The Need for Public Awareness on Health-Related Consequences of Heterosexual Anal Intercourse (HAI) in Sub-Saharan Africa

Human sexual repertoire continues to expand and diversify as a consequence of changing socio-cultural beliefs/ practices, demographics, sexual liberation, and increased access to sexually-oriented materials. Individuals actively seek and experiment on various novel and exotic methods of sexual stimulation and gratification including anal eroticism. Despite associated stigma, negative perceptions and its being a taboo practice in some societies, anal eroticism is widely practiced by women from all social and racial backgrounds. Heterosexual anal intercourse (HAI), itself a high-risk sexual practice, is often associated with other high-risk sexual or social behaviours such as substance abuse, transactional sex, partner violence/coercion, alcohol consumption, multiple partnerships, oro-anal sex and low condom use. It therefore confers an increased risk of STIs, HIV/AIDS and anal cancer among other health consequences. Sexual practices in sub-Saharan Africa (SSA) are thought to be limited to penile-vaginal intercourse; with penile- anal intercourse confined to gays, female sex workers and the pornographic industry. This perception, together with related social stigma and national legal frameworks, have hampered quality research and creation of awareness on the subject. People engage in HAI oblivious of related health risks. Likewise health professionals, either deliberately or for lack of knowledge, don’t broach the subject in their clinical sessions or other professional forums. SSA has the highest burdens of HIV/AIDS and STIs globally with weak health systems. Published data on HAI, though few and limited to special population sub-groups, indicate the possibility of the practice among general populations and is increasing. Thus a concern that these health conditions will increase with time, exerting enormous strains on national economies and reversing gains made so far. To mitigate the impact of individual sexual practices on overall health of populations, there is need for appropriate local research, public awareness and health professional education on various aspects of heterosexual anal intercourse in SSA.