Safer Anal Sex for Women

Since the onset of the HIV epidemic researchers from the Centers for Disease Control (CDC) have conducted numerous studies to calculate and identify behaviors that offer the highest risk of HIV infection. A study conducted in 1999 found that receptive unprotected anal sex carried the highest risk of HIV infection. That makes sense if you think about it. The anal mucosa are very friable and easily damaged especially during anal sex; an act that in relative terms can be very traumatic to the anal mucosa. It's for this reason that numerous prevention messages are targeted to people who engage in unsafe anal sex. However, while safer anal sex messages are targeted to gay men, prevention programs often overlook another group of people who engage in anal sex; namely women, straight, bisexual, and gay.

The risks of unprotected anal sex are clear and supported by reams of clinical data. Unprotected anal sex puts both partners at risk but the receptive partner is at the highest risk of HIV. In addition, anal sex without a condom can spread other sexually transmitted infections (STIs), namely gonorrhea, chlamydia, and syphilis. What's often forgotten about anal sex is that gay men are not the only group that engages in the activity. A recent study in New York City found that 30% of women 15 to 44 years of age had engaged in anal sex at some point in their life. And the HIV risk is as significant in women having anal sex as it is among gay men. The same study showed that women who have unprotected anal sex with an HIV-infected man are 30 times more likely to get HIV when compared to having one episode of unprotected vaginal sex with a man infected with HIV. So it's clear that the data supports the need for HIV prevention education regarding the risks of unprotected anal sex and furthermore, that information should be targeted not only to gay men but to heterosexual and gay women as well.

Are Woman Using Condoms?

Despite the lack of targeted prevention messages, most women do understand the importance of condom use in disease prevention; both HIV and STI's. However, it seems women are using condoms more during vaginal sex then they do during anal sex. Thomas Farley, the New York City Health Commissioner said that while the risks of unprotected anal sex seem to be widely known among women, "a large number of women are also putting themselves at high risk"; evidently by opting not to use condoms during anal sex. In fact the New York City study showed that only 23% of all women have used a condom during anal sex compared to 61% of gay men having anal sex.

Are Women Getting Tested for HIV?

Most everyone realizes the importance of HIV testing in the prevention of HIV infection. Most prevention messages talk about the importance and need for HIV testing. Yet it seems that those women who put themselves at the most sexual risk by having unprotected anal sex are also the women who get HIV tested least often. In fact, women having unprotected anal sex ("barebacking") were no more likely to get an HIV test than those women not having anal sex at all. Even more unfortunate are the missed opportunities for these women to get HIV tested. For instance, while over 90% of women who have unprotected anal sex see a health care provider, only little more than 30% of those women get HIV tested.

Many People are Dropping the Ball

As we look at the data; as we examine the trends; it's clear to me that many people are falling short of what's needed to address the problem of unprotected anal sex among straight and gay women.

• Prevention Educators - our prevention messages dealing with unsafe anal sex are targeted mainly to gay men. When in fact, women both straight and gay are engaging in unprotected anal sex. Our messages must change to include this at risk group.
• Healthcare Providers - providers must offer and or suggest HIV testing for their female patients regardless of the women's perceived risk. For instance, providers should address sexual history, including types of sexual practices (e.g. anal sex) when performing a woman's annual exam and Pap. Then with a detailed sexual history in hand, providers can identify those women at highest risk for STI's and HIV and offer HIV testing and prevention counseling in hopes of reducing the woman's sexual risk.
• People Engaging in Unsafe Anal Sex - unprotected anal sex by a woman is a risky sexual behavior and must be recognized as such. Among some women, especially among teen girls, anal sex is often viewed as a safe alternative to vaginal intercourse. While that may be true with regard to pregnancy, we have shown that anal sex is not the safe alternative many think. Condoms must be used with each and every sexual encounter, including anal sex. Many times the situation exists when men will not use condoms and won't discuss using condoms. In these situations, women must insist on condoms and must do their best to take control over their own sexual health.

Now that we have identified the problem what can women do to better protect themselves during anal sex? There are safer sex techniques available to women that will protect them during anal sex. The key is to use those techniques and methods each time there is sexual contact. It's important for all of us to realize that not only gay men have anal sex; unprotected anal sex is risky for anyone who engages in the practice; and straight, gay and bisexual women can protect themselves during anal sex. Understanding those things will help decrease the spread of HIV. Afterall, isn't that the ultimate goal of all of us?

_Sources

_{Keen, L.; "HIV Risk of Sex Practices Indentified"; The Washington Blade; 13 Aug 1999.}

_{New York City Department of Health and Mental Hygeine; "Women, Unprotected Anal Sex, and HIV Risk"; NYC Vital Signs; Feb 2010; Vol 9 No.2.}