Asia-Pacific E-Journal of Health Social Science https://sites.google.com/site/asiapacificejournalofhss/. December 2012. Volume 1, Number 2. All rights reserved.

ISSN 2244-0240

Research Brief

Men Who Engage in Anal Intercourse

Kent C. Tangcalagan University of San Jose Recoletos, Cebu City, Philippines, kent_tangcalagan@live.com

In addition to their exposure to unhealthy lifestyle practices (e.g., smoking), many men throughout the world are likewise at risk due to their sexual behavior, such as anal intercourse (American Psychological Association, Task Force on Gender Identity and Gender Variance, 2009). Whether insertive and/or receptive, anal sex, especially if it is unprotected (i.e., without using a condom), exposes individual men to the risk of acquiring sexually transmitted infections (STI). Of the approximately 19 million STI cases worldwide, 30% have been attributed to anal sex (Malhotra, 2008). The transmission of human immunodeficiency virus (HIV) via anal sex is also well-established, with reports stating that it occurs 5 times higher in receptive anal intercourse and 1.3 times higher in insertive anal intercourse (McBride & Fortenberry, 2010). Due to their pivotal role in the transmission of HIV and other STI, men engaging in anal intercourse have formed part of the primary target groups in HIV/AIDS prevention and control programs in various parts of the world (Interagency Youth Working Group, 2010; Regional HIV & Development Programme for Asia & the Pacific, 2009). Efforts directed at this category of sexually active men are seeking to alter these mens knowledge, attitudes and behavior regarding anal sex so that they adopt safer sex practices (e.g., consistent condom use). Although the overall target group and the strategic goal for prevention and control among the group tend to be clear, the socio-demographic characteristics of men having anal intercourse and using condoms in anal sex need to be understood more, particularly for countries (e.g., Philippines) with a great need for but sparse data on the subject (more than three fourths of new HIV infections occur among men who have sex with men in the Philippines). If the profiles of these men from scientific studies are known, such information can help prevention programs to accurately identify and reach out to men in greatest need of behavior change interventions. This report highlights the numbers and characteristics of men having anal intercourse and those wearing condoms in anal sex. Data were drawn from published large-scale surveys in Hong Kong, India, Philippines, United States and Thailand, which were accessed and reviewed for this report. Surveys had varying research designs and sample sizes ranging from 2,000 to about 40,000 men, who were asked about their anal intercourse

experience, among others, in the past 6 or 12 months. Surveys were conducted in a year or years between 1999 and 2005. Of the 8,529 men interviewed in Hong Kong (Lau et al., 2004), 0.14% and 0.11% reported to have unprotected insertive and unprotected receptive anal sex, respectively; and 0.3% mentioned using condom during anal sex. In the Philippines and Thailand, the numbers are higher. For example, in the Philippines, 2.4% of the 3,615 male respondents had unprotected insertive while 0.7% had unprotected receptive anal intercourse (the same number had condom use during anal penetration). In Thailand (n=2,049), 1.9% and 2.4% of men had unprotected insertive and unprotected receptive anal sex, respectively; and 3.0% were using a condom (Ministry of Public Health, 2005). From the study of 40,000 men in India (Khan, 2004), the collected figures were 8.7% among men who had insertive anal intercourse and 23.7% among those with receptive anal intercourse, both of which were practiced without condom use; about a fourth (23.5%) stated wearing a condom for this sexual act. The numbers obtained from a study of men in 21 US cities (n=8,175) are even higher: among them, 44.0% had unprotected insertive anal intercourse while 46% had unprotected receptive anal intercourse; only 39% had used condoms (Finlayson et al., 2008). Men having insertive and/or receptive anal intercourse have been described in the literature in terms of their socio-demographic backgrounds. Age and anal sex have been found to be significantly related (Lau et al., 2004), with those men younger than 35 years old having a likelihood to engage in such a behavior (Jimenez & Lee, 2001). Educational background has been identified as well as an explanatory factor, albeit the findings are inconsistent. According to the US National Health Statistic Report (2011), educational attainment and anal sex are not significantly related; in contrast, a Hong Kong study (Lau et al., 2004) demonstrated that men who are predisposed to engage in anal sex are more highly educated, even with better HIV related knowledge. With respect to marital status, men who are unmarried have a greater inclination to practice anal sex than their married counterparts (Jimenez & Lee, 2001; Lau et al., 2004; WHO SEARO, 2011).

Asia-Pacific E-Journal of Health Social Science: Men Who Engage in Anal Intercourse

Having religion, or lack thereof, has been cited also as a factor. For example, one US study reported that 16% among atheists; 9% among Catholics; 8% among the general population of Protestants; and 7% among conservative Protestants had anal sex (Zuckerman, 2009). Owing to its predictive influence on individual thinking and behavior, lifestyle is likewise a significant explanation for mens anal intercourse. In the Indian study cited earlier, those who had anal intercourse reported having taken alcohol or were heavy drinkers. Specifically, these men consumed alcohol for at least 3 days per week or 4 drinks per day or an amount equivalent to 6 drinks per occasion (Khan, 2004). Furthermore, it was found that these men had taken drugs: marijuana (46.3%); poppers (36.6%); hallucinogens (e.g., ecstasy) (24.0%); cocaine (19.3%); and amphetamines (12.9%). Finlayson et al. (2008) suggested that 10% of the men with anal sex had recently injected drugs. The characteristics of men who engage in anal sex but who use condoms have been outlined as well, albeit sketchy. Jimenez & Lee (2001) pointed to the association of age with condom use in anal sex, suggesting that adolescents and young adults are more inclined to consistently or to always use condoms. Lau et al. (2004) described condom users as having a higher educational attainment and better knowledge of STI and HIV/AIDS. Partner types also predict condom use: anal sex with paid or commercial sex workers is more likely to encourage condom use than anal sex with longterm partners (Klymenko & Andreeva, 2012). The foregoing evidence reveals cross-country differences in the numbers of men who engage in unprotected anal intercourse. There is a need for ethnographic studies on the socio-cultural and situational contexts of anal sex, that would help shed light as to why unprotected anal sex is less prevalent in Hong Kong or why it is more prevalent in India or the US. What factors and conditions drive men to engage or to not engage in anal intercourse, especially without a protection, and to use or not use condoms in anal sex? Moreover, it is crucial to collect definitive data on the sociodemographic backgrounds of men with varying anal sex-related practices. To date, the evidence on these topics is sparse and sporadic, yet it is needed as men having anal sex with men are driving the trajectory of HIV infections, such as that in the Philippines. REFERENCES American Psychological Association, Task Force on Gender Identity and Gender Variance. (2009). Report of the task force on gender identity and gender variance. Washington, DC: Author. Retrieved from http://www.apa.org/pi/lgbt/resources /policy/gender-identity-report.pdf. Interagency Youth Working Group. (2010). Young people most at risk of HIV. Geneva: WHO & UNICEF. Retrieved from http://www.unfpa.org/webdav/site/global/shared/iattyp/docs/Y oung%20People%20Most%20at%20Risk%20of%20HIV.pdf. Finlayson, T., Le, B., Smith, A., Bowles, K., Cribbin, M., Miles, I., Oster, A., Martin, T., Edwards, A., & DiNenno, E. (2008). HIV risk, prevention, and testing behaviors among men who have sex with men - National HIV Behavioral Surveillance System, 21 U cities, United States, 2008. Morbidity and Mortality Weekly Report, 60 (14), 1-11. Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6014.pdf. Jimenez, P., & Lee, R. (2000). Male sexual risk behavior and HIV/AIDS: A survey in three Philippine cities. Manila: Behavioral Sciences Department, De La Salle University and Family Health International. 2

Khan, S. (2004). MSM and HIV/ AIDS in India. Retrieved from http://www.nfi.net/NFI%20Publications/Essays/2004/MSM,%2 0HIV%20and%20India.pdf. Klymenko, N., & Andreeva, T. (2012). Determinants of condom use with occasional partners among MSM in Ukraine. Tobacco Control and Public Health in Eastern Europe, 2 (1), 43-54. Retrieved from http://andreevin.narod.ru/journal/2012/01/ TCPHEE_02_01_Klymenko.pdf. Lau, J., Kim, J., Lau, M.. & Tsui, H. (2004). HIV related behaviours and attitudes among Chinese men who have sex with men in Hong Kong: a population based study. Sexually Transmitted Infections Journal, 80 (6), 459-465. Retrieved from http://sti.bmj.com/content/80/6/459.full.pdf. Malhotra, S. (2008). Consequences of risky sexual behaviors. Journal of American Physicians and Surgeons, 13 (3), 88-90. Retrieved from http://www.jpands.org/vol13no3/malhotra .pdf. McBride, J., & Fortenberry, D. (2010). Heterosexual anal sexuality and anal sex behaviors: A review. Journal of Sex Research, 47 (2), 123-126. Retrieved from http://dx.doi.org/ 10.1080/00224490903402538. Regional HIV & Development Programme for Asia & the Pacific (2009). Developing a comprehensive package of services to reduce HIV among men who have sex with men (MSM) and transgender (TG) populations in Asia and the Pacific. Colombo: UNDP Regional Centre for Asia Pacific. Retrieved from http://media.routledgeweb.com/catalogs/asian_studies _catalog_2011_us.pdf. Ministry of Public Health. (2005). HIV prevalence among populations of men who have sex with men - Thailand, 2003 and 2005. Retrieved from http://www.cdc.gov/mmwr/ preview/mmwrhtml/mm5531a2.htm. US National Health Statistics Report. (2011). Sexual behaviour, sexual attraction and sexual identity in the United States: Data from the 2006-2008 national survey of family growth. Retrieved from http://www. cdc.gov/nchs/data/nhsr/nhsr036.pdf. WHO SEARO. (2011). HIV/AIDS among men who have sex with men and transgender populations in South-East Asia: The current situation and national responses. New Delhi: World Health Organization, Regional Office for South-East Asia. Retrieved from http://www.searo.who.int/LinkFiles/Publications_MSMcombined.pdf. Zuckerman, P. (2009). Atheism, secularity, and well-being: How the findings of social science counter negative stereotypes and assumptions. Sociology Compass, 3 (6), 949971. Retrieved from http://www.pitzer.edu/academics/faculty/ zuckerman/Zuckerman_on_Atheism.pdf.

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Seated: Dr. Romeo B. Lee, editor of the Asia-Pacific EJournal of Health Social Science; and chairperson of the Behavioral Sciences Department (BSD); and Dr. Sandrine Motamed of the University of Geneva. Standing: 2012-2013 scholars, Master of Health Social Science, BSD, De La Salle University, Manila, Philippines. Taken right after Dr. Motameds lecture on health research, on October 24, 2012.