What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

Owen, Branwen Nia; Baggaley, Rebecca F.; Elmes, Jocelyn; Harvey, Amy; Shubber, Zara; Butler, Ailsa R.; Silhol, Romain; Anton, Peter A.; Shacklett, Barbara L.; Straten, Ariane van der; Boily, Marie Claude

doi:10.1007/s10461-019-02477-w

Cited by 14 publications

(11 citation statements)

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“…A main limitation of this analysis is the use of face-to-face interviews to collect data, and AI as well as condomless sex may be underreported due to social-desirability bias. Meta-analyses have found that the reporting of AI increases with con dentiality of interview method (1,36,37). As reported elsewhere(6,8), we found AI to be more common among women with higher educational attainment.…”

Section: Discussionsupporting

confidence: 85%

Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

Owen

Baggaley

Maheu‐Giroux

et al. 2022

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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: 3,708 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.

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Section: Discussionsupporting

confidence: 85%

Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

Owen

Baggaley

Maheu‐Giroux

et al. 2022

Preprint

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“…Trends in prevalence and frequency of heterosexual anal intercourse may affect trends in population‐level sexual risks, which further depends on condom use during anal intercourse. This is may be to be lower than for vaginal intercourse , although a systematic review of South Africa indicated equal or higher condom use during anal intercourse . Some studies suggest that heterosexual anal intercourse has become more common over time but, generally, trends in heterosexual anal intercourse in sub‐Saharan Africa are poorly understood and impacts of different types of sexual intercourse on population‐level sexual risks could not be evaluated in this study.…”

Section: Discussionmentioning

confidence: 89%

Widespread changes in sexual behaviour in eastern and southern Africa: Challenges to achieving global HIV targets? Longitudinal analyses of nationally representative surveys

2019

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Introduction Sexual behaviour change contributed to reductions in HIV incidence in eastern and southern Africa between 1990 and 2010. More recently, there are indications that non‐regular partnerships have increased. However, the effect of these increases on population‐level risks for HIV and other sexually transmitted infections could have been reduced by simultaneous increases in condom use. We describe recent trends in sexual behaviour and condom use within the region and assess their combined effects on population levels of sexual risk. Methods Nationally representative Demographic and Health Survey data on sexually active males and females (15 to 49 years) were used for 11 eastern and southern African countries (≥3 surveys for each country; 1999 to 2016) to describe trends in sexual behaviour (multiple, non‐regular, and casual sexual partnerships; condom use; age at first sex). Logistic regressions tested for statistical significance of changes. Analyses were stratified by sex. Results Recent increases in multiple, non‐regular, and/or casual partnerships can be found for males in 10 countries and, for females, in nine countries; five countries exhibited recent decreases in age of sexual debut. Reduction in sex without condoms with non‐regular partners was observed in six countries for males and eight for females. Changes in the proportion of the overall population reporting condomless sex with non‐regular partners varied between countries, with declines in six countries and increases in three. Conclusions Extensive change in sexual behaviour occurred across eastern and southern Africa during the period of scale‐up of antiretroviral therapy programmes. This includes increasing multiple and non‐regular partnerships, but their potential effects on population‐level sexual risks were often offset by parallel increases in condom use. Strengthening condom programmes and reintegrating communication about behavioural dimensions into combination prevention programmes could help countries to meet international targets for reductions in HIV incidence.

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“…Heterosexual URAI practice could increase HIV incidence among women and impact HIV spread at the populationlevel if practised sufficiently often by a sufficient fraction of women [4]. Current evidence from three systematic reviews among young women, South African women, and female sex workers (FSWs) suggests that RAI is common, with pooled estimates of the proportions practising RAI ranging from 12 to 21% in the past 3 months and from 15 to 22% in their lifetimes across these three risk populations [5][6][7]. Although scarcer and more heterogeneous, data on the frequency of anal intercourse suggest that 2-16% of all sex acts among all women in these different risk populations are RAI [6,7].…”

Section: Introductionmentioning

confidence: 99%

Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis

et al. 2019

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Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03-2.38, N = 18, I 2 = 72%; pooled aRR = 2.23, 1.01-4.92, N = 5, I 2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I 2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I 2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I 2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI.

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What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

Cited by 14 publications

References 137 publications

Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

Widespread changes in sexual behaviour in eastern and southern Africa: Challenges to achieving global HIV targets? Longitudinal analyses of nationally representative surveys

Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis

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