Heterosexual Anal Intercourse


Published on

Published in: Health & Medicine, Education
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Heterosexual Anal Intercourse

  1. 1. Heterosexual Anal Intercourse Among Urban Female Adolescents: Prevalence and Associated Factors Carol F. Roye, EdD, CPNP Beatrice J. Krauss, PhD Paula Perlmutter Silverman, MPH Hunter College
  2. 2. Background  Heterosexual contact is the primary mode of HIV transmission in women.  But it’s not just who one’s sexual partner is  It is also what behaviors one is engaging in
  3. 3. The risks vary  Vaginal Intercourse  Oral Intercourse  Anal Intercourse
  4. 4. Anal Intercourse Background Information  Anal intercourse confers a very high risk of HIV transmission.  Researchers estimate that the probability of HIV transmission from receptive anal sex is between 5 to 10 times higher than for receptive vaginal intercourse.
  5. 5. Anal Intercourse  The unique morphology of the large intestine is one reason for this.  The intestinal mucosa contains most of the body's lymphocyte population and therefore likely represents the largest reservoir of human immunodeficiency virus type 1 (HIV-1) and site of viral replication
  6. 6. Risks Associated with Anal Intercourse  Researchers inundated punch biopsies of healthy vaginal and cervical tissue with HIV for 6-24 hours. During that time, the virus was unable to infect intact, healthy tissue.  Conversely, when healthy intestinal tissue was subjected to the same treatment, it was rapidly infected (Greenhead P, Hayes P, Watts PS, Laing KG, Griffin GE, Shattock RJ. Parameters of Human Immunofdeficiency Virus infection of human cervical tissue and inhibition by vaginal virucides. J Virol 2000;74:5577-5586.)
  7. 7. My Concern Are teens who use hormonal contraceptives at elevated risk for HIV because they are less likely to use condoms??
  8. 8. Background  A study of 600 Black and Hispanic teenage girls in New York City found that those who used hormonal contraceptives were significantly less likely to use condoms than those who used condoms only, even though they all identified AIDS risk as an important concern in their choice of contraceptive method. (Roye, 1998)
  9. 9. Background  Qualitative studies were then done to understand the context of condom use and nonuse.
  10. 10. “The last time you had vaginal intercourse, and did not use a condom, what were the reasons you did not use a condom?”  The NUMBER 1 REASON FOR NOT USING CONDOMS: They were using other protection - OCs or Depo - to protect them from pregnancy “Cause I was on the pill and can’t get pregnant.”
  11. 11. “The last time you had vaginal intercourse, and did not use a condom, what were the reasons you did not use a condom?”  Monogamy is another reason that teens do not use condoms  Even though many questioned their partners' fidelity, and many engage in serial monogamy.  “Because I feel that I can trust my partner, or at least I hope I can.”
  12. 12. We asked teens how we can help other teens use condoms Personalizing the message. “I am going to say it but there are a lot of teenagers that have AIDS. And, if they come out on TV and do like little conventions and stuff like that, [teens] can see that it can happen to teenagers also. Suppose it being someone my age, it would scare me. . . . It would make me think and I would use condoms.”
  13. 13. Therefore  A video tailored to this population makes a lot of sense.
  14. 14. And  We implemented a brief counseling protocol as well, which was an adaptation of the CDC’s Project RESPECT.
  15. 15. Purpose  To develop and test  Specifically, brief interventions to interventions which promote condom use are low- or no-cost, in this vulnerable and can be population. implemented in any clinical setting.
  16. 16. Intervention  Randomized Clinical Trial of: 1. Brief interactive patient counseling 2. Video education 3. Video and then brief patient counseling 4. Usual care See: Roye, C., Silverman, P., & Krauss, B. (2007). A brief, low- cost, theory-based intervention to promote dual method use by Black and Latina female adolescents: A randomized clinical trial. Health Education and Behavior, 34, 608-621.
  17. 17.  Teens who saw the video and then got counseling were significantly more likely to use a condom at last intercourse with main partner.
  18. 18. Sites  Planned Parenthood in the Bronx and Brooklyn
  19. 19. Data Collection  Data were collected at baseline and 3 month and 1-year follow-up  Eligibility criteria included: Black or Latina females, aged 15-21, who had engaged in vaginal intercourse, and who use or were starting use of a hormonal contraceptive.
  20. 20. Data  Data include:  ACASI computer-based questionnaire with detailed questions about sexual behaviors including oral, anal and vaginal intercourse
  21. 21. Results  N = 326  Age  range 15 - 21  mean age is 18.15  Ethnicity  50% Black/African American  44% Latina  6% Both
  22. 22. Sexual Behaviors Vaginal Intercourse  Age at first vaginal intercourse  Range 12-21  Mean = 15.3  47% reported condom use for last vaginal sex with main partner
  23. 23. Sexual Behaviors Oral Sex  78 % of the sample had performed oral sex on a partner  90% had had oral sex performed on them  Age at first oral sex ranged from 11-21years
  24. 24. Anal Intercourse In Our Sample  More than 1/3 (41%) of the teens had engaged in anal intercourse.  Significantly more Latina than Black teens had had anal intercourse (Z=3.59 [p<.001).  The reported age at first anal intercourse ranged from 12 – 21 years, with a mean of 16.8.
  25. 25. Anal Intercourse In Our Sample  Only 30% of those who reported anal intercourse reported using a condom during their last anal intercourse.  Young women who had ever had anal intercourse were significantly less likely than other teens to use condoms during vaginal intercourse.
  26. 26. Condom Use  Of the young women who had engaged in anal intercourse, 36% reported condom use at last vaginal intercourse with their main partner, and 30% reported condom use at anal intercourse.
  27. 27. SURPRISING!  Heterosexual anal intercourse has traditionally been looked on either:  As a way to protect vaginal virginity OR  As a form of birth control
  28. 28. HOWEVER  The young women in our sample had all lost their vaginal virginity AND  Were using a hormonal method of contraception
  29. 29. Additional correlates of AI  High-risk sexual history  younger at first vaginal intercourse  more likely to have had an STI  more likely to have been abused by a partner or by someone close to them.
  30. 30. Data by Age  Significant correlation between older age and history of AI (r=.336, p=.001).  However, there was no correlation between age and having had AI in the last 2 months .  May be explained by the fact that older teens may have been sexually active for a longer period of time
  31. 31. Why do young women engage in AI?  We need research to gain an understanding of the context of heterosexual anal intercourse.
  32. 32. Sexual Relationship Power  Recently, research has highlighted the importance of the construct of “sexual relationship power” (SRP) for understanding heterosexual relationships and behaviors
  33. 33.  Women with low SRP believe that their sexual partner is dominant (has power over them) and have little input into sexual decision-making  Women with high SRP have significantly more input into their sexual behaviors.
  34. 34.  We wanted to understand whether SRP plays a role in teens’ decisions to engage in AI  Hypothesized that teens with more SRP would have less AI  Literature shows that teens with greater SRP are more likely to use condoms during vaginal intercourse.
  35. 35. Second Study  A subsequent study was conducted on a different sample of young women  Same criteria as first study except:  1) use of a hormonal method was not an eligibility criterion  2) the questionnaire was supplemented with the Sexual Relationship Power Scale (Pulerwitz).
  36. 36. Sample  N = 101  Aged 14 – 22 (mean = 17.4)  30% of the sample self-identified as Black or African American  70% identified as Latina.
  37. 37. Results  23 young women had engaged in AI  2 Blacks, and 21 Latinas, a difference which was significant (p=.009).
  38. 38.  None of the young women reported using a condom during anal intercourse with their main partner!  43% reported using a condom at last vaginal intercourse with their main partner.
  39. 39. Why??  Perhaps condom use in general was primarily for disease, rather than for pregnancy prevention.  Young women may not recognize that AI presents a risk for HIV and other STIs.  We have data suggesting that teens are not aware of the risk, and may even think that AI is less risky than vaginal intercourse.  One study found that 1/5 of college students don’t consider AI to be sex at all!
  40. 40. Was there a correlation between AI and SRP Score?  There was no significant linear correlation between SRP score and AI
  41. 41. SRP and Anal Intercourse  But there was a significant quadratic relationship between AI and SRP (R square = .122; p = .003)
  42. 42.  Relationship power scores were divided into tertiles (low, medium and high).  Chi-square revealed that 54% of the women with low relationship power scores (RPS) had engaged in AI, as had 24% of those with high RPS.  Only 4% of those with mid- level scores had had AI.
  43. 43. Data by Ethnicity  78% of Latinas with low scores had had AI  33% of those with high scores had had AI.  Only one young woman in the middle had had AI (chi square = 13.955; p = .001).  Chi-squares could not be run on Black teens because there were too few who had engaged in AI.
  44. 44. SRP and Condom Use for Vaginal Intercourse  There was a significant linear relationship between SRP and condom use during vaginal intercourse in the expected direction.
  45. 45.  Why did SRP operate in the expected direction for condom use during vaginal intercourse, but an unexpected quadratic relationship was found between SRP and anal intercourse??
  46. 46.  The researchers hypothesize that young women with low SRP scores may be exploited by their partners perhaps explaining why they engage in AI.  Teens with high scores may be in more loving relationships and thus willing to engage in this behavior to please their partners.  And/or more interested in engaging in sexual exploration.
  47. 47.  Perhaps teens have been taught that they should use condoms during vaginal intercourse  Without having been taught about condom use for AI, they may not realize that it is necessary.  Or………………
  48. 48. Limitations  Self-report data  Sample limited to sexually active Black and Latina teenage girls  No data on partner age
  49. 49.  Research is needed to contextualize heterosexual adolescent AI, in order to develop effective HIV/AIDS prevention programs that address this high risk behavior
  50. 50.  More women engage in receptive AI than men  We must educate them about risk reduction for AI
  51. 51. Funded by  Study 1  NINR 5RO1NR007962-03  Study 2  American Nurses Foundation
  52. 52. THANK YOU croye@hunter.cuny.edu www.carolroye.org Please email me if you would like a copy of our DVD