International Training and Education Center for Health (I-TECH), 10 Natal Road, Belgravia, Harare.
Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, 16801, USA.
Afr Health Sci. 2022 Mar;22(1):11-20. doi: 10.4314/ahs.v22i1.3.
Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practised mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa.
A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI.
A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimate of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months' recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month's recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI.
Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA.
肛交被报道是传播人类免疫缺陷病毒（HIV）风险最高的性行为之一，而使用安全套可以最大程度地降低这种风险。虽然肛交主要被男男性行为者（MSM）采用，但也有报道称异性恋关系中也存在肛交。然而，在撒哈拉以南非洲地区，关于异性恋肛交中使用安全套的数据还不够充分。
对 2010 年 1 月至 2020 年 5 月期间在撒哈拉以南非洲地区进行的关于异性恋肛交中使用安全套的英文已发表文章进行了系统的文献回顾。文章在 PubMed 和 Google Scholar 电子数据库中进行了系统性检索。异性恋肛交被定义为男性与女性之间的阴茎穿透性肛交，无论涉及肛交行为的双方的性取向如何。
共有 21 项研究符合分析标准。大多数研究（21 项研究中有 17 项）报告女性参与异性恋肛交，而 21 项研究中有 9 项报告男性参与异性恋肛交。异性恋肛交中使用安全套的终生患病率估计值在 29%-97.5%之间。其他关于异性恋肛交中使用安全套的流行率估计值是在不同的回忆期报告的，12 个月的回忆期流行率估计值范围为 2.9%-59%；过去 3 个月的流行率估计值范围为 50%-94.4%；1 个月的回忆期流行率估计值范围为 5%-96%，最近一次性交的流行率估计值范围为 1%-55%。在女性性工作者（FSW）、男男性行为者（MSM）和一些普通人群中的女性中，异性恋肛交中使用安全套的比例普遍较低且/或不一致。在这项研究中，没有发现与异性恋肛交中使用安全套不一致或使用安全套较少相关的风险因素。
本研究表明，异性恋肛交中使用安全套的比例可能相当低，尤其是在 FSW、MSM 和一些普通人群中的女性中。使用安全套不一致或使用安全套较少的风险因素尚不清楚。在撒哈拉以南非洲地区，异性恋肛交和肛交中使用安全套的情况通常是一个研究不足的课题。未来的研究需要全面探讨异性恋肛交和肛交中使用安全套的情况，以便就该主题提供具体证据，为减少撒哈拉以南非洲地区异性恋人群中的 HIV 提供信息支持。
