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Condomless Anal Intercourse Among Males and Females at High Risk for Heterosexual HIV Infection

German, Danielle PhD, MPH*; Nguyen, Trang Quynh PhD*; Ogbue, Christine Powell DrPH*; Flynn, Colin MSc

Sexually Transmitted Diseases: June 2015 - Volume 42 - Issue 6 - p 317–323
doi: 10.1097/OLQ.0000000000000275
Original Study

Background Understanding and addressing heterosexual HIV transmission requires attention to the range and context of heterosexual sexual behaviors. We sought to determine population-based prevalence of condomless anal intercourse (CAI) among individuals at increased heterosexual HIV risk in Baltimore and to identify demographic, behavioral, and health-related correlates.

Methods Data were from a cross-sectional study of 185 males and 198 females at increased heterosexual risk for HIV recruited using respondent-driven sampling as part of Centers for Disease Control and Prevention's National HIV Behavioral Surveillance Project in Baltimore, August-December 2010. Bivariate and multivariate logistic regression examined factors associated with heterosexual CAI.

Results The sample was majority African American, with a mean age of 38 years among men and 34 years among women. Forty-two percent of men (95% confidence interval, 30.9%–52.0%) and 38% of women (95% confidence interval, 29.4%–47.2%) reported any CAI in the past year, with variance by partner type and sex. Among men, CAI was significantly associated with homelessness, casual and exchange partners, same-sex partner in past year, and substance use. Among women, CAI was significantly associated with lower education, casual and exchange partners, same-sex partner in past year, multiple partners, and substance use. In adjusted sex-specific models, males and females with increasing numbers of partners were more likely to engage in CAI.

Conclusions It is important to recognize the efficiency of transmission of HIV and other sexually transmitted infections through CAI. There is a need to broaden heterosexual sexual health promotion and HIV/sexually transmitted infection prevention to adequately and appropriately address risks and prevention strategies for anal intercourse.

A study of males and females at high risk for heterosexual HIV transmission in Baltimore found high rates of condomless anal intercourse associated with increasing numbers of partners.

From the *Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and †Maryland Department of Health and Mental Hygiene, Baltimore, MD

Conflict of interest: None declared.

Sources of support: Supported by the Centers for Disease Control and Prevention via subcontract with Maryland Department of Health and Mental Hygiene and NIDA T-32DA007292

Correspondence: Danielle German, PhD, MPH, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205. E-mail:

Received for publication January 20, 2015, and accepted March 9, 2015.

© Copyright 2015 American Sexually Transmitted Diseases Association