Heterosexual Anal Sex: Findings From A Large Population-Based Sample

Background: Anal sex poses a risk for sexually transmitted infections (STI), including HIV.

Objectives: To describe the prevalence of recent heterosexual anal sex among the general population of New York City.

Methods: In 2007, a telephone probability-based survey collected data from 2890 men and 4404 women aged 18-64 years. Weighted data analyses were performed for heterosexual men, defined as men reporting sex with females in the last year and no history (ever) of male partners (n=1947), and for women reporting sex with males in the last year (n=2256).

Results: Overall, 7.3% of heterosexual men reported insertive and 5.6% of women reported receptive anal sex in the last year. For these individuals, the percentage reporting anal sex peaked in the younger ages (range, 4.2% among men and 1.6% among women aged 45-64 years, to 13.8% among men and 10.8% among women aged 18-24 years). Women of all racial/ethnic groups were equally likely to engage in anal sex but more Hispanic men (13%) reported anal sex compared to others (e.g., 3.3% for non-Hispanic Black men). The prevalence of anal sex increased significantly with a greater number of sex partners (range, 5.4% among men and 4.5% among women with 1 partner, to 13.8% among men and 14.7% among women with >3 partners in the last year). Approximately only one-quarter of respondents reported always using condoms with anal sex during the past year (men: 27.9%, women: 22.7%).

Conclusions: Anal sex is relatively common, especially among persons with multiple partners. Low rates of consistent condom pose a risk for STI transmission.

Implications for Programs, Policy, and/or Research: Physicians should ask about anal sex practices to inform appropriate, anatomic site-specific screening. There is a need for commercially available tests for anorectal specimens. Public health messages should include information on heterosexual anal sex.