Nevertheless, there is evidence to suggest that anal intercourse is also widely practiced by women in the US 1 — 4. Given that anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse 10 — 13women who engage in unprotected anal intercourse with sexual partners of unknown or seropositive status may be at greater risk for acquiring HIV than women who do not practice anal intercourse or who use protection while doing so. Additionally, Halperin 1 found that women who engaged in anal intercourse were less likely to use condoms during anal intercourse than during vaginal intercourse. Most studies of heterosexual HIV transmission fail to distinguish between vaginal and anal intercourse in their assessments of coital acts, thus continuing to overlook anal intercourse as a potential source of HIV transmission. This oversight may be due to cultural taboos surrounding anal intercourse, including its association with homosexuality and its perceived lack of hygiene 1. A number of researchers have already pointed to the need for increased attention to anal intercourse as an understudied source of HIV transmission from seropositive men to their seronegative female partners 136 A topic that has received even scarcer attention is the circumstances under which women engage in anal intercourse. Our qualitative study was part of a larger study on rectal microbicide acceptability among men who have sex with men MSM and women who practice anal intercourse.
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