Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

Branwen Nia Owen; Rebecca F Baggaley; Mathieu Maheu-Giroux; Jocelyn Elmes; Adaora A Adimora; Catalina Ramirez; Andrew Edmonds; Kemi Sosanya; Tonya N Taylor; Michael Plankey; Julie A Cederbaum; Dominika Seidman; Kathleen M Weber; Elizabeth T Golub; Jessica Wells; Hector Bolivar; Deborah Konkle-Parker; Gudrun Pregartner; Marie-Claude Boily

doi:10.1186/s12905-022-01849-0

Longitudinal determinants of anal intercourse among women with, and without HIV in the United States

BMC Womens Health. 2022 Jul 14;22(1):291. doi: 10.1186/s12905-022-01849-0.

Authors

Branwen Nia Owen¹, Rebecca F Baggaley², Mathieu Maheu-Giroux³, Jocelyn Elmes^{4

5}, Adaora A Adimora^{6

7}, Catalina Ramirez⁷, Andrew Edmonds⁶, Kemi Sosanya⁸, Tonya N Taylor⁹, Michael Plankey¹⁰, Julie A Cederbaum¹¹, Dominika Seidman¹², Kathleen M Weber¹³, Elizabeth T Golub¹⁴, Jessica Wells¹⁵, Hector Bolivar¹⁶, Deborah Konkle-Parker¹⁷, Gudrun Pregartner¹⁸, Marie-Claude Boily^{4

19}

Affiliations

¹ Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, Praed Street, London, W2 1NY, UK. branwennia.owen@unibas.ch.
² Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK.
³ Department of Epidemiology, Biostatistics, and Occupational Health, School of Global and Population Health, McGill University, Montreal, Canada.
⁴ Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, Praed Street, London, W2 1NY, UK.
⁵ Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK.
⁶ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Montefiore Medical Center Bronx, New York, NY, USA.
⁹ Department of Medicine, Division of Infectious Disease, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
¹⁰ Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, D.C., USA.
¹¹ Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA.
¹² Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
¹³ Cook County Health/Hektoen Institute of Medicine, Chicago, IL, USA.
¹⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁵ Neil Hodson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
¹⁶ Division of Infectious Diseases, University of Miami-Miller School of Medicine, Miami, Fl, USA.
¹⁷ Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
¹⁸ Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
¹⁹ MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK.

Abstract

Background: Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.

Methods: 3708 women living with (73%), and without HIV (27%) participating in the Women's Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994-2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.

Results: AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96-0.98), Hispanic (aOR = 1.88, CI:1.47-2.41) or White (aOR = 1.62, CI:1.15-2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08-1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10-1.62), or both (aOR = 1.77, CI:1.13-2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05-1.66) or any drug use (aOR = 1.34, CI:1.09-1.66), multiple male partners (aOR = 2.64, CI:2.23-3.11), exchange sex (aOR = 3.45, CI:2.53-4.71), one or more female sex partners (aOR = 1.32, CI:1.01-1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53-2.09), and high depressive symptoms (aOR = 1.23, CI:1.08-1.39).

Conclusion: AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.

Keywords: Anal sex; Heterosexual; Prevention; Transmission; Women.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Female
HIV Infections* / prevention & control
Humans
Male
Sexual Behavior
Sexual Partners
Substance-Related Disorders*
United States / epidemiology
Violence

Abstract

Publication types

MeSH terms

Grants and funding