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.
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.
Authors: Rebecca F Baggaley; Dobromir Dimitrov; Branwen N Owen; Michael Pickles; Ailsa R Butler; Ben Masse; Marie-Claude Boily Journal: Am J Reprod Immunol Date: 2012-12-24 Impact factor: 3.886
Authors: Branwen N Owen; Jocelyn Elmes; Romain Silhol; Que Dang; Ian McGowan; Barbara Shacklett; Edith M Swann; Ariane van der Straten; Rebecca F Baggaley; Marie-Claude Boily Journal: J Int AIDS Soc Date: 2017-01-12 Impact factor: 5.396
Authors: Andrea L Wirtz; Carel Pretorius; Chris Beyrer; Stefan Baral; Michele R Decker; Susan G Sherman; Michael Sweat; Tonia Poteat; Jennifer Butler; Robert Oelrichs; Iris Semini; Deanna Kerrigan Journal: PLoS One Date: 2014-02-06 Impact factor: 3.240
Authors: Angela Kelly-Hanku; Andrew Vallely; Wing Young Nicola Man; David Wilson; Greg Law; Richard Gray Journal: BMC Public Health Date: 2013-12-01 Impact factor: 3.295
Authors: Piet Cools; Vicky Jespers; Liselotte Hardy; Tania Crucitti; Sinead Delany-Moretlwe; Mary Mwaura; Gilles F Ndayisaba; Janneke H H M van de Wijgert; Mario Vaneechoutte Journal: PLoS One Date: 2016-01-26 Impact factor: 3.240