Abstract
BackgroundPapua New Guinea (PNG) has a high burden of sexually transmitted infections (STIs) and the highest adult HIV prevalence in the Pacific region. Despite this burden of disease, heterosexual anal intercourse (HAI) has rarely been considered. Given the increasing number of, and interest in, behavioural surveys in PNG and the changing nature of PNG’s HIV epidemic, it is timely to conduct a systematic review of HAI in PNG order to improve sexual health.MethodsWe performed a systematic review of HAI in PNG as reported in peer-reviewed and non-peer-reviewed publications for the period 1950–May 2012. The search strategy identified 475 publications. After screening by geographical location, topic and methodology, we identified 23 publications for full text review, following which 13 publications were included in the final review. Using data from the review, we performed a risk equation analysis to demonstrate the potential impact of HAI on HIV acquisition and incidence in PNG.ResultsThere is a paucity of well-informed behavioural research on HAI in PNG. Inconsistency in key questions on HAI made it impossible to conduct a meta-analysis. The data available on HAI shows that it is practiced in all geographical areas and among all populations. Of those who reported HAI, rates varied from as low as 8% to as high as 77% depending on the recall period and partner type. Condom use during HAI was consistently low. Our risk equation analysis indicates that even if only 20% of females engage in HAI, and only 10% of sex acts involve HAI, the total number of new HIV infections among females would be 40% greater than if vaginal intercourse only occurred.ConclusionsOur findings of indicate that HAI may be an important driver of the HIV epidemic in PNG. In order to improve the sexual health of Papua New Guineans, efforts are required to improve behavioural surveillance of HAI as well as develop national HIV/STI programing and policy to better address the risks associated with unprotected HAI.
Highlights
Papua New Guinea (PNG) has a high burden of sexually transmitted infections (STIs) and the highest adult HIV prevalence in the Pacific region
Heterosexual anal intercourse in PNG: systematic review Following the methods outlined in the PRISMA Guidelines, after the initial search was completed and the removal of duplicates was finalised, our search strategy resulted in 475 publications
One study of female sex workers (FSW) reported on heterosexual anal intercourse (HAI) and penile-oral sex simultaneously making it impossible to discern what proportion of FSW engaged in HAI [57]
Summary
Papua New Guinea (PNG) has a high burden of sexually transmitted infections (STIs) and the highest adult HIV prevalence in the Pacific region. Despite this burden of disease, heterosexual anal intercourse (HAI) has rarely been considered. The risk of transmission during unprotected anal intercourse has been estimated to be 10 times greater than during unprotected vaginal intercourse [8,9,10]. HIV transmission is often presumed synonymous with vaginal intercourse, as there is no distinction between risk behaviours [12]. Despite the higher transmission risk of HIV from males to females during anal intercourse, behavioural surveys rarely acknowledge HAI
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
