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“This Will Not Enter Me”: Painful Anal Intercourse Among Black Men Who Have Sex with Men in South African Townships

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Abstract

Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk and protective behaviors among men who have sex with men (MSM). The purpose of this study was to identify attributions for and responses to painful RAI among Black MSM in South African townships. In-depth interviews were conducted with 81 Black MSM (ages 20–39 years) who were purposively recruited from four townships. The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex. Pain during RAI was brought up by many participants without specific prompting from the interviewer. Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. The main strategies participants used to address pain during RAI were setting sexual boundaries and lubricant use; a small number of participants reported purposefully consuming alcohol to prevent the pain associated with RAI. Black South African MSM can be supported to reduce pain during RAI in ways that reduce their HIV/STI risk. Culturally specific sexual health education, supportive sexual health services, and improved access to condom-compatible lubricants are important components of HIV/STI interventions for this population.

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Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (R01-MH083557; Principal Investigator: Theo Sandfort, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The HIV Center for Clinical and Behavioral Studies is supported by a center grant from the National Institute of Mental Health, P30 MH43520 (Principal Investigator: Robert H. Remien, Ph.D.). We wish to thank OUT Well-being, the communities that partnered with us in conducting this research, and the study participants for their contributions. We also thank study staff at all participating institutions for their work and dedication.

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Authors and Affiliations

  1. Division of Gender, Sexuality, & Health and HIV Center for Clinical and Behavioral Studies,, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA

    Kate L. Collier & Theo G. M. Sandfort

  2. Human and Social Development, Human Sciences Research Council, Pretoria, South Africa

    Vasu Reddy

  3. Humanities and Social Sciences, University of KwaZulu-Natal, Durban, South Africa

    Vasu Reddy

  4. Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

    Tim Lane

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  1. Kate L. Collier
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  2. Theo G. M. Sandfort
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  3. Vasu Reddy
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  4. Tim Lane
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Correspondence to Theo G. M. Sandfort.

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Collier, K.L., Sandfort, T.G.M., Reddy, V. et al. “This Will Not Enter Me”: Painful Anal Intercourse Among Black Men Who Have Sex with Men in South African Townships. Arch Sex Behav 44, 317–328 (2015). https://doi.org/10.1007/s10508-014-0365-4

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