Longitudinal determinants of anal intercourse among women with, and without HIV in the United States
File(s)
Author(s)
Type
Journal Article
Abstract
Background
Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.
Methods
3708 women living with (73%), and without HIV (27%) participating in the Women’s Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994–2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.
Results
AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96–0.98), Hispanic (aOR = 1.88, CI:1.47–2.41) or White (aOR = 1.62, CI:1.15–2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08–1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10–1.62), or both (aOR = 1.77, CI:1.13–2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05–1.66) or any drug use (aOR = 1.34, CI:1.09–1.66), multiple male partners (aOR = 2.64, CI:2.23–3.11), exchange sex (aOR = 3.45, CI:2.53–4.71), one or more female sex partners (aOR = 1.32, CI:1.01–1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53–2.09), and high depressive symptoms (aOR = 1.23, CI:1.08–1.39).
Conclusion
AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.
Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.
Methods
3708 women living with (73%), and without HIV (27%) participating in the Women’s Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994–2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.
Results
AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96–0.98), Hispanic (aOR = 1.88, CI:1.47–2.41) or White (aOR = 1.62, CI:1.15–2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08–1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10–1.62), or both (aOR = 1.77, CI:1.13–2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05–1.66) or any drug use (aOR = 1.34, CI:1.09–1.66), multiple male partners (aOR = 2.64, CI:2.23–3.11), exchange sex (aOR = 3.45, CI:2.53–4.71), one or more female sex partners (aOR = 1.32, CI:1.01–1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53–2.09), and high depressive symptoms (aOR = 1.23, CI:1.08–1.39).
Conclusion
AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.
Date Issued
2022-07-14
Date Acceptance
2022-06-23
Citation
BMC Womens Health, 2022, 22 (1)
ISSN
1472-6874
Publisher
BioMed Central
Journal / Book Title
BMC Womens Health
Volume
22
Issue
1
Copyright Statement
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
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to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
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mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
License URL
Sponsor
National Institutes of Health
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000825402000002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
5R01AI057020 Sub#201224310-05
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Obstetrics & Gynecology
Heterosexual
Anal sex
Women
Transmission
Prevention
TRANSMITTED-DISEASE CLINICS
INTIMATE PARTNER VIOLENCE
SEX
RISK
PREVALENCE
MEN
Publication Status
Published
Article Number
ARTN 291