Rectal Transmission of STIs/HIV among Women

Marjan Javanbakht, University of California, Los Angeles
Social and Behavioral Sciences
Targeted Theme: Contextual, Cultural, and Structural Issues in HIV Prevention and Care
Innovative, Developmental, Exploratory Award (IDEA)

Objective: Little is known about the prevalence rectal sexually transmitted infection in women. Among men who report anal sex, the prevalence of these infections are relatively high and can increase the risk of transmission of HIV. Evidence demonstrates that women also practice anal sex and are therefore at risk for these infections. The proposed study will investigate the prevalence of rectal sexually transmitted infections among women who report anal sex, as well as factors that may increase the risk of these infections among women.

Background/Significance: Unprotected anal sex is recognized as one of the most efficient modes of HIV sexual transmission and is a commonly practiced behavior with opposite sex partners, with estimates of ranging from 7-40% in the United States. It is also well established that the probability of transmitting HIV is increase in the presence of other sexually transmitted infections. This, along with evidence that most women who report anal sex report not using a condom for anal sex suggests that they are likely to exposed sexually transmitted infections, including HIV. Although it is clear that anal sex is a sexual practice with high probability of transmission of HIV, data on the prevalence of rectal infections and the contribution of these infections to HIV transmission among women who report anal sex is limited.

Methods: In the proposed study, we will use two different strategies to gain a better understanding of the context and the individual level factors that may increase a woman’s risk for these infections. First, we will interview 40 women attending the 12 public STD clinics in Los Angeles County. We will interview both women who are diagnosed with rectal sexually transmitted infections and women who are not diagnosed with these infections, in order to identify key differences. Simultaneous to the interviews, we will collect medical record information on the approximately 1,000 women seen at the public STD clinic who report anal sex. Currently, all clinics collect demographic, sexual practice, and behavioral information, and conduct laboratory test for sexually transmitted infections. The laboratory testing results, along with medical record information will be used to provide estimates of the prevalence and correlates of rectal sexually transmitted infections.

Expected Results/Impact: The findings from this study will be one of the first to describe the prevalence and factors associated with rectal infections among a relatively high risk group of women. At the end of the award period, these results will not only help inform overall rectal screening guidelines for women but will be used to develop prevention intervention aimed at reducing the acquisition of rectal STIs/HIV among women.