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Anal Sex Among HIV-Seronegative Women at High Risk of HIV Exposure

Gross Michael; Holte, Sarah E.; Marmor, Michael; Mwatha, Anthony; Koblin, Beryl A.; Mayer, Kenneth H.; for the HIVNET Vaccine Preparedness Study 2 Protocol Team
JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2000

To assess the prevalence and the sociodemographic and behavioral correlates of anal sex in a cohort of HIV-seronegative U.S. women at high risk of HIV exposure, we administered a risk assessment using audio computer-assisted selfinterview (A-CASI). Of 1268 sexually active women, 432 (32%) reported anal sex in the previous 6 months. Compared with women who did not report anal sex, those who did had more unprotected vaginal sex (median of 11 versus 7 episodes; p < .001) and a higher proportion of unprotected sexual (vaginal plus anal) episodes (median of 0.90 versus 0.81; p = .01). Anal sex was reported by higher proportions of women who did not always use condoms, who used crack in the past year, who were ≤35 years of age, with no formal education beyond high school, who had had a diagnosed sexually transmitted disease in the previous year, a primary male sex partner, and a male sex partner with a history of injecting use. Women were more likely to report anal sex by A-CASI than during interviewer-administered risk assessments (odds ratio [OR], 9.00; 95% confidence interval [CI], 1.14-71.0). A less biased method of ascertainment may account for the large proportion of women reporting anal sex. Given increased vaginal risk among women reporting anal sex, the relative importance of anal sex in heterosexual transmission merits further study. Behavioral and biomedical prevention strategies effective for anal as well as vaginal sex are needed.

Address correspondence and reprint requests to Michael Gross, SCHARP, Fred Hutchinson Cancer Research Cancer, 1100 Fairview Avenue North, MW-500, Seattle, WA 98109, U.S.A.; email:

The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Manuscript received December 28, 2000; accepted April 26, 2000.

© 2000 Lippincott Williams & Wilkins, Inc.