Meet Rig Rush - A Friendly Rectal Microbicide Advocate

Check out this interesting mini-bio of Rig Rush, the latest in IRMA's "Meet a Friendly Rectal Microbicide Advocate" series on the IRMA website here.  Rig is one of the six new bios just posted the other day, including individuals from Thailand, Kenya and the US.  Each will be featured on the blog, and you can read all of them here right now.


Rig Rush
Los Angeles, California

"By promoting affirming messages that reinforce normalizing overall sexual health and awareness, you can inspire individuals who engage in anal sex to take ownership and accountability of their own behaviors; making confident and informed decisions. In my fierce opinion, that is the basis for HIV and STD prevention."

Originally from Pittsburgh, Rig just moved across country to Los Angeles to become the new Community Mobilization Coordinator at the Black AIDS Institute. He has several interests including going to movies, amusement parks, and taking extremely long walks. He loves meeting different types of people and creating pleasant memories. He also happens to be one of the stars of the soon-to-be-released IRMA video called "The Rectal Revolution is Here: An Introduction to Rectal Microbicide Clinical Trials" being produced in collaboration with the Microbicide Trials Network and Population Council. In the video, Rig relates his experiences as a participant in a rectal microbicide trial with wit, warmth, and passion.

He believes that STD information, brochures and presentations focus on "drips, itches and stenches". Based on the available information, Rig felt he was the only individual who passionately enjoyed receptive anal sex. He also found the small amounts of health-related information regarding anal health/enjoyment highly offensive. Given his frustration, Rig was overjoyed when he heard about the research study that "celebrated the bottom perspective" - the study he talks about in the video.

He acknowledges that "men love sex, and they love unprotected sex, but most men do not think about risk when the moment arises." Condoms protect only when used consistently and correctly. However the concept of rectal microbicides "truly takes prevention and puts it where the rubber meets the road." He finds microbicides in general (both rectal and vaginal) to be the best modern step to fighting the HIV/AIDS epidemic that isn't gay specific. Rectal microbicides have the potential to have a vast and appealing impact on the community collectively.

Rig's advice for IRMA is to remain consistent and committed to promoting awareness and education about rectal microbicides and health. He feels that "the information one obtains from IRMA is very beneficial for the collective gay community."

He will soon be a featured speaker in the satellite session "Rectal Microbicides: Making HIV Prevention Gel" at the International AIDS Conference in Washington, DC with other members of IRMA and allies. The session is taking place in the afternoon on Sunday, July 22, 2012. More info on this event can be found here.

He works to motivate, inspire and unite gay black men and other men who have sex with men around a variety of issues, and continues to support and celebrate black gay men regardless of their HIV status. He strives to help others live productive, informed and authentic lives filled with healthy connections and relationships.

Rig's mother has had the deepest impact on his life. She is his symbol of strength, compassion and authenticity, which shaped Rig into the man he is today. His mother's fearless, positive and audacious appreciation for life ignited a fire that continuously resonates.

Thank you Rig for all that you do!



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*Please look for us on Facebook: www.facebook.com/InternationalRectalMicrobicideAdvocates, and you can follow us on Twitter: @rectalmicro.

*Also, please note that shared news items from other sources posted on this blog do not necessarily mean IRMA has taken any position on the article's content.
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Research on Douching Reveals Little Association to Sexually Transmitted Infections

via AIDSmap.com, by Gus Cairns

Neither rectal douching nor vaginal washing appear to be as significantly associated with sexually transmitted infections as had been feared, the International Microbicides Conference in Sydney heard yesterday.

In the case of women, vaginal washing and other vaginal health practices have been associated with bacterial vaginosis (BV), an imbalance in the types of bacteria that colonise the mucous surfaces of the vagina. BV can cause pelvic inflammatory disease and premature delivery in pregnant women and is associated with a higher risk of both acquiring and transmitting HIV.

The HPTN 035 trial of the candidate microbicide PRO2000 therefore included a survey of vaginal health practices, counselling against ones associated with a raised risk of BV, and assessing any link between these practices and BV. It found none, though a smaller study of women in Los Angeles did find an association not with douching and BV, but between the use of petroleum jelly as a lubricant and BV.

In the case of rectal douching in women and gay men, there is very little we currently know about the practice. However, findings over the last couple of years that the use of lubricants for anal sex, particularly water-based ones, is associated with higher rates of sexually transmitted infections have raised concerns that other practices that impact on the fragile rectal mucosa may also raise the risk of sexually transmitted infections (STIs) and HIV. International Rectal Microbicide Advocates (IRMA) have therefore conducted a survey of rectal douching practice. Interim results were presented yesterday and the survey is still ongoing.

Vaginal and rectal practices in women in HPTN 035 and in Los Angeles

In HPTN 035, vaginal hygiene practices were assessed at quarterly visits and the 3087 participants were counselled to try not to use the practices. They were divided into women who did not practise vaginal washing, ones who only used water and ones who used other products such as soap and water or commercial douches (Kasaro).

The proportion of women not practising any vaginal hygiene fell from 60% at baseline to 36.5% at last visit, and this was a steady fall over time, not just occurring immediately after the baseline visit.
Bacterial vaginosis (BV) was common at baseline and the proportion of women with it did not change over time – at any visit 36 to 38% of women had BV. There was no association between vaginal hygiene practices and BV.

Another study of women in Los Angeles (Brown) assessed vaginal hygiene and lubricant practices in an observational cohort of 141 women. The cohort was structured to reflect a mix of ethnicity and HIV serostatus: 26% had HIV and 40% were black, 34% white and 26% Latina. Their median age was 33 (range 18-65).

Read the Rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA Survey On Rect Douching and Enemas in 5 Languages - Please Participate!

IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

Take the survey in English, Spanish, French, Chinese, or Russian.

We're trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse and hope you - yes YOU - will fill out this brief anonymous survey (estimated time to complete: less than 15 minutes).

Please take the survey NOW and share this link widely!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Survey reveals gaps in HIV programming for MSM

Via PlusNews.

A new global survey of more than 5,000 men who have sex with men (MSM) reveals a marginalized group of people with little access to basic HIV prevention tools such as condoms and few means to learn about HIV.

Conducted by the Global Forum on MSM & HIV between 24 June and 17 August 2010, the survey sought to highlight key gaps in global efforts to provide MSM with evidence-informed HIV prevention services. More than 1,000 of the study participants - drawn from all over the world - were health workers; 22 percent reported being HIV-positive.

The authors recommend expanding access to HIV prevention services for MSM across the globe, more focus on promoting awareness of emerging HIV prevention interventions and more robust and sustained stigma-reduction efforts. Some of the major findings of the survey include:

Access to health services - Fifty-three percent of participants said they could easily access testing for sexually transmitted infections, while 51 percent said they had easy access to HIV counseling; 47 percent found STI treatment easily accessible.

Just 36 percent of MSM surveyed reported having easy access to HIV treatment, while 27 percent said it was available but difficult to access, was not available or had never heard of HIV treatment.

Access to HIV prevention - Free condoms were easily accessible only to 44 percent of participants, while just 29 percent could obtain lubricant.

Just 30 percent of participants reported easy access to each of the basic HIV prevention services, including behavioural HIV/AIDS interventions, HIV education materials, mental health services, free or low-cost medical care, media campaigns focused on reducing HIV, and laws/policies to ensure access to HIV prevention.

Just 25 percent said they had access to sex education.

Stigma - Africa reported the highest levels of stigma and external homophobia, followed by the Middle East, Asia-Pacific, Central/South America and the Caribbean, which all reported similar levels of stigma. Australia and New Zealand reported the lowest levels of stigma and external homophobia.

MSM from Africa and the Asia-Pacific region reported the highest levels of internalized homophobia.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

More Teen Virgins? Not So Fast

Via RHrealitycheck.org, by Martha Kempner

In 2006–2008, 29 percent of females and 27 percent of males ages 15 to 24 reported that they had never had sexual contact with another person. This was a small but statistically significant change from 2002 when it was 22 percent for both males and females.

Many teens are making responsible decisions when it comes to their sexual behavior; they delay sex, have fewer partners, and use contraception. And yet, we adults give them so little credit for behaving, in many ways, better than us.

AND THE SURVEY SAYS…

Traditionally, when thinking about sex and surveying individuals about their behavior, we have concentrated on penile-vaginal intercourse. This focus makes some sense from a public health perspective as it is the only behavior that can lead to both pregnancy and STDs. That said, other behaviors certainly carry a risk of STDs, and, the focus on vaginal sex by nature excludes all same-sex behavior. Still, I sense that the primary reason for this focus is something different—a societal understanding (however, inaccurate, incomplete, and exclusionary) that only penile-vaginal sex is sex.

There are lots of different theories about why the percentages of young people who had vaginal intercourse dropped during those years. Some argue that this is when teens started becoming highly aware of the risk of HIV and that a life-threatening STD was a game changer for teenagers.

Others credit sexuality education while still others undoubtedly credit abstinence-only-until-marriage programs. One mother of a teenager jokingly argued it was all because of video games, "if teens are really logging 30 hours a week of screen time, when would they possibly have time to have sex?" We may never really know but it is worth trying to understand as the numbers seem to have leveled out in recent years.


Read the full story
 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Viagra users more likely to have STDs

Via Sify News

Men, who use erectile dysfunction drugs like viagra, are more likely to have sexually transmitted diseases as compared to non-users, revealed a study. The findings indicate that physicians who prescribe erectile dysfunction drugs for their male patients should be sure to discuss the importance of safer sex practices, even with older patients. For the study, the researchers analysed insurance records of more than 1.4 million U.S. men over 40.

For the full study click here.

What gay men can teach straights about safe sex

via Salon.com, by Tracy Clark-Flory

Women are skipping the condoms when it comes to, well, the backdoor.

It seems women have a safe sex blind spot when it comes to anal sex, according to a new report by the New York City Health Department. Far fewer women consistently use condoms during anal sex than men who sleep with men; 23 percent and 61 percent, respectively.

It's easy to understand how some women might rationalize condomless anal sex, much like virginity pledges who, conveniently enough, don't count oral or anal sex as sex. If it doesn't "count" as sex sex, and there is no risk of pregnancy, why use protection? But, boy, does it ever count: As the report's press release explains, "past studies suggest that anal exposure to HIV poses 30 times more risk than vaginal exposure." Sadly, the new study finds that women who have anal sex without condoms are less likely to get regular STD tests than women who consistently use protection.

Read the rest.

Few Young Men Counseled on Sexual Health, Study Finds

via TheBody.com

Adolescent males continue to be overlooked by health care providers in terms of reproductive health services, new research shows.

Dr. Arik Marcell, assistant professor at Johns Hopkins University School of Medicine, and colleagues compared data from the 1995 National Survey of Adolescent Males and the 2002 National Survey of Family Growth to determine whether improvements have been made in the delivery of STD/HIV counseling services to male teens. They found that fewer than one-quarter of boys ages 15-19 received STD/HIV counseling by a provider during the previous year, according to the 2002 survey of 1,121 young men. These results represent no significant change from 1995, when a similar proportion received such counseling.

Males who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners were more likely to have received counseling, with roughly one-third saying they had been counseled about STDs in 2002. A similar proportion of those engaging in risky sex received counseling in 1995, the study found.

However, even fewer young men, less than one-fifth, discussed contraception with a health care provider in 2002. That compares with nearly two-thirds of sexually active young women, according to other surveys.

"The medical system is really set up to serve women and maternal-child health in ways that aren't addressing young men's needs," said Marcell.

The study, "Prevalence of Sexually Transmitted Infection/Human Immunodeficiency Virus Counseling Services Received by Teen Males, 1995-2002," was published online in the Journal of Adolescent Health (2010; doi:10.1016/j.adohealth.2009.12.002).

Debate on circumcision heightened as CDC evaluates surgery

Critics question the relevance of the African studies, saying that most of the HIV transmission in the United States occurs among drug addicts and gay men, whose risk would be unaffected by whether they were circumcised. They also worry that it will give circumcised men a false sense of security. And they say it permanently diminishes the sexual experience.

via Washington Post, by Rob Stein


Circumcision, long one of the most emotionally charged surgical procedures performed in the United States, has become the focus of yet another intense debate as leading health authorities are about to issue major new evaluations of the potential health benefits of the operation.

The war of words over the procedure has been sparked by a decision by the federal Centers for Disease Control and Prevention to issue recommendations for the first time about whether newborn boys and possibly even adult men should undergo the common surgical procedure, just as the American Academy of Pediatrics is poised to revise its position of not recommending the operation.

Read the rest.

History of Childhood Sexual Abuse and Unsafe Anal Intercourse in a Six-City Study of HIV-Positive Men Who Have Sex with Men

Among a population of HIV-positive men who reported unsafe anal intercourse with other men in the preceding year, the authors assessed rates of childhood sexual abuse and its demographic and mental health correlates. The researchers conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men (MSM), who were enrolled in the "Positive Connections" intervention.

Forty-seven percent of participants reported childhood sexual abuse, with 32 percent reporting the frequency of abuse was sometimes or often. The MSM reporting abuse were more likely to be Latino (odds ratio [OR]: 2.6; 95 percent confidence interval [CI]=1.6, 4.2; P<.001) or African American (OR=1.8; 95 percent CI=1.2, 2.7; P=.005) than white. Among MSM reporting abuse, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR]=1.3; P<.001) and unsafe anal intercourse (often, RR=1.5; sometimes, RR=2.0; P<.001) compared to men who were not abused.

"History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color," the authors concluded. "Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections."


Adapted from:
American Journal of Public Health 06.01.2009; Vol. 99; No. 6: P. 1079-1086; Seth L. Welles, Sc.D., Ph.D.; A. Cornelius Baker, B.A.; Michael H. Miner, Ph.D.; David J. Brennan, Ph.D.; Scott Jacoby, M.A.; B.R. Simon Rosser, Ph.D., M.P.H. This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.

HIV serosorting and the risk of STIs in MSM

[Presented at SÖDAK 2009: The German-Austrian-Swiss AIDS Congress, June 24-27 2009]

Marcus ULRICH and Axel J. SCHMIDT (Robert Koch Institut)

Objectives: We aimed to quantify the frequency and effectiveness of HIV risk management strategies and tactics other than condom use among men who have sex with men (MSM) in Germany and their impact on the frequency of sexually transmitted infections (STI).

Methods: For a cross-sectional survey a self-administered questionnaire was distributed via German MSM websites and medical practices in 2006. The majority (87%) of 6,833 analyzed participants were recruited online. We analyzed risk management of participants who reported HIVserosorting as a strategy (premeditated, planned) or as a tactic (depending on the situation) and explored the impact of HIV serosorting on the incidence of self-reported bacterial STIs by comparing serosorters with participants who reported other forms of risk management.

Results: HIV status has a large impact on the way how HIV serosorting is implemented. While HIV serosorting used strategically and tactically seems to be very similar in HIV positive MSM, there are distinct differences between HIV negative strategic and tactic serosorting. Except for HIV negative strategic serosorters, serosorting is associated with reduced condom use, higher partner numbers and a two to four fold increased risk of being diagnosed with bacterial STIs.

Discussion: HIV serosorting within primary relationships as well as with casual partners has emerged as a common risk management strategy and tactic in MSM. Apart from the problems of unambiguous communication about HIV status and the reliability of an HIV negative serostatus information, HIV serosorting as practiced currently by MSM in Germany is often used as an alternative to condoms, contributes to high incidences of STIs and hence elevated per-contact-risks for HIV transmission. Exclusive emphasis on HIV testing may encourage HIV serosorting, and thus may not solve the problems of HIV prevention, mainly because it lacks a comprehensive sexual risk reduction strategy for ART-naïve MSM diagnosed with HIV.

Slides from the presentation (in German)

Adult Male Circumcision Does Not Reduce the Risk of 3 Non Ulcerative STIs

Adult Male Circumcision Does Not Reduce the Risk of Incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis Infection: Results from a Randomized, Controlled Trial in Kenya.

J Infect Dis. 2009 Aug 1;200(3):370-378.

Mehta SD, Moses S, Agot K, Parker C, Ndinya-Achola JO, Maclean I, Bailey RC.
Department of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois; 2RTI International, Research Triangle Park, North Carolina; Departments of 3Medical Microbiology, 4Community Health Sciences, and 5Internal Medicine University of Manitoba, Winnipeg, Canada; and 6University of Nairobi, Illinois, and Manitoba Project, Kisumu, and 7Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.

Background. We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).

Methods. We evaluated the incidence of STI among men aged 18-24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.

Results. There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49-8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.

Conclusions. Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.

PMID: 19545209 [PubMed - as supplied by publisher]

Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women

ABSTRACT

J M H Risser PhD , P Padgett PhD, M Wolverton MPH and W L Risser MD PhD


US blacks carry a disproportionate risk of heterosexually transmitted HIV. This study aimed to evaluate the association between self-reported heterosexual anal intercourse and HIV. Using respondent-driven sampling (RDS), we recruited and interviewed 909 blacks from areas of high poverty and HIV prevalence in Houston, Texas, and who reported heterosexual sex in the last year. All individuals were tested for HIV. Weighted prevalence values were calculated to account for non-random recruitment associated with RDS. The weighted population prevalence of HIV infection was 2.4% and 2.5% among men and women, respectively. Education, employment status, income and crack cocaine use were not associated with HIV infection. Lifetime injection drug use (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31–8.33%) and heterosexual anal intercourse (OR 2.41, 95% CI 1.02–5.73%) were associated with HIV infection. Individuals who reported both injection drug use and heterosexual anal intercourse had 6.21 increased odds of HIV (95% CI 2.47–15.61%). Our results suggest that heterosexual anal sex may be a vector for HIV transmission, especially in the context of injection drug use. Prevention strategies directed at curbing the HIV epidemic among black heterosexuals require that we correctly identify the risks so that appropriate interventions can be developed.

Heterosexual anal sex common, frequently not protected by condoms

Heterosexual anal sex is common among STD clinic clients, but is frequently not protected by condom use.

Author: Hollander, D.
Publication:Perspectives on Sexual and Reproductive Health
Date: Mar 1, 2009

During the year following a visit to one of three public STD clinics, clients who returned for follow-up visits frequently reported engaging in heterosexual anal sex, mostly without using condoms. Multivariate analyses identified several characteristics that were positively associated with the odds of having anal sex during a three-month period, including number of partners, total number of sex acts and sexual activity with a main partner. By far the strongest predictor of consistent condom use during anal sex was consistent use during vaginal sex.

Read the rest on The Free Library.

Jamaica: Gay men in hiding - Avoiding health care because of stigma, survey suggests

via The Gleaner, by Petrina Francis

AS DEBATE stirs over the Jamaican Government's insistence on retaining legislation against buggery, homosexual men continue to suffer from discriminatory acts which make it difficult for them to seek health care in the country, a study has indicated.

A 2008 survey commissioned by the Ministry of Health showed 31.8 per cent of gay men in Jamaica are living with HIV. Another 8.5 per cent were found with chlamidia, 2.5 per cent had gonorrhoea and 5.5 per cent had syphilis.

According to a release from the Caribbean HIV & AIDS Alliance (CHAA), the high number of sexually transmitted infections among gay men, sometimes termed men who have sex with men (or MSM), is linked to the way they are treated by the law and members of the general population, including those in the health sector.

Read the rest.

'Baby boomers' hit by sex cancers

via BBC

The arrival of the "swinging sixties" may have heralded a rise in sexually-transmitted cancers, say researchers.

Rates of anal, vulval and vaginal cancers rose for "baby boomers" born in the decades after the Second World War.

Excerpt:

Dr David Robinson, who led the study, said: "These results have revealed a snapshot of just how much rates of these cancers have increased in the post war generations.

"For anal cancer, rates are now higher in women than in men - however, programmes of vaccination against HPV, whilst aimed primarily at reducing the burden of cervical cancer, may also help to reduce the incidence of cancers at these other sites."

Dr Lesley Walker, from Cancer Research UK, said that it was important people understood the dangers linked to HPV.

"Using a condom will lower the risk of exposure to the virus. HPV vaccines are an important advance for future generations, but the cervical screening programme remains vitally important in detecting any changes that might lead to cancer."

Read the whole thing on the BBC.

Heterosexual Anal Sex in the Age of HIV

People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

by Zoe Duby University of Cape Town

Research on sexual transmission of HIV consistently finds unprotected anal intercourse to be a highly predictive risk factor for sero-conversion. Despite this, most AIDS prevention messages targeted at heterosexuals continue to solely emphasise vaginal (and increasingly but still only occasionally oral) sexual transmission without mention of anal sex. This omission is influenced by the deeply entrenched taboos surrounding this sexual practice, as well as a lack of acknowledgment of its prevalence and significance as a heterosexual behaviour.

Partly as a consequence of this omission, the potential health risks of unprotected anal sex continue to be severely underestimated in the heterosexual community. Although knowledge seems to be high amongst the gay community, this appears not to be the case amongst heterosexuals. Evidence of this lies in the reportedly universal lower use of condoms for anal sex than for vaginal sex by heterosexuals. Data suggests that some people choose to practice anal sex due to misconceptions about the risks it poses. Anal sex is sometimes not considered to be “real sex” and evidence suggests that young girls choose anal sex as a means of preserving their virginity and as a form of contraception.

Evidently there are significant gaps in knowledge and awareness of the risks of unprotected anal sex amongst heterosexuals; many people choose to have anal sex as a “safe” alternative, thinking that it is not possible to transmit HIV through anal intercourse. This is largely due to the lack of information available that explicitly depicts and differentiates all potential sexual transmission vectors – vaginal, anal and oral. People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Why do heterosexuals have anal sex?

i. Virginity
Virginity maintenance is one of an array of reasons given for young people electing to have oral and anal sex over penile-vaginal penetrative sex; the substitution of non-vaginal sexual activities for vaginal intercourse is a means of maintaining “technical virginity.”

Religion and culture play a key role in condoning or prohibiting certain sexual practices. Ample data supports the assertion that young girls in Christian, Islamic and traditional societies throughout Africa practice anal sex in order to protect their vaginal virginity. In many cultures, a high value is placed by the family and society on safeguarding girls’ virginity until marriage. In addition, evidence shows that young people in the United States who pledge to remain virgins are more likely to have engaged in ‘alternative sexual behaviour’, in order to preserve their virginity. Research shows that among those who have not had vaginal intercourse, pledgers have shown to be more likely than their non-pledging peers to have engaged in both oral and anal sex. In communities with a higher proportion of virginity pledgers, overall STI rates are actually higher than in other settings. Reasons for this may lie in the lack of sex education that young people in conservative religious communities receive.

…a lot of my religious friends… who are trying to hold on to some sort of sanctity of waiting until they’re married to have sex – feel that oral sex and anal sex are sex that they can have that’s still not full sex in their eyes… I think that the youth… today… are searching for these things that don’t make them lose their virginity – but allow them to still sort of engage in sexual activity… like they think all their peers are.. It’s like a loophole – it’s like they’re desperate to hold onto their virginity – but they’re not scared to engage in other acts so that they look cool... [Respondent 1, Duby, 2008]

In some communities virginity until marriage is less an established religious issue than a traditional cultural preference. In some communities “virginity testing” is practiced. Young girls are examined before marriage to ensure that their hymen is intact. Discovery of a ruptured hymen brings shame to a girl and her family, and can jeopardise her eligibility for marriage. As a result of the high value placed on virginity and hymen maintenance (a falsity as the hymen can be ruptured in non-sexual activity such as tampon use or physical exercise) it appears that young people choose to have oral and anal sex instead.

In an era of abstinence and HIV prevention programmes advocating delayed sexual initiation, it can be argued that the social pressure to remain a virgin actually contributes to young women’s risk of infection, acts as a barrier to their adoption of preventive behaviours and encourages the subsitution of alternative non-vaginal sexual practices. Some young adults have unprotected anal sex unaware of the high risk of HIV and STI transmission it poses.

Research on adolescent sexual behaviour in the past has been largely limited to vaginal intercourse, thus accurate prevalence statistics for non-vaginal genital activity amongst adolescents are unavailable. Research and sexual health programmes have traditionally used the classification of an individual as ‘sexually active’ based on vaginal intercourse. This means that ‘technical virgins’ who are engaging in non-vaginal sexual activities are omitted from discussions on sexual risk, potentially excluding many sexually active young people and consequently placing them at greater risk.

ii. Contraception
In a similar vein to virginity maintenance, evidence suggests that heterosexual anal sex is also practiced as a means of contraception. Young women wishing to avoid pregnancy but still desirous of sexual activity choose anal sex as an alternative means of attaining sexual pleasure without fear of conception.

…the main reason for having anal sex, other than it just being nice for the guy – is ejaculation. He can come inside you and there’s no risk. [Female respondent, Duby, 2008]

Sexual partners wanting to have non-reproductive “flesh to flesh” sex without the presence of any form of contraception and without the physical barrier of a condom, may choose to have anal sex so that there will be no chance of conception if the male ejaculates inside the female.

…it’s a nice way because then there’s no stress if he comes inside you… [Female respondent, Duby, 2008]

iii. Misconceptions: Misinformed and Unaware
Sadly, available evidence suggests that anal sex is sometimes practiced as a form of “safe sex”, ironically as a means of avoiding HIV transmission. Due to the silence around the topic of heterosexual anal sex and its omission from discussion on safe sex, the assumption is made that it must be safe. Health care providers themselves are also often unaware of the risks of anal sex. The false impression created that anal sex is safer than vaginal sex may be due to its lack of address in health education. Safe sex promotion and HIV prevention strategies unwittingly encourage misperceptions that anal sex is a ‘safer’ form of sex. Evidence from anecdotal reports suggest that some people practice anal sex (either with a female or a male) because they believe it will protect them from STIs/HIV. The reason for this is because they have heard no discussion about the risks of infection through anal sex.

Condom Use and Anal Sex
Despite anal sex having been identified as the most predictive risk factor for sero conversion in heterosexual HIV transmission, its risks are still underestimated by the vast majority of sexually active heterosexuals. This is illustrated by data showing that reported rates of condom use are universally lower for heterosexual anal intercourse than vaginal, and that far more women engage in unprotected anal sex than gay men. The male homosexual population are more sensitised to condom use for anal sex than heterosexuals. This can be attributed to the fact that HIV and STI programs targeted at the general population do not specifically address anal sex, whereas prevention programmes aimed at the gay population do. Another reason may be that condoms are primarily used by women for contraceptive purposes rather than protecting against STIs. Due to the failure of prevention programmes to sensitise heterosexuals to the high risk of infection of HIV and other STIs through unprotected anal intercourse, the widespread assumption that HIV transmission between heterosexuals is synonymous with penile-vaginal penetrative sex is inadvertently reinforced. Most literature on HIV and AIDS does not pay heed to heterosexual anal sex, although contrary to the popular association of anal sex with homosexual men, numerically more heterosexuals engage in anal sex than homosexuals. But due to the highly stigmatised and hidden nature of heterosexual anal sex as a topic, both male and female heterosexuals are less likely to discuss and negotiate safe sex approaches to anal intercourse than homosexual men.

iv. Peer group pressure: “because everyone else is doing it”
In contrast to the pressure to maintain virginity exerted by religious and traditional communities, the power of the peer group should not be underestimated. Young people are subject to the powerful force of wanting to conform, of needing to be accepted into social groups. In ‘school yard’ discussions about sex prestige may be gained through sexual prowess and sexual experience. Some youths, in an effort to win respect and admiration from peers may exaggerate and boast about sexual experiences, in order to appear ‘mature’. Banter about adventurous and exciting new sexual positions, that may only be entirely theoretical, may exert pressure on more inexperienced teenagers to try out ‘what everyone else is doing’. Sexual prowess, expressed in terms of numerous sexual partners or claimed wide sexual experience, is linked to both peer and general social recognition, especially of a masculine profile.

v. Menstruation
Anal sex is sometimes used as an alternative form of penetrative sex when a woman is menstruating. Anal sex can constitute a more ‘convenient’ form of penetrative intercourse when a woman is menstruating, avoiding embarrassment, discomfort and the ‘messiness’ of blood on the bed sheets and bodies of both sexual partners.

…when she (my friend) had her period, they (her and her boyfriend) used to always just have anal sex instead, because then she could wear a tampon, and so that there didn't have to be any blood. [Female respondent, Duby, 2008]

Interviewer: You mentioned before that anal sex was something you did in your first relationship when you were menstruating – why?
Female respondent: Um – just because… firstly you didn’t want to get blood everywhere, all over the sheets and stuff, and secondly I didn’t feel very comfortable with getting blood on him… I felt like… I dunno – I just didn’t like the thought of that. And I never really asked him about what he thought about that – and then sometimes it can be a bit painful to have (vaginal) sex when you’re menstruating. [Duby, 2008]

Additionally, in some societies menstrual blood is seen as a dirty polluting substance, potentially dangerous for men to come into contact with.

vi. For money
In the world of commercial sex work, evidence suggests that men will pay more for anal sex, with added value if it is without a condom. Motivation for commercial sex workers to engage in anal intercourse with their clients lies in the offer of higher financial benefits for anal sex than for vaginal sex. Evidence also suggests that more economically or socially vulnerable sex workers, as well as drug-abusing women, are more likely to offer unprotected anal intercourse for clients, being more driven by financial incentives than their less vulnerable and more financially secure co-workers.

vii. For him
Some feminist writers have argued that women have only come to understand their sexual pleasure and desire in terms of a patriarchally defined female sexuality which serves the male. In the process women are denied their own sexual subjectivity and pleasure. However it may be informative to examine the personally perceived moral obligations that a woman has to fulfill and satisfy her sexual partner’s desires, needs and fantasies. Popular contemporary media often compounds the perception that good sex in a relationship is the woman’s responsibility (however it would not be fair to say that men do not also come under pressure to provide sexual pleasure to women).

…my partner is always eager to do that (have anal sex)… and then I’m always kind of like “I don’t know” – so I think that mutual enjoyment out of it would be nice… which is probably why I really want to explore it a little more… I think it’s… it’s selfish in a way – you know you don’t want to be too giving in a sexual relationship – you want to get just as much enjoyment out of it as him at the same time… so I suppose it’s about getting to that point where we’re both enjoying it as much as the other. [Female respondent, Duby, 2008]

Many heterosexual women feel compelled to provide anal sex to their male partner, believing it to be more pleasurable for him. Women accommodate the perceived needs and desires of men, incorporating male needs into their own perceptions of what they want themselves. Many heterosexual women express the concern that if they fail to provide the sex that their male partner desires, they will be rejected; the provision and accomodation of a male partner’s needs enhances security within a relationship. This is especially the case in cultures where women’s sexual pleasure is not recognised or valued.

…he didn't make me do it (have anal sex) if I really didn’t want to, but I did it because it was interesting for him to… explore this activity... this feeling… [Female respondent, Duby, 2008]

Interviewer: So why do you think men enjoy anal sex?
Female respondent: I think… in an animalistic sense, it’s more the power… the control, without it really even being rape – you know it’s not violent, it’s not… the person is allowing you to do it… and it probably makes them feel powerful – and you know it’s supposed to be tighter as well…

Interviewer: And do you feel, when you’re in that situation, do you feel it makes you more submissive?
Female respondent: Definitely. Because I’m not submissive by nature – and I suppose that’s why it feels a bit weird emotionally because you know I am literally not in control... I mean even from my experience of a partner’s reaction during anal sex, he kind of gets very… like an animal in a way… and he kind of loses a bit of himself and it becomes kind of… It’s difficult to explain... it has happened where it got to the point where I was like “ok, enough”… and they haven’t heard me… by choice – to put it bluntly… and that’s not… that’s not nice… that’s not cool, and that’s very sort of demoralising – and afterwards you really do feel violated… [Duby, 2008]


viii. Domination/submission
…some women enjoy it (anal sex) mostly because it pleases their partner and some women enjoy it because they do like the sensation – or they like being maybe more submissive or something like that… [Female respondent, Duby, 2008]

Penile-anal sex is sometimes viewed as more aggressive and transgressive than penile-vaginal sex, involving the domination of one partner over the subordinate other.

I think it’s definitely… the most vulnerable position a woman can be in… it obviously depends on the partner as well … what space he’s in when he initiated it... If it’s more because he’s not thinking about you in the process... there have been times when it’s been great, but sometimes it just makes you feel violated… even though you love the person that you’re with – and you care for them, you still feel a little bit violated after that… It also depends on how it’s received – how it’s valued… by the partner – because if it’s kind of like as they say “wham bam thank you maam”, then it’s sort of not appealing after that – but if it’s – if something does happen emotionally - and you do feel closer to that person and you can see that it’s reciprocated, then it becomes more intriguing, and then you think “maybe it won’t be so bad”… [Female respondent, Duby, 2008]

I think it’s quite a submissive thing to do… to be on the receiving end of it – I think there’s much more of a power dynamic than I think there is with ‘normal sex’…. That was all part of it – that was just part of the fantasy and the – you know what makes it fun…. and for him – I think that’s why he liked it as well - I think partly because you know you’re not facing each other – so it’s more about just the sex than about the love or anything…. [Female respondent, Duby, 2008]

ix. Love and intimacy
Some people feel that anal sex requires greater intimacy between sexual partners; couples may practice it out of the desire to expand their physical and intimacy boundaries, to “get closer” to each other and perhaps explore previously uncharted territory together.

…there’s a comfort level that goes above and beyond the comfort level of just having regular sex with somebody. Just to be able to do that and not feel gross and self-conscious about it… [Female respondent, Duby, 2008]

Due to both the physically and morally sensitive nature of anal sex, sometimes it is more symbolically imbibed than vaginal sex, involving a further degree of intimacy and trust between individuals (in the case of consensual anal sex).

x. Sexual adventure and sensation seeking
The historical association of anal sex with deviancy and pathology gives the impression that anal sex is something only practiced by perverse individuals. This of course is not the case; consensual anal sex constitutes a pleasurable part of many healthy sexual relationships. Heterosexual couples may practice anal sex out of a desire to try new things, experience novel sensations, explore physical boundaries and anatomical regions. Curiosity may induce temptation to try new sexual acts and positions.

…it’s like bungee jumping – you know you’re going to get scared – and you know it’s not going to be pleasant for the first few minutes but you know afterwards you’ll think: that wasn’t so bad… [Female respondent, Duby, 2008]

…it was mostly just because it was… just a different sensation or whatever… [Female respondent, Duby, 2008]

The first time I did it, I had to get used to the feeling – you know because it’s something that’s completely different from anything you’ve felt before… [Female respondent, Duby, 2008]

The ‘accomplishment motive’ may be particularly relevant to adolescents practicing anal sex, feeling they are under pressure to do everything that their peers have done. Alfred Kinsey referred to this desire that some people have to ‘keep score’ and have sex in every position available and known about, to attain a sense of achievement.

Interviewer: So what would you say are your key motivations for having anal sex?
Female respondent: I think just curiosity… to finally prove whether I’m going to like it or not… I don’t think I’ve explored it enough… to be honest… Just curiosity – I need to get it out of the way… otherwise I’ll just be wondering… [Duby, 2008]

xi. Sexual choice and variety
Sex is a consumer product in the context of the consumerist society we live in. There is a plethora of sexual choices and lifestyles that the (‘free’ and ‘modern’) individual sifts through and samples as a means through which to express the self. With sex shops, pornographic material, sex toys and sex shows becoming increasingly accessible and popular, we are inundated with imagery of the weird and wonderful world of adventurous and exciting sex. Within this jungle of sexual opportunities we are encouraged to find our sexual selves. In a context free from coercion, exploitation and economic pressure, the modern Western individual reaches sexual self-realisation through conscious choice.

Until now safe sex messages and HIV prevention programmes have retained a limited and narrow view of sex. Only recently have condom and lubricant manufacturers cottoned onto this thirst for sexual adventure and fun in the affluent West, and have increasingly geared certain products towards this and away from boring, outdated and conventional sex.

Interviewer: What would you say your motivations for trying anal sex the first time were?
Male respondent: I suppose curiosity… it feels like a part of my sexuality – maybe aspects of… aspects of it that intrigued me or aroused me – um… yeah all those reasons – and maybe I could even ask myself whether boredom, sexual boredom was initially a reason… [Duby, 2008]


xii. Subversion and deviance
The Christian influenced Western world has been largely conditioned by the pervasive philosophy of sex as a sin. In the dualistic notion of the temptation of the ‘forbidden fruit’, desire is increased by the forbidden nature of a sexual act, and sexual activity itself is enhanced by the very fact of transgression. The risk of ‘defying rules’ creates an aura of excitement and ‘additional thrill’. Arousal may be substantially increased if the sexual act is perceived to be an ‘illegitimate activity’.

…with my last sexual partner, I would often say to her, I feel like something nasty tonight… some days we’d be on the same page and other days we wouldn’t… I don’t know if subversion is the right word but something… you know sometimes you feel a little destructive – and letting your hair down and being a little nasty... is attractive… [Male respondent, Duby, 2008]

Some individuals choose to practice anal sex because of its moral positioning as “deviant”. In an attempt to challenge society and break from mainstream culture, people seek to indulge in behaviour, sexual and otherwise, that they perceive to be in opposition to societal norms and expectations. By making the conscious decision to practice anal sex they may be engaging in a discourse of subversion. The individual choosing to assert their agency in experimenting with sex and breaking away from socially ascribed sex norms and positions may get some satisfaction from the sense of subversion and escape from societal control.

…just because it is so taboo – I think that’s what makes it more appealing. [Female respondent, Duby, 2008]


Conclusion
Evidence for the high incidence of heterosexual anal sex increases, alongside scientific knowledge about the high risks of HIV and STI transmission through penile-anal intercourse. It can no longer be ignored. As long as the cloak of denial and taboo remains over the subject of heterosexual anal sex, not only are people continually being denied access to comprehensive information and health service provision catering to all their sexual health needs, but they are not being given the opportunity to make informed choices about practicing safe sex and thus protecting themselves and their partners from HIV infection.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Pervading moral judgements are hard to change but in creating and allowing space for discussion and expression of sexuality, sexual attitudes and sexual desires, dialogue will inevitably lead to a greater acceptance and acknowledgement of what has for so long been hidden and ignored. Research must begin to address heterosexual anal sexual practices more attentively to enable greater understanding of sexual motives and sexual behaviour, which in turn will inform HIV prevention programmes.


Interview data referenced from:
Duby, Zoe 2008. Heterosexual anal sex in the age of HIV: An exploratory study of a silenced subject Unpublished Master’s dissertation, Department of Sociology, Graduate School of Humanities, University of Cape Town

Biomedical interventions to prevent HIV infection: evidence, challenges, and way forward

via The Lancet

Summary

Intensive research efforts for more than two decades have not yet resulted in an HIV vaccine of even moderate effectiveness. However, some progress has been made with other biomedical interventions, albeit on the basis of inconsistent levels of evidence. The male condom, if used correctly and consistently, has been proven in observational studies to be very effective in blocking HIV transmission during sexual intercourse; and, in three randomised trials, male circumcision was protective against HIV acquisition among men. Treatment of sexually transmitted infections, a public health intervention in its own right, has had mixed results, depending in part on the epidemic context in which the approach was assessed. Finally, oral and topical antiretroviral compounds are being assessed for their role in reduction of HIV transmission during sexual intercourse. Research on biomedical interventions poses formidable challenges. Difficulties with product adherence and the possibility of sexual disinhibition are important concerns. Biomedical interventions will need to be part of an integrative package that includes biomedical, behavioural, and structural interventions. Assessment of such multicomponent approaches with moderate effects is difficult. Issues to be considered include the nature of control groups and the effect of adherence on the true effectiveness of the intervention.

Read the rest.

Heterosexual Anal Sex Activity in the Year After an STD Clinic Visit

Sexually Transmitted Diseases Vol. 35; No. 11: P. 905-909 (11..08)
Lin H. Tian, MD, MS; Thomas A. Peterman, MD, MSc; Guoyu Tao, PhD; Lesley C. Brooks, BA; Carol Metcalf, MBChB, MPH; Kevin C. Malotte, DrPH; Sindy M. Paul, MD, MPH; John M. Douglas Jr., MD; The Respect-2 Study Group

Click here for the abstract.

The research team undertook the current study to describe anal sex activity during a year and to identify factors associated with heterosexual anal sex and condom use. They performed secondary analysis of data from a trial conducted in three public STD clinics. The patients described sexual behaviors every three months for the year. To include multiple observations from each subject, logistic regression models with generalized estimating equations were used.

During the project, 2,357 heterosexual subjects reported on 6,611 three-month intervals that included 9,235 partnerships. About 18.3 percent of participants reported anal sex in a particular three-month interval; 39.3 percent reported anal sex during the year. Anal sex in at least two three-month intervals was reported by 23.5 percent.

The results found that anal sex was associated with having more sex acts, two or more sex partners, unprotected vaginal sex, and a main partner. For anal sex in the previous three months, 27.3 percent reported consistent condom use, while 63 percent reported never using condoms. Consistent condom use during anal sex was found to be associated with consistent condom use for vaginal sex, having two or more partners, and having anal sex with a casual or new partner.

"STD clinic patients were commonly engaged in heterosexual anal sex, and most of them never used condoms during anal sex," the authors concluded. "Patients who had anal sex tended to also engage in other risk behaviors that put them at risk of STD/[HIV]. Clinicians should ask about anal sex, appropriately examine and test patients who have had anal sex, and recommend condom use for both anal and vaginal sex."

Little HIV protection from circumcision for gay sex: study

[source]

Circumcision, which has been found to reduce by about one-half the transmission of HIV between heterosexuals, appears to offer far less protection for men engaging in homosexual intercourse, according to a study released Tuesday.

The research published in the October 8 issue of The Journal of the American Medical Association compiled 15 discrete studies of more than 50,000 male subjects in Africa.

The report by the US Centers for Disease Control and Prevention noted that male circumcision appears to reduce by between 50 and 60 percent the likelihood of female-to-male transmission of the potentially deadly AIDS virus.

But among men who report having male sexual partners, researchers found little difference in the rate of HIV infection between those who were circumcised and those who were not.

Of 53,567 subjects in the study, 52 percent were circumcised, meaning that they had had all or some of the foreskin removed from the penis.

The study's authors wrote that circumcision appears to provide "not statistically significant" protection from HIV in men who engage in anal sex with other men. The researchers said however that more research may be necessary to quantify the amount of protection -- or lack thereof -- provided by circumcision.

That view was echoed in an editorial that accompanied the article. A team of peer reviewers from Vanderbilt University concluded that "circumcision would likely be insufficiently efficient to be universally effective in reducing HIV risk, and will have to be combined with other prevention modalities to have a substantial and sustained prevention effect."

The findings did suggest however, that male circumcision may offer men engaging in heterosexual intercourse some protection against sexually-transmitted infections, such as syphilis or chlamydia.