Heterosexual anal intercourse HAI is not an uncommon behavior and it confers a higher risk of HIV transmission than vaginal intercourse. We assessed correlates of reporting HAI in the previous year. Then, among people reporting HAI in the past year, we assessed what event-level factors are associated with having HAI at last sex. Among people who had HAI in the past year, those who had HAI at last sex were more likely to have a partner who was HIV-positive or of unknown status or to have exchanged money or drugs for sex at last sex. There is evidence that the prevalence of HAI may be increasing in recent years, which may be due to a true increase in the behavior over time or heterosexuals becoming more comfortable reporting the behavior 2 , 3. Based on a meta-analysis, acquisition of HIV is times as likely to occur during receptive HAI as during receptive vaginal intercourse among heterosexuals 4. However, HAI still remains under-emphasized in prevention messages for heterosexuals. Previous research has shown that HAI is associated with a variety of risky behaviors, including drug use 5 — 7 , multiple partners 6 , 8 — 10 , concurrent partners 8 , and exchange sex 6 — 8 , 11 , suggesting that people who engage in HAI are in a higher risk population for acquisition of HIV and sexually transmitted infections STI.
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This study used qualitative methods to assess why women engage in heterosexual anal receptive intercourse AI with a male partner. Four focus groups which comprised women from diverse ethnicities were conducted. All groups were digitally recorded for transcription; transcripts were analyzed using the methods of grounded theory to determine themes. The riskiness of AI was assessed within relationship contexts. Past experience with AI including emotional and physical reactions was identified. Among the negative physical experiences of AI were pain and disliking the sensation, and uncomfortable side effects, such as bleeding of the rectum. Negative emotional experiences of AI included feelings of shame, disgust, and being offended by something her male partner did, such as spitting on his penis for lubrication. Positive physical experiences included liking the sensation. Many of the women also endorsed positive emotional experiences of AI, including that it was more intimate than vaginal sex, and that it was something they reserved only for special partners. The majority of AI episodes were unplanned and not discussed prior to initiation.
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