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Silhol R, Nordsletten A, Maheu-Giroux M, Elmes J, Staunton R, Owen B, Shacklett B, McGowan I, Feliciano KG, van der Straten A, Eller LA, Robb M, Marrazzo J, Dimitrov D, Boily MC. The Association Between Heterosexual anal Intercourse and HIV Acquisition in Three Prospective Cohorts of Women. AIDS Behav 2023; 27:4010-4021. [PMID: 37392271 PMCID: PMC10598156 DOI: 10.1007/s10461-023-04115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
The extent to which receptive anal intercourse (RAI) increases the HIV acquisition risk of women compared to receptive vaginal intercourse (RVI) is poorly understood. We evaluated RAI practice over time and its association with HIV incidence during three prospective HIV cohorts of women: RV217, MTN-003 (VOICE), and HVTN 907. At baseline, 16% (RV 217), 18% (VOICE) of women reported RAI in the past 3 months and 27% (HVTN 907) in the past 6 months, with RAI declining during follow-up by around 3-fold. HIV incidence in the three cohorts was positively associated with reporting RAI at baseline, albeit not always significantly. The adjusted hazard rate ratios for potential confounders (aHR) were 1.1 (95% Confidence interval: 0.8-1.5) for VOICE and 3.3 (1.6-6.8) for RV 217, whereas the ratio of cumulative HIV incidence by RAI practice was 1.9 (0.6-6.0) for HVTN 907. For VOICE, the estimated magnitude of association increased slightly when using a time-varying RAI exposure definition (aHR = 1.2; 0.9-1.6), and for women reporting RAI at every follow-up survey (aHR = 2.0 (1.3-3.1)), though not for women reporting higher RAI frequency (> 30% acts being RAI vs. no RAI in the past 3 months; aHR = 0.7 (0.4-1.1)). Findings indicated precise estimation of the RAI/HIV association, following multiple RVI/RAI exposures, is sensitive to RAI exposure definition, which remain imperfectly measured. Information on RAI practices, RAI/RVI frequency, and condom use should be more systematically and precisely recorded and reported in studies looking at sexual behaviors and HIV seroconversions; standardized measures would aid comparability across geographies and over time.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK.
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
| | - Ashley Nordsletten
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Jocelyn Elmes
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Roisin Staunton
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Branwen Owen
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, USA
| | - Ian McGowan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ariane van der Straten
- Center for AIDS Prevention studies, University of California, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Leigh Anne Eller
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Merlin Robb
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dobromir Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Hospital, 2 Norfolk Place, London, W2 1PG, UK
- HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
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Gaither TW, Siapno AED, Kianian R, Vincent N, Williams KC, Piquerias E, Russell MM, Litwin MS. Relationship between pelvic sensations and lifetime exposure to receptive anal intercourse among people with prostates. J Sex Med 2023; 20:1195-1205. [PMID: 37548267 DOI: 10.1093/jsxmed/qdad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals' sexual and relationship health. No large studies have previously looked at specific sensations experienced during RAI and how these sensations may change with experience. AIM In this study we aimed to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience of RAI. METHODS An internet survey was conducted on sensations felt during RAI among people with prostates from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data were stratified by lifetime exposure to RAI. OUTCOMES The primary outcomes assessed included the quantification of both the primary sensations experienced during RAI and the associated bother. RESULTS In total, 975 participants completed the survey. The median age was 32 (range 18-78) years. The average age of first participation in RAI was 21 ± 6.6 years. Most respondents were having sex at least once a week (65%). Nine percent of respondents reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 to >500 exposures), the reported frequency of pleasurable sensation increased from 41% to 92% (P < .0001), whereas severe insertional pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively (P < .0001). Urinary urgency sensation did not differ by lifetime RAI experience. CLINICAL IMPLICATIONS Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may differ by lifetime RAI exposure. STRENGTHS AND LIMITATIONS This is the first study to our knowledge to assess pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change over time among individuals. Internet-based participants may not be representative of clinical populations. CONCLUSION Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Allen E D Siapno
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Reza Kianian
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | | | - Kristen C Williams
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Eduardo Piquerias
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Marcia M Russell
- Department of Surgery, Section of Colorectal Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
- Surgical and Perioperative Careline, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Morhason-Bello IO, Mitchell K, Jegede AS, Adewole IF, Francis SC, Watson-Jones D. Heterosexual Oral and Anal Sex: Perceptions, Terminologies, and Attitudes of Younger and Older Adults in Ibadan, Nigeria. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:161-175. [PMID: 36123563 PMCID: PMC9484716 DOI: 10.1007/s10508-022-02313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 05/24/2023]
Abstract
Although heterosexual oral and anal sexual behaviors have been reported in sub-Saharan Africa, little is known about how they are understood and perceived, particularly, in West Africa. We undertook a qualitative exploration of local terminologies and sexual scripts associated with heterosexual oral and anal sex in preparation for a quantitative survey. We held focus group discussions (18) and interviews (44) with younger and middle-aged men and women from the general population and female sex workers (FSWs) in selected communities in Ibadan. Most participants had heard of oral and anal sex. Younger adults aged 18-25 years, particularly male participants and FSWs, appeared more informed than older adults in the general population. Sexually explicit movies were the most cited source of information. Oral and anal sexual behaviors were considered sensitive, with different local names, meanings, and interpretations. Participants advised against the use of slang terms in research. We identified six different scripts employed by participants in discussing oral and anal sex practices: protecting sexual relationship, financial reward, an alternative to vaginal sex, pleasure, male dominance and control, and risk, stigma, and disgust.
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Affiliation(s)
- Imran O Morhason-Bello
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kirstin Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ayodele S Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Isaac F Adewole
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Affiliation(s)
- Tabitha Gana
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Lesley M Hunt
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
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Owen BN, Baggaley RF, Maheu-Giroux M, Elmes J, Adimora AA, Ramirez C, Edmonds A, Sosanya K, Taylor TN, Plankey M, Cederbaum JA, Seidman D, Weber KM, Golub ET, Wells J, Bolivar H, Konkle-Parker D, Pregartner G, Boily MC. Longitudinal determinants of anal intercourse among women with, and without HIV in the United States. BMC Womens Health 2022; 22:291. [PMID: 35836248 PMCID: PMC9284855 DOI: 10.1186/s12905-022-01849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV. METHODS 3708 women living with (73%), and without HIV (27%) participating in the Women's Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994-2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI. RESULTS AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96-0.98), Hispanic (aOR = 1.88, CI:1.47-2.41) or White (aOR = 1.62, CI:1.15-2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08-1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10-1.62), or both (aOR = 1.77, CI:1.13-2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05-1.66) or any drug use (aOR = 1.34, CI:1.09-1.66), multiple male partners (aOR = 2.64, CI:2.23-3.11), exchange sex (aOR = 3.45, CI:2.53-4.71), one or more female sex partners (aOR = 1.32, CI:1.01-1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53-2.09), and high depressive symptoms (aOR = 1.23, CI:1.08-1.39). CONCLUSION AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.
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Affiliation(s)
- Branwen Nia Owen
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, Praed Street, London, W2 1NY, UK.
| | - Rebecca F. Baggaley
- grid.9918.90000 0004 1936 8411Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK
| | - Mathieu Maheu-Giroux
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics, and Occupational Health, School of Global and Population Health, McGill University, Montreal, Canada
| | - Jocelyn Elmes
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, Imperial College London, St Mary’s Campus, Norfolk Place, Praed Street, London, W2 1NY UK ,grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Adaora A. Adimora
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Catalina Ramirez
- grid.10698.360000000122483208Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Andrew Edmonds
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Kemi Sosanya
- grid.240283.f0000 0001 2152 0791Montefiore Medical Center Bronx, New York, NY USA
| | - Tonya N. Taylor
- grid.262863.b0000 0001 0693 2202Department of Medicine, Division of Infectious Disease, SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Michael Plankey
- grid.411667.30000 0001 2186 0438Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, D.C., USA
| | - Julie A. Cederbaum
- grid.42505.360000 0001 2156 6853Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | - Dominika Seidman
- grid.266102.10000 0001 2297 6811Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA USA
| | - Kathleen M. Weber
- grid.280773.90000 0004 0614 7142Cook County Health/Hektoen Institute of Medicine, Chicago, IL USA
| | - Elizabeth T. Golub
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jessica Wells
- grid.189967.80000 0001 0941 6502Neil Hodson Woodruff School of Nursing, Emory University, Atlanta, GA USA
| | - Hector Bolivar
- grid.26790.3a0000 0004 1936 8606Division of Infectious Diseases, University of Miami-Miller School of Medicine, Miami, Fl USA
| | - Deborah Konkle-Parker
- grid.410721.10000 0004 1937 0407Department of Medicine, University of Mississippi Medical Center, Jackson, MS USA
| | - Gudrun Pregartner
- grid.11598.340000 0000 8988 2476Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Marie-Claude Boily
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, Imperial College London, St Mary’s Campus, Norfolk Place, Praed Street, London, W2 1NY UK ,grid.7445.20000 0001 2113 8111MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
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Hensel DJ, von Hippel CD, Lapage CC, Perkins RH. Women’s techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18–93. PLoS One 2022; 17:e0268785. [PMID: 35767540 PMCID: PMC9242470 DOI: 10.1371/journal.pone.0268785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/04/2022] [Indexed: 11/26/2022] Open
Abstract
The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 40% of women find ‘Anal Surfacing’ pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using ‘Anal Shallowing’: penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using ‘Anal Pairing’: touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.
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Affiliation(s)
- Devon J. Hensel
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana, United States of America
- OMGYES Research Group, For Goodness Sake LLC, Berkeley, California, United States of America
- * E-mail:
| | | | - Charles C. Lapage
- OMGYES Research Group, For Goodness Sake LLC, Berkeley, California, United States of America
| | - Robert H. Perkins
- OMGYES Research Group, For Goodness Sake LLC, Berkeley, California, United States of America
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Faustino MJ, Gavey N. "You Feel Like Normal Sex is not Enough Anymore": Women's Experiences of Coercive and Unwanted Anal Sex with Men. Violence Against Women 2021; 28:2624-2648. [PMID: 34913380 DOI: 10.1177/10778012211045716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we explore the gendered dynamics of coercion described by 18 women we interviewed about their experiences of unwanted and nonconsensual heterosexual anal sex. Several women referred to what they believed to be the normative status of heterosexual anal sex. In many cases, the socially coercive effects of perceived norms intertwined with threads of interpersonal coercion, leaving women feeling pressured to agree to, or little room to refuse, anal sex they did not want. We discuss the ways that new sexual norms can translate into new pressures for women within the gendered framework of heterosexual relationships.
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Affiliation(s)
- Maria João Faustino
- Te Kura Mātai Hinengaro, School of Psychology, Te Whare Wānanga o Tāmaki Makaurau, 1415The University of Auckland, Auckland, New Zealand
| | - Nicola Gavey
- Te Kura Mātai Hinengaro, School of Psychology, Te Whare Wānanga o Tāmaki Makaurau, 1415The University of Auckland, Auckland, New Zealand
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Meuwly M, Auderset D, Stadelmann S, Suris JC, Barrense-Dias Y. Anal Intercourse among Heterosexual Young Adults: A Population-Based Survey in Switzerland. JOURNAL OF SEX RESEARCH 2021; 58:1061-1068. [PMID: 33428468 DOI: 10.1080/00224499.2020.1866481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Anal intercourse (AI) among heterosexuals is an understudied and taboo subject. This 2017 Swiss national study aimed to describe the characteristics and motivations of heterosexual young adults practicing AI. Participants with any same-sex experience, same-sex attraction or non-heterosexual identity were excluded. The Federal Statistical Office provided the initial sample and potential participants were recruited through postal mail inviting them to an online survey (response rate 15.1%). The sample comprised 3892 participants (52% males; 54% of the overall sample, mean age 26.3 years). Overall, 55% of women and 56% of men had never experienced AI, 17% and 12% had done it once and 28% and 32% more than once, respectively. We found that participants engaging in AI had higher odds of practicing intercourse while intoxicated, being younger at first sexual experience, not using a condom at last intercourse and reporting a history of sexual transmitted infections. The main reason reported by both genders for engaging in their first AI was being curious followed by being in love. In conclusion, AI is a widespread practice among heterosexual young adults and health professionals should be especially attentive to it.
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Affiliation(s)
- Marion Meuwly
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Diane Auderset
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Sophie Stadelmann
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Joan-Carles Suris
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
| | - Yara Barrense-Dias
- Department of Epidemiology and Health Systems, Research Group on Adolescent Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne
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Faustino MJ. Representations of heterosexual anal sex in Cosmopolitan magazine. CULTURE, HEALTH & SEXUALITY 2021; 23:1050-1065. [PMID: 32463331 DOI: 10.1080/13691058.2020.1755453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
Anal sex has been the object of unprecedented recent media visibility; however, media discourses of anal sex are still largely unstudied. This study explores the representations of anal sex in Cosmopolitan, available online on the magazine's website. Anal sex, mostly equated with heterosexual anal intercourse, is presented as trendy and popular, as well as potentially pleasurable and intimate. The articles pervasively characterise anal sex as a sexual activity that demands preparation, providing women with tips and techniques allegedly indispensable for a safe and pleasurable (or at least painless) practice of anal sex. The discourses offered are deeply gendered, however, picturing anal sex as a male obsession, and sometimes an expression of power and male conquest. Women's own experiences are portrayed in a more nuanced and heterogeneous way, combining narratives of pleasure and pain, personal initiative and coercion. Although women's individual right to refuse anal sex is often stressed, male pressure is naturalised, and certain dimensions of constraint in heterosexual interaction are normalised.
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Stewart J, Douglas G, O'Rourke T, Gammel C. Promoting safer sex in the context of heterosexual anal intercourse: A scoping review. J Clin Nurs 2021; 30:2111-2130. [PMID: 33377555 DOI: 10.1111/jocn.15628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/28/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES To locate and summarise existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies. BACKGROUND Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many healthcare providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population. DESIGN The study was based on Arksey and O'Malley's 2005 five-step methodology. METHODS A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990-2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA-ScR guideline criteria (File S1). RESULTS The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n = 26) in addition to sexually transmitted infection risks (n = 26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n = 6), factors that influence heterosexual anal intercourse (n = 10) and health promotion strategies for this population and practice (n = 4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included. CONCLUSIONS Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might use for encouraging safer sex in this population. RELEVANCE TO CLINICAL PRACTICE Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses' harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long-term sequelae.
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Affiliation(s)
- Joanne Stewart
- College and Community Health Centre, Alberta Health Services, Grande Prairie, AB, Canada
| | - Gillian Douglas
- Beaverlodge Community Health Services, Alberta Health Services, Beaverlodge, AB, Canada
| | - Tammy O'Rourke
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Carolyn Gammel
- Grande Prairie College & Community Health Centre, Alberta Health Services, Grande Prairie, AB, Canada
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Westmoreland DA, Gorbach P, Holloway IW, Arah OA, Javanbakht M. Individual and Partnership Factors Associated with Heterosexual Anal Intercourse Among Attendees of Public Sexually Transmitted Disease Clinics in Los Angeles County. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:347-358. [PMID: 33175271 PMCID: PMC7880871 DOI: 10.1007/s10508-020-01831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 07/25/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
Heterosexual anal intercourse (HAI) is an understudied sexual behavior and poses unique challenges to the prevention of sexually transmitted diseases (STDs). This study aimed to explore individual and partnership characteristics associated with HAI. This study used data collected from 243 young people who attended STD clinics in Los Angeles County between April 2012 and May 2014. Participants reported on sexual behaviors with their last three sexual partners. Hierarchical, mixed effects, repeated-measures analyses were used to assess partner-level (demographic) and individual-level (demographic and behavioral) factors associated with recent (past 6 months) HAI. Thirty-two percent of participants (n = 243) reported HAI with at least one recent sex partner, and 49% reported ever having anal intercourse (AI). After adjusting for demographic characteristics, HAI was more than twice as likely to occur in relationships (n = 503) lasting more than a year compared to relationships lasting less than one month. HAI was also more likely to occur in relationships where intimate partner violence (IPV) was reported either as IPV initiated by the respondent (aOR = 2.18, 95% CI 1.08-4.41) or IPV initiated by the partner (aOR = 2.38, 95% CI 1.27-4.47). Among our participants, a substantial proportion reported HAI in the recent past 6 months and nearly half reported lifetime AI. Notably, our results indicate the importance of relationship contexts for people engaging in HAI and highlight the increased risk of STD/HIV transmission in the context of relationships with intimate partner violence victimization and perpetration.
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Affiliation(s)
- Drew A Westmoreland
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
- Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, Room 626, New York, NY, 10027, USA.
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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12
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Reynolds GL, Fisher DG, Erlyana E, Otterloo LV. Rectal douching in a community sample of men and women. Int J STD AIDS 2020; 31:1082-1092. [PMID: 32914687 DOI: 10.1177/0956462419837483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rectal douching (RD) may be a vector for sexually transmitted infection (STI) acquisition. The aim of this study was to describe the relationship between RD, and the prevalence of various STIs and sexual behaviors in a sample of women and men in Long Beach, California. Five hundred and forty-seven men (mean age 42.8 years) and 530 women (mean age 37 years) recruited from a community-based setting between April 2010 and August 2014 completed the Risk Behavior Assessment and a questionnaire eliciting information on use of lubricants and enemas for vaginal intercourse (VI) and anal intercourse (AI). Participants were screened for high-risk behaviors for human immunodeficiency virus infection including injection drug use. Bivariate analyses were conducted separately for women and men. Based on the empirical results, separate logistic regression models for women and men were constructed. Sensitivity analysis was conducted to assess model fit for reduced samples of only those men and women who reported AI. For men, RD was associated with a lower odds of being hepatitis C antibody positive, greater odds of being positive for hepatitis B virus surface antigen, syphilis, and using lubricants for receptive anal intercourse (RAI). RD in women was associated with higher odds of a positive test for syphilis, ever vaginally douching for VI, and using lubricants for RAI. Men and women who practice RD report positive syphilis test results and use of lubricants for RAI. RD should not be perceived as preventing STIs.
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Affiliation(s)
- Grace L Reynolds
- Department of Health Care Administration, Center for Behavioral Research and Services, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA
| | - Dennis G Fisher
- Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Department of Health Care Administration, California State University, Long Beach, CA, USA
| | - Erlyana Erlyana
- Department of Health Care Administration, Center for Behavioral Research and Services, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA
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13
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Elmes J, Silhol R, Hess KL, Gedge LM, Nordsletten A, Staunton R, Anton P, Shacklett B, McGowan I, Dang Q, Adimora AA, Dimitrov DT, Aral S, Handanagic S, Paz-Bailey G, Boily MC. Receptive anal sex contributes substantially to heterosexually acquired HIV infections among at-risk women in twenty US cities: Results from a modelling analysis. Am J Reprod Immunol 2020; 84:e13263. [PMID: 32384198 DOI: 10.1111/aji.13263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
PROBLEM Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear. METHOD OF STUDY We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAFRAI ) accounting for uncertainty in parameter assumptions. RESULTS Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAFRAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts. CONCLUSION Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections.
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Affiliation(s)
- Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lukyn M Gedge
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Ashley Nordsletten
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Roisin Staunton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Peter Anton
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA
| | - Ian McGowan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Que Dang
- Vaccine Research Program, Division of AIDS, NIAID, Rockville, NIH, MD, USA
| | - Adaora A Adimora
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dobromir T Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sevgi Aral
- Division of Sexually Transmitted Disease Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,HPTN Modelling Centre, Imperial College London, London, UK
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14
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Wignall L, Scoats R, Anderson E, Morales L. A qualitative study of heterosexual men's attitudes toward and practices of receiving anal stimulation. CULTURE, HEALTH & SEXUALITY 2020; 22:675-689. [PMID: 31251120 DOI: 10.1080/13691058.2019.1627584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
This study examines the practice of and attitudes toward anal sexual stimulation among 30 heterosexual undergraduate men attending a UK university. While scientific and popular belief throughout the twentieth century has considered anal pleasure to be only for gay or gender non-conforming men, we find participants discuss such pleasure openly, and some have explored physically receiving anal pleasure. Participants did not stigmatise sexual pleasure derived from anal play, challenging cultural narratives that conflate anal receptivity with being gay. We document how ignorance around the best practices for anal sex may impede pleasure and the further exploration of sexual pleasure and highlight areas where sexual health and education interventions may be beneficial.
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Affiliation(s)
- Liam Wignall
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - Ryan Scoats
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Eric Anderson
- Department of Sport, Exercise and Health, Winchester University, Winchester, UK
| | - Luis Morales
- Department of Sport, Exercise and Health, Winchester University, Winchester, UK
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15
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Jones R, Hoover DR, Lacroix LJ, Garvey CM. Correlates of HIV Transmission Behaviors and HIV Testing in Predominately African American/Black Women with High-Risk Male Sex Partners. AIDS Behav 2020; 24:1876-1892. [PMID: 31834541 DOI: 10.1007/s10461-019-02762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study was conducted among predominately African American/Black women, aged 18-29, in Northeast cities with high HIV prevalence. Demographic, behavioral, and partner characteristics associated with condomless vaginal and anal sex acts with high-risk partners (CVS-HRP and CAS-HRP) and with HIV testing were explored. The high-risk sample was largely recruited online. Of 4972 women screened, 2254 (45.3%) were high-risk for HIV acquisition; 2214 were included. Bivariate and stepwise multivariate logistic regression models were fit. After adjusting for other factors, sex risk behavior did not differ by race and ethnicity. CAS-HRP was associated with believing condoms don't reduce HIV risk and with several high-risk behaviors, including; alcohol use, multiple partners, and sex with men who had sex with men, but, not with HIV testing. Half the sample had condomless sex with partners who never HIV tested and were themselves three times as likely to have never tested. These results point to the ongoing need for effective prevention strategies among at-risk heterosexual women.
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16
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Ezzell MB, Johnson JA, Bridges AJ, Sun CF. I (Dis)Like it Like That: Gender, Pornography, and Liking Sex. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:460-473. [PMID: 32342728 DOI: 10.1080/0092623x.2020.1758860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Rates of pornography consumption in the U.S. are high and increasing. With exploratory aims, this study addresses the questions: What is the association between pornography consumption and liking of sexual behaviors commonly depicted in pornography, and is enjoyment moderated by gender? Sexual scripts theory suggests that increased pornography consumption is associated with increased engagement in pornographic sex acts, but it does not speak to enjoyment of the acts when engaged. The current study seeks to fill that gap. Based on data collected from a larger sample of 1,883 heterosexual men and women (predominantly, 86.6%, college or university students) in the U.S., and comparing correlations between pornography consumption (frequency of use) and reported enjoyment of a range of sexual behaviors by gender using Fisher's z transformations (α value set at <.0025), analysis revealed that pornography consumption, overall, was not significantly correlated with increased enjoyment of the sexual acts that comprise the pornographic sexual script. However, gender was a significant moderating factor in the enjoyment, specifically, of degrading and/or uncommon acts. Male respondents were significantly more likely to report enjoying these acts than their female counterparts. These findings have possible implications for consumers, educators, and mental health professionals.
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Affiliation(s)
- Matthew B Ezzell
- Department of Sociology and Anthropology, James Madison University, Harrisonburg, VA, USA
| | - Jennifer A Johnson
- Department of Sociology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Chyng F Sun
- School of Professional Studies, New York University, New York, NY, USA
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17
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Stannah J, Silhol R, Elmes J, Owen B, Shacklett BL, Anton P, McGowan I, van der Straten A, Dimitrov D, Baggaley RF, Boily MC. Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis. AIDS Behav 2020; 24:667-681. [PMID: 31486008 PMCID: PMC7018785 DOI: 10.1007/s10461-019-02651-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03–2.38, N = 18, I2 = 72%; pooled aRR = 2.23, 1.01–4.92, N = 5, I2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI.
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18
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Scheidell JD, Dyer TP, Severe M, Tembunde YE, Young KE, Khan MR. Childhood Traumatic Experiences and Receptive Anal Intercourse Among Women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:23-30. [PMID: 32096340 PMCID: PMC8034482 DOI: 10.1363/psrh.12129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/01/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Receptive anal intercourse (RAI), which has become increasingly common among U.S. heterosexual women, is associated with STDs, including HIV, when it is unprotected and coercive. Childhood traumatic experiences may increase sexual risk behavior, but the relationship between childhood trauma and RAI among women has not been examined. METHODS Data from 4,876 female participants in Waves 1 (1994-1995), 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between nine self-reported childhood traumas (neglect; emotional, physical and sexual abuse; parental binge drinking and incarceration; and witnessing, being threatened with and experiencing violence) and RAI during adulthood using modified Poisson regression analysis. Whether depression, low self-esteem, drug use, relationship characteristics or sex trade involvement mediated the relationship between trauma and RAI was also explored. RESULTS Forty percent of the sample reported having engaged in receptive anal intercourse. After adjustment for sociodemographic characteristics, eight of the nine childhood traumas were associated with increased risk of RAI (adjusted prevalence ratios, 1.2-1.5); the strongest association was with experience of violence. Each unit increase in the number of traumas yielded a 16% increase in RAI prevalence. In mediation analyses, only drug use and relationship factors slightly attenuated the association between childhood trauma and RAI (1.2 for each). CONCLUSIONS Women with a history of childhood trauma may be at increased risk of engaging in RAI, highlighting the importance of screening and trauma-informed education in sexual health settings. Pathways linking childhood trauma and RAI among women are complex and warrant further research.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University School of Medicine, New York
| | - Typhanye P Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park
| | - MacRegga Severe
- Department of Population Health, New York University School of Medicine, New York
| | - Yazmeen E Tembunde
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park
| | - Kailyn E Young
- Department of Population Health, New York University School of Medicine, New York
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York
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19
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McBride KR. Examining Heterosexual Women's Anal Sexual Health Knowledge and Product Use. JOURNAL OF SEX RESEARCH 2019; 56:1070-1082. [PMID: 29746181 DOI: 10.1080/00224499.2018.1467368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prevalence rates indicate that receptive anal sex is increasingly part of heterosexual women's sexual repertoire. However, there is a body of literature linking this behavior to risk for adverse sexual health outcomes. Women's anal sexual health knowledge and awareness of behaviors associated with elevated risk have received less attention in the research literature. The aim of the current study was to examine anal sexual health knowledge and product use among heterosexual women aged 18 to 30 years. A total of 33 self-identified heterosexual women recruited from the general population participated in one of six focus groups. The results suggest that knowledge was variable. Salient sexual health themes centered on risks of human immunodeficiency virus/sexually transmitted infections (HIV/STIs), other infections, and physical harm/damage. Product-use themes included cleanliness/hygiene, comfort, and product safety. Participants expressed the desire for anal sexual health education. The results have implications for sexual health research, education, and clinical practice.
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Affiliation(s)
- Kimberly R McBride
- School of Population Health
- Health Disparities Research Collaborative, University of Toledo
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20
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Dobard CW, Makarova N, West-Deadwyler R, Taylor A, Dinh C, Martin A, Lipscomb J, Mitchell J, Khalil G, Garcia-Lerma G, Heneine W. Efficacy of Vaginally Administered Gel Containing Emtricitabine and Tenofovir Against Repeated Rectal Simian Human Immunodeficiency Virus Exposures in Macaques. J Infect Dis 2019; 218:1284-1290. [PMID: 29788316 DOI: 10.1093/infdis/jiy301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 01/09/2023] Open
Abstract
Vaginal microbicides containing antiretrovirals (ARVs) have shown to prevent vaginally acquired human immunodeficiency virus (HIV), but these products may not protect women who engage in anal sex. Intravaginal dosing with ARVs has shown to result in drug exposures in rectal tissues, thus raising the possibility of dual compartment protection. To test this concept, we investigated whether intravaginal dosing with emtricitabine (FTC)/tenofovir (TFV) gel, which fully protected macaques against repeated vaginal exposures to simian human immunodeficiency virus (SHIV), protects against rectal SHIV exposures. Pharmacokinetic studies revealed rapid distribution of FTC and TFV to rectal tissues and luminal fluids, albeit at concentrations 1-2 log10 lower than those in the vaginal compartment. Efficacy measurements against repeated rectal SHIV challenges demonstrated a 4.5-fold reduction in risk of infection in macaques that received intravaginal FTC/TFV compared to placebo gel (P = .047; log-rank test). These data support the concept of dual compartment protection by vaginal dosing and warrants developing ARV-based vaginal products with improved bidirectional dosing.
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Affiliation(s)
- Charles W Dobard
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalia Makarova
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rolieria West-Deadwyler
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chuong Dinh
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Martin
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Lipscomb
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Mitchell
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George Khalil
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gerardo Garcia-Lerma
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walid Heneine
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Benson LS, Gilmore KC, Micks EA, McCoy E, Prager SW. Perceptions of Anal Intercourse Among Heterosexual Women: A Pilot Qualitative Study. Sex Med 2019; 7:198-206. [PMID: 30833227 PMCID: PMC6522939 DOI: 10.1016/j.esxm.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction More than one-third of women in the U.S. have engaged in heterosexual anal intercourse (HAI), but little is known regarding women’s perceptions of HAI and motivations for engaging in this sexual behavior. Aim This study aimed to explore U.S. women’s motivations for engaging in HAI and to investigate how they navigate HAI in the context of sexual relationships. Methods Semi-structured interviews were conducted with 20 women, ages 18–50 years old, who had engaged in anal intercourse with a male partner within the past 3 months. The interview guide was developed utilizing a conceptual framework based on the Theory of Planned Behavior. Main Outcome Measure Thematic content analysis was performed, and salient themes were identified. Results Salient themes were identified in all key components of the construct, including attitudes toward the behavior, subjective norms, and perceived behavioral control. Women’s intent to engage in HAI was influenced by their attitudes toward HAI and level of control and trust with their partners. Primary motivators were partner and personal pleasure and sexual curiosity and experimentation. Conclusion The Theory of Planned Behavior construct was well suited to explore factors influencing women’s intent to engage in HAI. Most women perceive negative societal norms toward HAI. Although this does not appear to affect intention to engage in HAI, it does affect disclosure of this sexual activity with friends and healthcare providers. It is important for healthcare providers to provide open, non-judgmental counseling regarding HAI to decrease stigma, enhance communication, and improve sexual health. Benson LS, Gilmore KC, Micks EA, et al. Perceptions of Anal Intercourse Among Heterosexual Women: A Pilot Qualitative Study. Sex Med 2019;7:198–206.
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Affiliation(s)
- Lyndsey S Benson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
| | - Kelly C Gilmore
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Elizabeth A Micks
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Erin McCoy
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Sarah W Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
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22
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McBride KR. Heterosexual Women's Anal Sex Attitudes and Motivations: A Focus Group Study. JOURNAL OF SEX RESEARCH 2019; 56:367-377. [PMID: 28796537 DOI: 10.1080/00224499.2017.1355437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Focus group methods were used to explore heterosexual women's receptive anal sex attitudes and motivations. Behaviors under investigation included penile-anal intercourse (PAI), manual-anal stimulation, oral-anal contact, and the use of sex toys. A total of 33 self-identified heterosexual women ages 18 to 30 recruited from two metropolitan areas in the Midwestern United States participated in one of six focus groups. The findings suggest that women viewed heterosexual anal sex as an emerging norm. Attitudes and motivations were complex and varied by behavior. Dominant themes included curiosity, pain, pleasure, and stigma. Relational factors, including acquiescence, coercion, and consent, were also salient among participants. Factors that influence anal sexual behaviors may not be entirely distinct from those that influence other sexual behaviors; however, factors that influence anal intercourse may be distinct from those that influence nonintercourse anal sex. Improved understanding will allow scientists to better understand the integration of anal sex behaviors into the broader sexual repertoire.
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Affiliation(s)
- Kimberly R McBride
- a School of Population Health , University of Toledo
- b Health Disparities Research Collaborative , University of Toledo
- c Department of Women's and Gender Studies , University of Toledo
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23
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Reynolds GL, Fisher DG. A latent class analysis of alcohol and drug use immediately before or during sex among women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:179-188. [PMID: 30359095 DOI: 10.1080/00952990.2018.1528266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Alcohol and drug use by women is related to high-risk sexual practices and protective behaviors. OBJECTIVES To determine sexual risk and protective behaviors using information about women's drug use immediately before or during sex. METHODS Latent class analysis using PROC LCA in SAS software was used to determine classes of women using both past 30-day drug use and before or during sex. Participants were recruited from a community-based research site located in a low socio-economic area of Los Angeles County and completed the Risk Behavior Assessment, which elicits information on drug and sex risk behaviors. RESULTS The Risk Behavior Assessment and HIV and sexually transmitted infections testing was obtained on 812 women. Five distinct groups were identified by PROC LCA: An Abstinent group comprised of 26% of participants; an Alcohol and Marijuana group (16%); an Amphetamine group (11%); a No Sex-with-Alcohol group (37%); and a Poly Drug group (11%). Multinomial logistic regression revealed that sexual behaviors and condom use were different across the five groups: The Alcohol and Marijuana group had a higher odds of vaginal intercourse, while the No Sex-with-Alcohol group was most likely to use condoms for vaginal intercourse. The Poly Drug group had the highest risk for anal intercourse while the Amphetamine and Poly Drug groups had high proportions of women with injection-drug using and men-who-have-sex-with-men sexual partners. CONCLUSION Identifying women based on drug use immediately before or during sex can help providers understand prevention and risk-reduction practices and interventions for drug-using women.
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Affiliation(s)
- Grace L Reynolds
- a Department of Health Care Administration , California State University , Long Beach , CA , USA.,b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA
| | - Dennis G Fisher
- b Center for Behavioral Research and Services , California State University , Long Beach , CA , USA.,c Psychology Department , California State University , Long Beach , CA , USA
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Baggaley RF, Owen BN, Silhol R, Elmes J, Anton P, McGowan I, van der Straten A, Shacklett B, Dang Q, Swann EM, Bolton DL, Boily MC. Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis. Am J Reprod Immunol 2018; 80:e13039. [PMID: 30175479 DOI: 10.1111/aji.13039] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022] Open
Abstract
Quantifying HIV-1 transmission risk per-act of anal intercourse (AI) is important for HIV-1 prevention. We updated previous reviews by searching Medline and Embase to 02/2018. We derived pooled estimates of receptive AI (URAI) and insertive AI (UIAI) risk unprotected by condoms using random-effects models. Subgroup analyses were conducted by gender, study design, and whether antiretroviral treatment (ART) had been introduced by the time of the study. Two new relevant studies were identified, one of which met inclusion criteria, adding three new cohorts and increasing number of individuals/partnerships included from 1869 to 14 277. Four studies, all from high-income countries, were included. Pooled HIV-1 risk was higher for URAI (1.25%, 95% CI 0.55%-2.23%, N = 5, I2 = 87%) than UIAI (0.17%, 95 % CI 0.09%-0.26%, N = 3, I2 = 0%). The sole heterosexual URAI estimate (3.38%, 95% CI 1.85%-4.91%), from a study of 72 women published in a peer-reviewed journal, was significantly higher than the men-who-have-sex-with-men (MSM) pooled estimate (0.75%, 95% CI 0.56%-0.98%, N = 4, P < 0.0001) and higher than the only other heterosexual estimate identified (0.4%, 95% CI 0.08%-2.0%, based on 59 women, excluded for being a pre-2013 abstract). Pooled per-act URAI risk varied by study design (retrospective-partner studies: 2.56%, 95% CI 1.20%-4.42%, N = 2 (one MSM, one heterosexual); prospective studies: 0.71%, 95% CI 0.51%-0.93%, N = 3 MSM, P < 0.0001). URAI risk was lower for studies conducted in the ART era (0.75%, 95% CI 0.52%-1.03%) than pre-ART (1.67%, 95% CI 0.44%-3.67%) but not significantly so (P = 0.537). Prevention messages must emphasize that HIV-1 infectiousness through AI remains high, even in the ART era. Further studies, particularly among heterosexual populations and in resource-limited settings, are required to elucidate whether AI risk differs by gender, region and following population-level ART scale-up.
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Affiliation(s)
- Rebecca F Baggaley
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Branwen N Owen
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Anton
- Department of Medicine, UCLA Center for HIV Prevention Research, David Geffen School of Medicine at UCLA, UCLA AIDS Institute, Los Angeles, California
| | - Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, California.,Division of Infectious Diseases, Department of Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Que Dang
- Vaccine Research Program, Division of AIDS, National Institutes of Health, Bethesda, Maryland
| | - Edith M Swann
- Vaccine Research Program, Division of AIDS, National Institutes of Health, Bethesda, Maryland
| | - Diane L Bolton
- U.S. Military HIV Research Program, The Henry M. Jackson Foundation, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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25
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Lubricant Use and Rectal Chlamydial and Gonococcal Infections Among Men Who Engage in Receptive Anal Intercourse. Sex Transm Dis 2017; 43:423-8. [PMID: 27322042 DOI: 10.1097/olq.0000000000000463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of lubricants during anal intercourse is very common among men who have sex with men. However, few studies have evaluated associations between specific lubricants and rectal sexually transmitted infections (STIs). METHODS Between July 2012 and October 2013, we conducted a cross-sectional study of men who have sex with men recruited from an urban, public sexual health clinic. In a self-administered survey, participants identified the lubricants used and frequency of lubricant use in the previous three months. Among men reporting any receptive anal intercourse (RAI) in the previous 3 months, we used multivariable binomial regression models to analyze associations between recent use of 9 specific lubricants and prevalent rectal chlamydia, rectal gonorrhea, and either rectal infection. RESULTS Twenty-five percent of the 146 participants had rectal chlamydial infection and 21% had rectal gonococcal infection; 37% had either (chlamydial or gonococcal) infection. Three-quarters reported always or almost always using lubricant during recent receptive anal intercourse. After adjustment for age, race, human immunodeficiency virus status, and condom use, Gun Oil (adjusted prevalence ratio [aPR], 1.99; 95% confidence interval [CI], 1.04-3.80) and Slick (aPR, 3.55; 95% CI, 1.38-9.12) were significantly associated with prevalent gonococcal infection. No lubricants were significantly associated with prevalent rectal chlamydia, but in analyses of either rectal infection, precum (aPR, 1.68; 95% CI, 1.06-2.66), Vaseline (aPR, 1.70; 95% CI, 1.10-2.64), and baby oil (aPR, 2.26; 95% CI, 1.43-3.57) were all significantly associated with prevalent rectal infection. CONCLUSIONS Several lubricants were significantly associated with increased prevalence of rectal STI. Longitudinal studies are needed to examine any causal relationship between specific lubricants and STI acquisition.
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26
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Projecting the impact of anal intercourse on HIV transmission among heterosexuals in high HIV prevalence settings. J Theor Biol 2017; 437:163-178. [PMID: 29080780 DOI: 10.1016/j.jtbi.2017.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/29/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
Whereas penile vaginal intercourse (VI) is thought to be the dominant mode of HIV transmission in sub-Saharan Africa, cross-sectional studies in the region indicate the preponderance of heterosexual anal intercourse (AI) among high activity groups. A dynamic, heterosexual core group model with risk of infection through both vaginal and anal pathways is formulated and comprehensively analysed. The model is coupled to a general population model and fitted to HIV prevalence data for Zimbabwe in order to explore the parameter space related to heterosexual AI. The model fit supports a core group size ranging between 5-20% and exposure risk to AI in excess of 50%. The control effort quantified by the reproductive number (RA) at commencement of the epidemic corresponds to R0=4.40. With the contribution of heterosexual AI to Zimbabwe's (and that of the sub-Saharan African region) epidemic unknown, the study apportioned infections between the two infection pathways. New infections due to VI ranged from 2-4.5% and 0.5-2.7% from heterosexual AI. The study estimates infection probabilities ranging from 0.15 to 0.35 for both receptive and infective AI. By quantifying the incidence due to VI and AI risks, we put emphasis on the necessity for targeted interventions. To project the potential impact of heterosexual AI in high HIV prevalence settings, we raised the core group size to 20% in the year 2010 coinciding with reported heterosexual AI prevalence outside of Africa and allowed the proportion of infection risk associated with AI to vary. Prevalence and incidence projections were made up to the year 2020 starting from a baseline value of zero exposure to AI transmission risk per sex act, progressively increasing exposure to 50% and 70% respectively. A 50% exposure to AI would result in HIV prevalence scaling up by 23% from the baseline values in year 2020. Increasing exposure to 70% was projected to increase HIV prevalence by 38% in year 2020. The HIV infection risks associated with AI are recognised and inform HIV policy for men who have sex with men, yet the same risks are ignored in HIV intervention programmes for heterosexuals. This study highlights the potential danger of increasing prevalence of heterosexual AI in settings with high HIV prevalence. Evolving and globally cross pollinating sexual behaviors compel for dovetailing HIV policy making with sexology.
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McBride KR, Sanders SA, Hill BJ, Reinisch JM. Heterosexual Women's and Men's Labeling of Anal Behaviors as Having "Had Sex". JOURNAL OF SEX RESEARCH 2017; 54:1166-1170. [PMID: 28276936 DOI: 10.1080/00224499.2017.1289362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study explored labeling of penile-anal intercourse (PAI), manual-anal (MA), and oral-anal (OA) behaviors as having "had sex" among heterosexual men and women with such experience residing in the United States (n = 3,218). Adult men and women completed an online questionnaire assessing sexual behaviors and whether each counted as having had sex. With the exception of anal intercourse, there was high variation in whether a behavior was labeled having had sex. There was not consensus on which anal sexual behaviors constituted having had sex, with attitudes varying across age, gender, and behavioral experience. Those who were older, male, and had the specific behavioral experience were more likely to label it as having had sex. Behaviorally specific assessments of the various anal behaviors as part of the sexual repertoire is critical to more accurate evaluation of sexual histories and assessment of risks to sexual health.
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Affiliation(s)
- Kimberly R McBride
- a School of Population Health , University of Toledo
- b Department of Women's and Gender Studies , University of Toledo
| | - Stephanie A Sanders
- c Department of Gender Studies , Indiana University , Bloomington
- d Kinsey Institute for Research in Sex, Gender, and Reproduction
| | - Brandon J Hill
- e Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology , University of Chicago
| | - June M Reinisch
- f Kinsey Institute for Research in Sex, Gender, and Reproduction , Bloomington
- g Institute of Preventive Medicine, Danish Epidemiological Science Center , University of Copenhagen; and Museum of Sex , New York City
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28
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Abstract
Anal intercourse is reported by many heterosexuals, and evidence suggests that its practice may be increasing. We estimated the proportion of the HIV burden attributable to anal sex in 2015 among heterosexual women and men in the United States. The HIV Optimization and Prevention Economics model was developed using parameter inputs from the literature for the sexually active U.S. population aged 13-64. The model uses differential equations to represent the progression of the population between compartments defined by HIV disease status and continuum-of-care stages from 2007 to 2015. For heterosexual women of all ages (who do not inject drugs), almost 28% of infections were associated with anal sex, whereas for women aged 18-34, nearly 40% of HIV infections were associated with anal sex. For heterosexual men, 20% of HIV infections were associated with insertive anal sex with women. Sensitivity analyses showed that varying any of 63 inputs by ±20% resulted in no more than a 13% change in the projected number of heterosexual infections in 2015, including those attributed to anal sex. Despite uncertainties in model inputs, a substantial portion of the HIV burden among heterosexuals appears to be attributable to anal sex. Providing information about the relative risk of anal sex compared with vaginal sex may help reduce HIV incidence in heterosexuals.
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Mazeingia YT, Olijjira L, Dessie Y. Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia. Glob Health Res Policy 2017; 2:27. [PMID: 29202095 PMCID: PMC5683548 DOI: 10.1186/s41256-017-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/20/2017] [Indexed: 11/15/2022] Open
Abstract
Background Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Method Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Result Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers’ misperception and risk anal sexual experience. Conclusion Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk reduction for female sex workers. Electronic supplementary material The online version of this article (doi:10.1186/s41256-017-0047-6) contains supplementary material, which is available to authorized users.
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Villar-Loubet O, Weiss SM, Marks G, O’Daniels C, Jones D, Metsch LR, McLellan-Lemal E. Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: implications for STI/HIV prevention. CULTURE, HEALTH & SEXUALITY 2016; 18:1221-1237. [PMID: 27268227 PMCID: PMC5030148 DOI: 10.1080/13691058.2016.1182217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Heterosexual anal intercourse is associated with increased risk for HIV and other sexually transmitted infections. Research on the social and psychological risk factors associated with heterosexual unprotected anal intercourse among Hispanic women in the USA is limited. We examined demographic, mental health, relationship power, sexual self-efficacy, self-esteem, acculturation and HIV knowledge as correlates of unprotected anal intercourse among 514 HIV-negative Hispanic women, 18 to 59 years of age, residing in one urban county in southern Florida. In both unadjusted and adjusted results, the likelihood of engaging in unprotected anal intercourse was associated with food insecurity in the past 30 days (adjusted odds ratio [AOR] = 1.57, 95% confidence interval [CI] 1.03, 2.40) and more interpersonal power attributed to the male partner (AOR = 1.63, 95%CI 1.08, 2.45). Not significant, yet of possible importance, were ever having engaged in exchange sex (AOR = 1.96, 95%CI = 0.97, 3.98) and lower HIV knowledge (AOR = 0.80, 95%CI = 0.63, 1.01). Interventions aimed at reducing heterosexual unprotected anal intercourse risk for HIV infection among Hispanic women may benefit by addressing socioeconomic and interpersonal issues, and assessing HIV knowledge and comprehension.
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Affiliation(s)
- Olga Villar-Loubet
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Gary Marks
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Christine O’Daniels
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
- Carter Consulting, Inc., Atlanta, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Eleanor McLellan-Lemal
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
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Condomless Anal Intercourse Among Males and Females at High Risk for Heterosexual HIV Infection. Sex Transm Dis 2016; 42:317-23. [PMID: 25970308 DOI: 10.1097/olq.0000000000000275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding and addressing heterosexual HIV transmission requires attention to the range and context of heterosexual sexual behaviors. We sought to determine population-based prevalence of condomless anal intercourse (CAI) among individuals at increased heterosexual HIV risk in Baltimore and to identify demographic, behavioral, and health-related correlates. METHODS Data were from a cross-sectional study of 185 males and 198 females at increased heterosexual risk for HIV recruited using respondent-driven sampling as part of Centers for Disease Control and Prevention's National HIV Behavioral Surveillance Project in Baltimore, August-December 2010. Bivariate and multivariate logistic regression examined factors associated with heterosexual CAI. RESULTS The sample was majority African American, with a mean age of 38 years among men and 34 years among women. Forty-two percent of men (95% confidence interval, 30.9%-52.0%) and 38% of women (95% confidence interval, 29.4%-47.2%) reported any CAI in the past year, with variance by partner type and sex. Among men, CAI was significantly associated with homelessness, casual and exchange partners, same-sex partner in past year, and substance use. Among women, CAI was significantly associated with lower education, casual and exchange partners, same-sex partner in past year, multiple partners, and substance use. In adjusted sex-specific models, males and females with increasing numbers of partners were more likely to engage in CAI. CONCLUSIONS It is important to recognize the efficiency of transmission of HIV and other sexually transmitted infections through CAI. There is a need to broaden heterosexual sexual health promotion and HIV/sexually transmitted infection prevention to adequately and appropriately address risks and prevention strategies for anal intercourse.
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