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Perspect Sex Reprod Health. Author manuscript; available in PMC 2017 Sep 7.

1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA

2 Fenway Institute, Fenway Community Health, Boston, Mass, USA; Miriam Hospital/Brown University, Providence, RI, USA
All correspondence and reprint requests should be sent to Emily Woodman-Maynard, Fordham University, Department of Psychology, Keating Hall 226, Bronx, New York, 10458, or to ude.mahdrof@anyamnamdoow
The publisher's final edited version of this article is available at Perspect Sex Reprod Health
1. Halperin DT. Heterosexual anal intercourse: Prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care and STDs. 1999; 13 (12):717–730. [ PubMed ] [ Google Scholar ]
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4. Voeller B. AIDS and heterosexual anal intercourse. Archives of Sexual Behavior. 1991; 20 (3):233–276. [ PubMed ] [ Google Scholar ]
5. Cunningham I. An innovative HIV/AIDS research and education program in Puerto Rico. SIECUS Report. 1998; 26 (3):18–20. [ PubMed ] [ Google Scholar ]
6. Misegades L, et al. Anal intercourse among young low-income women in California: An overlooked risk factor for HIV? AIDS. 2001; 15 (4):534–535. [ PubMed ] [ Google Scholar ]
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9. Gross M, et al. Anal sex among HIV-seronegative women at high risk of HIV exposure. Journal of Acquired Immune Deficiency Syndromes. 2000; 24 (4):393–398. [ PubMed ] [ Google Scholar ]
10. Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiencyvirus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology. 1998; 148 (1):88–96. [ PubMed ] [ Google Scholar ]
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15. Guimarães MDC, et al. HIV-infection among female partners of seropositive men in Brazil. American Journal of Epidemiology. 1995; 142 (5):538–547. [ PubMed ] [ Google Scholar ]
16. Stadler JJ, Delany S, Mntambo M. Sexual coercion and sexual desire: Ambivalent meanings of heterosexual anal sex in Soweto, South Africa. AIDS Care. 2007; 19 (10):1189–1193. [ PubMed ] [ Google Scholar ]
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35. Pulerwitz J, et al. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002; 14 (6):789–800. [ PubMed ] [ Google Scholar ]
36. Dudley MG, et al. Correlates of high-risk sexual behavior among young men who have sex with men. AIDS Education and Prevention. 2004; 16 (4):328–340. [ PubMed ] [ Google Scholar ]
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39. Blais M. Vulnerability to HIV among regular male partners and the social coding of intimacy in modern societies. Culture, Health & Sexuality. 2006; 8 (1):31–44. [ PubMed ] [ Google Scholar ]
40. Gupta GR, Weiss E. Women’s lives and sex: Implications for AIDS prevention. Culture, Medicine and Psychiatry. 1993; 17 (4):399–412. [ PubMed ] [ Google Scholar ]
41. Nyswander D. Education for health: Some principles and their application. Health Education Monographs. 1956; 14 :65–70. [ Google Scholar ]
42. Rappaport J. Studies in empowerment: Introduction to the issue. Prevention in Human Services. 1984; 3 (2 & 3):1–7. [ Google Scholar ]
1. Halperin DT. Heterosexual anal intercourse: Prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care and STDs. 1999; 13 (12):717–730. [ PubMed ] [ Google Scholar ] [ Ref list ]
4. Voeller B. AIDS and heterosexual anal intercourse. Archives of Sexual Behavior. 1991; 20 (3):233–276. [ PubMed ] [ Google Scholar ] [ Ref list ]
3. Baldwin JI, Baldwin JD. Heterosexual anal intercourse: An understudied, high-risk sexual behavior. Archives of Sexual Behavior. 2000; 29 (4):357–373. [ PubMed ] [ Google Scholar ] [ Ref list ]
5. Cunningham I. An innovative HIV/AIDS research and education program in Puerto Rico. SIECUS Report. 1998; 26 (3):18–20. [ PubMed ] [ Google Scholar ] [ Ref list ]
7. Reinisch JM, et al. High-risk sexual behavior among heterosexual undergraduates at a Midwestern university. Family Planning Perspectives. 1992; 24 (3):116. [ PubMed ] [ Google Scholar ] [ Ref list ]
8. Friedman SR, et al. Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood. AIDS. 2001; 15 (15):2057–2060. [ PubMed ] [ Google Scholar ] [ Ref list ]
9. Gross M, et al. Anal sex among HIV-seronegative women at high risk of HIV exposure. Journal of Acquired Immune Deficiency Syndromes. 2000; 24 (4):393–398. [ PubMed ] [ Google Scholar ] [ Ref list ]
10. Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiencyvirus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology. 1998; 148 (1):88–96. [ PubMed ] [ Google Scholar ] [ Ref list ]
13. Padian NS, et al. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: Results from a ten-year study. American Journal of Epidemiology. 1997; 146 (4):350–357. [ PubMed ] [ Google Scholar ] [ Ref list ]
14. Seidlin M, et al. Heterosexual transmission of HIV in a cohort of couples in New York City. AIDS. 1993; 7 (9):1247–1254. [ PubMed ] [ Google Scholar ] [ Ref list ]
15. Guimarães MDC, et al. HIV-infection among female partners of seropositive men in Brazil. American Journal of Epidemiology. 1995; 142 (5):538–547. [ PubMed ] [ Google Scholar ] [ Ref list ]
6. Misegades L, et al. Anal intercourse among young low-income women in California: An overlooked risk factor for HIV? AIDS. 2001; 15 (4):534–535. [ PubMed ] [ Google Scholar ] [ Ref list ]
16. Stadler JJ, Delany S, Mntambo M. Sexual coercion and sexual desire: Ambivalent meanings of heterosexual anal sex in Soweto, South Africa. AIDS Care. 2007; 19 (10):1189–1193. [ PubMed ] [ Google Scholar ] [ Ref list ]
17. Ndinda C, et al. Perceptions of anal sex in rural South Africa. Culture, Health & Sexuality. 2008; 10 (2):205–212. [ PubMed ] [ Google Scholar ] [ Ref list ]
18. Halperin DT. HIV, STDs, anal sex and AIDS prevention policy in a northeastern Brazilian city. International Journal of STD & AIDS. 1998; 9 (5):294–298. [ PubMed ] [ Google Scholar ] [ Ref list ]
19. Goldstein DM. AIDS and women in Brazil--the emerging problem. Social Science & Medicine. 1994; 39 (7):919–929. [ PubMed ] [ Google Scholar ] [ Ref list ]
20. Authors, ***********, 2008. [ Ref list ]
21. Simon W, Gagnon JH. Sexual scripts: permanence and change. Archives of Sexual Behavior. 1986; 15 (2):97–120. [ PubMed ] [ Google Scholar ] [ Ref list ]
22. Tolman DL, Diamond LM. Desegregating sexuality research: cultural and biological perspectives on gender and desire. Annual Review of Sex Research. 2001; 12 (1):33–74. [ PubMed ] [ Google Scholar ] [ Ref list ]
23. Tolman DL. Femininity as a barrier to positive sexual health for adolescent girls. Journal of the American Medical Women’s Association. 1999; 54 (3):133–138. [ PubMed ] [ Google Scholar ] [ Ref list ]
24. Higgins JA, Hirsch JS. The pleasure deficit: Revisiting the “Sexuality connection” in reproductive health. International Family Planning Perspectives. 2007; 33 (3):133–139. [ PubMed ] [ Google Scholar ] [ Ref list ]
27. Wood JM, Koch PB, Mansfield PK. Women’s sexual desire: A feminist critique. Journal of Sex Research. 2006; 43 (3):236–244. [ PubMed ] [ Google Scholar ] [ Ref list ]
28. Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage; 2002. [ Google Scholar ] [ Ref list ]
29. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for grounded research. New York: Aldine de Gruyter; 1967. [ Google Scholar ] [ Ref list ]
30. Strauss AL, Corbin J. Basics of qualitative research: grounded theory procedures and techniques. Newbury Park, CA: Sage; 1990. [ Google Scholar ] [ Ref list ]
31. Philpott A, Knerr W, Maher D. Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet. 2006; 368 (9551):2028–2031. [ PubMed ] [ Google Scholar ] [ Ref list ]
32. Holland J, et al. Risk, power, and the possibility of pleasure: Young women and safer sex. Aids Care: Psychological and Socio-Medical Aspects of AIDS/HIV. 1992; 4 (3):273–283. [ PubMed ] [ Google Scholar ] [ Ref list ]
33. Gilligan C. In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard University Press; 1993. [ Google Scholar ] [ Ref list ]
34. Blanc AK. The effect of power in sexual relationships on sexual and reproductive health: An examination of the evidence. Studies in Family Planning. 2001; 32 (3):189–213. [ PubMed ] [ Google Scholar ] [ Ref list ]
35. Pulerwitz J, et al. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002; 14 (6):789–800. [ PubMed ] [ Google Scholar ] [ Ref list ]
36. Dudley MG, et al. Correlates of high-risk sexual behavior among young men who have sex with men. AIDS Education and Prevention. 2004; 16 (4):328–340. [ PubMed ] [ Google Scholar ] [ Ref list ]
38. Gutierrez-Martinez O, et al. Sexual sensation-seeking and worry about sexually transmitted diseases (STD) and human immunodeficiency virus (HIV) infection among Spanish adolescents. Psicothema. 2007; 19 (4):661–666. [ PubMed ] [ Google Scholar ] [ Ref list ]
39. Blais M. Vulnerability to HIV among regular male partners and the social coding of intimacy in modern societies. Culture, Health & Sexuality. 2006; 8 (1):31–44. [ PubMed ] [ Google Scholar ] [ Ref list ]
40. Gupta GR, Weiss E. Women’s lives and sex: Implications for AIDS prevention. Culture, Medicine and Psychiatry. 1993; 17 (4):399–412. [ PubMed ] [ Google Scholar ] [ Ref list ]
41. Nyswander D. Education for health: Some principles and their application. Health Education Monographs. 1956; 14 :65–70. [ Google Scholar ] [ Ref list ]
42. Rappaport J. Studies in empowerment: Introduction to the issue. Prevention in Human Services. 1984; 3 (2 & 3):1–7. [ Google Scholar ] [ Ref list ]

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1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA

1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA

1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA

1 HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, USA, and Fordham University, Department of Psychology, Bronx, New York, USA

2 Fenway Institute, Fenway Community Health, Boston, Mass, USA; Miriam Hospital/Brown University, Providence, RI, USA
Anal intercourse is a highly efficient mode of HIV transmission. Although much scholarly attention has been paid to anal intercourse between men who have sex with men, research on women’s experiences of anal sex has been scarce. Nevertheless, there is evidence to suggest that anal intercourse is also widely practiced by women in the US ( 1 – 4 ). Prior studies that examined the prevalence of sexual behaviors among women and included anal intercourse found that 20–30% of US women reported lifetime rates of anal intercourse ( 3 , 5 – 7 ) and 19%–32% of US women reported having had anal sex in the last 6–12 months ( 8 , 9 ).
Given that anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse ( 10 – 13 ), women who engage in unprotected anal intercourse with sexual partners of unknown or seropositive status may be at greater risk for acquiring HIV than women who do not practice anal intercourse or who use protection while doing so. For example, a New York study of initially serodiscordant, heterosexual couples found that a history of anal intercourse was one of the strongest predictors of eventual HIV transmission, adjusted OR = 10.81, 95% CI = 2.78–42.0 ( 14 ). Similarly, in Brazil, researchers found that seronegative women who practiced anal intercourse in addition to vaginal and/or oral intercourse with seropositive male partners were approximately four times as likely to acquire HIV than women who did not practice anal intercourse ( 15 ). Additionally, Halperin ( 1 ) found that women who engaged in anal intercourse were less likely to use condoms during anal intercourse than during vaginal intercourse.
Most studies of heterosexual HIV transmission fail to distinguish between vaginal and anal intercourse in their assessments of coital acts, thus continuing to overlook anal intercourse as a potential source of HIV transmission. This
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