AIDS and heterosexual anal intercourse

Arch Sex Behav. 1991 Jun;20(3):233-76. doi: 10.1007/BF01541846.


Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.

PIP: Since the route of transmission of HIV was mapped, the Centers for Disease Control and other authorities have discounted receptive and intercourse in heterosexuals as a significant risk factor: this review concludes that greater numbers of heterosexuals engage in anal coitus than do homosexual men, and that anal coitus carries a greater risk to women than does vaginal intercourse. Several recent studies conclude that the frequency of this behavior is a significant independent predictor of HIV seropositivity. It is probable but unknown whether women having receptive anal intercourse with bisexual men are at a greater risk than those with heterosexual partners. Reading the literature reveals a distinct ethnocentrism in the western medical profession that relegates this practice to homosexuals. A review o anecdotal data, survey data, and magazine and popular surveys indicates that the behavior is common. There are problems with ambiguous terminology, distinguishing receptive sex from anorectal stimulation or rear entry vaginal intercourse. Data on rectal STDs, usually thought to be due to poor hygiene in women, suggest as high as 20-29% solely rectal infections. The conservative conclusion is that 10% of American women engage in anal intercourse regularly. Although the number of women in this risk group of HIV transmission to other partnersis high, female-to-male transmission of HIV is not considered as likely in Western countries as is male-to-male transmission.

Publication types

  • Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / transmission*
  • Anal Canal*
  • Attitude of Health Personnel
  • Attitude to Health
  • Female
  • Global Health
  • Humans
  • Male
  • Physicians / psychology
  • Research
  • Risk Factors
  • Sex Factors
  • Sexual Behavior / ethnology
  • Sexual Behavior / psychology
  • Sexual Behavior / statistics & numerical data*
  • Sexually Transmitted Diseases / epidemiology
  • Sexually Transmitted Diseases / transmission
  • United States / epidemiology