Abstract
Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03–2.38, N = 18, I2 = 72%; pooled aRR = 2.23, 1.01–4.92, N = 5, I2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI.
Highlights
HIV acquisition risk during one receptive anal intercourse (RAI) act unprotected by pre-exposure prophylaxis (PrEP) or condoms (URAI) is higher than during receptive vaginalElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.intercourse (RVI) unprotected by PrEP or condoms (URVI), with pooled estimates from previous systematic reviews of 1.25% (95% confidence interval (CI) 0.55–2.23) and 0.08% (0.06–0.11) per URAI and URVI act, respectively [1,2,3]
Full-text review identified 19 articles and two further articles [12, 14] were identified through scanning bibliographies, giving a total of 21 included articles that reported on 17 unique longitudinal studies
16 studies reporting 18 independent cRR estimates, including one study reporting three independent estimates, and five studies reporting five independent aRR estimates were included in the meta-analysis (Fig. 1)
Summary
HIV acquisition risk during one receptive anal intercourse (RAI) act unprotected by pre-exposure prophylaxis (PrEP) or condoms (URAI) is higher than during receptive vaginal. Intercourse (RVI) unprotected by PrEP or condoms (URVI), with pooled estimates from previous systematic reviews of 1.25% (95% confidence interval (CI) 0.55–2.23) and 0.08% (0.06–0.11) per URAI and URVI act, respectively [1,2,3]. A risk equation model among high-risk women from 20 US cities estimated that 38% of HIV infections were due to RAI [11] Another modelling analysis in Papua New Guinea predicted that if 20% of all women practised RAI in 10% of sex acts, and 90% of RAI acts were condomless, the total number of new infections would be 40% greater than if only RVI occurred [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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.
