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Affiliation
1 Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands. n.veldhuijzen@amc-cpcd.org
Nienke J Veldhuijzen et al. Sex Health. 2011 Jun.
Affiliation
1 Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands. n.veldhuijzen@amc-cpcd.org
Introduction: Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI.
Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n=800) and Mombasa, Kenya (n=820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews.
Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4-24.7); OR Mombasa 2.1 (1.1-4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5-12.4); OR Mombasa 2.2 (1.1-4.3)); alcohol use before sex (OR Kigali 2.8 (1.4-5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2-4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7-7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5-1.9); OR Mombasa 0.5 (0.2-1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews.
Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.
Morris CN, Morris SR, Ferguson AG. Morris CN, et al. AIDS Behav. 2009 Oct;13(5):860-5. doi: 10.1007/s10461-008-9431-z. Epub 2008 Jul 30. AIDS Behav. 2009. PMID: 18665445
Okal J, Luchters S, Geibel S, Chersich MF, Lango D, Temmerman M. Okal J, et al. Cult Health Sex. 2009 Nov;11(8):811-26. doi: 10.1080/13691050902906488. Cult Health Sex. 2009. PMID: 19484638
Owen BN, M-Giroux M, Matse S, Mnisi Z, Baral S, Ketende SC, Baggaley RF, Boily MC. Owen BN, et al. PLoS One. 2020 Feb 11;15(2):e0228849. doi: 10.1371/journal.pone.0228849. eCollection 2020. PLoS One. 2020. PMID: 32045444 Free PMC article.
Hunter DJ. Hunter DJ. Epidemiology. 1993 Jan;4(1):63-72. Epidemiology. 1993. PMID: 8420583 Review.
Deniaud F. Deniaud F. Sante. 1997 Nov-Dec;7(6):405-15. Sante. 1997. PMID: 9503499 Review. French.
Morhason-Bello IO, Kabakama S, Baisley K, Francis SC, Watson-Jones D. Morhason-Bello IO, et al. Reprod Health. 2019 May 6;16(1):48. doi: 10.1186/s12978-019-0722-9. Reprod Health. 2019. PMID: 31060573 Free PMC article.
Owen BN, Baggaley RF, Elmes J, Harvey A, Shubber Z, Butler AR, Silhol R, Anton P, Shacklett B, van der Straten A, Boily MC. Owen BN, et al. AIDS Behav. 2020 Mar;24(3):697-713. doi: 10.1007/s10461-019-02477-w. AIDS Behav. 2020. PMID: 30953304 Free PMC article.
Chen J, Ren Y, Daharsh L, Liu L, Kang G, Li Q, Wei Q, Wan Y, Xu J. Chen J, et al. Front Microbiol. 2018 Mar 29;9:557. doi: 10.3389/fmicb.2018.00557. eCollection 2018. Front Microbiol. 2018. PMID: 29651274 Free PMC article.
Mazeingia YT, Olijjira L, Dessie Y. Mazeingia YT, et al. Glob Health Res Policy. 2017 Sep 8;2:27. doi: 10.1186/s41256-017-0047-6. eCollection 2017. Glob Health Res Policy. 2017. PMID: 29202095 Free PMC article.
Maheu-Giroux M, Baral S, Vesga JF, Diouf D, Diabaté S, Alary M, Abo K, Boily MC. Maheu-Giroux M, et al. Am J Epidemiol. 2018 Feb 1;187(2):287-297. doi: 10.1093/aje/kwx244. Am J Epidemiol. 2018. PMID: 28633387 Free PMC article.

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