When describing discrete occasions of anal intercourse, on eight occasions participants reported that they had used a condom for vaginal sex to prevent pregnancy, but had removed the condom prior to anal sex. Among those who reported using a condom during anal intercourse, on three occasions participants used the same condom for both vaginal and anal intercourse; on another three occasions participants used separate condoms for vaginal and anal intercourse; and on four occasions participants used condoms for anal intercourse but not vaginal intercourse, citing concern about hygiene or pregnancy as motivations.
Kimberly: Not at all. He never had done it before. Although nearly all of the participants were aware that unprotected anal intercourse might put them at risk for sexually transmitted infections, this knowledge apparently did not translate into behavioral change, as evidenced by the participant who had unprotected anal intercourse with her HIV-positive partner.
Following this line of reasoning, at first glance the pattern of male initiative over anal intercourse suggests that women might engage in anal intercourse under pressure, coercion, or persuasion from male partners. Nevertheless, as we did not survey a control group of women who engaged in low-risk, protected anal intercourse, it may be difficult to draw conclusions about the relationship between sexual risk-taking and pleasure-seeking behaviors from our sample alone.
Future research is needed to elucidate such relationships.
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When taken together, unprotected anal intercourse seemed to offer women a way to please their partners, to please themselves, and to avoid pregnancy. As long as some women view anal sex as a way to bypass pregnancy concerns while maintaining intimacy and sexual pleasure, the failure to educate this population on HIV and STI prevention may lead to increased infection.
A similar dynamic may be at work among women who engage in unprotected anal intercourse in order to achieve a greater degree of intimacy with their male partners, as in the case of some of our participants. Interventions to promote safer anal sex must find a way to increase the use of barrier methods without decreasing perceived intimacy between sexual partners.
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This may be done by emphasizing the intimate nature of anal intercourse, even when accompanied by condom use. Therefore, if part of what makes a woman feel like a woman is being desired by her male partner, vaginal and rectal microbicides should be marketed to women as products that will enhance their sexual desirability. Indeed, even in our small sample, the subgroup of women who had experienced non-consensual anal sex tended to report lower annual incomes than those who had not, though we did not test for statistical significance.
Future studies should seek to identify the specific factors that put women at risk for non-consensual, unprotected anal intercourse. To be successful, interventions must take into account the ways in which violence directed towards women can impact their ability to negotiate safe vaginal and anal sex.
Given that the need for female-controlled alternatives to condoms encompasses products that can be used intrarectally as well as vaginally, rectal microbicides should be marketed to women as well as to MSM. Limitations Our findings must be interpreted within the limitations of this study. Although the sample was ethnically and racially diverse, participation was limited to English-speaking women, and more low-income women were interviewed than middle- and upper-income women.
There are undoubtedly numerous women who practice anal intercourse with minimal risk Future studies should seek to quantitatively assess HIV and STI risk among a larger and more representative sample of women who engage in anal intercourse. Furthermore, notwithstanding that this may have been a highly-motivated group of women who welcomed the opportunity to talk about their anal sex experiences, it is important not to overlook how social constraints or norms about what is socially appropriate situated within the interview itself may have influenced how and what may have been discussed during the course of the interview.
Stadler et al. Despite the limitations of the study, the findings presented here have important implications for HIV interventions aimed at heterosexual women. Halperin DT. Erickson PI, et al. Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors. Heterosexual anal intercourse: An understudied, high-risk sexual behavior.
Archives of Sexual Behavior. Voeller AIDS and heterosexual anal intercourse. Cunningham Misegades L, et al. Reinisch JM, et al.
High-risk sexual behavior among heterosexual undergraduates at a Midwestern university. Family Planning Perspectives. Friedman SR, et al. Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood.
Gross M, et al. Journal of Acquired Immune Deficiency Syndromes. American Journal of Epidemiology. Vernazza PL, et al. Sexual transmission of HIV: Infectiousness and prevention.
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