AIDS and Behavior

, Volume 19, Issue 7, pp 1338–1360 | Cite as

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

  • Branwen N. Owen
  • Patrick M. Brock
  • Ailsa R. Butler
  • Michael Pickles
  • Marc Brisson
  • Rebecca F. Baggaley
  • Marie-Claude Boily
Original Paper


We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20–24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3–24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.


Anal intercourse Heterosexual Sexual behaviour Young people 

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  1. 1.
    Baggaley RF, White RG, Boily M-C. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39:1048–63.PubMedCentralPubMedGoogle Scholar
  2. 2.
    McGowan I, Taylor DJ. Heterosexual anal intercourse has the potential to cause a significant loss of power in vaginal microbicide effectiveness studies. Sex Transm Dis. 2010;37:361–4.PubMedGoogle Scholar
  3. 3.
    Brody S, Potterat JJ. Assessing the role of anal intercourse in the epidemiology of AIDS in Africa. Int J STD AIDS. 2003;14:431–6.PubMedGoogle Scholar
  4. 4.
    Mâsse BR, Boily M-C, Dimitrov D, Desai K. Efficacy dilution in randomized placebo-controlled vaginal microbicide trials. Emerg Themes Epidemiol. 2009;6:5.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Cohen MS, Dye C, Fraser C, Miller WC, Powers KA, Williams BG. HIV treatment as prevention: debate and commentary—will early infection compromise treatment-as-prevention strategies? PLoS Med. 2012;9:e1001232.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Boily M-C, Baggaley RF, Mâsse B. The role of heterosexual anal intercourse for HIV transmission in developing countries: are we ready to draw conclusions? Sex Transm Infect. 2009;85:408–10.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Baggaley RF, Dimitrov D, Owen BN, Pickles M, Butler AR, Masse B, et al. Heterosexual anal intercourse: a neglected risk factor for HIV? Am J Reprod Immunol. 2013;69:95–105.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Boily M-C, Dimitrov D, Abdool Karim SS, Mâsse B. The future role of rectal and vaginal microbicides to prevent HIV infection in h eterosexual populations: implications for product development and prevention. Sex Transm Infect. 2011;87:646–53.PubMedCentralPubMedGoogle Scholar
  9. 9.
    Nielsen A, Munk C, Kjaer SK. Trends in incidence of anal cancer and high-grade anal intraepithelial neoplasia in Denmark, 1978–2008. Int J Cancer. 2012;130:1168–73.PubMedGoogle Scholar
  10. 10.
    Jin F, Stein AN, Conway EL, Regan DG, Law M, Brotherton JML, et al. Trends in anal cancer in Australia, 1982–2005. Vaccine. 2011;29:2322–7.PubMedGoogle Scholar
  11. 11.
    Colón-López V, Ortiz AP, Soto-Salgado M, Torres-Cintrón M, Mercado-Acosta JJ, Suárez E. Anal cancer incidence and mortality in Puerto Rico. P R Health Sci J. 2013;32:76–81.PubMedCentralPubMedGoogle Scholar
  12. 12.
    WHO. Human papillomavirus (HPV) and cervical cancer. World Health Organization. 2014.Google Scholar
  13. 13.
    Asiaf A, Ahmad ST, Mohammad SO, Zargar MA. Review of the current knowledge on the epidemiology, pathogenesis, and prevention of human papillomavirus infection. Eur J Cancer Prev. 2013;23:206–24.Google Scholar
  14. 14.
    Aral S, Over M, Manhart L, Holmes KK. Sexually transmitted infections. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease control priorities in developing countries. 2nd ed. Washington: World Bank; 2006.Google Scholar
  15. 15.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.PubMedGoogle Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Nations U. Definition of Youth [Internet]. UN Fact Sheet. [cited 2014 Apr 1]. Available from:
  18. 18.
    Egger M. In: Egger M, Smith G, Altaman D, editors. Systematic reviews in health care: meta-analysis in context, vol. 2. London: Wiley; 2008.Google Scholar
  19. 19.
    Van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med. 2002;21:589–624.PubMedGoogle Scholar
  20. 20.
    Hedges LV, Olkin I. Statistical methods for meta-analysis. New York: Academic Press; 1985.Google Scholar
  21. 21.
    Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.Google Scholar
  22. 22.
    Team RC. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL. 2012. p.
  23. 23.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11:193–206.PubMedGoogle Scholar
  25. 25.
    Schmidt FL, Oh I-S, Hayes TL. Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results. Br J Math Stat Psychol. 2009;62:97–128.PubMedGoogle Scholar
  26. 26.
    Hedges LV, Vevea JL. Fixed- and random-effects models in meta-analysis [Internet]. Psychol Methods. 1998 [cited 2014 Sep 3]: 486–504. Available from:
  27. 27.
    Ioannidis JPA, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. 2008;336:1413–5.PubMedCentralPubMedGoogle Scholar
  28. 28.
    Tydén T, Palmqvist M, Larsson M. A repeated survey of sexual behavior among female university students in Sweden. Acta Obstet Gynecol Scand. 2012;91:215–9.PubMedGoogle Scholar
  29. 29.
    Cochran SD, Peplau LA. Sexual risk reduction behaviors among young heterosexual adults. Soc Sci Med. 1991;33:25–36.PubMedGoogle Scholar
  30. 30.
    DeBuono BA, Zinner SH, Daamen M, McCormack WM. Sexual behavior of college women in 1975, 1986, and 1989. N Engl J Med. 1990;322:821–5.PubMedGoogle Scholar
  31. 31.
    Story MD. A comparison of university student experience with various sexual outlets in 1974 and 1980. Adolescence. 1982;17:737–47.PubMedGoogle Scholar
  32. 32.
    Gindi RM, Ghanem KG, Erbelding EJ. Increases in oral and anal sexual exposure among youth attending sexually transmitted diseases clinics in Baltimore, Maryland. J Adolesc Health. 2008;42:307–8.PubMedCentralPubMedGoogle Scholar
  33. 33.
    Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis. 2007;196:1852–9.PubMedGoogle Scholar
  34. 34.
    Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006–2008 National Survey of Family Growth. Natl Health Stat Report. 2011;36:1–36.PubMedGoogle Scholar
  35. 35.
    Stulhofer A, Graham C, Bozicević I, Kufrin K, Ajduković D. An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults. Arch Sex Behav. 2009;38:209–25.PubMedGoogle Scholar
  36. 36.
    Stulhofer A, Baćak V. Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults. Sex Health. 2011;8:384–9.PubMedGoogle Scholar
  37. 37.
    Houston AM, Fang J, Husman C, Peralta L. More than just vaginal intercourse: anal intercourse and condom use patterns in the context of “main” and “casual” sexual relationships among urban minority adolescent females. J Pediatr Adolesc Gynecol. 2007;20:299–304.PubMedGoogle Scholar
  38. 38.
    Reinisch JM, Sanders SA, Hill CA, Ziemba-Davis M. High-risk sexual behavior among heterosexual undergraduates at a midwestern university. Fam Plann Perspect. 1992;24(116–21):145.Google Scholar
  39. 39.
    Reinisch JM, Hill CA, Sanders SA, Ziemba-Davis M. High-risk sexual behavior at a midwestern university: a confirmatory survey. Fam Plann Perspect. 1995;27:79–82.PubMedGoogle Scholar
  40. 40.
    Lescano CM, Houck CD, Brown LK, Doherty G, DiClemente RJ, Fernandez MI, et al. Correlates of heterosexual anal intercourse among at-risk adolescents and young adults. Am J Public Health. 2009;99:1131–6.PubMedCentralPubMedGoogle Scholar
  41. 41.
    Rotheram-Borus MJ, Marelich WD, Srinivasan S. HIV risk among homosexual, bisexual, and heterosexual male and female youths. Arch Sex Behav. 1999;28:159–77.PubMedGoogle Scholar
  42. 42.
    Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual behavior in the United States: results from a national probability sample of men and women ages 14–94. J Sex Med. 2010;7(Suppl 5):255–65.PubMedGoogle Scholar
  43. 43.
    Scott-Sheldon L, Carey MP, Carey KB. Alcohol and risky sexual behavior among heavy drinking college students. AIDS Behav. 2010;14:845–53.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Hensel DJ, Fortenberry JD, Orr DP. Variations in coital and noncoital sexual repertoire among adolescent women. J Adolesc Health. 2008;42:170–6.PubMedGoogle Scholar
  45. 45.
    Kabakchieva E, Vassileva S, Kelly JA, Amirkhanian YA, DiFranceisco WJ, McAuliffe TL, et al. HIV risk behavior patterns, predictors, and sexually transmitted disease prevalence in the social networks of young Roma (Gypsy) men in Sofia, Bulgaria. Sex Transm Dis. 2006;33:485–90.PubMedGoogle Scholar
  46. 46.
    Harvey SM, Bird ST, Henderson JT, Beckman LJ, Huszti HC. He said, she said: concordance between sexual partners. Sex Transm Dis. 2004;31:185–91.PubMedGoogle Scholar
  47. 47.
    Garry M, Sharman SJ, Feldman J, Marlatt GA, Loftus EF. Examining memory for heterosexual college students’ sexual experiences using an electronic mail diary. Health Psychol. 2002;21:629–34.PubMedGoogle Scholar
  48. 48.
    Morrison-Beedy D, Xia Y, Passmore D. Sexual risk factors for partner age discordance in adolescent girls and their male partners. J Clin Nurs. 2013;22:3289–99.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Simbayi LC, Kalichman SC, Jooste S, Cherry C, Mfecane S, Cain D. Risk factors for HIV-AIDS among youth in Cape Town, South Africa. AIDS Behav. 2005;9:53–61.PubMedGoogle Scholar
  50. 50.
    Matasha E, Ntembelea T, Mayaud P, Saidi W, Todd J, Mujaya B, et al. Sexual and reproductive health among primary and secondary school pupils in Mwanza, Tanzania: need for intervention. AIDS Care. 1998;10:571–82.PubMedGoogle Scholar
  51. 51.
    Napper LE, Fisher DG, Reynolds GL, Johnson ME. HIV risk behavior self-report reliability at different recall periods. AIDS Behav. 2010;14:152–61.PubMedCentralPubMedGoogle Scholar
  52. 52.
    Philips A, Gomez G, Boily M-C, Garnett G. A systematic review and meta-analysis of quantitative interviewing tools to investigate self-reported HIV and STI associated behaviours in low- and middle- income countries. Int J Epidemiol. 2010;39:1541–55.Google Scholar
  53. 53.
    Pluddemann A, Flisher AJ, Mathews C, Plu A, Carney T, Lombard C. Adolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa. Drug Alcohol Rev. 2008;27:687–92.PubMedGoogle Scholar
  54. 54.
    Jaspan HB, Flisher AJ, Myer L, Mathews C, Seebregts C, Berwick JR, et al. Brief report : methods for collecting sexual behaviour information from South African adolescents—a comparison of paper versus personal digital assistant questionnaires. J Adolesence. 2007;30:353–9.Google Scholar
  55. 55.
    Lane T, Pettifor A, Pascor S, Fiamma ARH. Heterosexual anal intercourse increases risk of HIV infection among young South African men. AIDS. 2006;20:112–32.Google Scholar
  56. 56.
    Nell A, Louw C, Hellstrom E, Braunstein SL, Treadwell I. HIV prevalence and incidence among sexually active females in two districts of South Africa to determine microbicide trial feasibility. PLoS One. 2011;6:6–13.Google Scholar
  57. 57.
    Karim QA. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168–74.Google Scholar
  58. 58.
    Béhanzin L, Diabaté S, Minani I, Lowndes CM, Boily M-C, Labbé A-C, et al. Assessment of HIV-related risky behaviour: a comparative study of face-to-face interviews and polling booth surveys in the general population of Cotonou, Benin. Sex Transm Infect. 2013;89:595–601.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Unterberger L. Let’s talk anal sex, that thing all guys want in bed these days. glamour. 2013;–love–life/blogs/smitten.
  60. 60.
    McGuire E. Naomi Wolf on the porn myth. Age (Omaha). 2010. p.–wolf.
  61. 61.
    Ajduković D, Stulhofer A, Baćak V. Rising popularity of anal intercourse and sexual risk taking: findings from two national probability studies of young Croatian adults. Int J STD AIDS. 2012;23:785–91.PubMedGoogle Scholar
  62. 62.
    Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS. 2005;16:102–7.PubMedGoogle Scholar
  63. 63.
    Braun-Courville DK, Rojas M. Exposure to sexually explicit Web sites and adolescent sexual attitudes and behaviors. J Adolesc Health. 2009;45:156–62.PubMedGoogle Scholar
  64. 64.
    Marston C, Lewis R. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK. BMJ Open. 2014;4:e004996.PubMedCentralPubMedGoogle Scholar
  65. 65.
    Lindberg LD, Jones R, Santelli JS. Noncoital sexual activities among adolescents. J Adolesc Health. 2008;43:231–8.PubMedGoogle Scholar
  66. 66.
    Schuster MA, Bell RM, Kanouse DE. The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse. Am J Public Health. 1996;86:1570–6.PubMedCentralPubMedGoogle Scholar
  67. 67.
    Kazaura MR, Masatu MC. Sexual practices among unmarried adolescents in Tanzania. BMC Public Health. 2009;9:1–6.Google Scholar
  68. 68.
    Caetano ME, Linhares IM, Pinotti JA, Maggio da Fonseca A, Wojitani MD, Giraldo PC. Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil. Int J Gynaecol Obstet. 2010;110:43–6.PubMedGoogle Scholar
  69. 69.
    Ma Q, Ono-Kihara M, Cong L, Pan X, Xu G, Zamani S, et al. Behavioral and psychosocial predictors of condom use among university students in Eastern China. AIDS Care. 2009;21:249–59.PubMedGoogle Scholar
  70. 70.
    Yu S, Deveaux L, Lunn S, Liu H, Brathwaite N, Li X, et al. At greatest risk: pre- and early adolescent Bahamian youth experiencing anal intercourse. Int J STD AIDS. 2007;18:396–401.PubMedGoogle Scholar
  71. 71.
    Hennessy M, Bleakley A, Fishbein M, Jordan A. Validating an index of adolescent sexual behavior using psychosocial theory and social trait correlates. AIDS Behav. 2008;12:321–31.PubMedCentralPubMedGoogle Scholar
  72. 72.
    Kaestle CE, Halpern CT. What’s love got to do with it? Sexual behaviors of opposite-sex couples through emerging adulthood. Perspect Sex Reprod Health. 2007;39:134–40.PubMedGoogle Scholar
  73. 73.
    Langille DB, Hughes J, Murphy GT, Rigby JA. Socio-economic factors and adolescent sexual activity and behaviour in Nova Scotia. Can J Public Health Rev. 2005;96:313–8.Google Scholar
  74. 74.
    Edgardh K. Sexual behaviour in a low-income high school setting in Stockholm. Int J STD AIDS. 2002;13:160–7.PubMedGoogle Scholar
  75. 75.
    Markham CM, Fleschler Peskin M, Addy RC, Baumler ER, Tortolero SR. Patterns of vaginal, oral, and anal sexual intercourse in an urban seventh-grade population. J Sch Health. 2009;79:193–200.PubMedCentralPubMedGoogle Scholar
  76. 76.
    Dake JA, Price JH, McKinney M, Ward B. Midwestern rural adolescents’ anal intercourse experience. J. Rural Health. 2011;27:196–204.PubMedGoogle Scholar
  77. 77.
    Higgins JA, Trussell J, Moore NB, Davidson JK. Young adult sexual health: current and prior sexual behaviours among non-Hispanic white US college students. Sex Health. 2010;7:35–43.PubMedGoogle Scholar
  78. 78.
    Fortenberry JD, Schick V, Herbenick D, Sanders SA, Dodge B, Reece M. Sexual behaviors and condom use at last vaginal intercourse: a national sample of adolescents ages 14 to 17 years. J Sex Med. 2010;7(Suppl 5):305–14.PubMedGoogle Scholar
  79. 79.
    Kotloff KL, Tacket CO, Wasserman SS, Bridwell MW, Cowan JE, Clemens JD, et al. A voluntary serosurvey and behavioral risk assessment for human immunodeficiency virus infection among college students. Sex Transm Dis. 1991;18:223–7.PubMedGoogle Scholar
  80. 80.
    Thomas SB, Gilliam AG, Iwrey CG. Knowledge about AIDS and reported risk behaviors among black college students. J Am Coll Health. 1989;38:61–6.PubMedGoogle Scholar
  81. 81.
    Breakwell GM, Fife-Schaw C. Sexual activities and preferences in a United Kingdom sample of 16 to 20-year-olds. Arch Sex Behav. 1992;21:271–93.PubMedGoogle Scholar
  82. 82.
    Cochran SD, Mays VM, Leung L. Sexual practices of heterosexual Asian-American young adults: implications for risk of HIV infection. Arch Sex Behav. 1991;20:381–91.PubMedGoogle Scholar
  83. 83.
    Hsu B, Kling A, Kessler C, Knapke K, Diefenbach P, Elias JE. Gender differences in sexual fantasy and behavior in a college population: a ten-year replication. J Sex Marital Ther. 1994;20:103–18.PubMedGoogle Scholar
  84. 84.
    Taylor SE, Dilorio C, Stephens TT, Soet JE. A comparison of AIDS-related sexual risk behaviors among African-American college students. J Natl Med Assoc. 1997;89:397–403.PubMedCentralPubMedGoogle Scholar
  85. 85.
    Weinberg MS, Lottes IL, Aveline D. AIDS risk reduction strategies among United States and Swedish heterosexual university students. Arch Sex Behav. 1998;27:385–401.PubMedGoogle Scholar
  86. 86.
    Flannery D, Ellingson L. Sexual risk behaviors amdon first year college students, 2000–2002. Californian J Health Promot. 2003;1:93–104.Google Scholar
  87. 87.
    McGuire E, Shega J, Nicholls G, Deese P, Landefeld CS. Sexual behavior, knowledge, and attitudes about AIDS among college freshmen. Am J Prev Med. 1992;8:226–34.PubMedGoogle Scholar
  88. 88.
    Carter M, Henry-Moss D, Hock-Long L, Bergdall A, Andes K. Heterosexual anal sex experiences among Puerto Rican and black young adults. Perspect Sex Reprod Health. 2010;42:267–74.PubMedGoogle Scholar
  89. 89.
    George C, Alary M, Otis J. Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica. West Indian Med J. 2007;56:433–8.PubMedGoogle Scholar
  90. 90.
    Perera B, Reece M. Sexual behavior of young adults in Sri Lanka: implications for HIV prevention. AIDS Care. 2006;18:497–500.PubMedGoogle Scholar
  91. 91.
    Auslander BA, Biro FM, Succop PA, Short MB, Rosenthal SL. Racial/ethnic differences in patterns of sexual behavior and STI risk among sexually experienced adolescent girls. J Pediatr Adolesc Gynecol. 2009;22:33–9.PubMedCentralPubMedGoogle Scholar
  92. 92.
    Childs G, Moneyham L, Felton G. Correlates of sexual abstinence and sexual activity of low-income African American adolescent females. J Assoc Nurses AIDS Care. 2008;19:432–42.PubMedGoogle Scholar
  93. 93.
    Fielder RL, Carey MP. Prevalence and characteristics of sexual hookups among first-semester female college students. J Sex Marital Ther. 2010;36:346–59.PubMedCentralPubMedGoogle Scholar
  94. 94.
    Roye CF, Krauss BJ, Silverman PL. Prevalence and correlates of heterosexual anal intercourse among Black and Latina female adolescents. J Assoc Nurses AIDS Care. 2010;21:291–301.PubMedCentralPubMedGoogle Scholar
  95. 95.
    Stankovic M, Miljkovic S, Grbesa G, Visnjic A. General characteristics of adolescent sexual behavior: national survey. Srp Arh Celok Lek. 2009;137:409–15.PubMedGoogle Scholar
  96. 96.
    Flannery D, Ellingson L, Votaw KS, Schaefer EA. Anal intercourse and sexual risk factors among college women, 1993–2000. Am J Health Behav. 2003;27:228–34.PubMedGoogle Scholar
  97. 97.
    DeMaria AL, Hollub AV, Herbenick D. Using genital self-image, body image, and sexual behaviors to predict gynecological exam behaviors of college women. J Sex Med. 2011;8:2484–92.PubMedGoogle Scholar
  98. 98.
    Cochran SD, Jasen K, Kalechstein A. Sexually transmitted diseases and AIDS. Changes in risk reduction behaviours among young adults. Sex Transm Dis. 1990;17:80–6.PubMedGoogle Scholar
  99. 99.
    Edgardh K. Sexual behaviour and early coitarche in a national sample of 17 year old Swedish girls. Sex Transm Infect. 2000;76:98–102.PubMedCentralPubMedGoogle Scholar
  100. 100.
    Hein K, Dell R, Futterman D, Rotheram-Borus MJ, Shaffer N. Comparison of HIV+ and HIV− adolescents: risk factors and psychosocial determinants. Pediatrics. 1995;95:96–104.PubMedGoogle Scholar
  101. 101.
    Langille DB, Beazley R, Shoveller J, Johnston G. Prevalence of high risk sexual behaviour in adolescents attending school in a county in Nova Scotia. Can J Public Health Rev. 1994;85:227–30.Google Scholar
  102. 102.
    MacDonald NE, Wells GA, Fisher WA, Warren WK, King MA, Doherty JA, et al. High-risk STD/HIV behavior among college students. JAMA. 1990;263:3155–9.PubMedGoogle Scholar
  103. 103.
    Madhok R, McCallum AK, McEwan R, Bhopal RS. Students’ knowledge and behavior concerning safer sex: a UK study. J Am Coll Health. 1993;42:121–5.PubMedGoogle Scholar
  104. 104.
    Misegades L, Page-Shafer K, Halperin D, McFarland W. Anal intercourse among young low-income women in California: an overlooked risk factor for HIV? AIDS. 2001;15:534–5.PubMedGoogle Scholar
  105. 105.
    Rosenthal D, Moore S, Buzwell S. Homeless youths: sexual and drug-related behaviour, sexual beliefs and HIV/AIDS risk. AIDS Care. 1994;6:83–94.PubMedGoogle Scholar
  106. 106.
    Stanton B, Li X, Black MM, Ricardo I, Galbraith J. Anal intercourse among preadolescent and early adolescent low-income urban African-Americans. Arch Pediatr Adolesc Med. 1994;148:1201–4.PubMedGoogle Scholar
  107. 107.
    Hale RW, Char D, Nagy K, Stockert N. Seventeen-year review of sexual and contraceptive behaviour on a college campus. Am J Obs Gynecol. 1993;168:1833–8.Google Scholar
  108. 108.
    Alzate H. Sexual behavior of Colombian female university students. Arch Sex Behav. 1978;7:43–54.PubMedGoogle Scholar
  109. 109.
    Johnson EH, Jackson LA, Hinkle Y, Gilbert D, Hoopwood T, Lollis CM, et al. What is the significance of black-white differences in risky sexual behavior? J Natl Med Assoc. 1994;86:745–59.PubMedCentralPubMedGoogle Scholar
  110. 110.
    Gilbert L, Alexander L. A profile of sexual health behaviors among college women. Psychol Rep. 1998;82:107–16.PubMedGoogle Scholar
  111. 111.
    Friedman SR, Flom PL, Kottiri BJ, Neaigus A, Sandoval M, Curtis R, et al. Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood. AIDS. 2001;15:2057–60.PubMedGoogle Scholar
  112. 112.
    Ramjee BG, Gouws E, Andrews A, Myer L, Weber AE. The acceptability of a vaginal microbicide among South African men. Int Fam Plan Perspect. 2001;27:164–70.Google Scholar
  113. 113.
    Gates GJ, Sonenstein FL. Heterosexual genital sexual activity among adolescent males: 1988 and 1995. Fam Plann Perspect. 2000;32(295–7):304.Google Scholar
  114. 114.
    Morhason-Bello IO, Oladokun A, Enakpene CA, Fabamwo AO, Obisesan KAOO. Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria. Afr J Reprod Heal. 2008;12:89–97.Google Scholar
  115. 115.
    Mpofu E, Flisher AJ, Bility K, Onya H, Lombard C. Sexual partners in a rural South African setting. AIDS Behav. 2006;10:399–404.PubMedGoogle Scholar
  116. 116.
    Tho LH, Singhasivanon P, Kaewkungwal J, Kaljee LM, Charoenkul C. Sexual behaviors of alcohol drinkers and non-drinkers among adolescents and young adults in Nha Trang, Vietnam. Southeast Asian J Trop Med Public Health. 2007;38:152–60.Google Scholar
  117. 117.
    Tortolero SR, Markham CM, Peskin MF, Shegog R, Addy RC, Escobar-Chaves SL, et al. It’s your game: keep it real: delaying sexual behavior with an effective middle school program. J Adolesc Health. 2010;46:169–79.PubMedCentralPubMedGoogle Scholar
  118. 118.
    Mellins CA, Brackis-Cott E, Dolezal C, Meyer-Bahlburg HFL. Behavioral risk in early adolescents with HIV+ mothers. J Adolesc Health. 2005;36:342–51.PubMedGoogle Scholar
  119. 119.
    So DW, Wong FY, DeLeon JM. Sex, HIV risks, and substance use among Asian American college students. AIDS Educ Prev. 2005;17:457–68.PubMedGoogle Scholar
  120. 120.
    Markham CM, Tortolero SR, Peskin MF, Shegog R, Thiel M, Baumler ER, et al. Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial. J Adolesc Health. 2012;50:279–88.PubMedGoogle Scholar
  121. 121.
    Dilorio C, Dudley WN, Soet J, Watkins J, Maibach E. A social cognitive-based model for condom use among college students. Nurs Res. 2000;49:208–14.PubMedGoogle Scholar
  122. 122.
    Goodman E, Cohall AT. Acquired immunodeficiency syndrome and adolescents: knowledge, attitudes, beliefs, and behaviors in a New York City adolescent minority population. Pediatrics. 1989;84:36–42.PubMedGoogle Scholar
  123. 123.
    Feldman DA, O’Hara P, Baboo KS, Chitalu NWLY. HIV prevention among Zambian adolescents: developing a value utilization/norm change model. Soc Sci Med. 1997;44:455–68.PubMedGoogle Scholar
  124. 124.
    Jemmott LS, Jemmott JB, Villarruel AM. Predicting intentions and condom use among Latino college students. J Assoc Nurses AIDS Care. 2002;13:59–69.PubMedGoogle Scholar
  125. 125.
    Baldwin JI, Baldwin JD. Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Arch Sex Behav. 2000;29:357–73.PubMedGoogle Scholar
  126. 126.
    Johnson EH, Gilbert D, Lollis C. Characteristics of African-American college students with HIV/AIDS. J Natl Med Assoc. 1994;86:931–40.PubMedCentralPubMedGoogle Scholar
  127. 127.
    Fleuridas C, Creevy K, Vela E. Sexual risk-taking in college students and functional families of origin. Fam Syst Heal. 1997;15:185–202.Google Scholar
  128. 128.
    Shapiro J, Radecki S, Charchian AS, Josephson V. Sexual behavior and AIDS-related knowledge among community college students in Orange County, California. J Community Health. 1999;24:29–43.PubMedGoogle Scholar
  129. 129.
    Civic D. College students’ reasons for nonuse of condoms within dating relationships. J Sex Marital Ther. 2000;26:95–105.PubMedGoogle Scholar
  130. 130.
    Roye CF, Tolman DL, Snowden F. Heterosexual anal intercourse among Black and Latino adolescents and young adults: a poorly understood high-risk behavior. J. Sex Res. 2012;507:715–22.Google Scholar
  131. 131.
    Ehde DM, Holm JE, Robbins GM. The impact of Magic Johnson’s HIV serostatus disclosure on unmarried college students’ HIV knowledge, attitudes, risk perception, and sexual behavior. J Am Coll Health. 1995;44:55–8.PubMedGoogle Scholar
  132. 132.
    Flisher A, Ziervogel C. Risk-taking behaviour of Cape Peninsula high school students. S Af Med J. 1993;83:495–8.Google Scholar
  133. 133.
    Hutchison BJ. Risky and safe sex: heterosexual youth, gender differences, and sexual risk-taking. Soc Rev. 1996;6:30–3.Google Scholar
  134. 134.
    Gurman T, Borzekowski DLG. Condom use among Latino college students. J Am Coll Health. 2004;52:169–78.PubMedGoogle Scholar
  135. 135.
    Ompad DC, Strathdee SA, Celentano DD, Latkin C, Poduska JM, Kellam SG, et al. Predictors of early initiation of vaginal and oral sex among urban young adults in Baltimore, Maryland. Arch Sex Behav. 2006;35:53–65.PubMedGoogle Scholar
  136. 136.
    Rahman M, Berenson AB. Pregnancy test taking is a correlate of unsafe sex, contraceptive nonadherence, pregnancy, and sexually transmitted infections in adolescent and young adult women. J. Womens Health. 2013;22:339–43.Google Scholar
  137. 137.
    Kakoko DC. Reported heterosexual intercourse and related behaviours among primary school pupils in Kinondoni district, Dar es Salaam, Tanzania. Cult Health Sex. 2013;15:235–45.PubMedGoogle Scholar
  138. 138.
    Stone N, Hatherall B, Ingham R, McEachran J. Oral sex and condom use among young people in the United Kingdom. Perspect Sex Reprod Health. 2006;38:6–12.PubMedGoogle Scholar
  139. 139.
    Mercer CH, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S, et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013;382:1781–94.PubMedCentralPubMedGoogle Scholar
  140. 140.
    McCauley HL, Dick RN, Tancredi DJ, Goldstein S, Blackburn S, Silverman JG, et al. Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females. J Adolesc Health. 2014;55:652–8.PubMedGoogle Scholar
  141. 141.
    Kerr DL, Ding K, Thompson AJ. A comparison of lesbian, bisexual, and heterosexual female college undergraduate students on selected reproductive health screenings and sexual behaviors. Womens Health Issues. 2013;23:e347–55.PubMedGoogle Scholar
  142. 142.
    Erickson PI, Bastani R, Maxwell AE, Marcus AC, Capell FJ, Yan KX. Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors. AIDS Educ Prev. 1995;7:477–93.PubMedGoogle Scholar
  143. 143.
    Jaffe LR, Seehaus M, Wagner C, Leadbeater BJ. Anal intercourse and knowledge of acquired immunodeficiency syndrome among minority-group female adolescents. J Pediatr. 1988;112:1005–7.PubMedGoogle Scholar
  144. 144.
    Foxman B, Aral SO, Holmes KK. Interrelationships among douching practices, risky sexual practices, and history of self-reported sexually transmitted diseases in an urban population. Sex Transm Dis. 1998;25:90–9.PubMedGoogle Scholar
  145. 145.
    Silverman JG, McCauley HL, Decker MR, Miller E, Reed E, Raj A. Coercive forms of sexual risk and associated violence perpetrated by male partners of female adolescents. Perspect Sex Reprod Health. 2011;43:60–5.PubMedGoogle Scholar
  146. 146.
    Zhang D, Pan H, Cui B, Law F, Farrar J, Ba-Thein W. Sexual behaviors and awareness of sexually transmitted infections among Chinese university students. J Infect Dev Ctries. 2013;7:966–74.PubMedGoogle Scholar
  147. 147.
    Lepusić D, Radović-Radovcić S. Alcohol—a predictor of risky sexual behavior among female adolescents. Acta Clin Croat. 2013;52:3–9.PubMedGoogle Scholar
  148. 148.
    Jozkowski KN, Satinsky SA. A gender discrepancy analysis of heterosexual sexual behaviors in two university samples. J. Community Health. 2013;38:1157–65.PubMedGoogle Scholar
  149. 149.
    Norris AE, Ford K. Sexual experiences and condom use of heterosexual, low-income African American and hispanic youth practicing relative monogamy, serial monogamy, and nonmonogamy. Sex Transm Dis. 1999;26:17–25.PubMedGoogle Scholar
  150. 150.
    Smith AM, de Visser R, Akande A, Rosenthal D, Moore S. Australian and South African undergraduates’ HIV-related knowledge, attitudes, and behaviors. Arch Sex Behav. 1998;27:279–94.PubMedGoogle Scholar
  151. 151.
    Gorbach PM, Manhart LE, Hess KL, Stoner BP, Martin DH, Holmes KK. Anal intercourse among young heterosexuals in three sexually transmitted disease clinics in the United States. Sex Transm Dis. 2009;36:193–8.PubMedGoogle Scholar
  152. 152.
    Maxwell AE, Bastani R, Yan KX. AIDS risk behaviours and correlates in teenagers attending sexually transmitted diseases clinics in Los Angeles. Genitourin Med. 1995;71:82–7.PubMedCentralPubMedGoogle Scholar
  153. 153.
    Moscicki AB, Millstein SG, Broering J, Irwin CE. Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics. J Pediatr. 1993;122:813–20.PubMedGoogle Scholar
  154. 154.
    Raffaelli M, Campos R, Merritt AP, Siqueira E, Antunes CM, Parker R, et al. Sexual practices and attitudes of street youth in Belo Horizonte, Brazil. Street Youth Study Group. Soc Sci Med. 1993;37:661–70.PubMedGoogle Scholar
  155. 155.
    Opoku B. Contraceptive use among “at-risk” women in a metropolitan area in Ghana. Acta Obstet Gynecol. 2010;89:1105–7.Google Scholar
  156. 156.
    McDonnell DD, Levy V, Morton TJM. Risk factors for Chlamydia among young women in a northern california juvenile detention facility: implications for community intervention. Sex Transm Dis. 2009;36:S29–33.PubMedGoogle Scholar
  157. 157.
    Seth P, Sales JM, DiClemente RJ, Wingood GM, Rose E, Patel SN. Longitudinal examination of alcohol use: a predictor of risky sexual behavior and Trichomonas vaginalis among African-American female adolescents. Sex Transm Dis. 2011;38:96–101.PubMedGoogle Scholar
  158. 158.
    Koniak-Griffin D, Lesser J, Uman G, Nyamathi A. Teen pregnancy, motherhood, and unprotected sexual activity. Res Nurs Health. 2003;26:4–19.PubMedGoogle Scholar
  159. 159.
    Koniak-Griffin D, Brecht ML. AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers. Health Educ Behav. 1997;24:613–24.PubMedGoogle Scholar
  160. 160.
    Rogala C, Tyden T. Does pornography influence young women’s sexual behaviour? Women’s Health Issues. 2003;13:39–43.PubMedGoogle Scholar
  161. 161.
    Solorio MR, Milburn NG, Rotheram-Borus MJ, Higgins C, Gelberg L. Predictors of sexually transmitted infection testing among sexually active homeless youth. AIDS Behav. 2006;10:179–84.PubMedCentralPubMedGoogle Scholar
  162. 162.
    MacDonald NE, Fisher WA, Wells GA, Doherty JA, Bowie WR. Canadian street youth: correlates of sexual risk-taking activity. Pediatr Infect Dis J. 1994;13:690–7.PubMedGoogle Scholar
  163. 163.
    Morrison DM, Baker SA, Gillmore MR. Sexual risk behavior, knowledge, and condom use among adolescents in juvenile detention. J Youth Adolesc. 1994;23:271–88.PubMedGoogle Scholar
  164. 164.
    Roy E, Haley N, Leclerc P, Lemire N, Boivin JF, Frappier JY, et al. Prevalence of HIV infection and risk behaviours among Montreal street youth. Int J STD AIDS. 2000;11:241–7.PubMedGoogle Scholar
  165. 165.
    Kabakchieva E, Amirkhanian YA, Kelly JA, McAuliffe TL, Vassileva S. High levels of sexual HIV/STD risk behaviour among Roma (Gypsy) men in Bulgaria: patterns and predictors of risk in a representative community sample. Int J STD AIDS. 2002;13:184–91.PubMedGoogle Scholar
  166. 166.
    Tydén T, Rogala C. Sexual behaviour among young men in Sweden and the impact of pornography. Int J STD AIDS. 2004;15:590–3.PubMedGoogle Scholar
  167. 167.
    Tian LH, Peterman TA, Tao G, Brooks LC, Metcalf C, Malotte CK, et al. Heterosexual anal sex activity in the year after an STD clinic visit. Sex Transm Dis. 2008;35:905–9.PubMedGoogle Scholar
  168. 168.
    Satterwhite CL, Kamb ML, Metcalf C, Douglas JM, Malotte CK, Paul S, et al. Changes in sexual behavior and STD prevalence among heterosexual STD clinic attendees: 1993–1995 versus 1999–2000. Sex Transm Dis. 2007;34:815–9.PubMedGoogle Scholar
  169. 169.
    Prado G, Pantin H, Huang S, Cordova D, Tapia MI, Velazquez M-R, et al. Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: a randomized controlled trial. Arch Pediatr Adolesc Med. 2012;166:127–33.PubMedCentralPubMedGoogle Scholar
  170. 170.
    Champion JD, Roye CF. Toward an understanding of the context of anal sex behavior in ethnic minority adolescent women. Issues Ment Health Nurs. 2014;35:509–16.Google Scholar
  171. 171.
    Decker MR, Miller E, McCauley HL, Tancredi DJ, Anderson H, Levenson RR, et al. Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics. Sex Transm Infect. 2014;90:145–9.PubMedCentralPubMedGoogle Scholar
  172. 172.
    Decker MR, Miller E, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, et al. Sex trade among young women attending family-planning clinics in Northern California. Int J Gynaecol Obstet. 2012;117:173–7.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Branwen N. Owen
    • 1
  • Patrick M. Brock
    • 1
  • Ailsa R. Butler
    • 1
  • Michael Pickles
    • 1
    • 2
  • Marc Brisson
    • 3
  • Rebecca F. Baggaley
    • 2
  • Marie-Claude Boily
    • 1
    • 3
  1. 1.Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
  2. 2.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
  3. 3.Département de Médecine Sociale et PréventiveUniversité LavalQuebecCanada

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