Contextualizing anal intercourse among Black and Hispanic adolescent and young adult women

Background: HIV is increasingly prevalent among female adolescents and young, minority women. Heterosexual contact is their primary risk. Unprotected receptive anal intercourse, a relatively common practice among young women, is the highest risk sexual behavior. Contextualizing heterosexual anal intercourse (HAI) is essential for developing effective HIV-prevention interventions.

Methods: This mixed methods study of young, minority women investigated the context of HAI and HAI refusal. Fifty-three minority young women were recruited at an urban college and adolescent clinic to complete a questionnaire about their sexual behaviors. Those who reported a history of HAI or HAI refusal were asked to participate in an interview (N=11).

Results:, On the questionnaire, 10 women (19%) reported HAI, and 28 (53%) reported having refused HAI, Among those interviewed, 10 had had HAI and 1 had refused. Although 93% of the young women surveyed associated HAI with HIV risk, 70% of those who had HAI never used condoms for it. All respondents associated vaginal intercourse with HIV risk; 8 % never use condoms. The qualitative results challenge beliefs about HAI, e.g., that girls don't like it. Some women reported enjoying HAI and initiated it. Others displayed confusion about HAI, reporting that HAI was accidental – or reporting HAI refusal when they had engaged in it. One respondent reported HAI to prevent pregnancy, and one reported it during menses.

Conclusions: This study suggests multiple reasons for HAI among young women. Interventions are needed that address misperceptions and model behaviors for women to reduce risk from HAI.