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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