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RESEARCH ARTICLE (Open Access)

Anal sex and associated HIV-related sexual risk factors among female sex workers in Andhra Pradesh, India

Rajesh Kumar Patra A , Bidhubhusan Mahapatra B C , Dolly Kovvali A , Laxminarayana Proddutoor A and Niranjan Saggurti B
+ Author Affiliations
- Author Affiliations

A Hindustan Latex Family Planning Promotion Trust, Veena Dhari Apt. 3-5-816, 3rd Floor, King Koti Road, Hyderguda, Hyderabad 500 029, India.

B Population Council, 142, Golf Links, New Delhi 110 003, India.

C Corresponding author. Email: bbmahapatra@popcouncil.org

Sexual Health 9(5) 430-437 https://doi.org/10.1071/SH11155
Submitted: 8 November 2011  Accepted: 8 May 2012   Published: 28 September 2012

Journal Compilation © CSIRO Publishing 2012 Open Access CC BY-NC-ND

Abstract

Background: This study aims to understand the correlates of anal sex practices among female sex workers (FSWs) and examine the association of anal sex with HIV-related sexual risk factors in Andhra Pradesh, India. Methods: A cross-sectional behavioural survey was conducted in 2011 among 795 FSWs aged 18 years or older. Probability-based cluster sampling was used to select respondents from sex work hotspots. Results: One-quarter (23%) of FSWs had practiced anal sex in the last year. The odds of practicing anal sex were higher among FSWs aged 35 years or more than in those aged less than 25 years (adjusted odds ratio (AOR): 2.05, P < 0.05), in those formerly married compared to those currently married (AOR: 1.88, P < 0.01), in those having an income only from sex work compared to those having additional sources of income (AOR: 1.54, P < 0.05), those reporting heavy alcohol consumption compared to those who did not (AOR: 2.80, P < 0.01) and those who experienced violence compared to those who had not (AOR: 2.80, P < 0.01). FSWs practicing anal sex were more likely to experience sexually transmissible infection (STI) related symptoms than those practicing only vaginal sex. There was no association between anal sex practice and condom use. Conclusions: Anal sex is associated with STI symptoms, a factor for HIV risk. HIV intervention programmes need to educate FSWs about the risks associated with anal sex.

Additional keywords: prostitution, sexual practices, sexually transmissible infections.


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 | 1:STN:280:DC%2BD3M%2Flsl2rsg%3D%3D&md5=f5efc10733f0cc401860f1be9c57921fCAS |

[2]  Veldhuijzen NJ, Ingabire C, Luchters S, Bosire W, Braunstein S, Chersich M, et al Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV. Sex Health 2011; 8 251–4.
Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV.Crossref | GoogleScholarGoogle Scholar |

[3]  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 | 1:STN:280:DC%2BD3c3gsl2gug%3D%3D&md5=d6bd73f6ee7123e461f2277462d519a1CAS |

[4]  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 | 1:STN:280:DC%2BD3Mzptl2iug%3D%3D&md5=ec56cad6223b3ff0daf28a00bc7d18ebCAS |

[5]  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 |

[6]  Erickson PI, Bastani R, Maxwell AE, Marcus AC, Capell FJ, Yan KX. Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors. AIDS Educ Prev 1995; 7 477–93.
| 1:STN:280:DyaK28vgtlWisg%3D%3D&md5=136acab5c90f21a143ab4897232d40daCAS |

[7]  Buchacz K, van der Straten A, Saul J, Shiboski SC, Gomez CA, Padian N. Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. J Acquir Immune Defic Syndr 2001; 28 289–97.
| 1:STN:280:DC%2BD3MnltFaguw%3D%3D&md5=d7750ccc2c9dd860eea407393c53cefdCAS |

[8]  Padian N, Marquis L, Francis DP, Anderson RE, Rutherford GW, O’Malley PM, et al Male-to-female transmission of human immunodeficiency virus. JAMA 1987; 258 788–90.
Male-to-female transmission of human immunodeficiency virus.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2s3osVantA%3D%3D&md5=84eafdb2e7a29605f121b7dbc9d144a8CAS |

[9]  Skurnick JH, Kennedy CA, Perez G, Abrams J, Vermund SH, Denny T, et al Behavioral and demographic risk factors for transmission of human immunodeficiency virus type 1 in heterosexual couples: report from the Heterosexual HIV Transmission Study. Clin Infect Dis. 1998; 26 855–64.
Behavioral and demographic risk factors for transmission of human immunodeficiency virus type 1 in heterosexual couples: report from the Heterosexual HIV Transmission Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3isFKmsw%3D%3D&md5=980bdd36e309c275b3c7a85f0b0db7f5CAS |

[10]  Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV. Am J Epidemiol 1998; 148 88–96.
Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czis1Gnsw%3D%3D&md5=100399e1d6ed26d0f51b34cb033ff862CAS |

[11]  Padian NS, Shiboski SC, Glass SO, Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study. Am J Epidemiol 1997; 146 350–7.
Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svhs1Cltg%3D%3D&md5=46c5046482552bb11677a413c55329d2CAS |

[12]  Voeller B. AIDS and heterosexual anal intercourse. Arch Sex Behav 1991; 20 233–76.
AIDS and heterosexual anal intercourse.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M3ot1KmtA%3D%3D&md5=8e116fb0930ac1c0842f4e6e5901272eCAS |

[13]  Silverman BG, Gross TP. Use and effectiveness of condoms during anal intercourse: a review. Sex Transm Dis 1997; 24 11–7.
Use and effectiveness of condoms during anal intercourse: a review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s7ntFGlsg%3D%3D&md5=9e5478596881bb5f5c0b939b66f5ae86CAS |

[14]  Priddy FH, Wakasiaka S, Hoang TD, Smith DJ, Farah B, Del Rio C, et al Anal sex, vaginal practices, and HIV incidence in female sex workers in urban Kenya: implications for the development of intravaginal HIV prevention methods. AIDS Res Hum Retroviruses 2011; 27 1067–1072.
Anal sex, vaginal practices, and HIV incidence in female sex workers in urban Kenya: implications for the development of intravaginal HIV prevention methods.Crossref | GoogleScholarGoogle Scholar |

[15]  Eng C. Anal cancer: current and future methodology. Cancer Invest 2006; 24 535–44.
Anal cancer: current and future methodology.Crossref | GoogleScholarGoogle Scholar |

[16]  Scott H, Khoury J, Moore BA, Weissman S. Routine anal cytology screening for anal squamous intraepithelial lesions in an urban HIV clinic. Sex Transm Dis 2008; 35 197–202.
Routine anal cytology screening for anal squamous intraepithelial lesions in an urban HIV clinic.Crossref | GoogleScholarGoogle Scholar |

[17]  Frisch M, Glimelius B, van den Brule AJ, Wohlfahrt J, Meijer CJ, Walboomers JM, et al Sexually transmitted infection as a cause of anal cancer. N Engl J Med 1997; 337 1350–8.
Sexually transmitted infection as a cause of anal cancer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FgtVSjtg%3D%3D&md5=85b48368c0091b3841291d9bd7f8096cCAS |

[18]  Leichliter JS. Heterosexual anal sex: part of an expanding sexual repertoire? Sex Transm Dis 2008; 35 910–1.
Heterosexual anal sex: part of an expanding sexual repertoire?Crossref | GoogleScholarGoogle Scholar |

[19]  Schwandt M, Morris C, Ferguson A, Ngugi E, Moses S. Anal and dry sex in commercial sex work, and relation to risk for sexually transmitted infections and HIV in Meru, Kenya. Sex Transm Infect 2006; 82 392–6.
Anal and dry sex in commercial sex work, and relation to risk for sexually transmitted infections and HIV in Meru, Kenya.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28rotlKktQ%3D%3D&md5=402322c14979834a68f66132f5567b9bCAS |

[20]  Bogart LM, Kral AH, Scott A, Anderson R, Flynn N, Gilbert ML, et al Sexual risk among injection drug users recruited from syringe exchange programs in California. Sex Transm Dis 2005; 32 27–34.
Sexual risk among injection drug users recruited from syringe exchange programs in California.Crossref | GoogleScholarGoogle Scholar |

[21]  Fonck K, Kaul R, Keli F, Bwayo JJ, Ngugi EN, Moses S, et al Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya. Sex Transm Infect 2001; 77 271–5.
Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvltVynsQ%3D%3D&md5=6c004856cc3d547a93c8abc7d642b99aCAS |

[22]  Ferguson A, Morris C. Assessing the role of anal intercourse in the epidemiology of AIDS in Africa. Int J STD AIDS 2003; 14 856
Assessing the role of anal intercourse in the epidemiology of AIDS in Africa.Crossref | GoogleScholarGoogle Scholar |

[23]  Gross M, Holte SE, Marmor M, Mwatha A, Koblin BA, Mayer KH. Anal sex among HIV-seronegative women at high risk of HIV exposure. The HIVNET Vaccine Preparedness Study 2 Protocol Team. J Acquir Immune Defic Syndr 2000; 24 393–8.
Anal sex among HIV-seronegative women at high risk of HIV exposure. The HIVNET Vaccine Preparedness Study 2 Protocol Team.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvmsVWjsw%3D%3D&md5=3f4efdf0b3df480101eb67a33825e33fCAS |

[24]  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 | 1:STN:280:DyaK1czmslCqsw%3D%3D&md5=66a82058199bab8b48379f6e6f3587d1CAS |

[25]  Ramjee G, Weber AE, Morar NS. Recording sexual behavior: comparison of recall questionnaires with a coital diary. Sex Transm Dis 1999; 26 374–80.
Recording sexual behavior: comparison of recall questionnaires with a coital diary.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzosFyisw%3D%3D&md5=a4a2a2e4ccbaa078dc6137f07c0b5f1aCAS |

[26]  Beattie TS, Bhattacharjee P, Ramesh BM, Gurnani V, Anthony J, Isac S, et al Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program. BMC Public Health 2010; 10 476–487.
Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program.Crossref | GoogleScholarGoogle Scholar |

[27]  Mondal S, Ramesh B, Blanchard JF, Moses S, eds. Condom use and experience of violence: evidence from polling booth surveys among female sex workers in Karnataka, India. XVI International AIDS Conference; 2006; Toronto, Canada.

[28]  Matheou A. A blind spot in HIV prevention – female anal sex in India. New Delhi: International HIV/AIDS Alliance in India; 2010.

[29]  National AIDS Control Organization (NACO). Targeted interventions among core groups under NACP III: operational guidelines. New Delhi: NACO; 2007. Available online at: http://www.nacoonline.org/upload/Publication/NGOs%20and%20targetted%20Intervations/NACP-III.pdf [verified 7 November 2011].

[30]  Bill & Melinda Gates Foundation (BMGF). Avahan – the India AIDS initiative: the business of HIV prevention at scale. New Delhi, India: BMGF; 2008.

[31]  Registrar General of India. Krishna: census 2011. New Delhi: Office of the Registrar General & Census Commissioner; 2011. Available online at: http://www.census2011.co.in/census/district/133-krishna.html [verified March 2012].

[32]  International Institute for Population Sciences (IIPS). District level household and facility survey (DLHS-3), 2007–08: India: key indicators: states and districts. Mumbai: IIPS, Ministry of Health and Family Welfare Government of India; 2010.

[33]  Indian Institute of Public Health (IIPH). Epidemiological appraisal of HIV situation in District Krishna using data triangulation. Hyderabad: IIPH; 2010.

[34]  Registrar General of India. Vizianagaram: census 2011. New Delhi: Office of the Registrar General & Census Commissioner; 2011. Available online at: http://www.census2011.co.in/census/district/129-vizianagaram.html [verified March 2012].

[35]  Indian Institute of Public Health (IIPH). HIV situation and response in Vizianagaram District: epidemiological appraisal using data triangulation. Hyderabad: IIPH; 2010.

[36]  Saidel T, Adhikary R, Mainkar M, Dale J, Loo V, Rahman M, et al Baseline integrated behavioural and biological assessment among most at-risk populations in six high-prevalence states of India: design and implementation challenges. AIDS 2008; 22 S17–34.
Baseline integrated behavioural and biological assessment among most at-risk populations in six high-prevalence states of India: design and implementation challenges.Crossref | GoogleScholarGoogle Scholar |

[37]  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 |

[38]  Dandona R, Dandona L, Kumar GA, Gutierrez J, McPherson S, Samuels F, et al Demography and sex work characteristics of female sex workers in India. BMC Int Health Hum Rights 2006; 6 6–16.
Demography and sex work characteristics of female sex workers in India.Crossref | GoogleScholarGoogle Scholar |

[39]  Hutton HE, McCaul ME, Santora PB, Erbelding EJ. The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients. Alcohol Clin Exp Res 2008; 32 2008–15.
The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients.Crossref | GoogleScholarGoogle Scholar |

[40]  Cook RL, Comer DM, Wiesenfeld HC, Chang CC, Tarter R, Lave JR, et al Alcohol and drug use and related disorders: an underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sex Transm Dis 2006; 33 565–70.
Alcohol and drug use and related disorders: an underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics.Crossref | GoogleScholarGoogle Scholar |

[41]  Kalichman SC, Simbayi LC, Jooste S, Cain D, Cherry C. Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa. Psychol Addict Behav 2006; 20 298–304.
Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa.Crossref | GoogleScholarGoogle Scholar |

[42]  Decker MR, Wirtz AL, Baral SD, Peryshkina A, Mogilnyi V, Weber RA, et al Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers. Sex Transm Infect 2012; 88 278–283.
Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers.Crossref | GoogleScholarGoogle Scholar |

[43]  Bradley J, Rajaram S, Alary M, Isac S, Washington R, Moses S, et al Determinants of condom breakage among female sex workers in Karnataka, India. BMC Public Health 2011; 11 S14
Determinants of condom breakage among female sex workers in Karnataka, India.Crossref | GoogleScholarGoogle Scholar |

[44]  Smith LB, Adler NE, Tschann JM. Underreporting sensitive behaviors: the case of young women’s willingness to report abortion. Health Psychol 1999; 18 37–43.
Underreporting sensitive behaviors: the case of young women’s willingness to report abortion.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7it1CgsA%3D%3D&md5=31a5e3629f2876416b288941e8cfe04eCAS |