How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis

Branwen N. Owen, Jocelyn Elmes, Romain Silhol, Que Dang, Ian McGowan, Barbara Shacklett, Edith M. Swann, Ariane Van Der Straten, Rebecca F. Baggaley, Marie Claude Boily

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Background: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. Methods: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by subgroups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. Results: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. Discussion: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.

Original languageEnglish (US)
Article number21162
JournalJournal of the International AIDS Society
Volume20
Issue number1
DOIs
StatePublished - Jan 12 2017

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Heterosexuality
Meta-Analysis
South Africa
Condoms
HIV
Interviews
Population
Unsafe Sex
Sex Workers
Sexually Transmitted Diseases
Sexual Behavior

Keywords

  • Anal intercourse
  • Heterosexual
  • Sexual behaviour
  • South Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis. / Owen, Branwen N.; Elmes, Jocelyn; Silhol, Romain; Dang, Que; McGowan, Ian; Shacklett, Barbara; Swann, Edith M.; Straten, Ariane Van Der; Baggaley, Rebecca F.; Boily, Marie Claude.

In: Journal of the International AIDS Society, Vol. 20, No. 1, 21162, 12.01.2017.

Research output: Contribution to journalReview article

Owen, Branwen N. ; Elmes, Jocelyn ; Silhol, Romain ; Dang, Que ; McGowan, Ian ; Shacklett, Barbara ; Swann, Edith M. ; Straten, Ariane Van Der ; Baggaley, Rebecca F. ; Boily, Marie Claude. / How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis. In: Journal of the International AIDS Society. 2017 ; Vol. 20, No. 1.
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abstract = "Background: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. Methods: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by subgroups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. Results: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4{\%} [95{\%}CI:9.4-27.5{\%}], three-month = 20.3{\%} [6.1-34.7{\%}]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2{\%} [0.0-47.4{\%}], recall period not stated = 40.1{\%} [36.2-44.0{\%}]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0{\%} and 0.7-21.0{\%} of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. Discussion: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.",
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AU - Owen, Branwen N.

AU - Elmes, Jocelyn

AU - Silhol, Romain

AU - Dang, Que

AU - McGowan, Ian

AU - Shacklett, Barbara

AU - Swann, Edith M.

AU - Straten, Ariane Van Der

AU - Baggaley, Rebecca F.

AU - Boily, Marie Claude

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N2 - Background: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. Methods: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by subgroups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. Results: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. Discussion: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.

AB - Background: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. Methods: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by subgroups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. Results: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. Discussion: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.

KW - Anal intercourse

KW - Heterosexual

KW - Sexual behaviour

KW - South Africa

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