque dinfection par le VIH ; ces analyses pourraient utilement sappuyer sur les developpements theoriques les plus recents tant de la recherche micro-economique que la recherche psychosociologique.

Preventive care's forgotten women: life course, sexuality, and sexual health among homosexually and bisexually active women in France.

Although studies show that women who have sex with women (WSW) have poorer sexual health and more limited access to health care for gynecological problems than other women, the social processes giving rise to such health differences have not, so far, been explored. These processes may be formed in response to a dominant social norm, which assigns women to a heterosexual and monogamous sexuality. Based on data from a national random survey of sexuality (N = 6,824), enriched by qualitative interviews with WSW (n = 40), this analysis shows that bisexually active women had similar socio-demographic profiles to heterosexually active women, whereas homosexually active women appeared to be more highly educated than other women and less likely to live as couples than bisexually active women. Bisexually active women had more diversified sexual trajectories and sexual networks than other women. Chlamydia prevalence was found to be higher among bisexually active women, and homosexually active women reported fewer medical consultations for gynecological reasons. These analyses highlight the need to deconstruct the binary classification of homosexual versus heterosexual women. Because of constraint by the monogamous heterosexual norm, bisexually active women were less likely to be tested for sexually transmitted infections, and homosexually active women were less likely to have had gynecological follow-ups.

Sexual risk-taking following relationship break-ups

Background Changes in sexual behaviour over time have resulted in more frequent relationship break-ups, which carry specific sexual health challenges that we aim to explore in this study. Study design The data were drawn from the French sexual behaviour survey, comprising a random sample of 4,798 women and 4,045 men aged 18–44 years. Logistic regression models were used to describe the associations between recent relationship break-ups and reported sexually transmitted infections and abortions over the same period, and being tested positive for Chlamydia at the time of the survey. Results Respondents who had experienced a break-up in the last five years (32% of women and 35% of men among respondents who were sexually active in the last five years) were more likely to report an abortion during the same time period (9% vs.5%, pu200a<u200a0.001) and to be tested positive for Chlamydia at the time of interview (3% vs. 1%, pu200a=u200a0.003), especially those aged 30–44. Women were less likely than men to have used a condom with a new partner after the separation (76% vs. 82%, pu200a=u200a0.005), which suggests gender asymmetry in preventive issues following a break-up. Conclusions This study shows that relationship dissolution is associated with higher sexual risk taking, especially among middle-aged adults.

La vie sexuelle après une rupture conjugale. Les femmes et la contrainte de l’âge

Most research on the period following divorce focuses on repartnering. This paper, which uses data from the 2001 ANRS-KABP AIDS survey, looks into a phase prior to repartnering : the pursuit of sexual and dating relationships. Among the persons aged 25 to 54 who had experienced a conjugal separation in the previous five years, four in five had had at least one new sexual partner who, in half of all cases, was already in a relationship with someone else. Men find a first new partner, followed by a second, more quickly than women. Moreover, women over 35 find a new partner less quickly and less often than women under 35. The duration of the previous partnership thus appears to be a handicap for women, while this is not the case for men.