Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
BMC Public Health. 2013 Dec 1;13:1108. doi: 10.1186/1471-2458-13-1108.
Papua New Guinea (PNG) has a high burden of sexually transmitted infections (STIs) and the highest adult HIV prevalence in the Pacific region. Despite this burden of disease, heterosexual anal intercourse (HAI) has rarely been considered. Given the increasing number of, and interest in, behavioural surveys in PNG and the changing nature of PNG's HIV epidemic, it is timely to conduct a systematic review of HAI in PNG order to improve sexual health.
We performed a systematic review of HAI in PNG as reported in peer-reviewed and non-peer-reviewed publications for the period 1950-May 2012. The search strategy identified 475 publications. After screening by geographical location, topic and methodology, we identified 23 publications for full text review, following which 13 publications were included in the final review. Using data from the review, we performed a risk equation analysis to demonstrate the potential impact of HAI on HIV acquisition and incidence in PNG.
There is a paucity of well-informed behavioural research on HAI in PNG. Inconsistency in key questions on HAI made it impossible to conduct a meta-analysis. The data available on HAI shows that it is practiced in all geographical areas and among all populations. Of those who reported HAI, rates varied from as low as 8% to as high as 77% depending on the recall period and partner type. Condom use during HAI was consistently low. Our risk equation analysis indicates that even if only 20% of females engage in HAI, and only 10% of sex acts involve HAI, the total number of new HIV infections among females would be 40% greater than if vaginal intercourse only occurred.
Our findings of indicate that HAI may be an important driver of the HIV epidemic in PNG. In order to improve the sexual health of Papua New Guineans, efforts are required to improve behavioural surveillance of HAI as well as develop national HIV/STI programing and policy to better address the risks associated with unprotected HAI.
巴布亚新几内亚（PNG）的性传播感染（STIs）负担沉重，是太平洋地区成人艾滋病毒感染率最高的国家。尽管疾病负担沉重，但异性肛交（HAI）却很少被考虑。鉴于在巴布亚新几内亚进行行为调查的数量不断增加，以及对这方面的兴趣越来越大，同时考虑到巴布亚新几内亚艾滋病毒流行情况的变化，现在及时对巴布亚新几内亚的 HAI 进行系统审查，以改善性健康状况是适时的。
我们对 1950 年 5 月至 2012 年期间在同行评议和非同行评议出版物中报告的巴布亚新几内亚 HAI 进行了系统审查。搜索策略确定了 475 篇出版物。经过地理位置、主题和方法筛选后，我们对 23 篇全文进行了审查，随后将 13 篇出版物纳入最终审查。使用审查数据，我们进行了风险方程分析，以展示 HAI 对巴布亚新几内亚艾滋病毒感染和发病率的潜在影响。
关于巴布亚新几内亚 HAI 的知情行为研究很少。关于 HAI 的关键问题不一致，使得无法进行荟萃分析。现有的 HAI 数据表明，它在所有地理区域和所有人群中都有实施。在报告 HAI 的人群中，根据回忆期和伴侣类型的不同，报告率从低至 8%到高至 77%不等。在 HAI 过程中使用避孕套的情况一直很低。我们的风险方程分析表明，即使只有 20%的女性从事 HAI，并且只有 10%的性行为涉及 HAI，那么女性中新感染艾滋病毒的人数也会比只有阴道性交增加 40%。
我们的研究结果表明，HAI 可能是巴布亚新几内亚艾滋病毒流行的一个重要驱动因素。为了改善巴布亚新几内亚人的性健康，需要努力改善 HAI 的行为监测，并制定国家艾滋病毒/性传播感染规划和政策，以更好地应对与无保护 HAI 相关的风险。
