Research Impact


UCL-led survey helps shape UK sexual health policy

The National Surveys of Sexual Attitudes and Lifestyles (Natsal), carried out every decade by a UCL-led team, have helped shape UK sexual health policy, notably around chlamydia, HPV and HIV.

Illustrated side profiles of people facing each other.

12 April 2022

The emergence of the HIV epidemic in the 1980s prompted UCL’s Professor Dame Anne Johnson to begin the first ever survey to gain an insight into the sexual health of a nation. Today, the National Surveys of Sexual Attitudes and Lifestyles (Natsal) are internationally renowned, the largest studies of their kind, and have contributed widely to understanding and improving the sexual health of people living in Britain – as well as inspiring other national sex surveys.

Professors Cath Mercer and Pam Sonnenberg now lead the Natsal study from UCL as joint Principal Investigators, joined by Professors Andrew Copas and Nigel Field. 

A contemporary picture of British sexual behaviour 

Through interviews with more than 45,000 men and women, representing a cross-section of society, the UCL surveys have gathered data every ten years since 1990. They have captured a contemporary picture of the British population’s sexual behaviour, lifestyles and attitudes and tracked changes across the generations.

Natsal findings have provided evidence to open up public dialogue about sex, informed strategies to improve sexual health, supported the work of charities and shaped changes to clinical practice and service delivery. 

Preventing HIV infections  

Natsal was initiated in response to the emerging HIV epidemic and has informed mathematical models of the burden of HIV, as well as national HIV prevention efforts, such as campaigns to increase testing.  

Most recently, the roll-out of pre-exposure prophylaxis (PrEP) for men at high risk of infection, have also depended on Natsal. An NIHR-funded analysis showed, using the survey’s data, that PrEP could result in a £1 billion cost saving and cut 25% of HIV infections within 15 years, proving that it would be cost-effective.  

Extending HPV vaccination  

Human papilloma virus (HPV), which increases the risk of cervical cancer, has been shown by Natsal to be the most common sexually transmitted infection (STI) in Britain. The Department of Health’s decision to extend HPV vaccination to both men who have sex with men and adolescent boys was informed by Natsal – for example, data on who was having sex with whom by age and gender.

Modelling using Natsal data proved that vaccination would keep infections in check and be cost-effective, and has since informed HPV policy in other countries. 

Screening of STIs and chlamydia 

The unique big picture perspective that Natsal provides has shaped national screening programmes for STIs, such as the National Chlamydia Screening Programme (NCSP). The surveys have also shed light on social inequalities – revealing that there is a high prevalence of chlamydia in women from deprived areas and that there is a greater burden of poor sexual health among ethnic minorities.

This has contributed to recommendations by sexual health charity The Terrence Higgins Trust and the British Association for Sexual Health and HIV, calling on commissioners to translate the evidence into targeted preventative action as part of sexual health services. 

Statutory sex and relationship education 

The Natsal surveys have also shaped sex and relationship education in schools. They have provided the evidence that led the Education Select Committee to conclude sex education should be statutory.

Natsal has also contributed to public conversations about sex, including through sexual health charity resources for the public, a popular science book and a Wellcome Collection exhibition. 

Research synopsis

National Surveys of Sexual Attitudes and Lifestyles health survey shapes policy, health and sex education. 

The National Surveys of Sexual Attitudes and Lifestyles (Natsal), which are carried out every decade by a multi-institutional team led by Professor Anne Johnson, have provided critical evidence to shape sexual health policy and practice, including national screening for chlamydia, HPV vaccination and the prevention and control of HIV. 



  • Image credit: Illustration by Studio Imeus