Vaginal sex, thigh sex, even armpit sex - people have sex in lots of ways, but in heterosexual anal sex, HIV prevention programming is silent about the high risk of infection that goes with it, and people may have mistaken this silence for safety.
The risk of contracting HIV through unprotected receptive anal sex is almost 20 times greater than the HIV risk associated with vaginal intercourse.
While this fact is often a focus in HIV prevention programming aimed at men-who-have-sex-with-men (MSM), it has been largely left out of programmes for heterosexuals, according to Zoe Duby of the University of Cape Town, South Africa, and the Desmond Tutu HIV Foundation.
Duby presented the findings of her study, which interviewed almost 400 people in Tanzania, Uganda and Kenya, at the 1st HIV Social Sciences and Humanities Conference held recently in Durban, South Africa.
“Safer sex programming has, in my opinion, failed to take into account varying definitions of sex. The omission of anal sex in safe sex messaging has been interpreted as meaning that anal sex is safe,” she told IRIN/PlusNews.
“What people preach out there, it’s just vaginal sex - not information on anal [sex],” said a young woman from Salgaa, Kenya, who was quoted in the research. “So somebody thinks, ‘if I do [sex] this other way, then I will not get HIV.’”
Even more worrying was that research showed healthcare workers often held similar views, and some incorrectly believed HIV was only present in vaginal fluid. The virus is, in fact, also present in male sperm and blood.
“Me, I do not want to practice vaginal sex because that is the highest [risk] sex that transmits HIV, so it is a belief… that non-vaginal sex does not transmit HIV,” one Kenyan healthcare worker reported.
A nurse in Malaba, Uganda, said: “As you go and have sex vaginally you can get HIV, but these other methods, they do not expose you [to HIV].”
Virginity, pregnancy and pleasure
East African respondents said anal sex was also practiced as a way to prevent pregnancy, increase sexual pleasure, or preserve a woman’s virginity, which was only associated with vaginal sex.
“A lady got married a real virgin… and then she started showing symptoms of HIV. When she was questioned… she started crying, saying that she was advised to only have anal sex so that she would still maintain her virginity and respect during marriage,” a Kenyan truck driver said during an interview.
|As you go and have sex vaginally you can get HIV, but these other methods, they do not expose you to HIV|
“Youth today are searching for these things that don’t make them lose their virginity but allow them to still sort of engage in sexual activity,” according to another young woman. Anal sex is seen as a cultural “loophole”.
“My religious friends who are trying to hold onto some sanctity of waiting until they’re married to have sex, they feel that oral and anal sex are sex that they can have that’s still not full sex,” a female respondent told Duby.
She said research about the use of anal sex to preserve virginity has noted similar views among young South African women, especially in communities that practice virginity testing.
Safe sex messaging
Duby cautioned that her results - part of a Family Health International evaluation of an HIV programme for mobile populations - should not be generalized, but did show that anal sex must be included HIV prevention programming.
“Sex has largely been defined as penile-vaginal penetrative sex… We hear this word ‘sex’ bandied about all the time but… we’re not really looking at… how [people] are defining it in order to tailor safe sex messaging.” she told IRIN/PlusNews.
“Due to the assumptions that sex refers to penile-vaginal penetration only, people put themselves at a greater risk of contracting HIV in an attempt to practice safe sex,” Duby added. “Unprotected anal sex can no longer be ignored as a significant contributing factor in the global HIV epidemic.”