1. Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis
- Author
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Barbara L. Shacklett, Marie-Claude Boily, James Stannah, Jocelyn Elmes, Ariane van der Straten, Dobromir T. Dimitrov, Rebecca F. Baggaley, Peter A. Anton, Branwen N. Owen, Ian McGowan, Romain Silhol, National Institutes of Health, and Medical Research Council (MRC)
- Subjects
Safe Sex ,Male ,1607 Social Work ,Social Sciences ,IMMUNODEFICIENCY-VIRUS TRANSMISSION ,YOUNG-PEOPLE ,Anal Canal ,HIV Infections ,law.invention ,DOUBLE-BLIND ,0302 clinical medicine ,law ,Risk Factors ,INFECTION ,Medicine ,030212 general & internal medicine ,Public, Environmental & Occupational Health ,education.field_of_study ,CONDOM USE ,Incidence ,Confounding ,3. Good health ,Health psychology ,Infectious Diseases ,Meta-analysis ,Public Health and Health Services ,Female ,Public Health ,0305 other medical science ,Life Sciences & Biomedicine ,Adult ,medicine.medical_specialty ,Social Work ,Social Psychology ,Sexual Behavior ,Population ,MEDLINE ,Sexual behaviour ,1117 Public Health and Health Services ,03 medical and health sciences ,Condom ,Humans ,Women ,FEMALE SEX WORKERS ,education ,Heterosexuality ,Epidemics ,Original Paper ,030505 public health ,Science & Technology ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,SEXUALLY-TRANSMITTED-DISEASES ,Heterosexual ,HIV ,PREVENTION ,Biomedical Social Sciences ,Social Sciences, Biomedical ,Anal intercourse ,Relative risk ,RISK-FACTORS ,business ,Demography ,PREEXPOSURE PROPHYLAXIS - Abstract
Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03–2.38, N = 18, I2 = 72%; pooled aRR = 2.23, 1.01–4.92, N = 5, I2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI. Electronic supplementary material The online version of this article (10.1007/s10461-019-02651-0) contains supplementary material, which is available to authorized users.
- Published
- 2020