Thursday, January 5, 2012

In Africa, anal sex goes Hetero

While I was in secondary school, I have always been told that rectal sex is something between two men. Even many anti gay activists have used this sexual practice as a means of attacking the gay movement. It is the core of the sodomy law in Africa and the buggery law in other part of the world.

However, the recent study in Africa has shown an increasing number of straight people and mostly young heterosexual people practising anal sex on a daily basis.

While the notion of sex in itself is a very difficult topic to tackle in the African setting, the mere fact that more and more straight couples in Africa are embarking on a rectal sexual journey for pleasure gives a call for concern – because most of this is unprotected by condoms.

An act of unprotected anal intercourse is 10 to 20 times more likely to result in HIV transmission compared to an act of unprotected vaginal intercourse, due to the different biological characteristics of the rectum which make it much more susceptible to infection.

What do we know?

According to Morenike Ukpong, a Nigerian Microbicide activist ; over 12% of young people in Nigeria are practising anal intercourse. In different studies done across Africa, the following were found as anal sexual practices among heterosexuals.

An anonymous survey of 2593 men and 1818 women in Cape Town according to Kalichman et al (2009), they found out 14% of Men and 10% of Women have engaged in anal sex in the last 3 months, of this only 67% of the men use condoms compared to just 50% of the woman.

Even there is a significant drop of condom use among truck drivers (N=320) in South Africa Ramjee et al (2002) and sex workers (N=147) in Kenya. Schwandt et al (2006). The two studies find 42% of truck drivers having anal sex with female sex workers, while it was 40% among female sex worker who said they have ever practised anal sex.

This is not the end of the surprising data. In Lane et al (2006) findings, it showed that young people between the ages of 15-24 years in South Africa engage in anal sexual behaviour. There is no difference between the sexes, while young male engage at rate of 5.5%, young female are at 5.3%.

More interesting is Matasha (1998) findings that among primary school pupils in Tanzania, 9% had anal sex as their first sexual experience.

Taken together, these studies show that there is a previously unknown anal sexual behaviour among heterosexuals but the focus on anal sex and health for many years has been the limited to gay/MSM communities.

What we are getting wrong

The focus of HIV prevention in Africa has always been primarily targeted at vaginal sex, and thereby prevention messages have always been use condoms. But we are now finding out that as straight people engage in anal sex, the likelihood of using condoms diminishes. For many, anal intercourse may be a form of virginity protection, or contraception, and there is a common belief that anal intercourse carries no risk for HIV infection.

Dr. Karim of the famous CAPRISA 004 argued that this sexual behaviour – when unprotected - could be driving a sizable amount of new HIV infections in Africa. In agreeing with him, I asked the question “is it time for us to broaden our scope of what HIV transmission looks like in Africa?”

If we still argue that HIV transmission in Africa is mainly heterosexual, are we assuming that the risk is only from unprotected vaginal intercourse? Or are we going to acknowledge the prevalence of unprotected anal intercourse among heterosexuals and address heterosexual transmission more broadly, and honestly?

Not only are we overlooking the reality and the prevalence of this sexual behaviour among the general heterosexual population (Note that these are small studies, which means that if we were to conduct bigger and broader survey we will find more), we are also losing the need to do a reassessment of our prevention strategy that will provide safer anal intercourse irrespective of gender or sexual orientation.

Coupled with the myth around anal sex is the lack of using the right lube. In a presentation at the strategic meeting by Dr. Brian Kanyemba from the Desmond Tutu foundation, he said people were using all kinds of things for lubricant: olive oil, Vaseline, Vicks and even mayonnaise - none of which are condom-compatible.

Gay and straight couples need to know the facts about anal intercourse, and need condoms and condom-compatible lubricants to engage in this behaviour in a safer way.

The hope. The future

Anal sex is a pleasurable sexual activities and it can be safe if and when certain conditions are met. These conditions include; using condoms with condom-compatible lubrication.

Another answer to safer anal sex is rectal Microbicides - which would be a lube or a gel with anti-HIV properties.

A safe and effective rectal Microbicides could help everyone engaging in anal sex have a pleasurable and safer sexual experience.

It is important to know however that it is not a replacement for condom use, but it is to be used as an additional option for protection, Ideally, one day we will have rectal Microbicides that not only protect against HIV, but other STDs as well.

As we drive towards zero HIV infection, it is also important we started looking at other prevention technologies that will be very easy for people to use without actually affecting their sexual behaviour.

As IRMA’s rectal Microbicides advocates sat down to work at the Project ARM meeting in Addis in 2010, one of the interesting things that came out was the need to intensify advocacy for rectal Microbicides in many ways and that includes engaging with our community to let people know that anal sex is a human behaviour, both homosexual and heterosexual.

There is increasing need for information on anal sex, anal  health and active involvement of NGOs in Africa. This campaign should also include NGOs working with African communities all over the world. Also we should start the discussion with women; both young and old that there is a need for more discussion on anal sex

Rectal Microbicides are looking like the future of HIV prevention, but for the dream to be achieved, there is the need for everyone to be involved in the process – on both the research and advocacy fronts.

From civil societies to clinicians, doctors to government officials, international organizations and funders the world over.

But while we await the rectal Microbicides reality, we should not forget that when we talk anal sex, we should also scream……… AND LUBE.

As without the right use of the right lube, anal sex will not only be painful and unpleasant, but also puts the receptive partner at the danger of sexually transmitted infections including HIV.

Anal sex is great, condom use is pleasure, but don’t forget AND LUBE.


Matasha et al (1998) Sexual and reproductive health among primary and secondary school pupils in Mwanza, Tanzania: need for intervention.