title: Contextual Factors Surrounding Anal Intercourse in Women: Implications for Sexually Transmitted Infection/HIV Prevention.
abstract: BACKGROUND
  Our objectives were to describe women's reasons for engaging in anal intercourse (AI), contextual factors surrounding AI, and how these vary by current rectal sexually transmitted infection (STI) status, and to assess women's knowledge and concerns about rectal infections.
  
  
  METHODS
  Between January 2011 and June 2013, we conducted semistructured, qualitative interviews among 40 women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible if they were at least 18 years of age, reported AI in the past 90 days, and were tested for rectal Chlamydia trachomatis and Neisseria gonorrhoeae. Interviews, which were guided by the theory of gender and power, were transcribed and coded to explore contextual factors surrounding AI.
  
  
  RESULTS
  On average, participants reported having 3 AI partners in their lifetime and most (n = 30) reported being in a serious relationship with a main/regular sex partner at the time of the interview. Motivations for engaging in AI and feelings about AI varied by rectal STI status. Women with a rectal STI more prominently conveyed the idea that AI was intended to please their sexual partner, whereas those who did not have a rectal STI reported AI more as a way to increase intimacy and personal sexual gratification. Almost all women (regardless of rectal STI status) reported limited to no knowledge about the risk of rectal STIs.
  
  
  CONCLUSIONS
  Among women, risk of acquiring rectal STIs may vary by reason for engaging in unprotected AI as well as other contextual factors. Providers should consider addressing these contextual factors to reduce risk.
authors.affiliation: From the *Department of Epidemiology and †Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles CA; and ‡Los Angeles County Department of Public Health, Los Angeles, CA.
authors.forename: Shauna
authors.initials: S
authors.lastname: Stahlman
authors.forename: Alanna E
authors.initials: AE
authors.lastname: Hirz
authors.forename: Ali
authors.initials: A
authors.lastname: Stirland
authors.forename: Sarah
authors.initials: S
authors.lastname: Guerry
authors.forename: Pamina M
authors.initials: PM
authors.lastname: Gorbach
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles / Q000453:epidemiology; D054327:Lubricants; D008875:Middle Aged; D009042:Motivation; D015995:Prevalence; D012002:Rectal Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology
chemical_list: D054327:Lubricants