Heterosexual Anal Intercourse in the United States [6]

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More than one-third of women in the U.S. have engaged in heterosexual anal intercourse (HAI). The risk of acquiring HIV per sexual act is estimated to be 18 times higher for receptive anal intercourse than receptive vaginal intercourse; HAI is also associated with lower rates of condom use. We sought to describe frequency of HAI and condom use, HAI motivations, and HIV knowledge in the U.S.


A nationally representative sexual behavior survey of 5,162 women and men aged 18–50 year old was conducted. Data were analyzed using chi-square tests, t tests, and multivariable log-binomial regression.


Thirty-seven percent of women have engaged in HAI. In the past three months, 12.2% have engaged in HAI, compared to 83.0% reporting vaginal intercourse. The most common motivations for HAI were self and partner pleasure and curiosity. Twice as many men as women reported ever using HAI as a method of contraception (13.5% vs 6.6%, P<.001). Condom use was lower for anal versus vaginal intercourse (9% vs 16%, P<.001). More than 70% of adults erroneously believe that HIV transmission risk is greater for vaginal intercourse than anal intercourse.


HAI is common in the U.S. Both women and men report a wide range of motivations for both HAI and condom use with HAI. Significant knowledge gaps exist regarding HAI and HIV transmission.

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