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Morhason-Bello IO, Mitchell K, Jegede AS, Adewole IF, Francis SC, Watson-Jones D. Heterosexual Oral and Anal Sex: Perceptions, Terminologies, and Attitudes of Younger and Older Adults in Ibadan, Nigeria. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:161-175. [PMID: 36123563 PMCID: PMC9484716 DOI: 10.1007/s10508-022-02313-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 05/24/2023]
Abstract
Although heterosexual oral and anal sexual behaviors have been reported in sub-Saharan Africa, little is known about how they are understood and perceived, particularly, in West Africa. We undertook a qualitative exploration of local terminologies and sexual scripts associated with heterosexual oral and anal sex in preparation for a quantitative survey. We held focus group discussions (18) and interviews (44) with younger and middle-aged men and women from the general population and female sex workers (FSWs) in selected communities in Ibadan. Most participants had heard of oral and anal sex. Younger adults aged 18-25 years, particularly male participants and FSWs, appeared more informed than older adults in the general population. Sexually explicit movies were the most cited source of information. Oral and anal sexual behaviors were considered sensitive, with different local names, meanings, and interpretations. Participants advised against the use of slang terms in research. We identified six different scripts employed by participants in discussing oral and anal sex practices: protecting sexual relationship, financial reward, an alternative to vaginal sex, pleasure, male dominance and control, and risk, stigma, and disgust.
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Affiliation(s)
- Imran O Morhason-Bello
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kirstin Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ayodele S Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Isaac F Adewole
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Suzanna C Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Magno L. [Qualitative studies on truck drivers and HIV/AIDS: contributions for the analysis of vulnerability]. CIENCIA & SAUDE COLETIVA 2019; 24:715-728. [PMID: 30892494 DOI: 10.1590/1413-81232018243.28912016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 03/18/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to conduct a critical identification and analysis, based on the analytical framework of the concept of vulnerability of truck drivers to HIV. The criteria for inclusion were to address the issue of truck drivers' susceptibility to HIV/AIDS and to adopt the qualitative approach. A total of 445 abstracts were located, of which 17 articles were included in the analysis and categorized as "sociocultural studies", "evaluative studies" and "risk behavior studies." The analysis was based on reflections surrounding the concept of vulnerability in health. The study criticizes the predominance of qualitative studies of a behaviorist nature, with an emphasis on the identification of risk behaviors, concepts and representations about HIV/AIDS. Furthermore, it points to studies of a sociocultural and evaluative nature that transcend the barrier of individual behaviors, expanding the scope of analysis, analysis of structural phenomena and interactions of subjects faced with the epidemic, duly approaching the concept of vulnerability. The review reveals the need for studies that take into account the concept of vulnerability, contextualizing the behaviors to the socio-structural dimensions involved in the AIDS epidemic.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia. R. Silveira Martins 2555, Cabula. 41150-000 Salvador BA Brasil.
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Morhason-Bello IO, Kabakama S, Baisley K, Francis SC, Watson-Jones D. Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review. Reprod Health 2019; 16:48. [PMID: 31060573 PMCID: PMC6501425 DOI: 10.1186/s12978-019-0722-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral and anal sexual behaviours are increasingly reported among adolescents and adults reporting heterosexual sex in peer-reviewed journals in high income countries, but less is known about these behaviours in low and middle-income countries, especially in sub-Saharan Africa. The aim of this systematic review is to describe the prevalence of, and motivations for, oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa. METHODS A systematic review of published articles that reported oral and or anal sex in sub-Saharan Africa was conducted from seven databases up to and including 30th August 2018. RESULTS Of 13,592 articles, 103 met the inclusion criteria. The prevalence of reporting ever practising oral sex among adolescents, university students and a combined population of adolescents/adults ranged from 1.7-26.6%, 5.0-46.4% and 3.0-47.2% respectively. Similarly, prevalences of reported ever practising anal sex ranged from 6.4-12.4% among adolescents, 0.3-46.5% among university students and 4.3-37.8% amongst combined population of adolescents and adults. Higher prevalences of oral and anal sex were reported among populations at high-risk for sexually transmitted infections and HIV and university students and, in most studies, both behaviours were more commonly reported by males than females. Heterosexual oral and anal sexual acts were associated with some high-risk behaviours such as inconsistent condom use and multiple sexual partners. CONCLUSION Reported oral and anal sex between men and women are prevalent behaviours in sub-Saharan Africa. Health professionals and policy makers should be aware of these behaviours and their potential associated health risks.
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Affiliation(s)
- Imran O. Morhason-Bello
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Suzanna C. Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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Carlos S, López-del Burgo C, Ndarabu A, Osorio A, Rico-Campà A, Reina G, Burgueño E, de Irala J. Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort. PLoS One 2019; 14:e0210398. [PMID: 30650137 PMCID: PMC6334946 DOI: 10.1371/journal.pone.0210398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. METHODS OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15-59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. RESULTS Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting "not" having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. CONCLUSIONS Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa.
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Affiliation(s)
- Silvia Carlos
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- * E-mail:
| | - Cristina López-del Burgo
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
| | | | - Alfonso Osorio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- School of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Anaïs Rico-Campà
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gabriel Reina
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Microbiology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Burgueño
- Monkole Hospital, Kinshasa, Democratic Republic of Congo
- School of Medicine, University of Mwene-Ditu, Mwene-Ditu, Democratic Republic of the Congo
| | - Jokin de Irala
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
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Mtenga SM, Pfeiffer C, Tanner M, Geubbels E, Merten S. Linking gender, extramarital affairs, and HIV: a mixed methods study on contextual determinants of extramarital affairs in rural Tanzania. AIDS Res Ther 2018; 15:12. [PMID: 29880001 PMCID: PMC5991469 DOI: 10.1186/s12981-018-0199-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extramarital sex is a potential driver of human immunodeficiency virus (HIV) transmission for long-term couples in sub-Saharan Africa. It is increasingly recognized that preventing sexual risk behaviours requires an understanding and adjustment of sexual relationship factors beyond the individual level. We investigated the association between extramarital affairs and HIV status, factors associated with extramarital affairs, and created insights in the context and pathways for married men and women in rural Tanzania who engage in extramarital affairs. METHODS A cross-sectional sequential explanatory mixed method design was employed. The WHO-Social determinants of health perspective guided the study. Using logistic regression, we analysed the MZIMA project community surveillance representative sample of 3884 married partners aged 15+ residing in Ifakara town, Tanzania (2012-2013). Multinomial logistic regression analysis established the relative risk ratio (RRR) of different social and economic factors with lifetime (proxy) and recent (12 months prior to survey) extramarital affairs. Logistic regression analysis determined the association between extramarital affairs and HIV status. Semi-structured interviews and focus group discussions explored the quantitative findings, capturing the experiences and norms regarding extramarital affairs. RESULTS We found a significant association between lifetime (proxy) extramarital affairs and HIV infection among women only. The RRR of having extramarital affairs (lifetime proxy) was significantly higher among Village Community Bank (VICOBA) members, the re-married, consumers of alcohol, those from southern regions, non-Muslims, and those with older age. In the case of recent extramarital affairs (12 months prior to survey), associations were significant for the same variables except for religion, having an income was also associated with the outcome. Qualitative narratives reflected that, desire to prove manhood (masculinity) supported by societal normative beliefs such as; 'it is not realistic for a man to stay without extramarital partner' and religious beliefs; 'a man shall dominate a woman' encouraged men's extramarital affairs. For women, striving for financial autonomy, obligations to pay back debts borrowed from several VICOBA, and limited support from their husbands encouraged their engagement in extramarital affairs. Low relationship quality (conflict and sexual dissatisfaction) were reported to encourage both men and women's extramarital affairs. CONCLUSIONS The findings show that the link between extramarital affairs and HIV has a gender dimension in which women are more likely to acquire HIV through extramarital affairs (case of recent extramarital affairs (12 months prior to survey). Future programs seeking to address risk sexual behaviors in Tanzanian marriages can consider context-sensitive interventions which address aspects beyond 'individual risk' and women's financial uncertainties, and include couple's relationship quality, excessive alcohol behaviors, normative masculinity ideology and societal norms, that encourage women's economic dependence and men's engagement in multiple sexual partnerships. Microfinance projects (e.g. VICOBA) could be a platform for gender-transformative approaches, combining economic empowerment and HIV risk protection strategies.
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Ishtiaq R, Asif A, Jamil AR, Irfan A, Ishtiaq D. Knowledge and Attitude About Sexually Transmitted Infections Amongst Truck Drivers in Southern Punjab, Pakistan. Cureus 2017; 9:e1118. [PMID: 28451477 PMCID: PMC5406173 DOI: 10.7759/cureus.1118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There is very limited knowledge about sexually transmitted infections (STIs) transmission and prevention present amongst high-risk groups such as truck drivers in Pakistan because of lack of awareness and understanding about barrier techniques. OBJECTIVE The aim of this study was to collect and access the data gathered from truck drivers about symptoms of STIs, their attitude towards hazards of multiple sexual partners, homosexuality, transmission and consequences of STIs, and their perception about preventing it using condoms and other barrier methods. METHODS This study was conducted at small roadside tea stalls and local rest areas on Karachi road, Lodhran near the city of Bahawalpur in Southern Punjab, Pakistan. A structured questionnaire was designed, and 50 willing truck drivers of the city of Bahawalpur were included and interviewed. It was a cross-sectional study. Data was collected on knowledge about the STIs and use of barrier methods like condoms. Quantitative data was assessed and analyzed using SPSS version 23.0 (IBM, NY, USA). RESULTS Fifty truck drivers of Bahawalpur were interviewed via standardized questionnaire in this study. All of them provided answers about their knowledge of STIs. Twenty drivers (40%) reported burning micturition, and only two (four percent) knew the real cause of it. Thirty-two (64%) of them were well aware of the use of condoms. Thirty-eight (76%) truck drivers had the knowledge about the adverse effects of multiple sex partners. CONCLUSION The truck drivers of Bahawalpur city are quite vulnerable to STIs and this demonstrates the importance of prevention programs that can target this particular group. A significant number of the respondents had serious gaps in their knowledge about STIs like acquired immunodeficiency syndrome (AIDS), especially its modes of transmission, signs, and symptoms. The knowledge of other routes of human immunodeficiency virus (HIV) transmission like needle sharing and blood transfusion, and precautionary steps should be given due respect in HIV/AIDS awareness programs.
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Affiliation(s)
- Rizwan Ishtiaq
- General Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Ammar Asif
- General Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | | | - Areba Irfan
- General Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Daniyal Ishtiaq
- General Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan
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Fleming PJ, DiClemente RJ, Barrington C. Masculinity and HIV: Dimensions of Masculine Norms that Contribute to Men's HIV-Related Sexual Behaviors. AIDS Behav 2016; 20:788-98. [PMID: 26696261 PMCID: PMC4799765 DOI: 10.1007/s10461-015-1264-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Numerous studies have documented a relationship between masculine norms and men's HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men's sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men's HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men's sexual behavior: (1) uncontrollable male sex drive, (2) capacity to perform sexually, and (3) power over others. While the existing literature does help explain the relationship between masculine norms and men's sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts.
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Affiliation(s)
- Paul J Fleming
- Division of Global Public Health, University of California, San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA.
| | - Ralph J DiClemente
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
- Center for AIDS Research, Prevention Sciences & Epidemiology Core, Atlanta, GA, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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