Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults

Aleksandar Štulhofer A B and Valerio Baćak A
+ Author Affiliations
- Author Affiliations

A Sexology Unit, Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, I. Lučića, 3, 10000 Zagreb, Croatia.

B Corresponding author. Email: astulhof@ffzg.hr

Sexual Health 8(3) 384-389 https://doi.org/10.1071/SH10078
Submitted: 27 June 2010  Accepted: 19 October 2010   Published: 23 May 2011

Abstract

Background: There is evidence that anal sex is becoming increasingly popular among heterosexual women and men. Several studies carried out in especially vulnerable populations (e.g. sex workers and low-income youth) suggested that anal sex may indicate a more general propensity to sexual risk-taking. Methods: To assess whether this epidemiologically important finding holds in the case of young adults from the general population, we analysed data from a cross-sectional probability survey carried out in 2010 on 1005 Croatian women and men aged 18–25. Results: Anal intercourse was reported by 36.5% of 861 sexually experienced participants (42.7% of men and 29.8% of women). About one-third of them (34%) used a condom at most recent anal intercourse. The experience of anal sex was significantly associated (P < 0.001) with all four indicators of sexual risk-taking (condom use at most recent vaginal intercourse, number of sexual partners in the past year, concurrent sexual relationships and anonymous sex in the past year), as well as with negative attitudes and beliefs about condom use (P < 0.01). Sexual sensation-seeking mediated the relationship between anal sex and some of the sexual risk-taking behaviours. Conclusion: According to the findings, heterosexual anal sex is directly and indirectly associated with increased behavioural risks of acquiring HIV and other sexually transmissible infections (STI). Sex education and STI prevention programs should focus on the importance of using protection when practicing anal sex.

Additional keywords: anal intercourse, condom use, HIV risk, sexually transmissible infection risk.


References

[1]  Baldwin JI, Baldwin JD. Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Arch Sex Behav 2000; 29 357–73.
Heterosexual anal intercourse: an understudied, high-risk sexual behavior.Crossref | GoogleScholarGoogle Scholar |

[2]  Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, et al Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet 2001; 358 1835–42.
Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.Crossref | GoogleScholarGoogle Scholar |

[3]  McBride KR, Fortenberry JD. Heterosexual anal sexuality and anal sex behaviors: a review. J Sex Res 2010; 47 123–36.
Heterosexual anal sexuality and anal sex behaviors: a review.Crossref | GoogleScholarGoogle Scholar |

[4]  Satterwhite CL, Kamb ML, Metcalf C, Douglas JM, Malotte CK, Paul S, et al Changes in sexual behavior and STD prevalence among heterosexual STD clinic attendees: 1993–1995 versus 1999–2000. Sex Transm Dis 2007; 34 815–9.

[5]  Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15–44 years of age, United States, 2002. Adv Data 2005; 362 1–55.

[6]  Laumann EO, Gagnon JH, Michael RT, Michaels S. The social organization of sexuality: sexual practices in the United States. 1st ed. Chicago: University of Chicago Press; 1994.

[7]  Braun-Courville DK, Rojas M. Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors. J Adolesc Health 2009; 45 156–62.
Exposure to sexually explicit web sites and adolescent sexual attitudes and behaviors.Crossref | GoogleScholarGoogle Scholar |

[8]  Rogala C, Tydén T. Does pornography influence young women’s sexual behavior? Women’s Health Issues 2003; 13 39–43.
Does pornography influence young women’s sexual behavior?Crossref | GoogleScholarGoogle Scholar |

[9]  Halperin DT. Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I. AIDS Patient Care STDS 1999; 13 717–30.
Heterosexual anal intercourse: prevalence, cultural factors, and HIV infection and other health risks, Part I.Crossref | GoogleScholarGoogle Scholar |

[10]  Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis 2002; 29 38–43.
Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use.Crossref | GoogleScholarGoogle Scholar |

[11]  Voeller B. AIDS and heterosexual anal intercourse. Arch Sex Behav 1991; 20 233–76.
AIDS and heterosexual anal intercourse.Crossref | GoogleScholarGoogle Scholar |

[12]  Ibañez GE, Kurtz SP, Surratt HL, Inciardi JA. Correlates of heterosexual anal intercourse among substance-using club-goers. Arch Sex Behav 2010; 39 959–67.
Correlates of heterosexual anal intercourse among substance-using club-goers.Crossref | GoogleScholarGoogle Scholar |

[13]  Koblin BA, Hoover DR, Xu G, Frye V, Latka MH, Lucy D, et al Correlates of anal intercourse vary by partner type among substance-using women: baseline data from the UNITY study. AIDS Behav 2010; 14 132–40.
Correlates of anal intercourse vary by partner type among substance-using women: baseline data from the UNITY study.Crossref | GoogleScholarGoogle Scholar |

[14]  Reynolds GL, Latimore AD, Fisher DG. Heterosexual anal sex among female drug users: US national compared to local Long Beach, California data. AIDS Behav 2008; 12 796–805.
Heterosexual anal sex among female drug users: US national compared to local Long Beach, California data.Crossref | GoogleScholarGoogle Scholar |

[15]  Karim SS, Ramjee G. Anal sex and HIV transmission in women. Am J Public Health 1998; 88 1265–6.
Anal sex and HIV transmission in women.Crossref | GoogleScholarGoogle Scholar |

[16]  Friedman SR, Flom PL, Kottiri BJ, Neaigus A, Sandoval M, Curtis R, et al Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood. AIDS 2001; 15 2057–60.
Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood.Crossref | GoogleScholarGoogle Scholar |

[17]  Houston AM, Fang J, Husman C, Peralta L. More than just vaginal intercourse: anal intercourse and condom use patterns in the context of “main” and “casual” sexual relationships among urban minority adolescent females. J Pediatr Adolesc Gynecol 2007; 20 299–304.
More than just vaginal intercourse: anal intercourse and condom use patterns in the context of “main” and “casual” sexual relationships among urban minority adolescent females.Crossref | GoogleScholarGoogle Scholar |

[18]  Roye CF, Krauss BJ, Silverman PL. Prevalence and correlates of heterosexual anal intercourse among black and Latina female adolescents. J Assoc Nurses AIDS Care 2010; 21 291–301.
Prevalence and correlates of heterosexual anal intercourse among black and Latina female adolescents.Crossref | GoogleScholarGoogle Scholar |

[19]  Lane T, Pettifor A, Pascoe S, Fiamma A, Rees H. Heterosexual anal intercourse increases risk of HIV infection among young South African men. AIDS 2006; 20 123–5.
Heterosexual anal intercourse increases risk of HIV infection among young South African men.Crossref | GoogleScholarGoogle Scholar |

[20]  Misegades L, Page-Shafer K, Halperin D, McFarland W. Anal intercourse among young low-income women in California: an overlooked risk factor for HIV? AIDS 2001; 15 534–5.
Anal intercourse among young low-income women in California: an overlooked risk factor for HIV?Crossref | GoogleScholarGoogle Scholar |

[21]  de Visser RO, Smith AMA, Rissel CE, Richters J, Grulich AE. Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults. Aust N Z J Public Health 2003; 27 146–54.
Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults.Crossref | GoogleScholarGoogle Scholar |

[22]  Štulhofer A, Graham C, Božičević I, Kufrin K, Ajduković D. An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults. Arch Sex Behav 2009; 38 209–25.
An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults.Crossref | GoogleScholarGoogle Scholar |

[23]  Bagić D. The influence of refusals on the validity of the pre-election telephone survey: the case of the 2003 parliamentary elections. Društvena Istraživanja 2004; 13 439–61.

[24]  Štulhofer A, Baćak V, Ajduković D, Graham C. Understanding the association between condom use at first and most recent sexual intercourse: an assessment of normative, calculative, and habitual explanations. Soc Sci Med 2010; 70 2080–4.
Understanding the association between condom use at first and most recent sexual intercourse: an assessment of normative, calculative, and habitual explanations.Crossref | GoogleScholarGoogle Scholar |

[25]  Kalichman SC, Rompa D. Sexual sensation seeking and sexual compulsivity scales: reliability, validity, and predicting HIV risk behavior. J Pers Assess 1995; 65 586–601.
Sexual sensation seeking and sexual compulsivity scales: reliability, validity, and predicting HIV risk behavior.Crossref | GoogleScholarGoogle Scholar |

[26]  Peter J, Valkenburg PM. Adolescents’ exposure to sexually explicit online material and recreational attitudes toward sex. J Commun 2006; 56 639–60.
Adolescents’ exposure to sexually explicit online material and recreational attitudes toward sex.Crossref | GoogleScholarGoogle Scholar |

[27]  Leichliter JS, Chandra A, Liddon N, Fenton KA, Aral SO. Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States. J Infect Dis 2007; 196 1852–9.
Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States.Crossref | GoogleScholarGoogle Scholar |

[28]  Wiederman MW. Volunteer bias in sexuality research using college student participants. J Sex Res 1999; 36 59–66.
Volunteer bias in sexuality research using college student participants.Crossref | GoogleScholarGoogle Scholar |

[29]  Gullette DL, Lyons MA. Sensation seeking, self-esteem, and unprotected sex in college students. J Assoc Nurses AIDS Care 2006; 17 23–31.
Sensation seeking, self-esteem, and unprotected sex in college students.Crossref | GoogleScholarGoogle Scholar |

[30]  Teva I, Bermúdez MP, Buela-Casal G. Sexual sensation seeking, social stress, and coping styles as predictors of HIV/STD risk behaviors in adolescents. Youth & Society 2010;
Sexual sensation seeking, social stress, and coping styles as predictors of HIV/STD risk behaviors in adolescents.Crossref | GoogleScholarGoogle Scholar |

[31]  Exner TM, Correale J, Carballo-Diéguez A, Salomon L, Morrow KM, Dolezal C, et al Women’s anal sex practices: implications for formulation and promotion of a rectal microbicide. AIDS Educ Prev 2008; 20 148–59.
Women’s anal sex practices: implications for formulation and promotion of a rectal microbicide.Crossref | GoogleScholarGoogle Scholar |

[32]  Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS 2005; 16 102–7.
Associations between pornography consumption and sexual practices among adolescents in Sweden.Crossref | GoogleScholarGoogle Scholar |

[33]  Štulhofer A, Ajduković D, Božičević I, Kufrin K. AIDS and youth – Croatia 2005. Zagreb: Ministarstvo Zdravstva i Socijalne Skrbi, Hrvatski Zavod za Javno Zdravstvo; 2006.

[34]  Bijelić N. Sex education in Croatia: Tensions between secular and religious discourses. Eur J Womens Stud 2008; 15 329–43.
Sex education in Croatia: Tensions between secular and religious discourses.Crossref | GoogleScholarGoogle Scholar |

[35]  Hardy S. Anal sex: phallic and other meanings. In: Seidman S, Fischer N, Meeks C, editors. Introducing the new sexuality studies, 1st edn. London: Routledge; 2006. p. 114–120.

[36]  Pinkerton S, Cecil H, Bogart L, Abramson P. The pleasures of sex: an empirical investigation. Cogn Emotion 2003; 17 341–53.
The pleasures of sex: an empirical investigation.Crossref | GoogleScholarGoogle Scholar |

[37]  Santelli JS, Morrow B, Anderson JE, Lindberg LD. Contraceptive use and pregnancy risk among US high school students, 1991–2003. Perspect Sex Reprod Health 2006; 38 106–11.
Contraceptive use and pregnancy risk among US high school students, 1991–2003.Crossref | GoogleScholarGoogle Scholar |