Wamoyi Joyce, Mongi Aika, Sally Mtenga, Kakoko Deodatus, Shamba Donat, Geubbels Eveline, Kapiga Saidi
National Institute for Medical Research, Department of Sexual and Reproductive Health, P.O Box 1462, Mwanza, Tanzania.
Mwanza Intervention Trial Unit (MITU), Mwanza, Tanzania.
BMC Public Health. 2015 Apr 24;15:417. doi: 10.1186/s12889-015-1768-4.
The risk of contracting HIV through heterosexual anal sex (HAS) is significantly higher than from vaginal intercourse. Little has been done to understand the discourses around HAS and terms people use to describe the practice in Tanzania. A better understanding of discourses on HAS would offer useful insights for measurement of the practice as well as designing appropriate interventions to minimise the risks inherent in the practice.
This study employed qualitative approaches involving 24 focus group discussions and 81 in-depth interviews. The study was conducted in 4 regions of Tanzania, and included samples from the general population and among key population groups (fishermen, truck drivers, sex workers, food and recreational facilities workers). Discourse analysis was conducted with the aid of NVIVO versions 8 and 10 software.
Six discourses were delineated in relation to how people talked about HAS. Secrecy versus openness discourse describes the terms used when talking about HAS. "Other" discourse involved participants' perception of HAS as something practiced by others unrelated to them and outside their communities. Acceptability/trendiness discourse: young women described HAS as something trendy and increasingly gaining acceptability in their communities. Materiality discourse: describes HAS as a practice that was more profitable than vaginal sex. Masculinity discourse involved discussions on men proving their manhood by engaging in HAS especially when women initiated the practice. Masculine attitudes were also reflected in how men described the practice using a language that would be considered crude. Public health discourse: describes HAS as riskier for HIV infection than vaginal sex. The reported use of condoms was low due to the perceptions that condoms were unsuitable for anal sex, but also perceptions among some participants that anal sex was safer than vaginal sex.
Discourses among young women and adult men across the study populations were supportive of HAS. These findings provide useful insights in understanding how different population groups talked about HAS and offer a range of terms that interventions and further research on magnitude of HAS could draw on when addressing health risks of HAS among different study populations.
通过异性肛交感染艾滋病毒的风险显著高于阴道性交。在坦桑尼亚，人们对围绕异性肛交的话语以及用于描述这种行为的术语了解甚少。更好地理解关于异性肛交的话语，将为衡量这种行为以及设计适当的干预措施以降低该行为固有的风险提供有益的见解。
本研究采用定性方法，包括24次焦点小组讨论和81次深入访谈。研究在坦桑尼亚的4个地区进行，样本包括普通人群和关键人群（渔民、卡车司机、性工作者、食品和娱乐设施工作者）。借助NVIVO 8版和10版软件进行话语分析。
根据人们谈论异性肛交的方式，确定了六种话语。保密与公开话语描述了谈论异性肛交时使用的术语。“他人”话语涉及参与者将异性肛交视为与他们无关且在其社区之外的其他人所进行的行为。可接受性/时尚性话语：年轻女性将异性肛交描述为一种时尚行为，并且在她们的社区中越来越被接受。物质性话语：将异性肛交描述为比阴道性交更有利可图的行为。男子气概话语涉及关于男性通过进行异性肛交来证明自己男子气概的讨论，尤其是当女性发起这种行为时。男性的态度也体现在他们用粗俗语言描述这种行为的方式上。公共卫生话语：将异性肛交描述为比阴道性交更容易感染艾滋病毒的行为。由于认为避孕套不适合肛交，以及一些参与者认为肛交比阴道性交更安全，报告的避孕套使用率较低。
研究人群中的年轻女性和成年男性的话语支持异性肛交。这些发现为理解不同人群如何谈论异性肛交提供了有益的见解，并提供了一系列术语，干预措施以及关于异性肛交规模的进一步研究在解决不同研究人群中异性肛交的健康风险时可以借鉴。
