Advertisement

AIDS and Behavior

, Volume 21, Issue 10, pp 2895–2903 | Cite as

Contribution of Anal Sex to HIV Prevalence Among Heterosexuals: A Modeling Analysis

  • Ann O’Leary
  • Elizabeth DiNenno
  • Amanda Honeycutt
  • Benjamin Allaire
  • Simon Neuwahl
  • Katherine Hicks
  • Stephanie Sansom
Original Paper

Abstract

Anal intercourse is reported by many heterosexuals, and evidence suggests that its practice may be increasing. We estimated the proportion of the HIV burden attributable to anal sex in 2015 among heterosexual women and men in the United States. The HIV Optimization and Prevention Economics model was developed using parameter inputs from the literature for the sexually active U.S. population aged 13–64. The model uses differential equations to represent the progression of the population between compartments defined by HIV disease status and continuum-of-care stages from 2007 to 2015. For heterosexual women of all ages (who do not inject drugs), almost 28% of infections were associated with anal sex, whereas for women aged 18–34, nearly 40% of HIV infections were associated with anal sex. For heterosexual men, 20% of HIV infections were associated with insertive anal sex with women. Sensitivity analyses showed that varying any of 63 inputs by ±20% resulted in no more than a 13% change in the projected number of heterosexual infections in 2015, including those attributed to anal sex. Despite uncertainties in model inputs, a substantial portion of the HIV burden among heterosexuals appears to be attributable to anal sex. Providing information about the relative risk of anal sex compared with vaginal sex may help reduce HIV incidence in heterosexuals.

Keywords

HIV Heterosexual Anal intercourse 

Notes

Acknowlegements

The findings and conclusions in this report are those of the authors and do not represent official views of the Centers for Disease Control and Prevention. The authors wish to acknowledge the contributions of Marie-Claude Boily and Michael Pickles by sharing relevant research on heterosexual anal sex and providing consulting advice on the calibration of the U.S. National HIV Model used for analyses. They also wish to acknowledge Emily L. Tucker and Christopher Goodrich for implementing the programming to make this analysis possible.

Funding Source

This research was supported by the Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Contract No. 200-2012-53603 (Tasks 5 and 6).

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest or financial relationships to disclose.

Supplementary material

10461_2016_1635_MOESM1_ESM.docx (459 kb)
Supplementary material 1 (DOCX 458 kb)

References

  1. 1.
    Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048–63.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW, Patel P, et al. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 2002;29(1):38–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk: a systematic review. AIDS. 2014;28(10):1509–19.CrossRefPubMedGoogle Scholar
  4. 4.
    Laumann EO, Gagnon JH, Michael RT, Michaels S. The social organization of sexuality: sexual practices in the United States. Chicago, IL: University of Chicago Press; 1994.Google Scholar
  5. 5.
    Halpern CT, Haydon AA. Sexual timetables for oral-genital, vaginal, and anal intercourse: sociodemographic comparisons in a nationally representative sample of adolescents. Am J Public Health. 2012;102(6):1221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Copen CE, Chandra A, Febo-Vazquez I, Higgins JA, Trussell J, Moore NB, et al. Sexual behavior, sexual attraction, and sexual orientation among adults aged 18–44 in the United States: data from the 2011–2013 national survey of family growth. Natl Health Stat Rep. 2016;7(88):1–14.Google Scholar
  7. 7.
    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(1):35–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Justman J, Befus M, Hughes J, Wang J, Golin CE, Adimora AA, et al. Sexual behaviors of US women at risk of HIV acquisition: a longitudinal analysis of findings from HPTN 064. AIDS Behav. 2015;19(7):1327–37.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD, et al. Sexual behaviors, relationships, and perceived health status among adult women in the United States: results from a national probability sample. J Sex Med. 2010;7:277–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual behaviors, relationships, and perceived health among adult men in the United States: results from a national probability sample. J Sex Med. 2010;7(Suppl 5):291–304.CrossRefPubMedGoogle Scholar
  11. 11.
    National Institute of Mental Health. (NIMH) Multisite HIV prevention trial group. The NIMH multisite HIV prevention trial: reducing HIV sexual risk behavior. Science. 1998;280(5371):1889–94.CrossRefGoogle Scholar
  12. 12.
    Leichliter JS. Heterosexual anal sex: part of an expanding sexual repertoire? Sex Transm Dis. 2008;35(11):910–1.CrossRefPubMedGoogle Scholar
  13. 13.
    McBride KR, Fortenberry JD. Heterosexual anal sexuality and anal sex behaviors: a review. J Sex Res. 2010;47(2):123–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Unterberger L. That thing all guys want in bed these days. Glamourcom. 2013.Google Scholar
  15. 15.
    Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A. International trends in anal cancer incidence rates. Int J Epidemiol. 2016;. doi: 10.1093/ije/dyw276.PubMedGoogle Scholar
  16. 16.
    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(5):1168–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Reynolds GL, Fisher DG, Rogala B. Why women engage in anal intercourse: results from a qualitative study. Arch Sex Behav. 2015;44(4):983–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Sanders SA, Reinisch JM, Duby Z, Colvin C, Khawcharoenporn T, Kendrick S, et al. Would you say you “had sex” if…? JAMA. 1999;281:275–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Khawcharoenporn T, Kendrick S, Smith K. HIV risk perception and preexposure prophylaxis interest among a heterosexual population visiting a sexually transmitted infection clinic. AIDS Patient Care STDS. 2012;26(4):222–33.PubMedGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. HIV Surveil Suppl Rep. 2012;14(4):1–26.Google Scholar
  21. 21.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data-United States and 6 U.S. dependent areas-2010. HIV Surveil Suppl Rep. 2013;18(2, part B):1–47.Google Scholar
  22. 22.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data-United States and 6 dependent areas—2012. HIV Surveil Suppl Rep. 2014;19(3):22.Google Scholar
  23. 23.
    Introcaso CE, Xu F, Kilmarx PH, Zaidi A, Markowitz LE. Prevalence of circumcision among men and boys aged 14–59 years in the United States, National Health and Nutrition Examination Surveys 2005–2010. Sex Transm Dis. 2013;40(7):521–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, Fortenberry JD. Condom use rates in a national probability sample of males and females ages 14–94 in the United States. J Sex Med. 2010;7(Suppl 5):266–76.CrossRefPubMedGoogle Scholar
  25. 25.
    Aral SO, Patel DA, Holmes KK, Foxman B. Temporal trends in sexual behaviors and sexually transmitted disease history among 18- to 39-year-old Seattle, Washington, residents: results of random digit-dial surveys. Sex Transm Dis. 2005;32(11):710–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J. 2012;6:98–107.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kreuter MW, Wray RJ, Boily MC, Baggaley RF, Wang L, Masse B, et al. Tailored and targeted health communication: strategies for enhancing information relevance. Am J Health Behav. 2003;27(Suppl 3):S227–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis. 2009;9(2):118–29.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Centers for Disease Control and Prevention. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2014 Clinical practice guideline. Atlanta, GA: Centers for Disease Control and Prevention. 2014. http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.
  30. 30.
    Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, et al. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005;191(9):1403–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;. doi: 10.1002/14651858.CD003255.PubMedGoogle Scholar
  32. 32.
    Smith DK, Herbst JH, Zhang X, Rose CE. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2015;68(3):337–44.CrossRefPubMedGoogle Scholar
  33. 33.
    Crepaz N, Marks G, Liau A, Mullins MM, Aupont LW, Marshall KJ, et al. Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: a meta-analysis. AIDS. 2009;23(13):1617–29.CrossRefPubMedGoogle Scholar
  34. 34.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.CrossRefPubMedGoogle Scholar
  35. 35.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Siegfried N, Muller M, Deeks JJ, Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev. 2009;2:CD003362.Google Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA)  2016

Authors and Affiliations

  1. 1.Division of HIV/AIDS Prevention, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.RTI InternationalResearch Triangle ParkDurhamUSA
  3. 3.RTI Health SolutionsResearch Triangle ParkDurhamUSA

Personalised recommendations