Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  12. WHO. Human papillomavirus (HPV) and cervical cancer. World Health Organization. 2014.

  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. 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. 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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  17. Nations U. Definition of Youth [Internet]. UN Fact Sheet. [cited 2014 Apr 1]. Available from: http://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf.

  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. Van Houwelingen HC, Arends LR, Stijnen T. Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med. 2002;21:589–624.

    PubMed  Google Scholar 

  20. Hedges LV, Olkin I. Statistical methods for meta-analysis. New York: Academic Press; 1985.

    Google Scholar 

  21. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1–48.

    Google Scholar 

  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. http://www.R-project.org/.

  23. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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: http://bayes-1.ucmerced.edu/jvevea/290/F062DAA4d01.pdf.

  27. Ioannidis JPA, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. 2008;336:1413–5.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  29. Cochran SD, Peplau LA. Sexual risk reduction behaviors among young heterosexual adults. Soc Sci Med. 1991;33:25–36.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  31. Story MD. A comparison of university student experience with various sexual outlets in 1974 and 1980. Adolescence. 1982;17:737–47.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  43. Scott-Sheldon L, Carey MP, Carey KB. Alcohol and risky sexual behavior among heavy drinking college students. AIDS Behav. 2010;14:845–53.

    PubMed Central  PubMed  Google Scholar 

  44. Hensel DJ, Fortenberry JD, Orr DP. Variations in coital and noncoital sexual repertoire among adolescent women. J Adolesc Health. 2008;42:170–6.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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. 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. 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. 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. 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.

    PubMed Central  PubMed  Google Scholar 

  59. Unterberger L. Let’s talk anal sex, that thing all guys want in bed these days. glamour. 2013;http://www.glamour.com/sex–love–life/blogs/smitten.

  60. McGuire E. Naomi Wolf on the porn myth. Age (Omaha). 2010. p. http://www.theage.com.au/lifestyle/life/naomi–wolf.

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  65. Lindberg LD, Jones R, Santelli JS. Noncoital sexual activities among adolescents. J Adolesc Health. 2008;43:231–8.

    PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  67. Kazaura MR, Masatu MC. Sexual practices among unmarried adolescents in Tanzania. BMC Public Health. 2009;9:1–6.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. Edgardh K. Sexual behaviour in a low-income high school setting in Stockholm. Int J STD AIDS. 2002;13:160–7.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  76. Dake JA, Price JH, McKinney M, Ward B. Midwestern rural adolescents’ anal intercourse experience. J. Rural Health. 2011;27:196–204.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  90. Perera B, Reece M. Sexual behavior of young adults in Sri Lanka: implications for HIV prevention. AIDS Care. 2006;18:497–500.

    CAS  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  108. Alzate H. Sexual behavior of Colombian female university students. Arch Sex Behav. 1978;7:43–54.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  110. Gilbert L, Alexander L. A profile of sexual health behaviors among college women. Psychol Rep. 1998;82:107–16.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. 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. 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.

    CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  125. Baldwin JI, Baldwin JD. Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Arch Sex Behav. 2000;29:357–73.

    CAS  PubMed  Google Scholar 

  126. Johnson EH, Gilbert D, Lollis C. Characteristics of African-American college students with HIV/AIDS. J Natl Med Assoc. 1994;86:931–40.

    CAS  PubMed Central  PubMed  Google Scholar 

  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. 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.

    CAS  PubMed  Google Scholar 

  129. Civic D. College students’ reasons for nonuse of condoms within dating relationships. J Sex Marital Ther. 2000;26:95–105.

    CAS  PubMed  Google Scholar 

  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. 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.

    CAS  PubMed  Google Scholar 

  132. Flisher A, Ziervogel C. Risk-taking behaviour of Cape Peninsula high school students. S Af Med J. 1993;83:495–8.

    CAS  Google Scholar 

  133. Hutchison BJ. Risky and safe sex: heterosexual youth, gender differences, and sexual risk-taking. Soc Rev. 1996;6:30–3.

    Google Scholar 

  134. Gurman T, Borzekowski DLG. Condom use among Latino college students. J Am Coll Health. 2004;52:169–78.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  147. Lepusić D, Radović-Radovcić S. Alcohol—a predictor of risky sexual behavior among female adolescents. Acta Clin Croat. 2013;52:3–9.

    PubMed  Google Scholar 

  148. Jozkowski KN, Satinsky SA. A gender discrepancy analysis of heterosexual sexual behaviors in two university samples. J. Community Health. 2013;38:1157–65.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  158. Koniak-Griffin D, Lesser J, Uman G, Nyamathi A. Teen pregnancy, motherhood, and unprotected sexual activity. Res Nurs Health. 2003;26:4–19.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  160. Rogala C, Tyden T. Does pornography influence young women’s sexual behaviour? Women’s Health Issues. 2003;13:39–43.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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. 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.

    PubMed Central  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Disease Epidemiology, Imperial College London, London, UK

    Branwen N. Owen, Patrick M. Brock, Ailsa R. Butler, Michael Pickles & Marie-Claude Boily

  2. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK

    Michael Pickles & Rebecca F. Baggaley

  3. Département de Médecine Sociale et Préventive, Université Laval, Quebec, Canada

    Marc Brisson & Marie-Claude Boily

Authors
  1. Branwen N. Owen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick M. Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ailsa R. Butler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Pickles
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc Brisson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca F. Baggaley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marie-Claude Boily
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Branwen N. Owen.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Owen, B.N., Brock, P.M., Butler, A.R. et al. Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis. AIDS Behav 19, 1338–1360 (2015). https://doi.org/10.1007/s10461-015-0997-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-015-0997-y

Keywords

Search

Navigation