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Heterosexual Anal Intercourse among Community and Clinical Settings in Cape Town, South Africa
  1. Seth Kalichman (seth.k{at}
  1. University of Connecticut, United States
    1. Leickness Simbayi (lsimbay{at}
    1. HSRC Cape Town, South Africa
      1. Demetria Cain (demetria.cain{at}
      1. University of Connecticut, United States
        1. Sean Jooste (sjoost{at}
        1. HSRC Cape Town, South Africa


          Background: Anal intercourse is an efficient mode of HIV transmission and may play a role in heterosexual HIV epidemics of southern Africa. However, little information is available on the anal sex practices of heterosexuals in South Africa.

          Purpose: To examine the occurrence of anal intercourse in samples drawn from community and clinic settings.

          Methods: Anonymous surveys collected from convenience samples of 2593 men and 1818 women in two townships and one large city STI clinic in Cape Town. Measures included demographics, HIV risk history, substance use, and three month retrospective sexual behavior.

          Results: A total of 14% (n = 360) men and 10% (n = 172) women reported engaging in anal intercourse in the past three months. Men used condoms during 67% and women 50% of anal intercourse occasions. Anal intercourse was associated with younger age, being unmarried, having a history of STIs, exchanging sex, using substances, having been tested for HIV, and testing HIV positive.

          Conclusions: Anal intercourse is reported relatively less frequently than unprotected vaginal intercourse among heterosexuals. The low prevalence of anal intercourse among heterosexuals may be offset by its greater efficiency for transmitting HIV. Anal sex should be discussed in heterosexual HIV prevention programming.

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