Health Department Highlights Health Risks of Unprotected Anal Sex Among Heterosexual Women in New York City

Unprotected anal sex poses well known health hazards for men, but new research suggests that the practice is a significant health issue for women as well. More than 100,000 New York City women engage in anal intercourse each year, according to a new report from the Health Department, and many are not taking the steps needed to prevent HIV and other sexually transmitted infections.

Anal membranes are easily damaged during sex, facilitating the spread of infection. Past studies suggest that anal exposure to HIV poses 30 times more risk than vaginal exposure. But the New York City findings suggest that women are less likely than men who have sex with men to use condoms during anal sex. The figure is just 23%, according to the new report, compared to 61% among men who have sex with other men. The full report is available at nyc.gov/health.

"Tens of thousands of New Yorkers are engaging in sexual behavior that is especially risky," said Dr. Thomas Farley, New York City Health Commissioner. "Many people are aware of the risk of HIV when men have sex with other men, but this report shows that a large number of women also are putting themselves at high risk through unprotected anal sex. For both men and women, the overall message is clear: Never engage in unprotected anal sex. Use a condom every time."

Just as condoms are especially important for people who engage in anal intercourse, so is HIV testing. Yet the new report finds that women who engage in unprotected anal sex have lower testing rates than women who always use condoms during anal sex -- 35% versus 63%, respectively. By the same token, women who had unprotected anal sex were the least likely to report that a health care provider had offered HIV testing during the past year. Only 11% of the highest-risk women (versus 47% of those using condoms) said a provider had recommended testing in the past year -- even though 94% of them had seen one.

The report does not estimate the HIV burden among women who engage in unprotected anal sex, but most HIV infections diagnosed in women result from heterosexual intercourse. Among women with known sources of exposure, heterosexual contact accounted for 90% of the infections diagnosed in New York City in 2008.

Unprotected Anal Sex Is Most Common Among Younger Women and Those With Multiple Partners

Women 18 to 24 years old are nearly six times more likely than those aged 45 to 64 to report unprotected anal sex (11% versus 2%). And whereas 15% of women with three or more sex partners reported engaging in anal sex in the past year, the figure was just 4% among those with one partner. Reports of anal sex in the past year are similar across race and ethnicity, with Asian women reporting 8%, white women 7%, Hispanic women 6% and black women 4%.

Recommendations for Reducing Sexually Transmitted Infections

The new report highlights the importance of safer sex in a city where approximately 74,000 new sexually transmitted infections are reported each year, along with 3,800 new HIV diagnoses. Some recommendations:

• Health care providers should offer STI and HIV testing to all patients, regardless of their stated sexual history.
• People engaging in anal sex should always use condoms. Free NYC Condoms and other alternative male condoms, in addition to female condoms and lubricant, are available at locations throughout New York City. Call 311 or visit nyc.gov/condoms for more information.
• Unless they're in mutually monogamous relationships, people who have had unprotected sex should get tested for HIV and other STIs at least once a year. Free, confidential screening is available at Health Department clinics, no appointment required. Call 311 for clinic locations and hours of operation. Services are available to people 12 and older without parental notification and without regard to immigration or insurance status.
• If you have exposed any partners to a sexually transmitted infection (including HIV), it is important to tell them so they can be tested and treated if necessary. People who want help notifying partners, or who want to do so anonymously, can find assistance by calling 311 or visiting inSPOT NYC (www.inspot.org/Newyorkcity).