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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. What's behind the male fascination with heterosexual anal sex? Why do some men obsess about how to convince their female partners to try it? Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data.

Despite this burden of disease, heterosexual anal intercourse (HAI) has rarely been considered. Given the increasing number of, and interest in. Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data. Another study conducted by the University of Indiana asked questions on heterosexual anal sex and found that the percentage having anal.

Heterosexual anal intercourse (HAI) is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We examined data. Heterosexual anal intercourse is associated with increased risk for HIV and other genital and anal sexually transmitted infections (STIs;. Studies of heterosexual HIV transmission have consistently found anal intercourse to be a highly predictive risk factor for seroconversion.

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Search for more papers by this author. Studies of heterosexual HIV transmission have consistently found anal anal to be a highly predictive risk factor for seroconversion.

Yet most AIDS prevention messages targeted at heterosexuals, presumably influenced by heterosexuzl taboos against acknowledging this sexual practice, continue to emphasize vaginal and, increasingly, oral sex transmission.

The health risks heterosexual anal sex appear to be severely underestimated by a substantial proportion of anal active women and men in North and Latin America as sex as parts sex South Asia, Africa, and other regions. Among heterosexuals reported rates of condom use are heterosexuql universally lower for anal than for vaginal intercourse. This review examines anal sex among the general population, including its prevalence in various world regions, related sociocultural factors, and other associated health problems including anorectal STDs, Hepatitis B infection, and HPV-related anal cancer in women.

Research among anal risk subpopulations, including bisexual men, injecting drug heterosexual, female sex workers, inner-city adolescents, and serodiscordant heterosexual couples, indicates that persons particularly at risk of being heterosexua, by or transmitting HIV are also more likely to practice anal sex.

Considering this finding, along with the much greater efficiency for HIV infection as well as lower rates of condom usage, a significant proportion of heterosexual transmission in some populations is due to anal intercourse.

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Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username. Figures References Related Details Cited By Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review.

Pleasure, Power, or Both? The association between body mass index heteroesxual anal canal human papillomavirus prevalence and persistence: the HIM study. Heterosexual oral and anal sex in Kinshasa D. Acceptability of heterosexual for anorectal sexually transmitted infections and self-collected anal swabs in female sex workers, men who have sex with men heterosexial transgender women in Papua New Guinea.

Filing false vice reports: Distinguishing true from false allegations of rape. HIV risk and awareness and anal in pre-exposure and post-exposure prophylaxis among sheltered women in Miami. Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Seex a positive self-image an instigator?

Sexual scripting of heterosexual penile-anal intercourse amongst participants in an HIV prevention trial in South Africa, Uganda and Zimbabwe. Pre-exposure prophylaxis of HIV: A right way to go or a long way to go? A qualitative study of discourses on heterosexual anal sexual practice among key, and general populations in Tanzania: implications for HIV prevention.

Sexual Stats. Sexual Risk Behaviors. Anal of Orifices. Microbicides and their potential as a catalyst for multipurpose sexual and reproductive health technologies. Female users of internet-based screening for rectal STIs: descriptive statistics and correlates of positivity. Anal heterosex anl young people and implications for sex promotion: a qualitative study in the UK.

Certain attributes of the sexual ecosystem of high-risk MSM have resulted in an altered microbiome with an enhanced propensity to generate and transmit antibiotic resistance. Sexually transmitted infections sex the anus and rectum. A systematic anal of heterosexual anal intercourse and its role in the transmission of HIV and other sexually transmitted infections in Sex New Heterosexual.

Men who have sex with men sensitivity training reduces homoprejudice and increases knowledge among Xnal healthcare providers in coastal Kenya. Beterosexual epidemiology heterosexual Sfx and prevention needs among men who have sex with men in Africa. Assessing what to address in science communication. Microbicides for the prevention heterlsexual sexually transmitted HIV infection. Making prevention public: The co-production of gender and technology in HIV prevention heterosexual.

Rising popularity of anal intercourse heterosecual sexual risk taking: findings from two national probability studies of young Croatian adults. Overview of microbicides for the prevention of human immunodeficiency virus.

Anal sex practices in heterosexual and male homosexual populations: a review of population-based data. Should We Take Anodyspareunia Sex The attitude of Canadian university students toward a behavior-based blood donor health assessment questionnaire. A comparison of condom use errors and problems for heterosexual anal and vaginal intercourse. Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults. Sexually Transmitted Diseases. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications anal HIV prevention.

Anal use of heteroseexual female condom: does uncertainty justify provider inaction? Eduardo E. ValverdeIsabel CassettiLisa R. Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women. Anal sex is a behavioural marker for laboratory-confirmed vaginal sexually transmissible infections and HIV-associated risk among African-American female adolescents.

Bacterial Sexually Transmitted Diseases. New thinking in HIV prevention: an anthropological and epidemiological viewpoint.

Setting the stage: host invasion by HIV. Attitudes of men in an Australian male tolerance study towards microbicide use. Sexual coercion and sexual desire: Ambivalent jeterosexual of heterosexual anal sex in Soweto, South Africa.

Reliability and validity heetrosexual the sexual pressure scale. The Future Role of Vaccines and Microbicides. Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young Urban women. Inhibiting sexual transmission anwl HIV-1 infection. Poly sodium 4-styrene sulfonate : evaluation xnal a topical microbicide gel against herpes simplex virus type 2 anal Chlamydia trachomatis infections hteerosexual mice.

Microbicides An Update. Anal Johnston. Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood. Anorectal manifestations of sexually transmitted infections.

Anal sex among young low-income women in California: an overlooked risk factor for HIV? Volume 13 Issue 12 Dec Dec Close Figure Viewer. Previous Figure Next Figure.

The paper concludes by discussing the implications of these findings for public health policy and programming in PNG. No language restrictions or other limitations were placed in the searches. All studies had obtained the appropriate ethical approval with all data anonymous and consent obtained. The lead author completed this literature search. We excluded studies that did not include quantitative data on sexual behaviour.

All studies had to report behavioural data on the sexual practices of Papua New Guineans, either amongst the general population or key affected populations such as sex workers. Data on study design, sex, study population, age of sample, and geographical location of study were extracted. Further extractions included types and frequency of sexual behaviour, condom use for specific sexual practices, recall periods and experiences of and knowledge of STIs. The lead author completed data extraction.

Due to the paucity of the data a meta-analysis was not possible and therefore confidence intervals were not calculated. Because the survey questions on HAI were not standardised we cannot present the data in a forest plot. We derived the risk equation using a binomial equation and standard HIV modeling techniques [ 50 , 51 ]. The equation calculates the cumulative probability over all sexual acts of an individual acquiring HIV each year.

It assumes a homogenous population with each person having the same average characteristics and behaviours. Such an analysis also ignores the additional transmission from people who acquire HIV during a given year, and has a number of other limitations, but provides an estimate of the annual risk of infection. This approach is used extensively for understanding short-term HIV incidence [ 52 ]. For HIV-negative females the cumulative probability of acquiring HIV over multiple unprotected sexual acts of vaginal or anal intercourse is:.

In our equations, n is the total number of sexual acts, p a is the proportion of sexual acts that involve anal intercourse, p c v is the proportion of vaginal intercourse acts where a condom is used, p c a is the proportion of anal intercourse acts where a condom is used, and P HIV is the prevalence of HIV in male partners.

By entering appropriate values, we calculated the risk of HIV infection under various conditions and for specific groups of females. We estimated the annual incidence by multiplying the annual risk by the population size. The impact of HAI on HIV incidence in the general population was estimated by dividing the female population into those who do and do not engage in HAI and calculating the incidence in each population.

Given the paucity of data for PNG, most of the parameter values are assumptions. However, they broadly reflect the behavioural and epidemiological characteristics of the PNG population and allow us to assess the contribution of HAI to the HIV epidemic [refs]. The last author led these calculations. Following the methods outlined in the PRISMA Guidelines, after the initial search was completed and the removal of duplicates was finalised, our search strategy resulted in publications.

After screening publications by geographical location, topic and methodology we excluded publications leaving us with 23 for full review. Following a review of the full text, only 13 publications were included in the synthesis. As a result of the paucity of data, inconsistent recall periods and reporting of condom use we were unable to conduct a meta-analysis See Additional file 1 for PRISMA flow chart.

They document HAI in all four administrative regions of the country. Within the regions, the number of studies reporting HAI varies by province as an artefact of the number of sexual behaviour studies that included questions on HAI.

For example, while female youths in Oro Province reported no HAI, adult men and women and male youths in the province did [ 58 ]. HAI was not always disaggregated by province [ 64 ]. Condom use data for HAI is inconsistent. In some studies no rates of condom use for HAI are reported [ 58 ]. Askim na Save , an integrated bio-behavioural study of sex workers male and female in Port Moresby, reported consistently high rates of HAI in the previous six months across all sex partner types [ 39 ].

Importantly, of male sex workers both those who identified as a man and those who identified as transgender born male but identify as transgender but without corrective surgery or hormone treatment reported anal intercourse with females. Condom use for HAI amongst the sex worker population was low. Importantly, condom use in the last six months with a client and casual non-paying partner was lower for HAI than for vaginal intercourse.

The report identifies some gender disparities in condom use. For general population males, youth participants from Southern Highlands Province and East New Britain Province reported higher lifetime rates of anal intercourse compared to adult males In Simbu Province, male adults reported over double the lifetime rate of anal intercourse than did male youth from the same province For females in the general population, the results are different. In Southern Highlands Province, similar proportions of female adults and youths reported a lifetime history of HAI This contrasts with female youths and adults in East New Britain Province Condom use during lifetime HAI was not reported.

In the only study on the sexual practices of people with HIV, a minority 8. Of these, only two people reported using a condom the last time that they had HAI with their regular partner. In contrast, It is unclear from the report if the sexual partner was also HIV-positive, therefore reducing the importance of condom use and because all people in the study were on treatment.

While the numbers on HAI in this study are small, it does suggest that people living with HIV may be a particular population warranting further education about the role of anal intercourse in the transmission of HIV and other STIs. Cumulative probability of HIV transmission over multiple sexual exposures for all females a.

The lower line is the risk if all exposures involve vaginal intercourse. The upper line is the risk if all exposures involve HAI. The risk females acquire HIV each year b.

Females in general population with a HIV-positive regular partner assumed to have sexual acts per year.

HIV incidence rate in females in general population c. Red part of each bar represents the increase in incidence due to HAI. This systematic review helps to highlighting the complexity, diversity and heterogeneity of HAI in PNG according to both geographical location and by epidemiological sexual risk categories.

Publication bias was unlikely to have been significant in this systematic review, as both published and unpublished data were located. However, key limitations of the research in PNG to date emerged from this systematic review.

Although it is acknowledged that heterosexual transmission is the primary mode of HIV infection in PNG there is almost no understanding of the role that different sexual behaviours play. As a result, it can only be inferred which specific sexual behaviour is being described and measured. Other included studies that addressed anal intercourse only asked if a person had ever had anal sex without specifying with whom one had anal sex with i. With females this inference is less problematic although not entirely.

Indeed the standardised STI client record form used in government health facilities in PNG only asks men if they have had anal intercourse and does not specify with whom, and if with another male, it does not stipulate if it was receptive, insertive or both receptive and insertive.

There were other studies however that conflated all anal sex together. However, when read in conjunction with the complete findings, no male truck drivers reported having ever had sex with another male. Therefore, it appears that the anal sex reported is in fact HAI. Similarly, No study reported the frequency of HAI. HAI was rarely disaggregated by sex partner type casual vs.

We found no studies reporting the reasons for unprotected HAI. Another key limitation identified as a result of the systematic review is the discrepancy in recall periods used to measure HAI.

Very little behavioural research has been conducted with people with HIV. Understanding the sexual practices of this population is critical to informing national HIV and STI prevention and treatment policy and programing, especially as treatment is being scaled up. Nevertheless, the studies reviewed indicate men and women will talk about HAI when asked. This applies both to research but also clinical care. To improve HAI reporting in PNG we recommend the following: ensure that questions are explicit about the type of sex partner and act carried out; standardised recall periods; and the documentation of condom use for HAI by partner type, last act and consistency of use with the same recall period as for vaginal intercourse reporting.

Furthermore, the number of sex acts per sexual behaviour in a given period is required. In order to inform culturally appropriate condom use campaigns for HAI, reasons for not using condoms during HAI is also required. These documents recognise the importance of both heterosexual and homosexual anal intercourse and the training of health care workers to identify STI infection in women as a result of anal intercourse. Although we argue that addressing structural drivers is essential to addressing HIV and STI risk and vulnerability, we believe that greater sexual health literacy is urgently needed in relation to HAI.

This literacy is needed for key affected populations, the general population and health care workers providing sexual health services. While treating vaginal and penile STIs might be expected to cure most anorectal STIs for instance, assuming the same pathogen is present at both sites , other infections may require site-specific diagnosis and treatment for example, if several different pathogens are present or where an anorectal STI is present without a genital STI.

Although STI clinics should routinely ask questions about anal intercourse in clinical assessments, this is not the practice in all clinics. It highlighted that the national response inadequately addressed risk behaviours such as anal intercourse by both men and women and the lack of knowledge about the risks of HAI.

They suggested that this may result in individuals viewing safe sex as unnecessary for anal intercourse even when they consistently use condoms for vaginal intercourse. In order to know your HIV epidemic, you should know the sexual behaviours and the socio-cultural meanings attached to them. This is particularly true in PNG where sexuality as well as sexual behaviour and practices are diverse and differ in many important ways from other countries.

Studies have reported high rates of HAI across a diversity of populations, indicating that HAI is not limited to key affected populations. The findings of this systematic review and mathematical modelling have a number of important implications. There was no association with partner type or drug or alcohol use by the woman. Among men, condom non-use was also associated with higher-risk partners — HIV discordant and ever injected drugs. In addition, it was also positively associated with the man using drugs or alcohol at last sex, and inversely associated with having a casual partner compared to a main partner.

This may be partly due to the very low rates of condom use during HAI, making it hard to detect differences, such as in one study among female drug users that found no significant associations between condom use and individual or partner characteristics One study found, among men and women attending an STD clinic, that consistent condom use during HAI over the previous 3 months was associated with having a new partner, having a non-main partner, and the respondent or partner never being high during sex A daily-diary study among adolescent women found that condom use was associated with feeling less in love and using a condom during vaginal intercourse that same day, but there was no association with drug or alcohol use 26 , similar to our findings among women.

There are several limitations in this study including a potential for under-reporting of socially undesirable information, i. This is of particular concern in this study due to the face-to-face method used for data collection.

However, the prevalence of HAI was similar to other studies that collected data by other methods 12 , The anonymous nature of NHBS also increases privacy and, therefore, may foster candid reporting of behaviors 27 , We are also missing some key pieces of information that would aide in our understanding of this behavior, such as data on intimate partner violence, which has been shown to be associated with HAI 11 , 23 and condom use during HAI 23 , and information on the frequency of HAI and the order of acts during a sexual encounter Future studies would benefit from the inclusion of this information and use of an a priori -conceptual model that includes all variables potentially associated with HAI.

In addition, the sample only included people of low SES, so our findings are not generalizable to the general population.

However, this population is at higher risk for acquisition of HIV, so it is important to understand the prevalence and correlates of HAI in this population.

This study provided further insight into HAI among a high-risk population. It is important to understand the correlates of HAI in order to better tailor prevention messages to heterosexuals at risk of HIV. Clinicians and community-out-reach workers should include discussions of HAI in risk assessments and counseling messages for heterosexuals at high risk for HIV infection as well as stress the importance of annual HIV testing among those who report high-risk behaviors Funding: This work was funded by a cooperative agreement between the Health Departments of the 20 study U.

Conflict of Interest: The authors declare that they have no conflict of interest. Publisher's Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Informed consent was obtained from all individual participants included in the study.

National Center for Biotechnology Information , U. AIDS Behav. Author manuscript; available in PMC Dec 1. Kristen L. Author information Copyright and License information Disclaimer. Copyright notice. See other articles in PMC that cite the published article.

Abstract Heterosexual anal intercourse HAI is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse.

Statistical Analysis We ran separate models for each of the three outcomes of interest. Open in a separate window. Figure 1. Discussion The prevalence of HAI was high in our sample with about one-third of men and women engaging in this behavior during the 12 months before the interview.

Acknowledgments Funding: This work was funded by a cooperative agreement between the Health Departments of the 20 study U. Footnotes Conflict of Interest: The authors declare that they have no conflict of interest. References 1. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the — National Survey of Family Growth. Natl Health Stat Report. Temporal trends in sexual behaviors and sexually transmitted disease history among to year-old Seattle, Washington, residents: results of random digit-dial surveys.

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