Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

Owen, Branwen Nia; Brock, Patrick M.; Butler, Ailsa R.; Pickles, Michael; Brisson, Marc; Baggaley, Rebecca F.; Boily, Marie‐Claude

doi:10.1007/s10461-015-0997-y

Cited by 45 publications

(43 citation statements)

References 148 publications

(45 reference statements)

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“…Although scarce, the available data on AI frequency suggests that AI is practised frequently, with 2.4-15.9% of all intercourse acts being anal among all FSW study participant samples. Similar to previous review findings regarding heterosexual AI practice among young people and South Africans [37,38], we found a non-statistically significant indication that AI prevalence may have increased over time. In qualitative research Indian and East African FSW have described AI practice during sex work as becoming more common over time due to increased client demand [9,[39][40][41].…”

Section: Discussionsupporting

confidence: 86%

“…AI is a highly stigmatised behaviour in many societies and thus its reporting is likely subject to social desirability bias and is likely more accurately reported using more confidential interview methods [37,38]. As the majority of studies in this review used FTFI, the least confidential interviewing method, our pooled estimates of AI prevalence and estimates of AI frequency likely underestimate its practice among FSW.…”

Section: Discussionmentioning

confidence: 94%

“…It is clear from this review and others [37,38] that data collection on AI practice requires improvement, especially given how effectively HIV is transmitted during AI and how commonly it is practiced. Previous research suggests that survey items must be carefully piloted in order to minimise misunderstanding and that one effective approach may be the use of pictograms to unambiguously clarify what is meant by AI [44].…”

Section: Recommendations For Future Reporting Of Ai Practicementioning

confidence: 97%

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What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

et al. 2019

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HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers' (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2-19.3%, N = 30, I 2 = 99%; past month: 16.2% 95%CI 10.8-21.6%, N = 18, I 2 = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7-36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1-83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 94%

Section: Recommendations For Future Reporting Of Ai Practicementioning

confidence: 97%

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What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

et al. 2019

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“…AI prevalence did not increase with longer recall periods as would be expected if people do not practice AI all their life; instead, recall period had no discernible effect, which we also found in our systematic review on AI practice among young people [5]. These observations suggest that either reporting accuracy decreases over time, as previously reported in other sexual behaviour studies [83–85], and/or that those who initiate AI continue to practice it all their life.…”

Section: Discussionsupporting

confidence: 63%

How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta‐analysis

Owen

Elmes

Silhol

et al. 2017

Journal of the International AIDS Society

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Background: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa’s generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. Methods: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by sub-groups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. Results: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4–27.5%], three-month = 20.3% [6.1–34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0–47.4%], recall period not stated = 40.1% [36.2–44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2–40.0% and 0.7–21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. Discussion: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa’s HIV epidemic.

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“…This is may be to be lower than for vaginal intercourse , although a systematic review of South Africa indicated equal or higher condom use during anal intercourse . Some studies suggest that heterosexual anal intercourse has become more common over time but, generally, trends in heterosexual anal intercourse in sub‐Saharan Africa are poorly understood and impacts of different types of sexual intercourse on population‐level sexual risks could not be evaluated in this study.…”

Section: Discussionmentioning

confidence: 89%

Widespread changes in sexual behaviour in eastern and southern Africa: Challenges to achieving global HIV targets? Longitudinal analyses of nationally representative surveys

2019

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Introduction Sexual behaviour change contributed to reductions in HIV incidence in eastern and southern Africa between 1990 and 2010. More recently, there are indications that non‐regular partnerships have increased. However, the effect of these increases on population‐level risks for HIV and other sexually transmitted infections could have been reduced by simultaneous increases in condom use. We describe recent trends in sexual behaviour and condom use within the region and assess their combined effects on population levels of sexual risk. Methods Nationally representative Demographic and Health Survey data on sexually active males and females (15 to 49 years) were used for 11 eastern and southern African countries (≥3 surveys for each country; 1999 to 2016) to describe trends in sexual behaviour (multiple, non‐regular, and casual sexual partnerships; condom use; age at first sex). Logistic regressions tested for statistical significance of changes. Analyses were stratified by sex. Results Recent increases in multiple, non‐regular, and/or casual partnerships can be found for males in 10 countries and, for females, in nine countries; five countries exhibited recent decreases in age of sexual debut. Reduction in sex without condoms with non‐regular partners was observed in six countries for males and eight for females. Changes in the proportion of the overall population reporting condomless sex with non‐regular partners varied between countries, with declines in six countries and increases in three. Conclusions Extensive change in sexual behaviour occurred across eastern and southern Africa during the period of scale‐up of antiretroviral therapy programmes. This includes increasing multiple and non‐regular partnerships, but their potential effects on population‐level sexual risks were often offset by parallel increases in condom use. Strengthening condom programmes and reintegrating communication about behavioural dimensions into combination prevention programmes could help countries to meet international targets for reductions in HIV incidence.

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Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

Cited by 45 publications

References 148 publications

What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta‐analysis

Widespread changes in sexual behaviour in eastern and southern Africa: Challenges to achieving global HIV targets? Longitudinal analyses of nationally representative surveys

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