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Heterosexual Anal Intercourse: Prevalence, Cultural Factors, and
HIV Infection and Other Health Risks, Part I
Halperin, DT
AIDS Patient Care and STDs [AIDS Patient Care STDs]. Vol. 13, no.
12, pp. 717-730. Dec 1999.
Studies of heterosexual HIV transmission have consistently found
anal intercourse to be a highly predictive risk factor for
seroconversion. Yet most AIDS prevention messages targeted at
heterosexuals, presumably influenced by cultural taboos against
acknowledging this sexual practice, continue to emphasize vaginal
and, increasingly, oral sex transmission. The health risks of anal
sex appear to be severely underestimated by a substantial
proportion of sexually active women and men in North and Latin
America as well as parts of South Asia, Africa, and other regions.
Among heterosexuals reported rates of condom use are nearly
universally lower for anal than for vaginal intercourse. This
review examines anal sex among the general population, including
its prevalence in various world regions, related sociocultural
factors, and other associated health problems including anorectal
STDs, Hepatitis B infection, and HPV-related anal cancer in women.
U.S. survey and other data suggest that, in terms of absolute
numbers, approximately seven times more women than homosexual men
engage in unprotected receptive anal intercourse. Research among
higher risk subpopulations, including bisexual men, injecting drug
users, female sex workers, inner-city adolescents, and
serodiscordant heterosexual couples, indicates that persons
particularly at risk of being infected by or transmitting HIV are
also more likely to practice anal sex. Considering this finding,
along with the much greater efficiency for HIV infection as well
as lower rates of condom usage, a significant proportion of
heterosexual transmission in some populations is due to anal
intercourse. This typically stigmatized and hidden sexual practice
must be given greater emphasis in AIDS/STD prevention, women's
care, and other health promotion programs.
 Descriptors: Article Subject Terms Adolescence | Adolescents | Anus | Drug abuse | Heterosexuality | Human immunodeficiency virus | Prostitution | Risk
assessment | Sexual behavior | Urban areas | Urban environments | Article Taxonomic Terms Human immunodeficiency virus
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