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Anal sex practices in heterosexual and male homosexual populations: A review of population-based data
Abstract
Anal sex is known to be an important risk factor for anal cancer. Yet compared with vaginal intercourse, little is known about anal sex practices in either heterosexual or male homosexual populations. Of the data that are available, it appears a significant and increasing minority of heterosexuals have ever practised anal intercourse. Among homosexual men, most, but not all, report anal sex, with large proportions of men engaging in both insertive and receptive anal intercourse. The most significant finding of the review was the dearth of population-based data, particularly relating to homosexual men.
... All variables that were associated with incident anal HPV detection (P value < .2, Wald test) in univariable analyses were included in the multivariable model; some variables were forced into the multivariable model because they were a priori considered relevant based on literature or our specific research question: sexual exposure status (the main variable of interest), number of lifetime male sex partners [22][23][24], HPV serostatus [10,25,26], and HIV status [27,28]. Other (candidate) variables included demographic and health-related characteristics (age, tobacco smoking, cannabis use in the previous 6 months, popper use in the previous 6 months, and alcohol use in the previous 6 months) and sexual behavior characteristics (age at first anal intercourse and years since anal sexual debut). ...
... We found that having a higher number of lifetime sex partners showed a trend toward significance and being HIV infected was significantly associated with incident anal HPV detections. Both more lifetime sex partners [22][23][24] and HIV infection [27,28] could be seen as indicators for the probability of prior infection. We also expected that having a positive HPV serostatus at baseline, a marker for (previous) infection, would be positively associated with incident anal HPV detection, but we did not find this. ...
... In line with the studies referred to above, we found that incident anal HPV detection was more likely in HIV-infected MSM. We also considered lifetime number of male sex partner as an important potential risk factor for anal HPV detection, since it can be seen as proxy for past HPV exposure [22][23][24]. In the current study, we observed a (nonsignificant) increased risk for incident anal HPV detection with increasing number of lifetime sex partners. ...
Background:
We aimed to assess whether sexual exposure may explain all incident anal HPV detections among men who have sex with men (MSM).
Methods:
A longitudinal study among MSM was conducted between 2010 and 2013 with six-monthly visits and up to 24 months of follow-up. Risk-factor questionnaires, blood samples, and anal and penile self-swabs were collected at each visit. Self-swabs were used for detection and genotyping of HPV by SPF10-PCR/DEIA/LiPA25 system. Serum samples were tested for high-risk (hr)HPV antibodies. Incident anal HPV detection rates among sexually non-, low and highly exposed MSM were compared. Factors associated with incident anal hrHPV detection were assessed using multivariable Cox regression.
Results:
714 men (median age 40 years; 39% HIV positive) were included in the analysis. Incident anal detections of all hrHPV-types were observed among both sexually non-exposed and exposed MSM. In multivariable analyses, highly sexually exposed, being HIV-infected and having a penile HPV infection were positively associated with incident anal HPV detection; those reporting more sex partners had a non-significantly increased risk of HPV detection.
Conclusion:
Incident anal hrHPV detection is common among recently non-exposed MSM, suggesting that a reactivated latent HPV infection instead of an incident infection may underlie incident HPV detection.
... Sexual minority populations have higher rates of smoking, as well as complications from smoking, compared with heterosexual populations [18][19][20]. Sexual minorities also demonstrate higher rates of other cancer-related risk behaviors, including indoor tanning, high-risk alcohol consumption and high-risk sexual activity [15,16,[20][21][22]. In addition to causing cervical cancer in women, human papillomavirus (HPV) has also been shown to cause anal malignancies in men, and condomless anal intercourse is an important risk factor for anal cancer [21,22]. ...
... Sexual minorities also demonstrate higher rates of other cancer-related risk behaviors, including indoor tanning, high-risk alcohol consumption and high-risk sexual activity [15,16,[20][21][22]. In addition to causing cervical cancer in women, human papillomavirus (HPV) has also been shown to cause anal malignancies in men, and condomless anal intercourse is an important risk factor for anal cancer [21,22]. An overwhelming majority homosexual men report engaging in anal intercourse, and have much higher rates of anal sexual activity compared with heterosexual people [21,22]. ...
... In addition to causing cervical cancer in women, human papillomavirus (HPV) has also been shown to cause anal malignancies in men, and condomless anal intercourse is an important risk factor for anal cancer [21,22]. An overwhelming majority homosexual men report engaging in anal intercourse, and have much higher rates of anal sexual activity compared with heterosexual people [21,22]. Furthermore, the percentage of men who have sex with men (MSM) engaging in unprotected anal intercourse has increased in recent years [23], and MSM continue to have a high prevalence of anal cancer [24]. ...
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
... 5 Heywood and Smith review published data on anal sexual practices and highlight the paucity of data that are available at a population level. 6 They make the important point that in many populations, perhaps twice as many heterosexuals engage in anal intercourse as homosexual men, particularly in some countries in Latin America, where heterosexual anal sex is more common. 6 They highlight the paucity of data on the frequency of anal sex and other activities such as digital stimulation, which could potentially transmit the human papillomavirus (HPV). ...
... 6 They make the important point that in many populations, perhaps twice as many heterosexuals engage in anal intercourse as homosexual men, particularly in some countries in Latin America, where heterosexual anal sex is more common. 6 They highlight the paucity of data on the frequency of anal sex and other activities such as digital stimulation, which could potentially transmit the human papillomavirus (HPV). 6 Machaleck et al. take on the task of describing the epidemiology of anal HPV infection in MSM. ...
... 6 They highlight the paucity of data on the frequency of anal sex and other activities such as digital stimulation, which could potentially transmit the human papillomavirus (HPV). 6 Machaleck et al. take on the task of describing the epidemiology of anal HPV infection in MSM. 7 They highlight the very high prevalence (93%) of HPV infection in MSM with HIV and the high prevalence in HIV-negative MSM (64%). ...
This editorial describes the contents of this special issue of Sexual Health devoted to anal cancer. The aim of the issue is to provide readers with information to assist them in making decisions about what to do about detecting anal cancer early in men who have sex with men with HIV. Should they be advocating screening? It discusses the epidemiology of HPV infection, anal intraepithelial neoplasia, and anal cancer in MSM, heterosexual men and women; anal cancer screening and treatment of anal cancer. And most importantly, what should be done about vaccinating boys with the HPV vaccine.
... In a representative sample of the U.S. population, for example, 9% of women reported having had anal intercourse in the past year, yet, only 1.2% had anal sex during their most recent sexual event [20]. Oroanal sex is also regarded as rare in heterosexual dyads [25]. In addition, both members of a MSM (but not a heterosexual) partnership can, and commonly do, practice receptive and insertive anal and oral sex [25]. ...
... Oroanal sex is also regarded as rare in heterosexual dyads [25]. In addition, both members of a MSM (but not a heterosexual) partnership can, and commonly do, practice receptive and insertive anal and oral sex [25]. The net effect of these differences creates a more interconnected ecosystem between the component habitats of the MSM sexual ecology -the penis, rectum and oropharyngeal (PROP) sites. ...
Surveillance data from a number of countries have indicated that antibiotic resistance in N. gonorrhoea is strongly associated with men who have sex with men (MSM). This manuscript advances the hypothesis that certain features of the MSM sexual ecosystem may be responsible for this association. It is argued that in comparison with heterosexuals, high-risk MSM (hrMSM) have a higher prevalence of oro-penile, oro-rectal and anal sex which facilitates an enhanced mixing of the pharyngeal, rectal and penile microbiomes. In addition, hrMSM have an increased number of sexual partners per unit time and an increased prevalence of sexual relationships overlapping in time. The increased flux of microbiomes between different body habitats between sexual partners, in combination with the increased connectivity of the sexual network, serve to create a novel high-risk MSM sexual ecosystem with important consequences for the genesis and spread of antibiotic resistance.
... However, recent studies indicated that numbers of heterosexual men discovering the anal region as pleasurable might be increasing. (40,41). A qualitative study on 30 young heterosexual men showed that participants could speak openly on the idea of anal stimulation during sexual activity. ...
Introduction:
Penile and genital surgery for congenital or acquired conditions is daily practice in reconstructive urology. These procedures, which carry the risk of disrupting nerves and blood vessels, may impair the genital sensation, and affect the capacity for sexual pleasure. Self-reported tools are needed to systematically assess the male genitalia before and after reconstructive surgeries in terms of genital sensation and sexual experience.
Aim:
This study validated the Dutch translation of the self-assessment of genital anatomy and sexual functioning (SAGASF-M) questionnaire and investigated the perceptions of healthy men regarding their genital anatomy and sensory function.
Methods:
Eight-hundred and eight sexually active men with a median age of 39 years (18-79 years) and no history of genital procedures other than circumcision filled out an online version of the questionnaire. Twenty-four participants were randomly recruited to confirm the responses of the SAGASF-M questionnaire by a clinical evaluation.
Main outcome measures:
The SAGASF-M questionnaire comprises of multiple-choice questions and clarifying illustrations asking men to rate their genital appearance, overall sexual sensitivity, and pain perception as well as the intensity and the effort to reach orgasm. Prespecified regions of the glans, penile shaft, scrotum, perineum, and anus are evaluated through this questionnaire.
Results:
Only slight variability in anatomical ratings was observed. Overall discrimination between different genital areas in terms of genital sensation was significant. The bottom of the glans or frenular area was rated the highest contributor to "Sexual pleasure", followed by the other regions of the glans and shaft. The same distribution was found for "Orgasm intensity" and "Orgasm effort". The anal region was generally rated the lowest. "Discomfort/Pain" was rated lower than any of the other sensory function indicators and the top of the glans and anal region were rated most likely to perceive this unpleasant sensation. Participants reported significantly more sexual pleasure and intense orgasms when stimulated by a sexual partner compared to self-stimulation. Homosexual and bisexual men reported a higher contribution of the perineal and anal regions in sexual pleasure and orgasm. No significant difference between circumcised and uncircumcised individuals regarding overall genital sensation could be found.
Conclusion:
The Dutch translation of the SAGASF-M questionnaire is a valuable and reliable tool for self-assessment of genital anatomy and sensation, providing a site-specific attribution of a patient's perceived sexual function. Further prospective research with this questionnaire could aid in the patient-centered improvement of genital surgery. This article is protected by copyright. All rights reserved.
... In a review of population-based data, researchers found that most gay men report having had anal sex, compared to a small minority of heterosexual men (Heywood & Smith, 2012). Penetrative anal sex using a penis requires the same level of erectile functioning in the individual whose penis is penetrating an anus as penile-vaginal intercourse (the individual who is performing the penetration is typically referred to as the "top"). ...
Research and clinical work on sexual functioning in men has traditionally focused on the presence or absence of erectile dysfunction (ED) or the inability to maintain an erection sufficient for satisfactory sexual performance. However, for men who have sex with men (MSM), receptive anal intercourse is a common form of sexual expression. Existing work on men’s sexual dysfunction does not effectively address receptive anal sex functioning, and there is a need to understand how stressors can impact this common sexual behavior. The goal of the present study was to understand how stressors can impact erective and receptive anal sex functioning among MSM. In the present study, we hypothesized that minority stress (as operationalized by integrating identity management and heterosexual self-presentation) would have an impact on MSM’s sexual functioning overall and adapted a previous measure of sexual dysfunction (International Index of Erectile Functioning) to better assess this relationship. Data were collected from 228 men (Mage = 31.74, SD = 9.41); exploratory factor analysis was used to create a new measure of sexual functioning, and regression analyses were used to examine the relationships between heterosexual self-presentation and identity management and sexual functioning. Results demonstrated that higher heterosexual self-presentation was associated with more functional impairment in erectile function and receptive anal sex functioning as well as use of functional enhancement medications or substances. The results of the present study extend extant work on minority stress to sexual functioning of MSM and are relevant to the sexual health concerns of MSM.
... This result may be related to the practice of anal sex, which in our study was strongly associated with higher PRHIV (OR = 2.59). This sexual practice is the highest-risk sexual activity for HIV transmission (CDC, 2020a) and is also a frequent sexual practice among MSM (Heywood & Smith, 2012). However, it may also relate to other overlapping psychosocial and emotional problems (e.g. ...
This study aimed to analyze the factors (sociodemographic, sex-related, HIV-related, and psychological) associated with perceived risk of HIV (PRHIV) among sexually experienced individuals from the general population in Portugal. The sample of this cross-sectional study comprised 902 participants, who completed an online questionnaire assessing sociodemographic and sex-related data, HIV prophylaxis, HIV testing and knowledge, attachment, emotion regulation, distress tolerance, and PRHIV. Multiple factors were significantly associated with higher PRHIV. These included self-defining as gay/lesbian or bisexual, not insisting on using condoms, having a higher number of sexual partners, using the Internet to find sexual partners, having had an STD, having anal and oral sex, and testing for HIV in the last year. Psychological factors such as higher levels of attachment-related anxiety and avoidance, higher use of expressive suppression emotional regulation strategy, and lower levels of distress tolerance were associated with higher PRHIV. This study, one of the few conducted in Europe, shows that diverse factors from different categories are associated with PRHIV, but sex-related factors have a prominent role. Our findings also suggest that to understand the formation of HIV risk perceptions, psychological factors regarding affect regulation should be considered, highlighting the importance of examining affect regulation in future interventions.
... Among homosexual men, most, but not all, report anal sex, with large proportions of men engaging in both insertive and receptive anal intercourse. 12 In our country's Khyber Pakhtoon Khawa Province (KPK), it is outwardly common that Pashtun males do sexual activity with young boys which is suggested by IRIN as a "a practice now deeply rooted in the local culture." 13 The Internet is promoting "solidarity" among homosexuals in Pakistan. ...
Objective: To observe the number of sodomy cases and their associated factors reported to Abbasi Shaheed Hospital for medicolegal examination in Karachi. Study design and setting: The retrospective study design conducted at medicolegal section of Abbasi Shaheed Hospital Karachi from January 2016 till December 2018 reported from 45 different police stations of Karachi. Methodology: This was a single centred study on sodomy conducted by using non-probability sampling technique. Data was collected from medico legal section of Abbasi Shaheed Hospital, Karachi, from a period of January 2016 till December 2018 reported from 45 different police stations of Karachi. Results: A total of 102 sodomy cases were reported in various police stations of Karachi during this period. Majority of cases were reported in the police stations belonging to Surjani town (11) followed by Sir Syed (9), Sohrab Goth (9), North Naziamabad (8) and Gulbahar (7). Majority of the convicts belonged to the age range 21-30 years followed by 10-20 years of age. Majority of the accused were found to be living alone without family for earning purpose. All of them were usually of poor socio economic conditions and illiterate. Majority of the couples were found to be related to each other. Presence of semen stains, sexual potency and DNA analysis further confirmed their involvement. Conclusion: Majority of the accused were of young age, poor, living alone without family, illiterate and from laborer class. These might be the factors responsible for their involvement in alleged sexual behavior.
... Although there were no supporting behavioural data, it is possible that economic factors influence the number of sex partners or unsafe sexual behaviour. Lifetime number of male sex partners is an important risk factor for anal HPV infection and has been shown to be a proxy for HPV exposure in previous studies [20,21]. As the data of this report combining two cohort studies that had different questionnaires regarding behaviour practice, we did not analyse behaviour data to avoid bias. ...
Objectives:
Persistent anal high-risk human papillomavirus (HR-HPV) infection is a major risk factor for anal cancer among men who have sex with men (MSM) and transgender women (TGW). We aimed to estimate incidence, clearance, and persistence of anal HR-HPV in HIV-positive and HIV-negative MSM and TGW, and to assess factors for HR-HPV persistent.
Design:
Prospective cohort study.
Methods:
MSM and TGW aged ≥18 years, were enrolled from Indonesia, Malaysia, and Thailand, then followed-up 6 monthly for 12 months. Anal swabs were collected at every visit for HR-HPV genotypes to define anal HR-HPV incidence, clearance, and persistence. Logistic regression was used to evaluate factors associated with HR-HPV persistence.
Results:
325 MSM and TGW were included in this study, of whom 72.3% were HIV-positive. The incidence of anal HR-HPV persistence was higher in HIV-positive than HIV-negative MSM participants (28.4/1000 vs 13.9/1000 person-months). HIV-positive participants had HR-HPV lower clearance rate than HIV-negative participants (OR 0.3; 95% CI 0.1-0.7). The overall persistence of HR-HPV was 39.9% in HIV-positive and 22.8% HIV-negative participants. HPV-16 was the most persistent HR-HPV in both HIV-positive and HIV-negative participants. HIV infection (aOR 2.87; 95% CI 1.47-5.61), living in Kuala Lumpur (aOR 4.99; 95% CI 2.22-11.19) and Bali (aOR 3.39; 95% CI 1.07-10.75), being employed/freelance (aOR 3.99; 95% CI 1.48-10.77), and not being circumcised (aOR 2.29; 95% CI 1.07-4.88) were independently associated with anal HR-HPV persistence.
Conclusion:
HIV-positive MSM and TGW had higher risk of persistent anal HR-HPV infection. Prevention program should be made available and prioritized for HIV-positive MSM and TGW where resources are limited.
... Anal sex is a prevalent behavior, depicted since antiquity [1][2][3], and reported across populations and the globe [4][5][6][7][8][9]. However, anal sex is also under-reported depending on data collection methods and social context [4], likely due to stigma [2,10,11]. ...
We conducted a series of studies to validate a new scale of stigma toward anal sex, culturally tailored to cisgender men who have sex with men (MSM). In Study 1 we conducted in-depth interviews (N = 35) to generate items. In Study 2, we reduced the item pool through an online survey (N = 268), testing scale performance, dimensionality, and convergent and discriminant validity. For Study 3, we recruited another online sample (N = 1605), randomized to exploratory or confirmatory factor analyses to finalize item reduction, then assessed validity among sexually active MSM (n = 1263). Final subscales encompassed self-stigma (6 items, Cronbach’s α = .72), provider stigma (5 items, Cronbach’s α = .79), and omission of information (6 items, Cronbach’s α = .73; full 3-factor scale = .80). We developed a 17-item measure, grounded in the lived experience of cisgender MSM. Future work should examine associations with health-seeking behavior.
... For example, 5 years after approval by the Food and Drug Administration, only 4% of MSM had engaged in preexposure prophylaxis (PrEP) (Hammack et al., 2018), and while engagement has since increased (Finlayson et al., 2019), retention continues to be sub-optimal (Chan et al., 2019). One possible impediment to health seeking among MSM is stigma toward the sexual behavior most associated with HIV transmission, anal sex, which is both prevalent and highly stigmatized among both MSM and heterosexual populations (Baggaley, White, & Boily, 2010;Carter, Henry-Moss, Hock-Long, Bergdall, & Andes, 2010;Heywood & Smith, 2012;McBride & Fortenberry, 2010). Indeed, both MSM and heterosexuals conceal aspects of anal sexuality, like receptive positioning and desire for pleasure, in part to prevent maltreatment (McDavitt & Mutchler, 2014;Quinn et al., 2019;Ravenhill & de Visser, 2018;Roye, Tolman, & Snowden, 2013). ...
Gay, bisexual, and other men who have sex with men (MSM) experience alarming HIV disparities alongside sub-optimal engagement in HIV interventions. Among MSM, stigma toward anal sexuality could interfere with engagement in HIV prevention, yet few studies have examined MSM perspectives on anal sex stigma or its health-related sequelae. Guided by theory, we aimed to characterize anal sex stigma, related sexual concerns, and barriers to health seeking, like concealment. We elicited community input by purposively interviewing 10 experts in MSM health and then 25 racially, ethnically, and geographically diverse cisgender MSM. Participants reported experienced, internalized, and anticipated forms of anal sex stigma that inhibited health seeking. Experienced stigma, including direct and observed experiences as well as the absence of sex education and information, contributed to internalized stigma and anticipation of future devaluation. This process produced psychological discomfort and concealment of health-related aspects of anal sexuality, even from potentially supportive sexual partners, social contacts, and health workers. Participants characterized stigma and discomfort with disclosure as normative, pervasive, and detrimental influences on health-seeking behavior both during sex and within healthcare interactions. Omission of information appears to be a particularly salient determinant of sexual behavior, inhibiting prevention of harm, like pain, and leading to adverse health outcomes. The development of measures of anal sex stigma and related sexual concerns, and testing their impact on comfort with disclosure, sexual practices, and engagement in health services could identify modifiable social pathways that contribute to health disparities among MSM, like those seen in the HIV epidemic.
... To accommodate the additional LS patients, it may be necessary to make changes elsewhere in the system, for example changing the approach to surveillance for those at moderately increased risk of CRC. 32,33 There are concerns that implementation of universal tumour testing amounts to genetic testing without consent. ...
Lynch Syndrome is characterised by the development of colorectal, endometrial and other cancers, often at a young age. It is caused by constitutional mutations of DNA mismatch repair genes and cancers that arise in this setting are mismatch repair deficient, as demonstrated by loss of the relevant mismatch repair protein and microsatellite instability. In theory, universal screening of all index colorectal cancers for mismatch repair deficient should identify individuals who are at higher than population risk of carrying a constitutional mutation in the mismatch repair genes. A health economic evaluation in the UK found that this type of screening strategy applied to individuals under the age of 51 years was highly cost effective. In Australia, some centres routinely test all colorectal cancers for mismatch repair deficient, however there is currently no systematic national approach to screening. Given the cost effectiveness of universal screening is dependent on uptake of constitutional testing by the index case and their relatives, we suggest that research into the determinants and barriers to uptake of constitutional testing is a high priority. Further, given that the health care context can influence the assessment of cost-effectiveness, we propose that the UK economic evaluation also needs to be undertaken in an Australian context. Lynch Syndrome (LS) is a familial cancer syndrome which predisposes to colorectal cancer (CRC), endometrial and other cancers, such as gastric and ovarian cancer. It is caused by constitutional mutations in the DNA mismatch repair (MMR) genes MSH2, MLH1, MSH6 and PMS2. Rarely, some cases of LS are caused by constitutional methylation of the promoter of MLH1 or MSH2 rather than a constitutional sequence change.
... This is particularly important as it has been well documented that the vagina, while variable in size, is variable within a known and limited range [14][15][16][17], and that vaginal insertion of objects of certain sizes can be uncomfortable for some women. Additionally, anal stimulation as part of sexual activities has been reported by an increasing number of women and men in the United States [18][19][20], though little is known about the use of anal sex toys outside of the somewhat extensive anal foreign body literature [21,22]. ...
IntroductionVibrators and dildos are commonly used by women and men in the United States, and are increasingly recommended by clinicians. In addition, sex toys and various household objects are sometimes used for sexual stimulation in ways that pose health risks to their users. Data about the dimensions of such products may inform clinicians' recommendations.AimThe purpose of the present study was to assess the sizes (length and circumference) of vibrators and dildos marketed for vaginal or anal insertion on websites that sell sexual enhancement products.Methods
Eight websites that sell sexual enhancement products were identified for inclusion in the study. The dimensions of vaginal vibrators and dildos listed for sale on each website were noted, and descriptive data were calculated for each website.Main Outcome MeasuresProduct length and circumference (mean, median, and range).ResultsPopular sex toy distributers offer a variety of product sizes. The length of many vibrators and dildos was sized between 4 and 6 in, and circumference was between 4 and 5 in. However, some companies featured products of a considerably larger size than others.Conclusion
Length and circumference of vibrators and dildos varied, but on average approximated mean penile dimensions. Clinicians' recommendations for use of vaginal or anal products can be enhanced by familiarity and offering additional information about product sizes and retailers. Herbenick D, Barnhart KJ, Beavers K, and Benge S. Vibrators and other sex toys are commonly recommended to patients, but does size matter? Dimensions of commonly sold products. J Sex Med **;**:**–**.
... 13 14 Given the high vulnerabilities associated with HAI in commercial and non-commercial sex settings, a few research studies have assessed anal intercourse prevalence and associated factors among FSWs and the general population. [15][16][17] Similar to findings from other countries in commercial sex settings, studies on FSWs in India have also documented an increased trend for anal intercourse with clients. 13 14 18 19 In India and elsewhere, the primary reason for FSWs selling anal sex is the extra money it brings from clients. ...
Objectives
Self-reported anal intercourse by female sex workers (FSWs) documented in recent studies from India range between 11.9% and 22%. However, comparable data on anal intercourse and condom use from male clients of FSWs is lacking. Using data from a bio-behavioural survey (2009–2010), we examined prevalence of anal intercourse, male clients’ self-reported inconsistent condom use during anal intercourse with FSWs, and correlates of this behaviour in India's high HIV prevalence southern states (Andhra Pradesh, Maharashtra and Tamil Nadu combined).
Methods
Using two-stage time location cluster sampling, we recruited 4803 clients of FSWs, ages 18–60 years, who had purchased sex from an FSW in the past month. After obtaining informed consent, respondents were interviewed and tested for HIV and sexually transmitted infections (syphilis, gonorrhoea and chlamydia). Logistic regression analysis was used to identify the factors associated with inconsistent condom use during anal intercourse (in the past 6 months) with FSWs.
Results
Overall, 12.3% clients reported anal intercourse in the past 6 months, of whom 48.4% used condoms inconsistently. Clients of FSWs who were ages 26 years or older (AOR 2.68, p=0.032); employed as manual labourers (AOR 2.43, p=0.013); consumed alcohol (AOR 2.63, p=0.001); reported five or more sex acts with FSWs in the past month (AOR 2.53, p=0.031); and perceived themselves to be at higher risk for HIV (AOR 4.82, p=0.001) were more likely to inconsistently use condoms during anal intercourse.
Conclusions
The results suggest that sex workers and their clients commonly practice anal intercourse, but a relatively high proportion of clients do not consistently use condoms, leading to a greater risk of acquiring HIV and its further transmission to other male and female sexual partners. Given the multidirectional risk, safer sex communication on heterosexual anal intercourse must be incorporated into HIV prevention programmes.
... This is consistent with increases in the lifetime experience of oral and anal sex in other countries. 11,14,25 The reasons for these increases are unclear, but they may be due to increased experimenting associated with liberal societies and the 'sexualisation' of the popular media and advertising. The increased availability of pornography via the Internet, which frequently depicts oral and anal sex, may also have contributed to increased experimentation. ...
Unlabelled:
Background Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13.
Methods:
Computer-assisted telephone interviews were completed by a representative sample of 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2%.
Results:
Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon.
Conclusion:
There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.
... Although many MSM in this population were screened for extragenital GC/CT at least annually according to CDC recommendations, a number of MSM were not screened for extragenital GC/CT at all. Population-based studies investigating sexual behaviors of MSM in the United States indicate that 62%-90% of MSM participated in unprotected receptive oral sex in the past 6 months and that 57%-83% of MSM participated in receptive anal sex in the past 6 months-1 year [14][15][16][17]. If these numbers are extrapolated to our sample of MSM, it seems likely that many MSM at risk of extragenital infection were not screened, possibly resulting in many infections being missed because MSM who seek care at STD clinics may be at higher risk for STDs than MSM seeking care in other healthcare settings. ...
Background:
Gonorrhea (GC) and chlamydia (CT) are the most commonly reported notifiable diseases in the United States. The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) be screened for urogenital GC/CT, rectal GC/CT, and pharyngeal GC. We describe extragenital GC/CT testing and infections among MSM attending sexually transmitted disease (STD) clinics.
Methods:
The STD Surveillance Network collects patient data from 42 STD clinics. We assessed the proportion of MSM attending these clinics during July 2011-June 2012 who were tested and positive for extragenital GC/CT at their most recent visit or in the preceding 12 months and the number of extragenital infections that would have remained undetected with urethral screening alone.
Results:
Of 21 994 MSM, 83.9% were tested for urogenital GC, 65.9% for pharyngeal GC, 50.4% for rectal GC, 81.4% for urogenital CT, 31.7% for pharyngeal CT, and 45.9% for rectal CT. Of MSM tested, 11.1% tested positive for urogenital GC, 7.9% for pharyngeal GC, 10.2% for rectal GC, 8.4% for urogenital CT, 2.9% for pharyngeal CT, and 14.1% for rectal CT. More than 70% of extragenital GC infections and 85% of extragenital CT infections were associated with negative urethral tests at the same visit and would not have been detected with urethral screening alone.
Conclusions:
Extragenital GC/CT was common among MSM attending STD clinics, but many MSM were not tested. Most extragenital infections would not have been identified, and likely would have remained untreated, with urethral screening alone. Efforts are needed to facilitate implementation of extragenital GC/CT screening recommendations for MSM.
... Receptive anal sex as well as an increasing number of receptive anal sex partners are known to be important risk factors for anal cancer (9). In Puerto Rico (PR), a population-based study reported that 64.4% of men and 57.1% of the women older than 18 years old had ever engaged in anal sex (10). ...
Anal cancer is a rare tumor that is associated with oncogenic HPV genotypes. This study aims to compare the age-standardized rates (ASRs) of anal cancer incidence and mortality in men and women living in Puerto Rico (PR) with those of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanics (USH) living in the continental United States (US).
ASRs were calculated based on cancer data that came from the PR Cancer Central Registry and from the Surveillance, Epidemiology, and End Results (SEER) program. The age-specific relative risks (RR) and 95% Confidence Interval (95% CI) were estimated using Poisson regression models.
Comparing the period of 2001 to 2004 to that of 1992 to 1996, the incidence of anal cancer increased among NHW, NHB, and PR men. In females, an increase in the incidence was observed for all racial groups except for Puerto Rican women. When evaluating findings by age groups, Puerto Rican men younger than 60 years old had a 20% higher incidence of anal cancer than did USH men of the same age strata (RR: 2.20; 95% CI = 1.48-3.29). However, Puerto Rican females had a lower incidence of anal cancer than NHW and NHB women. An increased percent change in mortality was observed only in NHW and NHB men. A decreasing trend was observed in all racial/ethnic groups except for NHW women.
Our results support the notion that there are racial/ethnic differences in anal cancer incidence and mortality, with potential disparities among men and women in PR compared with USH men and women. Given the increasing incidence trends in anal cancer, particularly among PR, NHW, and NHB men, further investigation is needed to better elucidate screening practices that can aid in the prevention of anal cancer.
... In one study 18.2% of men with anal warts were heterosexuals [21]. A recent review [22] of anal sexual practices in heterosexuals highlighted the paucity of data in this area including sexual practices such as anal digital stimulation of men by their female partner. Ongoing monitoring of the impact of the vaccine in men is warranted as the Australian Government has extended the national HPV vaccination program to include vaccination for boys in 2013 [23]. ...
Background
There has been a rapid decline in the number of young heterosexuals diagnosed with genital warts at outpatient sexual health services since the national human papillomavirus (HPV) vaccination program started in Australia in 2007. We assessed the impact of the vaccination program on the number of in-patient treatments for genital warts.
Methods
Data on in-patient treatments of genital warts in all private hospitals were extracted from the Medicare website. Medicare is the universal health insurance scheme of Australia. In the vaccine period (2007–2011) and pre-vaccine period (2000–2007) we calculated the percentage change in treatment numbers and trends in annual treatment rates in private hospitals. Australian population data were used to calculate rates. Summary rate ratios of average annual trends were determined.
Results
Between 2000 and 2011, 6,014 women and 936 men aged 15–44 years underwent in-patient treatment for genital warts in private hospitals. In 15–24 year old women, there was a significant decreasing trend in annual treatment rates of vulval/vaginal warts in the vaccine period (overall decrease of 85.3% in treatment numbers from 2007 to 2011) compared to no significant trend in the pre-vaccine period (summary rate ratio (SRR) = 0.33, p < 0.001). In 25–34 year old women, declining trends were seen in both vaccine and pre-vaccine periods (overall decrease of 33% vs. 24.3%), but the rate of change was greater in the vaccine period (SRR = 0.60, p < 0.001). In 35–44 year old women, there was no significant change in both periods (SRR = 0.91, p = 0.14). In 15–24 year old men, there was a significant decreasing trend in annual treatment rates of penile warts in the vaccine period (decrease of 70.6%) compared to an increasing trend in the pre-vaccine period (SRR = 0.76, p = 0.02). In 25–34 year old men there was a significant decreasing trend in the vaccine period compared to no change in the pre-vaccine period (SRR = 0.81, p = 0.04) and in 35–44 year old men there was no significant change in rates of penile warts both periods, but the rate of change was greater in the vaccine period (SRR = 0.70, p = 0.02).
Conclusions
The marked decline in in-patient treatment of vulval/vaginal warts in the youngest women is probably attributable to the HPV vaccine program. The moderate decline in in-patient treatments for penile warts in men probably reflects herd immunity.
To date, very little research literature exists concerning receptive penetrative anal eroticism in straight men. Of particular interest are its impacts upon other factors relevant to masculinities, sex roles, and the study of sexualities. Several co-constituted features of masculinity are likely to be relevant to straight-male anal sexuality, including masturbatory play with penetrative sex toys. Specifically, this study seeks to explore, “Do men who report greater comfort with receptive penetrative anal eroticism also report less transphobia, less obedience to masculine gender norms, greater partner sensitivity, and greater awareness about rape?” This study uses semi-structured interviews with thirteen men to explore this question, analyzed with a naturalist and constructivist grounded theory approach in the context of sexualities research and introduces transhysteria as a parallel concept to Anderson’s homohysteria. This analysis recognizes potential socially remedial value for encouraging male anal eroticism with sex toys.
Context
Studies conducted in the late 1980s on human immunodeficiency virus
(HIV) infection among older men who have sex with men (MSM) suggested the
epidemic had peaked; however, more recent studies in younger MSM have suggested
continued high HIV incidence.Objective
To investigate the current state of the HIV epidemic among adolescent
and young adult MSM in the United States by assessing the prevalence of HIV
infection and associated risks in this population in metropolitan areas.Design
The Young Men's Survey, a cross-sectional, multisite, venue-based survey
conducted from 1994 through 1998.Setting
One hundred ninety-four public venues frequented by young MSM in Baltimore,
Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco
(Calif) Bay Area; and Seattle, Wash.Subjects
A total of 3492 15- to 22-year-old MSM who consented to an interview
and HIV testing.Main Outcome Measures
Prevalence of HIV infection and associated characteristics and risk
behaviors.Results
Prevalence of HIV infection was high (overall, 7.2%; range for the 7
areas, 2.2%-12.1%) and increased with age, from 0% among 15-year-olds to 9.7%
among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher
among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8),
young men of mixed or other race (OR, 4.8; 95% CI, 3.0-7.6), and Hispanics
(OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans
and Pacific Islanders (OR, 1.1; 95% CI, 0.5-2.8). Factors most strongly associated
with HIV infection were being black, mixed, or other race; having ever had
anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20
or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive
men knew they were infected before this testing; 37 (15%) were receiving medical
care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence
of unprotected anal sex during the past 6 months was high (overall, 41%; range,
33%-49%).Conclusions
Among these young MSM, HIV prevalence was high, underscoring the need
to evaluate and intensify prevention efforts for young MSM, particularly blacks,
men of mixed race or ethnicity, Hispanics, and adolescents.
By the late 1980s, the human immunodeficiency virus (HIV) epidemic among
men who have sex with men (MSM) in the United States appeared to have peaked.1- 6
However, studies in the 1980s mainly sampled men 30 years of age and older;
analyses of the small subsamples of men younger than 30 years suggested higher
HIV incidence3- 4 and more sexual
risks2- 3,5,7
than among older men. In the 1990s, 6 cross-sectional surveys that focused
on small samples of young MSM found high prevalence of HIV and sexual risk
behaviors.8- 13
These and other findings involving sexually transmitted diseases (STDs) and
unsafe sex,14- 15 and HIV seroincidence16- 18 signal a significant
and continuing HIV epidemic among MSM.
The 1992 through 1993 Young Men's Survey (YMS), conducted in San Francisco
and Berkeley, Calif, was 1 of the 6 cross-sectional surveys focusing on young
MSM in the 1990s.10 Of the 425 participants
aged 17 to 22 years, 9.4% were HIV positive, and 32.7% reported having unprotected
anal sex in the past 6 months. To determine whether this public health problem
was widespread, the Centers for Disease Control and Prevention (CDC) and local
public health officials adapted and expanded the YMS conducted in the years
1994 through 1998 to include the San Francisco Bay Area (San Francisco, Oakland,
and San Jose, Calif), Baltimore, Md; Dallas, Tex; Los Angeles, Calif; Miami,
Fla; New York, NY; and Seattle, Wash. In this first multisite report of the
1994 though 1998 YMS, we confirm that the 1992 through 1993 YMS findings held
true not only in the San Francisco Bay Area19
but also in the 6 other areas.
Introduction:
Little is known about the prevalence of sexual behaviors among the black and Hispanic populations in the United States outside the context of sexual risk and disease transmission in "high-risk" samples.
Aim:
This study sought to establish current rates of sexual behaviors, sexual health care practices (i.e., experiences with testing and diagnosis of sexually transmitted infections [STIs]), and condom use in a probability sample of black and Hispanic adult men and women in the United States.
Main outcome measures:
Sexual behaviors including solo masturbation, partnered masturbation, receiving oral sex and giving oral sex, vaginal intercourse, and anal intercourse were assessed. Self-reported rates of HIV and other STI testing, and self-reported history of STI diagnosis were examined. Also assessed were rates of condom use during most recent and past 10 vaginal intercourse events.
Methods:
Data from a probability sample of 1246 black and Hispanic adults were analyzed to explore sexual behaviors, condom use, and STI testing and diagnosis trends.
Results:
Masturbation, oral sex, and vaginal intercourse were prevalent among black and Hispanic men and women throughout the life course. Anal intercourse and same-gender sexual activities were less common. Self-reported rates of HIV testing were relatively high but varied by gender across age groups. Similarly, rates of testing for other STI were high and differed by gender across age groups. Overall rates of condom use among black and Hispanic men and women were relatively high and did not appear to be related to a variety of situational factors including location of sexual encounter, relationship status, other contraceptive use, and substance use during sexual activity.
Conclusion:
These data provide a foundation for understanding diverse sexual behaviors, sexual health-care practices, and condom use among the general population of black and Hispanic men and women in the United States.
The role of human papillomavirus (HPV) in malignant and non-malignant genital diseases in women is well known and the corresponding epidemiological burden has been widely described. However, less is known about the role of HPV in anal, penile and head and neck cancer, and the burden of malignant and non-malignant HPV-related diseases in men. The objective of this review is to estimate the epidemiological burden of HPV-related cancers and non-malignant diseases in men in Europe.
The annual number of new HPV-related cancers in men in Europe was estimated using Eurostat population data and applying cancer incidence rates published by the International Agency for Research on Cancer. The number of cancer cases attributable to HPV, and specifically to HPV16/18, was calculated based on the most relevant prevalence estimates. The annual number of new cases of genital warts was calculated from the most robust European studies; and latest HPV6/11 prevalence estimates were then applied. A literature review was also performed to retrieve exhaustive data on HPV infection at all anatomical sites under study, as well as incidence and prevalence of external genital warts, recurrent respiratory papillomatosis and HPV-related cancer trends in men in Europe.
A total of 72, 694 new cancer cases at HPV-related anatomical sites were estimated to occur each year in men in Europe. 17,403 of these cancer cases could be attributable to HPV, with 15,497 of them specifically attributable to HPV16/18. In addition, between 286,682 and 325,722 new cases of genital warts attributable to HPV6/11were estimated to occur annually in men in Europe.
The overall estimated epidemiological burden of HPV-related cancers and non-malignant diseases is high in men in Europe. Approximately 30% of all new cancer cases attributable to HPV16/18 that occur yearly in Europe were estimated to occur in men. As in women, the vast majority of HPV-positive cancer in men is related to HPV16/18, while almost all HPV-related non-malignant diseases are due to HPV6/11. A substantial number of these malignant and non-malignant diseases may potentially be prevented by quadrivalent HPV vaccination.
This report presents national estimates of several measures of sexual behavior, sexual attraction, and sexual identity among males and females aged 15-44 years in the United States, based on the 2006-2008 National Survey of Family Growth (NSFG). These data are relevant to demographic and public health concerns, including fertility and sexually transmitted infections among teenagers and adults. Data from the 2006-2008 NSFG are compared with data from the 2002 NSFG and other national surveys.
Data for 2006-2008 were collected through in-person interviews with a national sample of 13,495 males and females in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The overall response rate for the 2006-2008 NSFG was 75%.
Sexual behaviors among males and females aged 15-44 based on the 2006-2008 NSFG were generally similar to those reported based on the 2002 NSFG. Among adults aged 25-44, about 98% of women and 97% of men ever had vaginal intercourse, 89% of women and 90% of men ever had oral sex with an opposite-sex partner, and 36% of women and 44% of men ever had anal sex with an opposite-sex partner. Twice as many women aged 25-44 (12%) reported any same-sex contact in their lifetimes compared with men (5.8%). Among teenagers aged 15-19, 7% of females and 9% of males have had oral sex with an opposite-sex partner, but no vaginal intercourse. Sexual attraction and identity correlates closely but not completely with reports of sexual behavior. Sexual behaviors, attraction, and identity vary by age, marital or cohabiting status, education, and race and Hispanic origin.
Despite a demonstrated relationship between sexual behaviors and health, including clinical risks, little is known about contemporary sexual behavior.
To assess the rates of sexual behavior among adolescents and adults in the United States.
We report the recent (past month, past year) and lifetime prevalence of sexual behaviors in a nationally representative probability sample of 5,865 men and women ages 14 to 94 in the United States (2,936 men, 2,929 women).
Behaviors assessed included solo masturbation, partnered masturbation, giving and receiving oral sex, vaginal intercourse, and anal intercourse.
Masturbation was common throughout the lifespan and more common than partnered sexual activities during adolescence and older age (70+). Although uncommon among 14- to 15-year olds, in the past year 18.3% of 16- to 17-year-old males and 22.4% of 16- to 17-year-old females performed oral sex with an other-sex partner. Also in the past year, more than half of women and men ages 18 to 49 engaged in oral sex. The proportion of adults who reported vaginal sex in the past year was highest among men ages 25-39 and for women ages 20-29, then progressively declined among older age groups. More than 20% of men ages 25-49 and women ages 20-39 reported anal sex in the past year. Same-sex sexual behaviors occurring in the past year were uncommonly reported.
Men and women engage in a diverse range of solo and partnered sexual behaviors throughout the life course. The rates of contemporary sexual behavior provided in this report will be valuable to those who develop, implement, and evaluate programs that seek to improve societal knowledge related to the prevalence of sexual behaviors and to sexual health clinicians whose work to improve sexual health among the population often requires such rates of behavior.
HIV prevalence and associated risk behaviors were examined among Thai bisexually active men (MSMW, n = 450) and men who have sex with men only (MSM-only, n = 1,125). Cross sectional venue-day-time sampling was used to collect data. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 8.2% among MSMW and 21.2% among MSM-only. Consistent condom use with male partners was higher among MSMW (77.6%) than MSM-only (62.9%), and lower with female partners (44.4%). Lack of family confidant, migration, concern about acquiring HIV infection, and self-reported STD were associated with HIV prevalence among MSMW. Older age, lower educational level, residing in Bangkok or Chiang Mai, living away from family, recruitment from a sauna, increased frequency of visiting the surveyed venue, practicing receptive or both receptive and insertive anal intercourse, inconsistent condom use with male paying partners, and a history of drug use were associated with HIV prevalence in MSM-only.
Series editors J M Stephenson, A Babiker
The study of sexual behaviour lies at the heart of understanding the transmission dynamics of sexually transmitted infections (STIs). Academic investigation into sexual behaviour dates back to the 18th century and, over time, has employed a variety of approaches including the medical and psychiatric investigation of sexual disorders, anthropological investigations, and survey research based largely on volunteer samples. More recent studies, driven largely by the public health response to HIV/AIDS, have focused on large scale probability sample survey research.1–5 Key areas of inquiry have shifted towards describing population patterns of risk behaviours for STI/HIV transmission, understanding how epidemics of STIs are generated, and informing disease control strategies.
Sexual behaviour is a largely private activity, subject to varying degrees of social, cultural, religious, moral and legal norms and constraints. A key challenge for all sex survey research is to generate unbiased and precise measures of individual and population behaviour patterns. Methods are needed to minimise measurement error which may be introduced by participation bias, recall and comprehension problems, and respondents' willingness to report sensitive and sometimes socially censured attitudes or behaviours.6, 7 This paper briefly considers the role of different types of study in understanding STI epidemiology. It then focuses on potential sources of measurement error in survey research and strategies for assessing and limiting them.Sex Transm Inf 2001;77:84–92
The type of study chosen will depend on the purpose of the investigation. However, studies generally fall into four main groups: general population surveys, studies on population subgroups, partner and network studies, ethnographic and qualitative studies.
### GENERAL POPULATION PROBABILITY SAMPLE SURVEYS
Cross sectional population surveys aim to describe the overall distribution of behaviours in populations. By using probability sampling techniques and maximising response rates, large scale behavioural surveys can provide robust estimates of the prevalence …
An Internet survey was conducted during the 2001-2002 academic year to examine the health risk behaviors, including HIV/STI associated behaviors, of self-identified lesbian, gay, bisexual, and transgender (LGBT) college students in the United States. A total of 450 LGBT college students completed the entire online survey. Most respondents attended a 4-year (96.9%), coeducational (98.6%), non-religiously affiliated (87.5%), public (68.6%) institution. Eighty-nine percent reported having sex with someone of the same sex and 45% had multiple (6 or more) sex partners during their lifetime. Most reported using a condom consistently during penile-vaginal (61%) and anal sex (63%). However, only 4% used a condom or other barrier consistently during oral sex and 28% used a condom or other barrier during their last sexual encounter. Injection drug use and needle-sharing behavior was low (2.1% and 1.1%, respectively). Comparisons with heterosexual college students' HIV/STI associated risk behaviors are included. Results may be useful for HIV/STI prevention programs targeting LGBT college students.
This study was conducted in order to determine the prevalence of men having sex with men (MSM) and their HIV related behaviours and attitudes among Chinese men in Hong Kong.
A large scale, random, population based, anonymous telephone survey of 14 963 men between the ages of 18-60 was conducted. The overall response rate was approximately 57%.
Of the respondents, 4.6% had ever engaged in MSM activity. In the 6 months preceding the survey, 2.0% had engaged in MSM behaviours (active MSM) and 0.5% reported having engaged in anal sex MSM behaviours. Among anal sex MSM, consistent condom use was 42.9% with male non-commercial sex partners and even lower with male commercial sex partners (35.7%). Approximately 11% of anal sex MSM and 4.1% of the non-anal sex MSM had contracted an STD in the last 6 months. The prevalence of HIV testing was only 20.6% among anal sex MSM and 11.9% among non-anal sex MSM.
Active MSM in Hong Kong are at high risk of HIV infection. The belief of low vulnerability to HIV is prevalent among active MSM in Hong Kong with only 2.0% believing that their chances of HIV infection as being "very likely."
To compare the characteristics of a self-selected, convenience sample of men who have sex with men (MSM) recruited through the internet with MSM drawn from a national probability survey in Great Britain.
The internet sample (n = 2065) was recruited through two popular websites for homosexual men in Great Britain in May and June 2003. This sample was compared with MSM (n = 117) from the National Survey of Sexual Attitudes and Lifestyles (Natsal), a probability sample survey of adults resident in Great Britain conducted between May 1999 and February 2001.
No significant differences were observed between the samples on a range of sociodemographic and behavioural variables (p>0.05). However, men from the internet sample were younger (p<0.001) and more likely to be students (p = 0.001), but less likely to live in London (p = 0.001) or report good health (p = 0.014). Although both samples were equally likely to report testing for HIV, men from the internet sample were more likely to report a sexually transmitted infection in the past year (16.9% v 4.8%, adjusted odds ratio 4.14, 95% CI 1.76 to 9.74; p = 0.001), anal intercourse (76.9% v 63.3%; p = 0.001) and unprotected anal intercourse in the past 3 months (45% v 36.6%; p = 0.064).
The internet provides a means of recruiting a self-selected, convenience sample of MSM whose social and demographic characteristics are broadly similar to those of MSM drawn from a national probability survey. However, estimates of high-risk sexual behaviour based on internet convenience samples are likely to overestimate levels of sexual risk behaviour in the wider MSM population.
Heterosexual anal and oral sex are related to the acquisition of sexually transmitted infections, including human immunodeficiency virus infection. We examined the correlates of heterosexual anal and oral sex in the general population, using data from the National Survey of Family Growth.
The sample included 12,571 men and women aged 15-44 years (79% response rate).
One-third of men and women had ever had anal sex, and three-quarters had ever had oral sex. Condom use during last oral or anal sex was relatively uncommon. In separate models for men and women, having ever had anal sex was associated with white race, age of 20-44 years, and having had a non-monogamous sex partner. White race, age of 20-44 years, being married, and having higher numbers of lifetime sex partners were related to having ever given oral sex in men and women. Giving oral sex was associated with having a non-monogamous sex partner in men. Ever receiving oral sex was associated with white race and a non-monogamous sex partner in men and women.
It would be beneficial to track the prevalence of heterosexual anal and oral sex and associated condom use on a more frequent basis.
This review discusses the social science and public health literature on anal intercourse between men, and between men and women, from a global perspective. Most studies on heterosexual anal intercourse have been conducted in Western countries. Populationwide random sample surveys in these countries indicate that a significant minority, and sometimes a majority, of heterosexual men and women have ever engaged in anal intercourse. A smaller minority do so frequently. In some countries, such as in Latin America, anal intercourse is more common than in the West, as it is among subgroups within the West, such as specific ethnic groups, some sex workers and men who have sex with men and women. Anal intercourse is a central practice in sex between men in comparison to sex between men and women. Studies of gay men in Western countries indicate that between 70 per cent and 80 per cent have engaged in anal intercourse in the past six to 12 months. There is a paucity of data documenting homosexual sex in non-Western countries but it is apparent that in some countries, for example in Latin America and the Middle East, homosexual sex is socially constructed according to insertive and receptive gendered sex roles and does not typically correspond with gay identities. Also discussed are health aspects of anal intercourse, including physical trauma, the transmission of pathogens, maintaining anal health, and the need for health practitioners to address the practice during clinical consultations.
Objectives:
To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM).
Design:
Two large, stratified probability sample surveys of the general population.
Methods:
Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000).
Results:
In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25).
Conclusions:
Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data.
Background: Men who have sex with men (MSM) continue to be at high risk for HIV infection. Here we evaluate trends in HIV prevalence, estimated HIV incidence, and risk behavior among MSM in Bangkok, Thailand.
Methods: Between 2003 and 2007, 3 biennial cross-sectional HIV prevalence assessments were conducted among MSM in Bangkok, Thailand, using venue-day-time sampling. Oral fluid was tested for HIV infection; demographic and behavioral data were self-collected using hand-held computers. Estimates of annual HIV incidence in young MSM were derived as follows: (number of HIV infections/sum of [current age-age at start of anal intercourse]) × 100). Logistic and Poisson regression was used to evaluate trends in HIV prevalence, estimated HIV incidence, and risk behavior.
Findings: The overall HIV prevalence increased from 17.3% in 2003 to 28.3% in 2005 to 30.8% in 2007 (P < 0.001 for trend). The estimated HIV incidence among young MSM increased from 4.1% in 2003 to 6.4% in 2005, to 7.7% in 2007 (P < 0.02 for trend). The increase in HIV prevalence from 2005 to 2007 was not statistically significant. The proportion of men reporting anal sex and casual or steady male sex partners in the past 3 months significantly decreased, whereas the proportion reporting drug use and drug use during sex significantly increased. No increase was observed in the proportion of men reporting consistent condom use.
Interpretation: Our data suggest that after a strong increase from 2003 to 2005, the HIV prevalence among MSM in Bangkok may have begun to stabilize. Given the continuing high levels of risk behavior and the estimated high HIV incidence in young MSM, additional HIV preventive interventions are necessary.
We assessed trends in behavioral risk for HIV infection among men who have sex with men (MSM). Seattle MSM participated in
random digit dial telephone surveys in 2003 (n=400) and 2006 (n=400). Fourteen percent in 2003 and 9% in 2006 reported unprotected anal intercourse with a partner of different or unknown
HIV status (non-concordant UAI; odds ratio [OR]=0.7; 95% confidence interval [CI]: 0.5, 1.2). Compared to participants in
2003, participants in 2006 met a greater proportion of their anal sex partners through the Internet (OR=2.0; 95% CI: 1.2,
3.1). Although the proportion of anal sex partnerships formed online increased between 2003 and 2006, Internet partnerships
were not more risky than those initiated elsewhere. While the emergence of the Internet as a venue through which men meet
partners demonstrates that sexual risk among MSM remains highly dynamic, our findings suggest that sexual risk behavior among
MSM is currently stable.
KeywordsMen who have sex with men–HIV–Behavioral surveillance–Random digit dial
This study assessed the risky sexual behavior of a group of adult men and women with sexual experience within the past 1year
who, while in a relationship with a stable partner, reported having sex with another person. The data were collected in 2003
using a nationally representative, multi-stage stratified probability sample (n=1,271) of women and men in South Korea. Via hierarchical regression models, we assessed the gendered effects of socioeconomic
characteristics, health behavior, sex behavior, and safe sex attitude factors. According to the results, for groups with concurrent
sexual partnership experience, if the subject was a single person with smoking and drinking who had engaged in sex resulting
in unwanted pregnancy, and anal sex initiated before the age of 17, the likelihood of engaging in concurrent sexual partnerships
was statistically significant. Furthermore, our gender-elaborated analysis demonstrated that the majority of sexual risk was
borne by women. When the partners of concurrent sexual partnerships are categorized by type, the key characteristic of a casual
relationship or relationship with female sex workers is one-night-stand sex, accompanied by drinking. This study found that,
for groups with concurrent sexual partnerships experience, there is a statistical association between health risky variables
and risky sexual behavior. We should attempt to intervene in these concurrent sexual partnerships groups for the effective
management of sexually transmitted infections.
There is evidence that anal sex is becoming increasingly popular among heterosexual women and men. Several studies carried out in especially vulnerable populations (e.g. sex workers and low-income youth) suggested that anal sex may indicate a more general propensity to sexual risk-taking.
To assess whether this epidemiologically important finding holds in the case of young adults from the general population, we analysed data from a cross-sectional probability survey carried out in 2010 on 1005 Croatian women and men aged 18-25.
Anal intercourse was reported by 36.5% of 861 sexually experienced participants (42.7% of men and 29.8% of women). About one-third of them (34%) used a condom at most recent anal intercourse. The experience of anal sex was significantly associated (P<0.001) with all four indicators of sexual risk-taking (condom use at most recent vaginal intercourse, number of sexual partners in the past year, concurrent sexual relationships and anonymous sex in the past year), as well as with negative attitudes and beliefs about condom use (P<0.01). Sexual sensation-seeking mediated the relationship between anal sex and some of the sexual risk-taking behaviours.
According to the findings, heterosexual anal sex is directly and indirectly associated with increased behavioural risks of acquiring HIV and other sexually transmissible infections (STI). Sex education and STI prevention programs should focus on the importance of using protection when practicing anal sex.
Human papillomaviruses (HPVs) are a large family of small double-stranded DNA viruses that infect squamous epithelia. It has been established that infection with specific HPV types is a contributing factor to different types of anogenital cancer, including vulval, vaginal, anal, penile, and head and neck cancers. Approximately 4% of all cancers are associated with HPV. HPV infection is the major cause of cervical cancer and genital warts. Genital HPV infections are very common, are sexually transmitted, and have a peak prevalence between ages 18 and 30. Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN) and eventually to invasive cancer of the cervix (ICC). CINs are genetically unstable lesions with a 30-40% risk of progression to ICC. If left untreated, they form a spectrum of increasing cytological atypia, ranging from low-grade CIN1 to high-grade CIN3; the latter are caused almost exclusively by high-risk HPVs, HPV 16 and 18. Infection with HPV requires a microabrasion in the genital epithelium. The oncogenic properties of high-risk HPV reside in the E6 and E7 genes, which if inappropriately expressed in dividing cells deregulate cell division and differentiation. HPV DNA testing has been shown consistently to be superior to cytology in terms of sensitivity and positive predictive value and will become a major tool in cervical cancer screening, at least in the developed countries.
Human papillomavirus (HPV) is an extremely prevalent sexually transmitted infection that is typically acquired soon after onset of sexual activity. The burden of HPV-related malignant and nonmalignant disease is high in men and women. High-risk or oncogenic types of HPV cause cervical, vaginal, and vulvar cancer in women. These types have also been shown to cause penile cancer in men and a substantial proportion of oropharyngeal and anal malignancy in men and women. Low-risk types of HPV cause anogenital warts. Prevention of penile, anal, and oropharyngeal cancers and anogenital warts represents potential benefits of the HPV vaccine in men. This review focuses on HPV disease in men, existing data on HPV vaccination in men, and various factors associated with the decision to vaccinate boys and young men, as well as the timing of vaccination.
Anogenital pre-malignancies and malignancies are frequently encountered. Aetiopathogenetically, human papillomavirus (HPV) infection plays a critical role. However, there is a variable degree of association of HPV infection with the development of anogenital malignancies. In this context, the high level of clinically unapparent HPV infection should be considered. Therefore, the question arises if the association with HPV is always causative. Besides HPV, pre-existent lichen sclerosus is also an important aetiopathologic factor in the development of anogenital malignancies.
Common anogenital pre-malignancies comprise Bowen’s disease (BD), Bowenoid papulosis (BP) and erythroplasia of Queyrat (EQ). From a clinical point of view, these are clearly different entities, but from a histopathological point of view, BD, BP and EQ are indistinguishable. They all represent forms of squamous intraepithelial neoplasia (IN).
Intraepithelial neoplasia (IN) is not only restricted to squamous variants, but also includes non-squamous IN, Paget’s disease (PD) and melanoma in situ. The risk of developing anogenital (pre)malignancies or other tumours is higher in immunocompromised and immunodeficient patients, in particular those suffering from human immunodeficiency virus (HIV) infection. Such risk factors will affect treatment and follow-up modalities. Regarding prophylactic measures, a relatively recent but very important development is the availability of HPV vaccination on a large scale. Momentarily, the effects of such vaccination, on a population-based scale, are not yet clear but will become apparent in the near future. Management of anogenital pre-malignancies and malignancies should be tailor-made and may be organized in a multidisciplinary fashion.
There is a lack of recent data on the extent to which gay men engage in insertive anal intercourse (IAI) and receptive anal intercourse (RAI). Accurate assessments of the overall risk of infection from HIV and other sexually transmitted infections (STIs) require such data because versatile men who engage in both roles have heightened vulnerability for becoming infected and infecting others.
To investigate the extent to which gay men are versatile with regard to having IAI and RAI.
Percentages of gay men who reported engaging in IAI, RAI, or both during the past 12 months and in their most recent sexual encounter.
Eight hundred fifty-six Australian gay men completed an online survey to retrospectively report on their sexual practices over the past 12 months.
Of men who had anal intercourse in the past 12 months, 83% had both IAI and RAI, of whom 57% were highly versatile in that they had approximately equal numbers of partners for IAI and RAI. Of men who had anal intercourse in their most recent sexual encounter, as many as one in five (20%) had reciprocal anal intercourse, having both IAI and RAI with the same partner in a single encounter. Condom use was significantly less likely with reciprocal (38%) than nonreciprocal anal intercourse (50%; P = 0.04). While highly versatile men were less likely to know their HIV status, practices at most recent sexual encounter such as reciprocal anal intercourse and condom use were not significantly related to either their HIV status or that of their partner.
Engaging in both IAI and RAI appears to be common among gay men. HIV/STI prevention strategies would benefit from paying attention to the implications of high rates of versatile sexual practices, particularly the tendency for condoms to be used less often when having reciprocal anal intercourse.
Data on adolescents' sexual and condom use behaviors provides an empirical basis for a range of social, educational, clinical, and public health endeavors.
This study has two purposes: to describe the recent and lifetime prevalence of a variety of sexual behaviors; and, to describe factors associated with condom use at last penile-vaginal intercourse.
Data included those from male (N = 414) and female (N = 406) adolescents (ages 14-17 years) from a nationally representative probability sample. Survey items addressed occurrence (past 90 days, past year, lifetime) of solo masturbation, partnered masturbation, oral sex given to a partner, oral sex received from a partner, vaginal intercourse, and anal intercourse. Participants reporting partnered sexual behaviors in the past year completed additional items about condom use, location of sex, partner characteristics, other sexual behaviors, and alcohol or marijuana use at the most recent sexual event.
Adjusted rates (by gender) of sexual behaviors, and characteristics of most recent vaginal sex event as a function of condom use/non-use.
Lifetime prevalence of solo masturbation was common for males (80%) and females (48%). Lifetime prevalence of penile-vaginal sex increased with each year of age for both adolescent men and women; however, penile-vaginal sex within the previous 90 days was much less frequently reported. Rates of condom use for penile-vaginal sex were 80% for males and 69% for females. Lifetime anal sex rates were 4.7% for males and 5.5% for females.
Sexual behavior among adolescents was more prevalent and diverse in older adolescent cohorts. Condom use for penile-vaginal intercourse was reported for a majority of events.
To provide a foundation for those who provide sexual health services and programs to men in the United States, the need for population-based data that describes men's sexual behaviors and their correlates remains.
The purpose of this study was to, in a national probability survey of men ages 18-94 years, assess the occurrence and frequency of sexual behaviors and their associations with relationship status and health status.
A national probability sample of 2,522 men aged 18 to 94 completed a cross-sectional survey about their sexual behaviors, relationship status, and health.
Relationship status; health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse and anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse and anal intercourse in the past year.
Masturbation, oral intercourse, and vaginal intercourse are prevalent among men throughout most of their adult life, with both occurrence and frequency varying with age and as functions of relationship type and physical health status. Masturbation is prevalent and frequent across various stages of life and for both those with and without a relational partner, with fewer men with fair to poor health reporting recent masturbation. Patterns of giving oral sex to a female partner were similar to those for receiving oral sex. Vaginal intercourse in the past 90 days was more prevalent among men in their late 20s and 30s than in the other age groups, although being reported by approximately 50% of men in the sixth and seventh decades of life. Anal intercourse and sexual interactions with other men were less common than all other sexual behaviors.
Contemporary men in the United States engage in diverse solo and partnered sexual activities; however, sexual behavior is less common and more infrequent among older age cohorts.
Past surveys of sexual behavior have demonstrated that female sexual behavior is influenced by medical and sociocultural changes. To be most attentive to women and their sexual lives, it is important to have an understanding of the continually evolving sexual behaviors of contemporary women in the United States.
The purpose of this study, the National Survey of Sexual Health and Behavior (NSSHB), was to, in a national probability survey of women ages 18-92, assess the proportion of women in various age cohorts who had engaged in solo and partnered sexual activities in the past 90 days and to explore associations with participants' sexual behavior and their relationship and perceived health status. Past year frequencies of masturbation, vaginal intercourse, and anal intercourse were also assessed.
A national probability sample of 2,523 women ages 18 to 92 completed a cross-sectional internet based survey about their sexual behavior.
Relationship status; perceived health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse, anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse, and anal intercourse in the past year.
Recent solo masturbation, oral sex, and vaginal intercourse were prevalent among women, decreased with age, and varied in their associations with relationship and perceived health status. Recent anal sex and same-sex oral sex were uncommonly reported. Solo masturbation was most frequent among women ages 18 to 39, vaginal intercourse was most frequent among women ages 18 to 29 and anal sex was infrequently reported.
Contemporary women in the United States engage in a diverse range of solo and partnered sexual activities, though sexual behavior is less common and more infrequent among older age cohorts.
Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations.
The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population.
Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years.
Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events.
Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups.
These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy.
To examine whether improvements have been made in the delivery of sexually transmitted infection and/or human immunodeficiency virus (STI/HIV) counseling services to teen males.
Analysis was performed using the 1995 National Survey of Adolescent Males (N = 1,729, response rate = 75%) and the 2002 National Survey of Family Growth (N = 1,121, response rate = 78%), which are two nationally representative surveys of 15-19-year-old males. Main outcome measure included discussion about STIs/HIV with a doctor/nurse. Weighted bivariate and multivariate Poisson regression analyses examined the association of outcome measures and survey year among males engaging in various types of sexual behaviors (e.g., varying partner numbers, higher risk sex) unadjusted and adjusted for sociodemographic and health care access factors.
In 2002, STI/HIV counseling receipt in the past year was reported by one-third of males who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners. Only 26% of males reporting high-risk sex (e.g., sex with prostitute, person with HIV or often/always high with sex) reported STI/HIV counseling receipt. Overall, no improvements were found between 1995 and 2002 in STI/HIV counseling, even after controlling for sociodemographic and health care access factors.
Mechanisms are needed to raise the importance of STI/HIV counseling services among sexually active male teens as well as to improve health care providers' delivery of these services.
Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research.
To explore the relative contribution of secular trends and public health policies to changes in sexual behaviour.
Three random probability surveys of the sexual behaviour of people aged 18-69 years were conducted in 1970, 1992 and 2006 in France.
Data of the 2006 survey (n = 12,364) were compared with those from two surveys carried out in 1970 (n = 2625) and 1992 (n = 20,055).
Over the last decades, median age at first intercourse has decreased by 4 years for women (22.0 in the 1930s vs. 17.6 in the 2000s) and 1 year for men (18.1 vs. 17.2). Lifetime number of sexual partners increased for women (1.8 in 1970 vs. 4.4 in 2006), but not for men (11.8 vs. 11.6). At the same time, the proportion of respondents, especially women, who reported nonpenetrative sexual practices and considered sexual intercourse essential to well being was on the increase. These changes are mainly attributed to an increase in women's social status. A marked increase in condom use was observed following the first AIDS/HIV prevention campaigns in the 1980s.
Public health interventions that are synergistic with trends in social norms are likely to be more effective than those that run counter to them. In France, sexual health and HIV prevention policies aimed at harm limitation appear to have chimed with secular trends. The evidence of greater diversification of sexual practices offers potential to increase the range of safer sex messages used in public health interventions.
In 1993 Oliver and Hyde conducted a meta-analysis on gender differences in sexuality. The current study updated that analysis with current research and methods. Evolutionary psychology, cognitive social learning theory, social structural theory, and the gender similarities hypothesis provided predictions about gender differences in sexuality. We analyzed gender differences in 30 reported sexual behaviors and attitudes for 834 individual samples uncovered in literature searches and 7 large national data sets. In support of evolutionary psychology, results from both the individual studies and the large data sets indicated that men reported slightly more sexual experience and more permissive attitudes than women for most of the variables. However, as predicted by the gender similarities hypothesis, most gender differences in sexual attitudes and behaviors were small. Exceptions were masturbation incidence, pornography use, casual sex, and attitudes toward casual sex, which all yielded medium effect sizes in which male participants reported more sexual behavior or permissive attitudes than female participants. Most effect sizes reported in the current study were comparable to those reported in Oliver and Hyde's study. In support of cognitive social learning theory, year of publication moderated the magnitude of effect sizes, with gender differences for some aspects of sexuality increasing over time and others decreasing. As predicted by social structural theory, nations and ethnic groups with greater gender equity had smaller gender differences for some reported sexual behaviors than nations and ethnic groups with less gender equity. Gender differences decreased with age of the sample for some sexual behaviors and attitudes.
While vibrating products have been recommended by clinicians for the treatment of male sexual dysfunctions, knowledge is lacking with regard to the prevalence of vibrator use among men in the United States, the characteristics of men who use vibrators, and whether there are relations between vibrator use and sexual function among men.
To establish lifetime and recent prevalence rates for vibrator use by men in the United States, to document the characteristics of men who use vibrators and their reasons for using vibrators, and to explore relations between men's vibrator use and sexual function.
During April 2008, data were collected from a population-based cross-sectional survey of 1,047 men aged 18-60 years in the United States. Analyses were conducted using post-stratification data weights.
Measures included sociodemographics, health status and health-related behaviors, sexual behaviors, vibrator use, and sexual function.
For both solo and partnered sexual activities, the prevalence of men who had incorporated a vibrator into sexual activities during their lives was 44.8%, with 10.0% having done so in the past month, 14.2% in the past year, and 20.5% over 1 year ago. Men who had used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam. Men who had used vibrators recently also scored higher on four of the five domains of the International Index of Erectile Function (erectile function, intercourse satisfaction, orgasmic function, and sexual desire).
Among men in the United States, vibrator use during solo and partnered sexual interactions is common and is associated with a wide array of positive sexual health characteristics. Future research should continue to explore ways in which men incorporate vibrators into solo sexual acts, partnered sexual play, and sexual intercourse.
Although prior research has demonstrated that many adolescents engage in noncoital sexual behavior, extant peer-reviewed studies have not used nationally representative data or multivariate methods to examine these behaviors. We used data from Cycle 6 of National Survey of Family Growth (NSFG) to explore factors related to oral and anal sex among adolescents.
Data come from 2,271 females and males aged 15-19 in 2002. Computer-assisted self-administered interviews were used to collect sensitive information, including whether respondents had ever engaged in vaginal, oral or anal sex. We used t tests and multivariate logistic regression to test for differences and identify independent characteristics associated with experience with oral or anal sex.
In all, 54% of adolescent females and 55% of adolescent males have ever had oral sex, and one in 10 has ever had anal sex. Both oral sex and anal sex were much more common among adolescents who had initiated vaginal sex as compared with virgins. The initiations of vaginal and oral sex appear to occur closely together; by 6 months after first vaginal intercourse, 82% of adolescents also engaged in oral sex. The strongest predictor of anal sex involvement was time since initiation of vaginal sex and the likelihood of anal sex increased with greater time since first vaginal intercourse. Teens of white ethnicity and higher socioeconomic status were more likely than their peers to have ever had oral or anal sex.
Health professionals and sexual health educators should address noncoital sexual behaviors and risk for sexually transmitted infections risk, understanding that noncoital behaviors commonly co-occur with coital behaviors.
To the Editor.—
In their valuable report on acquired immunodeficiency syndrome (AIDS) in women, Guinan and Hardy1 infer that heterosexual anal intercourse plays little part in the sexual spread of the AIDS virus (the human immunodeficiency virus [HIV]), a viewpoint editorially echoed in the same issue of JAMA.2 However, inasmuch as receptive anal intercourse carries the highest relative risk by far for homosexual men, we underestimate the practice among heterosexuals at some peril.Sex researchers, unlike most physicians, are familiar with data indicating that about one fourth of American women occasionally engage in anal intercourse and about 10% do so regularly for pleasure.3,4 We find that such information is obtained from most women only after repeated personal interviews and development of strong trust in the interviewer.5 Thus, standard medical or field interviews are unlikely to reveal such activity, reinforcing the mistaken impression that anal intercourse is
Studies of heterosexual HIV transmission have consistently found anal intercourse to be a highly predictive risk factor for seroconversion. Yet most AIDS prevention messages targeted at heterosexuals, presumably influenced by cultural taboos against acknowledging this sexual practice, continue to emphasize vaginal and, increasingly, oral sex transmission. The health risks of anal sex appear to be severely underestimated by a substantial proportion of sexually active women and men in North and Latin America as well as parts of South Asia, Africa, and other regions. Among heterosexuals reported rates of condom use are nearly universally lower for anal than for vaginal intercourse. This review examines anal sex among the general population, including its prevalence in various world regions, related sociocultural factors, and other associated health problems including anorectal STDs, Hepatitis B infection, and HPV-related anal cancer in women. U.S. survey and other data suggest that, in terms of absolute numbers, approximately seven times more women than homosexual men engage in unprotected receptive anal intercourse. Research among higher risk subpopulations, including bisexual men, injecting drug users, female sex workers, inner-city adolescents, and serodiscordant heterosexual couples, indicates that persons particularly at risk of being infected by or transmitting HIV are also more likely to practice anal sex. Considering this finding, along with the much greater efficiency for HIV infection as well as lower rates of condom usage, a significant proportion of heterosexual transmission in some populations is due to anal intercourse. This typically stigmatized and hidden sexual practice must be given greater emphasis in AIDS/STD prevention, women's care, and other health promotion programs.
Studies conducted in the late 1980s on human immunodeficiency virus (HIV) infection among older men who have sex with men (MSM) suggested the epidemic had peaked; however, more recent studies in younger MSM have suggested continued high HIV incidence.
To investigate the current state of the HIV epidemic among adolescent and young adult MSM in the United States by assessing the prevalence of HIV infection and associated risks in this population in metropolitan areas.
The Young Men's Survey, a cross-sectional, multisite, venue-based survey conducted from 1994 through 1998.
One hundred ninety-four public venues frequented by young MSM in Baltimore, Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco (Calif) Bay Area; and Seattle, Wash.
A total of 3492 15- to 22-year-old MSM who consented to an interview and HIV testing.
Prevalence of HIV infection and associated characteristics and risk behaviors.
Prevalence of HIV infection was high (overall, 7.2%; range for the 7 areas, 2.2%-12. 1%) and increased with age, from 0% among 15-year-olds to 9.7% among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8), young men of mixed or other race (OR, 4.8; 95% CI, 3. 0-7.6), and Hispanics (OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans and Pacific Islanders (OR, 1. 1; 95% CI, 0.5-2.8). Factors most strongly associated with HIV infection were being black, mixed, or other race; having ever had anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20 or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive men knew they were infected before this testing; 37 (15%) were receiving medical care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence of unprotected anal sex during the past 6 months was high (overall, 41%; range, 33%-49%).
Among these young MSM, HIV prevalence was high, underscoring the need to evaluate and intensify prevention efforts for young MSM, particularly blacks, men of mixed race or ethnicity, Hispanics, and adolescents. JAMA. 2000;284:198-204
Researchers have paid little attention to adolescents' experience with genital sexual activity other than vaginal intercourse, even though oral and anal intercourse expose youth to the risk of sexually transmitted diseases.
Males aged 15-19 interviewed in 1988 and 1995 as part of the National Survey of Adolescent Males were asked questions about whether they had ever engaged in a series of genital sexual activities. These data were collected in a self-administered questionnaire that respondents completed at the end of the interview.
In 1995, 55% of males aged 15-19 reported that they had ever engaged in vaginal intercourse, 53% that they had ever been masturbated by a female, 49% that they had ever received oral sex, 39% that they had ever given oral sex and 11% that they had ever engaged in anal sex. More than three-quarters of males who had had vaginal intercourse reported experience with masturbation or oral sex by a female. Moreover, one in five males who had never had vaginal intercourse reported having been masturbated by a female, and one in seven said they had received oral sex. Between 1988 and 1995, the proportion of males who reported having ever been masturbated by a female increased significantly, from 40% to 53%. There were less sizable shifts in the proportions who had received oral sex: Overall proportions were similar in both years, although levels more than doubled among black teenagers, an increase that brings them in line with levels of oral sex reported by white and Hispanic adolescent males in 1995.
Evidence from the National Survey of Adolescent Males showing that a substantial share of male teenagers engage in genital sexual activity beyond vaginal sexual intercourse underlines the importance of monitoring a broad spectrum of sexual behaviors among teenagers. More detailed data with larger samples of both males and females are needed to determine the frequency and timing of these behaviors. Measuring risk for STD infections among teenagers requires attention to all forms of genital sexual activity.
The objective of the study was to establish a behavioural surveillance system (BSS) for sexually-related risk behaviours of the Hong Kong adult male general population. Benchmark data were obtained by interviewing 1,020 male respondents, age 18 to 60. The results showed that: (1) 14% of the respondents had engaged in commercial sex in the past six months, (2) 27% of the male commercial sex clients did not always use condoms when having sexual intercourse with commercial sex workers (CSWs), (3) 1.5% of the respondents had contracted sexually transmitted diseases (STDs) in the past six months, (4) 6.1% of respondents had only ever had sex with a man, (5) 0.8% of the respondents had practised unprotected anal intercourse with a man in a six-month period, (6) 4.4% of respondents practised sexually-related high risk behaviours, defined as unprotected sex with a CSW or unprotected anal intercourse with a man, and (7) 36.4% of those who engaged in commercial sex had not used condoms with their regular sex partners. Commercial sex was often practised outside Hong Kong, very commonly in Mainland China or Macau, and was often practised at multiple locations by the same client. Effective programmes have to be able to reduce the size of the at-risk population. This study together with future ones, will form the first BSS in Hong Kong for the general male population and will provide a relevant yardstick for programme evaluation.
Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990).
We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990.
We interviewed 11161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25-34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London.
Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes.
Although condoms most likely prevent HIV infection, evidence of their effectiveness against other sexually transmitted diseases is mixed.
The goal of the study was to determine whether condom use prevents genital human papillomavirus (HPV) infection and HPV-related conditions.
We conducted a literature review and meta-analysis of the effect of condom use on the prevention of genital warts, subclinical HPV infection, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer (ICC).
Among 27 estimates from 20 studies, there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive. However, risk for genital warts, CIN of grade II or III (CIN II or III), and ICC was somewhat reduced.
Available data are too inconsistent to provide precise estimates. However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts, CIN II or III, and ICC.
To describe the prevalence and features of homosexual experience and recent homosexual encounters among a representative sample of Australian adults.
Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women).
Overall, 8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives (p<0.001); these figures fell to 5.7% and 5.0% respectively (p=0.106) when non-genital sexual experience was excluded. 1.9% of men and 1.5% of women reported homosexual experience in the past year. Men who reported homosexual experience reported more same-sex partners than did women (means 31.6 and 3.2, p<0.001), and men and women who identified as homosexual or bisexual reported more sexual partners in total than those who identified as heterosexual. Respondents reporting homosexual experience were significantly more likely to be from an English-speaking background, have higher levels of education, live in a major city, and report a white-collar or managerial/professional occupation. Women who reported homosexual experience were less likely to have a middle or high income. In the most recent homosexual encounter, genital touching was the most commonly reported practice, and oral sex was reported much more frequently than in heterosexual encounters.
Homosexually and bisexually identified men and women had higher total numbers of partners than heterosexuals. Improved societal attitudes towards homosexuality are likely to lead to further increases in estimates of the prevalence of homosexual experience in the community.
To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults.
Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women).
Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters.
Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.
There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.
To describe the methods and process of the Australian Study of Health and Relationships.
A computer-assisted telephone interview was developed and applied to a stratified sample of the Australian population. After initially weighting to reflect the study design, the sample was further weighted to reflect the location, age and sex distribution of the 2001 Census.
Interviews were completed with 10,173 men and 9,134 women aged 16-59 years from all states and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). After accounting for the survey design and weighting to the 2001 Census, the sample appears broadly representative of the Australian population.
The combination of methods and design in the Australian Study of Health and Relationships, coupled with the high response rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.
To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM).
Two large, stratified probability sample surveys of the general population.
Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000).
In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25).
Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data.
Research studying HIV risk-taking behaviour has tended to focus on specific populations who are characterized by particular behaviours. Such practices include the extent of unprotected anal intercourse among homosexual men, the sharing of injecting equipment among drug users and unprotected vaginal intercourse among female sex workers. There is often a failure among both researchers and practitioners to address specific risk behaviours outside of the defined risk group. Reviewed here are studies of heterosexual anal intercourse, with special attention to drug users and female sex workers. Among the general population, the reporting of heterosexual anal intercourse varies greatly across time and cultural groups. However, a body of recent research suggests that, despite some geographical differences, rates in most countries are relatively high. Many studies have also found that associated condom usage is low. Although unprotected anal intercourse is known to be an efficient method for the transmission of HIV and other viral infections, it has rarely been addressed outside cohorts of men who have sex with men. Of particular concern is the interaction of risk behaviours among drug users and women engaging in prostitution, many studies having found high levels of unprotected anal intercourse among these groups. Harm reduction interventions must address all the health risk behaviours their target groups are engaging in, if the challenge of reducing the transmission of HIV and other viral infections is to be met.
The aim of this paper is to present trends in reported HIV-related behaviours among men having sex with men (MSM) in Switzerland. In 1992, 1994, 1997 and 2000 a standardized anonymous questionnaire was placed in gay newspapers and distributed in gay associations. High levels of protection (no anal sex or consistent condom use) with casual partners were found: around 90%, with a peak in 1994 and a slight decrease in 2000 to the level of 1992. With the steady partner, the level of protection was 57% in 1992, 61% in 1997 and decreased in 2000 to the same level as in 1992. The proportion of couples with both HIV statuses known increased from 49% in 1994 to 59% in 2000. In 2000, 26% of concordant HIV negative couples protected themselves compared to 83% of those exposed to an actual or potential risk (HIV status discordant or unknown). Within each category of couples, there was no change over time in the level of reported practice of anal sex and condom use. This slight decrease in prevention behaviour justifies efforts to maintain HIV/AIDS prevention targeted at gay men.
Data from a nationally representative household survey of South African youth aged 15-24 years found that sexually active men reporting anal intercourse were nearly twice as likely to be HIV infected as men reporting only vaginal sex (OR 1.7, 95% CI 1.0-3.0). The associated risk was more pronounced among men aged 15-19 years (OR 4.3, 95% CI 1.5-12.1). The association among women was not significant (OR 1.2, 95% CI 0.7-2.0).
To determine if an association exists in young men who have sex with men (MSM) between being under the influence of alcohol or drugs during sex and participation in sexual behaviors which increase the risk of human immunodeficiency virus (HIV).
A total of 3492 young MSM were interviewed through the Young Men's Survey, an anonymous, cross-sectional, multisite, venue-based survey conducted from 1994 through 1998 at 194 public venues frequented by MSM aged 15 to 22 years in 7 US cities.
The majority of young MSM reported both receptive and insertive anal intercourse, and of these, approximately half reported not using condoms. Report of unprotected receptive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (adjusted odds ratio [AOR]=1.5; 95% confidence interval [CI]=1.2-1.8), cocaine (AOR=1.6; 95% CI=1.1-2.2), amphetamines (AOR=1.5; 95% CI=1.1-2.0) or marijuana during sex (AOR=1.3; 95% CI=1.1-1.6). Report of unprotected insertive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (AOR=1.2; 95% CI=1.0-1.5), cocaine (AOR=1.5; 95% CI=1.1-2.0) or amphetamines (AOR=1.9; 95% CI=1.4-2.6).
HIV prevention strategies for young MSM need to incorporate substance use risk reduction.
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