Is Anal Sex Safe?
There are a number of health risks with anal sex, and anal intercourse is the riskiest form of sexual activity for several reasons, including the following:
- The anus lacks the natural lubrication the vagina Penetration can tear the tissue inside the anus, allowing bacteria and viruses to enter the bloodstream. This can result in the spread of sexually transmitted infections including HIV. Studies have suggested that anal exposure to HIV poses 30 times more risk for the receptive partner than vaginal exposure. Exposure to the human papillomavirus (HPV) may also lead to the development of anal warts and anal cancer. Using lubricants can help some, but doesn’t completely prevent tearing.
- The tissue inside the anus is not as well protected as the skin outside the anus. Our external tissue has layers of dead cells that serve as a protective barrier against infection. The tissue inside the anus does not have this natural protection, which leaves it vulnerable to tearing and the spread of infection.
- The anus was designed to hold in feces. The anus is surrounded with a ring-like muscle, called the anal sphincter, which tightens after we defecate. When the muscle is tight, anal penetration can be painful and difficult. Repetitive anal sex may lead to weakening of the anal sphincter, making it difficult to hold in feces until you can get to the toilet. However, Kegel exercises to strengthen the sphincter may help prevent this problem or correct it.
- The anus is full of bacteria. Even if both partners do not have a sexually-transmitted infection or disease, bacteria normally in the anus can potentially infect the giving partner. Practicing vaginal sex after anal sex can also lead to vaginal and urinary tract infections.
Anal sex can carry other risks as well. Oral contact with the anus can put both partners at risk for hepatitis, herpes, HPV, and other infections. For heterosexual couples, pregnancy can occur if semen is deposited near the opening to the vagina.
Even though serious injury from anal sex is not common, it can occur. Bleeding after anal sex could be due to a hemorrhoid or tear, or something more serious such as a perforation (hole) in the colon. This is a dangerous problem that requires immediate medical attention. Treatment involves a hospital stay, surgery, and antibiotics to prevent infection.
There is an increasing and potentially catastrophic HIV and sexual health epidemic in gay men and men who have sex with men (MSM) in every part of the world, Professor Kevin Fenton, the National Director of Health and Wellbeing at Public Health England, told the BHIVA autumn conference last week.
Despite having an increasing number of tools to prevent HIV, Professor Fenton added, HIV prevalence in MSM is increasing almost everywhere and incidence (the proportion who acquire HIV every year) is stubbornly refusing to change.
Professor Fenton said that optimising HIV testing programmes for MSM, particularly in countries where they faced criminalisation and discrimination, was key to controlling the epidemic, but that this would be a “challenge”.
HIV in gay men and MSM globally
Gay men everywhere have higher rates of HIV than in the general population, Fenton said. It is estimated that the HIV rate in MSM is eight times that of the general population in low-income countries and 23 times the general-population rate in high-income countries. The most reliable prevalence figures suggest that, regionally, Latin America and the Caribbean have especially high rates, but in no country of the world is HIV prevalence lower in MSM than in the population as a whole. Even in South Africa, the country with more people living with HIV than any other, HIV is twice as common in MSM as it is in other people.
In the developed world, the US has, by some way, the highest rate of HIV new diagnoses in MSM, though the UK has possibly the highest current rate in Europe. However, in terms of the rate of increase of new diagnoses, it is central-European countries such as Poland, the Czech Republic and Hungary, historically with very low prevalence, that are seeing the fastest-growing European epidemics in MSM.
In the lower-income world, reliable estimates of incidence are harder to come by, but over the last few years studies have found huge increases in HIV diagnoses in MSM in countries ranging from Thailand and China through Kenya to Nicaragua and Peru. The highest-ever annual HIV incidence recorded in a study comes from a group of MSM in Kenya, where a quarter of those originally HIV negative had HIV a year later. Unfortunately, African countries – and some in other areas of the world – initially denying they had MSM at all or any HIV problem in them, are now responding to the realisation that many people with HIV are MSM by introducing repressive measures such as increased criminalisation.
HIV was especially high, Fenton said, partly for biological reasons. It is now estimated that anal sex is 18 times better at transmitting HIV than vaginal sex. The chance of HIV being caught from having receptive anal sex once with a partner with a detectable HIV viral load is about 1.4% or one in 71 encounters; but because people have sex together more than once, the per-partner likelihood of catching HIV from a sero-different partner is, in gay men, about 40%.
Another factor in gay men’s higher HIV prevalence, Fenton added, was that because gay men have more partners and higher changeover rates, their sexual networks are more closely connected: 25% of gay men diagnosed with HIV were members of a cluster that had HIV viruses that were genetically identical, suggesting rapid transmission within the network, compared with 5% of heterosexual people.
Gay men do not just have more HIV for biological reasons, however, noted Fenton. The rates of smoking (at 27 to 66%, according to area), recreational drug use, lifetime depression (about 40%) and lifetime severe anxiety (at 20%) are all roughly double in gay men what they are in the general population. Underpinning these are higher rates of traumatic experience such as child sexual abuse (CSA) and intimate partner violence (IPV).
In several studies that looked at rates of depression, drug use, CSA and IPV in gay men, and related them to HIV prevalence and high risk sex, gay men with three or four of these conditions were twice as likely to have HIV and three times as likely to have had recent high-risk sex than men with none of them.
Socioeconomic disadvantage and racism also magnified the effects of HIV in MSM: this was one of the reasons why black gay men in the US are three times more likely to have HIV than white gay men.
Preventing HIV in gay men and MSM
How can we start to reduce the burden of HIV in gay men? Fenton commented that survey after survey showed that MSM, especially in parts of the world where they are criminalised and/or especially stigmatised, were reluctant to ‘come out’ to healthcare providers; often justifiably so, as there are many cases of their being refused HIV care and treatment if they do.
He called for healthcare workers to have training in the diversity of MSM and their health issues; culturally competent care is a basic human right, he added, especially as healthcare workers may be able to help MSM in their coming-out process because of their unique social role.
We have more HIV prevention options than we used to, and others based on antiretroviral therapy – such as pre-exposure prophylaxis (PrEP) – were in development, he said. HIV testing was now not just a gateway to treatment if MSM tested positive but could also be a gateway to a more tailored approach, and access to, behavioural and biomedical interventions for HIV. HIV testing frequency needed to increase in gay men, and options such as testing in routine care, at home and within social networks needed to be considered.
Gay men also needed to be helped to develop communication skills and more respectful attitudes towards their own health and towards other MSM. “We need to increase healthy, responsible and respectful sexual behaviours and relationships,” Fenton said, and to look at ways to help gay men have better sex with less harm.
Health workers needed training to provide “supportive, non-judgmental care”, he added, and the “sometimes systematic” exclusion of MSM from HIV prevention, services and research had to be combated.
Policies for enhancing HIV prevention in MSM did exist, Fenton concluded. As well as addressing the social and structural epidemic drivers, they included “ensuring effective and culturally competent combination prevention and treatment approaches”.
Protesters urge repeal of Jamaica’s anti-buggery law. (Photo courtesy of Jamaican Anti-Homophobia Stand)
LGBT rights activists in three countries today protested for repeal of Jamaica’s anti-gay “buggery law,” which provides for up to 10 years in prison for same-sex intimacy. The LGBT rights group Jamaica Anti-Homophobia Stand issued this press release:
First Annual International Day of Action against Jamaica’s Buggery Law
Activists in the United States, Canada, and the United Kingdom Protest Jamaican Homophobia
NEW YORK – On the 52nd anniversary of Jamaica’s independence from the United Kingdom, human rights activists renew their calls for the repeal of that country’s buggery law, which effectively criminalizes lesbian, gay, bisexual, and transgender (LGBT) life. Violation of the colonial-era law carries a sentence of up to 10 years imprisonment with hard labor. However, the consequences reverberate throughout Jamaican society, helping to fuel widespread anti-LGBT violence.
The U.S. Department of State, the Organization of American States, the United Nations Human Rights Council, and Amnesty International have condemned the history of violence and discrimination against LGBT individuals in Jamaica and called for repeal of the buggery law.
Jamaican Prime Minister Portia Simpson-Miller (Photo courtesy of PRI)
Jamaican Prime Minister Portia Simpson-Miller has failed to act to repeal the law despite indications during her 2011 campaign that she would work with the LGBT community. Since then, activists have filed two suits against the law.
In June, thousands of Jamaicans rallied in support of keeping the law and against the “homosexual agenda” after the government had been reportedly discussing the possibility of repeal. Few voices openly favoring repeal have been heard within Jamaica.
Several activists at today’s protest have either been forced to flee to Jamaica or have family and friends under threat there. Dwayne Brown, founder of Jamaica Anti-Homophobia Stand, said, “From the safety of our adopted sanctuary countries, we demand an end to the grave injustices perpetrated against our LGBT brothers and sisters. Every day, they must fight for their lives.”
“Jamaica’s ‘Emancipendence’ celebration is an appropriate time to reflect on the realization of the dream of inclusion captured in our motto ‘Out of Many One People,’” stated Maurice Tomlinson, a prominent human rights lawyer forced to flee Jamaica. “We are standing today, as Jamaicans in the Diaspora along with our allies, to affirm that ALL Jamaicans are citizens and deserve the full rights of our citizenship.”
Jason Latty, President of the Caribbean Alliance for Equality, said, “It is imperative for the survival and vitality of the Jamaican people that we move swiftly to repeal the buggery law. My organization is outraged about the increasing acts of terror directed against LGBT Jamaicans. A nation that does not respect the life and dignity of its people is a nation on the decline.”
Edwin Sesange, Director of the Out and Proud Diamond Group, stated, “This is the time for Jamaica to practice love for all. The buggery law should be scrapped immediately before more lives are lost. The government of Jamaica and its citizens should work towards achieving equality and justice for all its citizens, including LGBTI people.”
“In Jamaica, people masquerading under the guise of ‘religious’ leaders have carried the banner for hatred and violence directed against LGBTI people,” said Rev. Pat Bumgardner, Senior Pastor of Metropolitan Community Church of New York and Executive Director of the Global Justice Institute. “Ending the buggery law will help Jamaica celebrate the diversity of God’s creation and honor the value, dignity, and worth of all life.”
“We plan to hold internationally coordinated protests every Independence Day until all Jamaicans can be considered free at last,” concluded Dwayne Brown.