title: Condomless Anal Intercourse Among Males and Females at High Risk for Heterosexual HIV Infection.
abstract: BACKGROUND
  Understanding and addressing heterosexual HIV transmission requires attention to the range and context of heterosexual sexual behaviors. We sought to determine population-based prevalence of condomless anal intercourse (CAI) among individuals at increased heterosexual HIV risk in Baltimore and to identify demographic, behavioral, and health-related correlates.
  
  
  METHODS
  Data were from a cross-sectional study of 185 males and 198 females at increased heterosexual risk for HIV recruited using respondent-driven sampling as part of Centers for Disease Control and Prevention's National HIV Behavioral Surveillance Project in Baltimore, August-December 2010. Bivariate and multivariate logistic regression examined factors associated with heterosexual CAI.
  
  
  RESULTS
  The sample was majority African American, with a mean age of 38 years among men and 34 years among women. Forty-two percent of men (95% confidence interval, 30.9%-52.0%) and 38% of women (95% confidence interval, 29.4%-47.2%) reported any CAI in the past year, with variance by partner type and sex. Among men, CAI was significantly associated with homelessness, casual and exchange partners, same-sex partner in past year, and substance use. Among women, CAI was significantly associated with lower education, casual and exchange partners, same-sex partner in past year, multiple partners, and substance use. In adjusted sex-specific models, males and females with increasing numbers of partners were more likely to engage in CAI.
  
  
  CONCLUSIONS
  It is important to recognize the efficiency of transmission of HIV and other sexually transmitted infections through CAI. There is a need to broaden heterosexual sexual health promotion and HIV/sexually transmitted infection prevention to adequately and appropriately address risks and prevention strategies for anal intercourse.
authors.affiliation: From the *Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and †Maryland Department of Health and Mental Hygiene, Baltimore, MD.
authors.forename: Danielle
authors.initials: D
authors.lastname: German
authors.forename: Trang Quynh
authors.initials: TQ
authors.lastname: Nguyen
authors.forename: Christine Powell
authors.initials: CP
authors.lastname: Ogbue
authors.forename: Colin
authors.initials: C
authors.lastname: Flynn
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D040343:Behavioral Risk Factor Surveillance System; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D020010:Heterosexuality; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D014481:United States; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data*