Background: Pakistanis are the second largest ethnic minority group in the UK. However, there is a paucity of sexual health research among this group. In contrast to their parents’ generation, other South Asians are beginning to have premarital (sexual) relationships. This change may be occurring among young Pakistanis. In this thesis I explore social and cultural influences on the relationships and sexual behaviours of Pakistani youth, in order to determine whether there is unmet sexual health need. Methods: I analysed data from the second National Survey of Sexual Attitudes & Lifestyles (Natsal-2), exploring attitudes, learning about sex and first sexual experiences among Pakistanis (n=365). I then carried out thirty in-depth interviews with young Pakistanis and community workers to explore key life issues and implications for relationships and sexual behaviour. Findings: In Natsal-2, Pakistanis reported more conservative sexual attitudes than other groups, e.g. many saw premarital sex as wrong. They were also more likely to be married at first sex. Yet two-thirds of Pakistani men also reported being in non-marital relationships at this time, suggesting attitudes are not necessarily consonant with behaviour. The in-depth interviews found that premarital relationships are commonplace among youth, but due to social and cultural constraints, are conducted in secrecy. Young Pakistanis strive to maintain individual and cultural reputation. There were gender differences in perceptions, relationship types and vulnerability to sexual health risk. Sexual health knowledge was poor and few had access to support. Conclusions: Contrary to faith and cultural norms, premarital relationships do occur among Pakistani youth. The secrecy of these relationships and the pressures and complex gender roles they negotiate mean that some young Pakistanis are at risk of poor sexual health. This has implications for the delivery of appropriate preventative and curative services, which should encompass a broad understanding of sexual health and risk
