Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, Praed Street, London, W2 1NY, UK.
Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK.
BMC Womens Health. 2022 Jul 14;22(1):291. doi: 10.1186/s12905-022-01849-0.
Anal intercourse (AI) is not uncommon among U.S. women and, when condomless, confers a far greater likelihood of HIV transmission than condomless vaginal intercourse. We aim to identify determinants preceding AI, among women with, and women without HIV.
3708 women living with (73%), and without HIV (27%) participating in the Women's Interagency HIV Study provided sexual behavior and other data at 6-monthly visits over a median of 9 years (1994-2014). We used generalized estimating equation models to examine sociodemographic, structural and behavioral determinants reported in the visit preceding (1) AI, and (2) condomless AI.
AI was reported at least once over follow-up by 31% of women without, and 21% with HIV. AI was commonly condomless; reported at 76% and 51% of visits among women living without HIV, and with HIV, respectively. Women reporting AI were more likely to be younger (continuous variable, adjusted odds ratio (aOR) = 0.97, 95% confidence interval (CI):0.96-0.98), Hispanic (aOR = 1.88, CI:1.47-2.41) or White (aOR = 1.62, CI:1.15-2.30) compared to Black, and have at least high school education (aOR = 1.33, CI:1.08-1.65). AI was more likely following the reporting of either (aOR = 1.35, CI:1.10-1.62), or both (aOR = 1.77, CI:1.13-2.82) physical and sexual violence, excessive drinking (aOR = 1.27, CI:1.05-1.66) or any drug use (aOR = 1.34, CI:1.09-1.66), multiple male partners (aOR = 2.64, CI:2.23-3.11), exchange sex (aOR = 3.45, CI:2.53-4.71), one or more female sex partners (aOR = 1.32, CI:1.01-1.75), condomless vaginal intercourse (aOR = 1.80, CI:1.53-2.09), and high depressive symptoms (aOR = 1.23, CI:1.08-1.39).
AI disproportionally follows periods of violence victimization, substance use, multiple sex partners and depression. Better prevention messaging and biomedical interventions that reduce acquisition or transmission risk are needed, but when AI occurs in the context of violence against women, as our findings indicate, focusing on gender-based violence reduction and immediate treatment to reduce HIV transmission risk is important.
肛交（AI）在美国女性中并不少见，而且如果没有使用安全套，那么 AI 导致 HIV 传播的可能性要远远大于无套阴道交。我们的目标是确定在 HIV 阳性和阴性女性中，发生 AI 之前的相关决定因素。
3708 名女性参与了妇女间艾滋病毒研究（Women's Interagency HIV Study），其中 HIV 阳性女性占 73%，HIV 阴性女性占 27%。在中位数为 9 年（1994-2014 年）的每 6 个月一次的随访中，这些女性提供了性行为和其他数据。我们使用广义估计方程模型，对在随访前（1）AI 和（2）无套 AI 报告中出现的社会人口统计学、结构和行为决定因素进行了检查。
在没有 HIV 的女性中，至少有一次 AI 报告，比例为 31%；在 HIV 阳性女性中，比例为 21%。AI 通常是无套的；在没有 HIV 的女性中，76%的报告中有 AI，在 HIV 阳性女性中，51%的报告中有 AI。报告 AI 的女性更年轻（连续变量，调整后的优势比（aOR）=0.97，95%置信区间（CI）：0.96-0.98），更有可能是西班牙裔（aOR=1.88，CI：1.47-2.41）或白人（aOR=1.62，CI：1.15-2.30），而不是黑人，并且至少接受过高中教育（aOR=1.33，CI：1.08-1.65）。无论是报告（aOR=1.35，CI：1.10-1.62），还是报告（aOR=1.77，CI：1.13-2.82）身体和性暴力、过度饮酒（aOR=1.27，CI：1.05-1.66）或任何药物使用（aOR=1.34，CI：1.09-1.66），还是报告多个男性性伴侣（aOR=2.64，CI：2.23-3.11）、性交易（aOR=3.45，CI：2.53-4.71）、一个或多个女性性伴侣（aOR=1.32，CI：1.01-1.75）、无套阴道交（aOR=1.80，CI：1.53-2.09）或有较高的抑郁症状（aOR=1.23，CI：1.08-1.39），都更有可能发生 AI。
AI 主要发生在遭受暴力侵害、物质滥用、多个性伴侣和抑郁的时期。需要更好的预防信息传递和生物医学干预措施来降低获得或传播的风险，但当 AI 发生在针对妇女的暴力行为背景下时，正如我们的研究结果所示，重点关注减少基于性别的暴力和立即进行治疗以降低 HIV 传播风险是很重要的。
