Introduction Although HIV rates among South African youth are among the highest in the world, most research efforts have overlooked anal sex as a contextualising factor.

Methods In 2012, a pencil-and-paper survey was completed by 937 youth 16 years of age and older who were attending low-income secondary schools in Cape Town.

Results Eleven and 31% of female and male youth, respectively, reported ever having anal sex. Among sexually active male and female respondents, those who had ever had anal sex were more likely to report inconsistent condom use, perpetrate dating violence, and experience victimisation and perpetration of sexually coercive behaviour. Female respondents who had ever had anal sex had significantly lower levels of HIV information than sexually active females who had not had anal sex.

Conclusion Rates of anal sex are higher for boys than girls in the survey, yet the associated risk factors were strikingly similar. Harm reduction strategies for anal sex should be made available to South African youth.