Anal Intercourse and the Female Condom - Commentary

Adding the Female Condom to the Public Health Agenda on Prevention of HIV and Other Sexually Transmitted Infections Among Men and Women During Anal Intercourse

June 2009, Vol 99, No. 6 | American Journal of Public Health 985-987
© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.141200

Elizabeth A. Kelvin, PhD, MPH, Raymond A. Smith, PhD, Joanne E. Mantell, PhD, MSPH and Zena A. Stein, MA, MBBCh

The authors are with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York. Zena A. Stein is also with the G. H. Sergievsky Center, Columbia University, New York.

Legal barriers to conducting public health research on methods of protection for anal intercourse were lifted in the United States in 2003 when the US Supreme Court invalidated all state antisodomy laws. Although research funding has been available for the development of rectal microbicides, the female condom, which has already been approved for vaginal use, has not been evaluated for anal use.

Although there is no evidence that the female condom is safe for anal intercourse, it has already been taken up for off-label use by some men who have sex with men. This demonstrates the urgent need for more protection options for anal intercourse and, more immediately, the need to evaluate the safety and efficacy of the female condom for anal intercourse.

In the United States, anal intercourse is a common practice. Among men aged 25 to 44 years in the United States, 3.9% report having had anal intercourse with another man, and 40% report having had anal intercourse with a woman. Among women aged 25 to 44 years in the United States, 35% report having had heterosexual anal intercourse. Hence, discussions about anal intercourse should not assume that the practitioners are all men who have sex with men (MSM). In fact, there are an estimated 4 times more women than there are MSM practicing receptive anal intercourse in the United States. Unprotected anal intercourse is the sexual activity associated with the highest risk of HIV infection.

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