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Try out PMC Labs and tell us what you think. Learn More. 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 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.

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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 23. 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.

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However, HAI still remains under-emphasized in prevention messages for heterosexuals. research has shown that HAI is associated with a variety of risky behaviors, including drug use 5 — 7multiple partners 68 — 10concurrent partners 8and exchange sex 6 — 811suggesting that Anal Ontario woman who engage in HAI are in a higher risk population for acquisition of HIV and sexually transmitted infections STI.

Additionally, condom use is uncommon during HAI, with some studies indicating that condom use during HAI is less common than condom use during vaginal sex 13 It is important to characterize the groups with higher prevalence of this behavior, and, among those who are engaging in this behavior, what appears to influence condom use, in order to better tailor prevention messages. Several studies have looked at the association between having HAI and demographic characteristics and risk behaviors, but the HAI measure is typically past year or three months.

More information could be gained by looking at a particular sexual event, such as, the characteristics of the partner and context of the event that are associated with having HAI. In addition, very few papers have looked at factors associated with condom use during HAI among people who practice HAI. Obtaining a better understanding of these factors could allow better targeting of prevention messages. The purpose of this study was to describe the prevalence and correlates of HAI among men and women with low socioeconomic status SES from 20 cities across the United States considering both individual and partner characteristics.

In addition, factors associated with lack of condom use at last sex were assessed among those who had HAI. Participants were recruited by respondent-driven sampling RDSa type of chain-referral sampling. These individuals are then given 3—5 coupons to recruit other people they know into the study.

Recruitment continues until the sample size is met or the end of the data collection period. The Anal Ontario woman and other methods used for the heterosexual NHBS sample have been described in more detail elsewhere Eligibility for the heterosexual cycle of NHBS was restricted to men and women between 18 and 60 years old, who had not ly participated inwere residents of a study MSA, were able to complete the survey in English or Spanish, were able to provide informed consent, and reported having vaginal or anal sex in the past 12 months with an opposite sex partner.

Individuals could participate in the survey regardless of SES and injection drug use history. However, in order to obtain a sample that was at higher risk for HIV through heterosexual sex but not injection drug use, only people of low SES who Anal Ontario woman not injected drugs in the past year were allowed to recruit other participants.

Low SES was defined as having no more than a high school education, or a household income in at or below the U. Department of Health and Human Services poverty guidelines. The guidelines vary by the of dependents in a household Trained interviewers administered a computer-assisted personal interview that covered demographic information, sexual and drug use behaviors, and HIV testing history.

Anonymous HIV testing was offered to all participants and was conducted following the interview. Participants received incentives for completing the interview and for the HIV test. The incentive format cash or gift card and amount varied by city based on formative assessment and local policy. NHBS activities were approved by local institutional review boards in each participating city and the protocol was approved by the CDC 19 For this analysis, the sample was restricted to only men and women who completed the interview with valid responses as assessed by the interviewer, were of low SES, and did not report being HIV-positive.

Self-reported HIV-positive participants were not included in the analysis because our area of interest for this paper was understanding behavior among heterosexuals who are not HIV-infected in order to tailor HIV primary prevention messages. Participants were asked how many opposite-sex partners they had in the 12 months before interview and then, of these, the with whom they had anal sex.

Anyone who answered one or more was coded as having HAI in the 12 months before interview. Respondents were also asked detailed questions about their last sexual event with an opposite-sex partner, including whether they had anal sex, if so, whether they used a condom for anal sex, and if so, whether the condom was used for the entire act of anal sex. Participants who reported that they did not use a condom and those who did but not for the entire time were coded as not using a condom at last HAI. Several covariates were included in the models as predictors. The cut point for dichotomizing the of sex partners was set at the median of partners reported.

Women and men with same-sex partners in the past year were included in our sample of heterosexuals, because, even though they are not strictly practicing heterosexual sex, they do still have opposite-sex partners and can be exposed to risk through this behavior.

Participants were coded as having an STD in the past year if they reported being told by a health care professional that they had syphilis, gonorrhea, Chlamydia, or another STD. We ran separate models for each of the three outcomes of interest. Separate models were necessary because each model included a different sub-sample of the population. Anal Ontario woman estimating equation GEE models based on a Poisson distribution with robust standard errors were used to assess the association between each outcome and several demographic and individual and partner risk behaviors.

In order to control for the study de, city and the recruiter's value for the outcome were included in the model as fixed effects and recruitment chain was treated as the cluster. All the analyses, both bivariable and multivariable, controlled for study de. The mean age was The proportion non-Hispanic white varied from 0. The mean age ranged was 33 years in Los Angeles to 46 years in San Francisco. Among both men and women, there was a higher prevalence of HAI among those who were between 25 and 49 years old, had a lower income, or were homeless in the past year Table I.

There was a higher prevalence of HAI among those who reported having been diagnosed with an STD in the past year compared to those who had not. HAI was also associated with several past-year risk behaviors, such as exchange sex, binge drinking, drug use, and having a same-sex partner.

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In multivariable analysis, all of these Anal Ontario woman except testing for HIV in the past 12 months, income, and non-injection drug use, and among men, injection drug use, remained ificant Table I. Typically, HAI was not practiced with all of a respondent's sex partners. In order to determine what partnership characteristics may be associated with having HAI with that partner, a further analysis was conducted looking at factors associated with having HAI at last sex among those who had HAI in the past year. 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.

Among those who had HAI in the past year, about one-third of men and women had HAI at last sex, furthermore, condom use at last sex was very rare, and even lower with high-risk partners such as partners with discordant status, who reported male-male sex among women or injection drug use among men.

Low condom use rates have been noted in other work as well 5614but correlates of condom use during HAI have not been as well studied.

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Our analysis demonstrated in a sample of men and women from across the U. In our sample, white non-Hispanic women were more likely to report HAI than black non-Hispanic women. Few studies have looked at correlates of condom use during HAI, but two have found that black men and women were more likely to use a condom during HAI than white Anal Ontario woman and women 22 HAI was associated with experiencing homelessness in the past year among both men and women.

This finding supports other work that has found the same association 6 As has been shown in work 67911we found that past HAI was associated with other higher risk behaviors, including having multiple sex partners, injection drug use, exchange sex, and binge drinking, as well as having same-sex partners. Given this combination of high-risk behaviors, especially having multiple sex partners, these heterosexuals should be re-tested annually for HIV according to CDC guidelines 25 ; however, in our sample the inverse relationship between risk and HIV testing was found.

One study among youth in Baltimore found the same inverse relationship among male participants, but not female participants Among those who reported HAI in the past year, HAI at last sex was associated with having a higher-risk partner for both men and women — potentially HIV discordant, ever injected drugs, and an exchange partner.

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Given that almost all the HAI was unprotected, it is concerning that the partners tended to be at high risk with a potentially higher HIV prevalence. Women who did not use a condom were more likely to have a higher-risk partner — potentially HIV discordant and ever had sex with another man. 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.

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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 Anal Ontario woman no ificant 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 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 26similar 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 1123 and condom use during HAI 23and 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 Anal Ontario woman 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 InformationU. AIDS Behav. Author manuscript; available in PMC Dec 1. Kristen L. Author information Copyright and 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 Anal Ontario woman 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: of random digit-dial surveys. Sex Transm Dis. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention.

Int J Epidemiol. Correlates of anal intercourse vary by partner type among substance-using women: baseline data from the UNITY study. Heterosexual anal intercourse among men in Long Beach, California. J Sex Res. Prevalence and correlates of heterosexual anal intercourse among clients attending public sexually transmitted disease clinics in Los Angeles County.

Anal intercourse among young heterosexuals in three sexually transmitted disease clinics in the United States. Gender differences in heterosexual anal sex practices among women and men in substance abuse treatment. Individual, partner, and partnership level correlates of anal sex among youth in Baltimore city.

Arch Sex Behav. Correlates of heterosexual anal intercourse among substance-using club-goers. J Acquir Immune Defic Syndr. Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Relationship characteristics associated with anal sex among female drug users. Behavioral surveillance among people at risk for HIV infection in the U.

Public Health Rep. Piloting a system for behavioral surveillance among heterosexuals at increased risk of HIV in the United States. Federal Register [Internet] Dec 1; 77 17 —5.

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