Official websites use. Share sensitive information only on official, secure websites. Correspondence to Dr. Current evidence suggests that anal intercourse AI during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus HIV epidemics has been investigated. Poisson regressions were used to identify AI determinants. Despite representing a small fraction of all sex acts, AI is an underestimated source of HIV transmission.
Increasing availability and uptake of condoms, lubricants, and pre-exposure prophylaxis for women engaging in AI could help mitigate HIV risk.
Female sex workers FSWs share a disproportionately high burden of human immunodeficiency virus HIV infection worldwide 1. This results from an intertwined sets of behavioral, biological, and sociostructural factors that enhance their vulnerability to HIV acquisition 2. Although sex work intersects with injecting drug use in some settings, the primary mode of HIV acquisition and transmission for FSWs is thought to be vaginal intercourse VI.
Insertive and, particularly, receptive anal intercourse AI carry a well-recognized heightened risk of HIV transmission as compared with VI 3 , 4 , which does not substantially differ between male-female and male-male contacts 5 , 6. Paradoxically, the role of heterosexual AI in HIV epidemics seems to have been minimized in prevention, assuming that AI contributes little to HIV transmission despite growing evidence that this behavior is quite common among heterosexual men and women of all ages 7 β 9.
Collecting reliable information on AI prevalence, frequency, and determinants is key to designing more effective HIV prevention efforts. Targeted interventions among high-risk populations, such as FSWs performing receptive AI, could be an effective way to further curb HIV transmission Specifically, evidence suggests that condom use during AI is lower and breakage more frequent than during VI 3 , 12 β Studies have also associated substance abuse, sexual violence, and coercion with AI practices 10 , 15 β These factors could further enhance HIV transmission during AI; understanding these vulnerability patterns remains important to prevention efforts.
