15th International AIDS Conference Bangkok, Thailand — July 11-July 16, 2004

Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. LbOrC21

T Lane¹, A Pettifor², A Fiamma³, H Rees²¹University of California San Francisco, San Francisco, United States; ²Reproductive Health Research Unit, Johannesburg, South Africa; ³University of California Los Angeles, Los Angeles, United States
¹University of California San Francisco, San Francisco, United States; ²Reproductive Health Research Unit, Johannesburg, South Africa; ³University of California Los Angeles, Los Angeles, United States

BACKGROUND: Recent studies have disputed the claim that anal intercourse is uncommon in sub-Saharan Africa, and argue that the contribution of anal intercourse to the HIV epidemic in the region has been overlooked because researchers and study participants are reluctant to discuss this behavior.

METHODS: Anal sex prevalence and its role as a risk factor in HIV infection were estimated from a nationally representative sample of South Africans aged 15-24. Participants (n=11904) completed a behavioural interview and tested for HIV. Logistic regression was employed using STATA 7.0 to build a model predicting HIV infection as an outcome of four variables: vaginal sex only, anal and vaginal sex, lifetime sexual partners > 2, and condom use at last sexual intercourse.

RESULTS: HIV prevalence was 10.2% (95% CI 9.3-11.3); males 4.8%, females 15.5%. Anal intercourse prevalence was 3.6% among both men and women. After controlling for types of sexual intercourse, numbers of partners, and condom use at last sex, we observed an elevated risk of HIV infection in respondents reporting anal and vaginal intercourse. Women who reported both were at greater risk of infection (OR 12.8, 95% CI 8.8-19.0) compared to women reporting vaginal only (OR 9.5, 95% CI 7.3-12.3). Risk was also elevated for men reporting both (OR 6.0, 95% CI 3.5-10.5) vs. vaginal only (3.2, 95% CI 2.3-4.6).

CONCLUSIONS: Anal sex contributes to the population risk of HIV infection in South Africa. Current HIV prevention strategies may unwittingly encourage misperceptions about the relative safety of anal sex. The data indicate that condoms may not be used as consistently during anal intercourse as during vaginal intercourse. Further studies should compare consistency of condom use for vaginal and anal sex. Qualitative research should systematically investigate anecdotal reports that youth choose anal sex as form of birth control and HIV risk reduction. Relevant and appropriate interventions for anal sex risk reduction should be developed, and should include increased access to condom-safe lubricants.

040711
LbOrC21

Copyright © 2004 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.