Background Understanding of the context of anal sex behaviour among Black and Hispanic adolescent women with a history of sexually transmitted infection (STI/HIV) has public health implications for health promotion and risk reduction behavioural interventions.

Methods African-American (n = 94, 16.8%) and Mexican-American (n = 465, 83.2%) women (14–18 years) with histories of sexual risk behaviour, STI or violence, recruited from metropolitan sexual health clinics for participation in a clinical trial for behavioural interventions, completed semi-structured interviews to assess psychosocial and situational factors associated with high sexual risk behaviour, substance use, STI/HIV acquisition, and violence occurrence at study entry.

Results Anal sex varied by ethnicity (24.1% Mexican-American, 10.6% African-American, p = 0.004) and was associated with more (p < 0.05) run-away, school dropout, sexual partners, bisexuality, sex for favours, money or friends with benefits, group sex, substance and alcohol use, sex when high, history of STI, withdrawal for birth control and psychological distress. More (94.3% vs. 85.1%) and higher levels of violence (8.37 vs. 6.38) overall, and by comparisons of sexual and physical violence was identified. Age at first anal sex (15.85 years) with partner age (18.43 years), ever condom use for anal sex (38%), anal sex past year (79.5%), past 6 months (61.2%), past 3 months (36.7%) with limited condom use (40.8%) was self-reported. Fewer women reporting anal sex could stop having sex with partners having sex with others (64.7% vs. 76.2%) while more believed it’s okay to have a man on the side for more variety/sex (43.9% vs. 18.3%), he fools around so why shouldn’t I? (25.8% vs. 15.1%) or I get high and lose control (24.2% vs. 14.5%).

Conclusions Conceptualization of anal sex behaviour within partner relationships is important for modification of evidence-based sexual health promotion interventions to enhance efficacy for prevention of violence, substance use, unintended pregnancy and STI/HIV among ethnic minority adolescent women.