AIDS and heterosexual anal intercourse

Abstract

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.

Heterosexual Anal Sex Among Female Drug Users: U.S. National Compared to Local Long Beach, California Data

“…It can be hypothesized that younger women may engage more in anal sex than older women as an alternative to birth control, especially in low-income areas with fewer resources. Alternatively, they may engage in anal sex as frequently as older women but are more willing to report this activity, while older women may report having anal sex less due to taboos associated with HAS (Voeller, 1991).…”

“…Thirty-five percent of women and 40% of men aged 25-44 reported ever having heterosexual anal sex (HAS) (Mosher, Chandra, Jones, & Division of Vital Statistics, 2002). Anal sex carries a greater risk for women than vaginal intercourse (Misegades et al 2001;Voeller, 1991) with respect to HIV transmission, yet research has found that women underestimate the risks of anal sex (Halperin, 1999), and are less likely to use condoms during anal intercourse than vaginal intercourse (Misegades & Page-Shafer, 2001;Solorio, Milburn, Rotheram-Borus, Higgins, & Gelberg, 2006). In fact, seven times more women than homosexual men engage in unprotected receptive anal sex (Halperin).…”

College Students' Reasons for Nonuse of Condoms Within Dating Relationships

“…The similarity of these reasons to the ones for not using condoms for vaginal sex underscores the predominance of pregnancy prevention over STD protection concerns in the college student population. For women, anal sex is a higher risk behavior for transmission of HIV than vaginal sex (Voeller, 1991). If college students were concerned about becoming infected with HIV/STD, they would prioritize the use of condoms for anal sex.…”

Understanding the HIV Epidemic in the Dominican Republic: A Prevention Success Story in the Caribbean?

“…33 Consideration of such findings should also take into account that this highly stigmatized behavior is likely to be substantially underreported in surveys. [34][35][36] In a 1994 study of 354 MSM in Santo Domingo, only 22% of the interviewees self-identified as being ''homosexual,'' with over half self-identifying as ''heterosexuals'' (among whom HIV prevalence was 8%). 19 One of the main reasons that MSM tend to have much higher HIV prevalence than the general population is the unusually high risk of receptive anal intercourse, which is estimated to be 10-20 times riskier, per act, than receptive vaginal intercourse.…”