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Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. There is no magic bullet and behavior alone is unlikely to change the course of the epidemic. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large. South Africa remains the country with over 6 million people reported to be infected with HIV [ 2 ]. Swaziland has the highest adult prevalence rate of

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In many African countries, young girls are encouraged or forced to marry older men [ 3638 ] which can make young girls vulnerable to HIV infection in several ways. In terms of the generalizability of our discussion on condom use and HIV and STI prevention, we must emphasize that our sample only consisted of women who had recently engaged in unprotected anal intercourse with a partner of unknown or seropositive HIV status. AIDS Behav. This is primarily due to the fragility of the rectal mucosa [ 29 ]. First, the interviewer explained to the participants that the interview would U n aids anul sex africa on penile-anal intercourse. It is fun to be in an environment when you can relax knowing that everyone is U n aids anul sex africa same.

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Caramel Mature Porno Brand VATAA New York [etc. Parents, you can easily block access to Roswell twins site. Wanker Lab Now this has been thrown out along with many other so-called empirical conclusions. This increase may be attributable in part to the relaxation of traditional village U n aids anul sex africa but appears to be due primarily to the destitution of poor migrant women, who may become prostitutes, and to the greater mobility and rootlessness of young male migrants and soldiers. In rural tribes where female circumcision occurs, it is nearly universal in the U n aids anul sex africa population; however, its prevalence is decreasing in urban areas [ 11 ]. Tube Captain

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Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. There is no magic bullet and behavior alone is unlikely to change the course of the epidemic. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large.

South Africa remains the country with over 6 million people reported to be infected with HIV [ 2 ]. Swaziland has the highest adult prevalence rate of Transmission is mainly through heterosexual sex, with women disproportionately infected compared to their male counterparts. It is reported that every minute one young woman becomes infected with HIV [ 3 ]. A number of studies conducted among non-pregnant women in parts of east and southern Africa suggest prevalence rates ranging from There have been reports of a decline or stabilizing in HIV prevalence among women in southern Africa [ 6 , 7 ].

However, HIV incidence data from large scale clinical trials and cohort studies suggests that the low prevalence masks high HIV incidence rates [ 8 - 11 ]. Rehle et al. The disproportionate impact of the HIV epidemic on women can be attributable to several factors including biological, social, behavioral, cultural, economic and structural.

In SSA a combination of these factors has led to the disparate increase in HIV infection rates among women compared to their male counterparts [ 15 ]. Women are at a greater physiological risk of contracting HIV than men.

This is in part because women have a greater mucosal surface area exposed to pathogens and infectious fluid for longer periods during sexual intercourse and are likely to face increased tissue injury. Young women are at particularly high risk due to cervical ectopy which facilitates greater exposure of target cells to trauma and pathogens in the vagina [ 16 ].

For women, the risk is increased due to difficulty in diagnosing STIs which are often asymptomatic in presentation [ 18 ], thus making treatment difficult [ 16 ]. A study by Ramjee et al. Observational evidence suggests that progesterone containing injectable contraception depot medroxyprogesterone acetate DMPA may be putting women at higher risk of HIV acquisition [ 20 - 23 ].

There is however some conflicting studies which have not observed this risk [ 24 - 26 ]. Based on conflicting evidence on the role of DMPA on HIV acquisition, the World Health Organization WHO released a statement recommending that women on hormonal injectable progestin contraception should be counseled to use condoms in conjunction with pregnancy prevention methods to prevent HIV acquisition [ 28 ].

Studies in Uganda, Rwanda and Zimbabwe have shown that pregnant women are at a higher risk of HIV infection than lactating or other women, possibly due to physiological changes that a woman undergoes during pregnancy [ 29 ].

High levels of oestrogen and progesterone either during pregnancy or from exogenous sources could cause changes in the structure of the genital mucosa or cause immunological changes, such as an increase in mucosal lymphoid aggregates or hormone-induced overexpression of co-receptors associated with HIV infection. Increased levels of oestrogen are also associated with cervical ectopy in young women which in turn increases risk to HIV infection [ 29 ].

Supporting evidence suggests that women have a window of vulnerability approximately seven to ten days after ovulation in their menstrual cycle in which the potential for viral infectivity in the female reproductive tract is increased.

This is due to the suppressing influence of sex hormones on the innate, humoral and cell-mediated immune systems. This takes place in the upper and lower female reproductive tract, and overlaps with the upregulation of co-receptors for HIV uptake and the recruitment of potentially infectable cells [ 30 ].

At a broader societal level, several factors influence the scale and rate of the epidemic spread such as overall HIV and STI prevalence, sexual practices, marriage and other cultural norms including structural factors not in control of the individual.

Here, the needs and desires of women are not considered significant and often women play no part in sexual decision making, nor are they allowed to express their sexuality [ 31 , 32 ].

There may be violent consequences if a woman were to take the initiative in sex, suggest condom use or refuse sexual advances [ 31 ]. In certain cultures men are regarded as the heads of the family, decision-makers and the ones who control resources and finances while women are expected to respect their husbands, accept polygamous relationships and fulfill family and community tasks [ 33 ].

Women then look for other partners resulting in a complex web of cultural practice and multiple partnerships placing both men and women at high risk of HIV infection. Community elders identify a man with whom the widow has to have sex; someone who has often had several sexual partners in the process of cleansing others. The ritual is also practiced in other situations, such as after a birth the mother, regardless of marital status, has unprotected sex with a man believing the act will cleanse the baby and encourage health; after miscarriage; and where a man has acquired a boat for fishing, a woman has sex with the man to cleanse away evil spirits which may capsize the boat [ 36 ].

This practice is believed to provide heightened sexual pleasure for the male partner. For women, it causes friction and possible tearing of delicate vaginal mucosal lining, increasing the risk of HIV acquisition. Deeply entrenched traditional and cultural practices; often interwoven with religious beliefs make change in behaviour very difficult and complex [ 36 ].

Virginity testing, a physical examination of girls and women to determine whether the hymen is unbroken , is now widely regarded as a human rights abuse. Although virginity testing was a common traditional practice among unmarried couples in South Africa and Uganda, it was, until recently, no longer commonplace.

However, in an attempt to promote abstinence among girls, this practice has seen resurgence [ 36 ]. In many African countries, young girls are encouraged or forced to marry older men [ 36 , 38 ] which can make young girls vulnerable to HIV infection in several ways. The change from virginity to frequent unprotected sex increases their risk of HIV infection. Even if they were sexually active prior to marriage, marriage usually drastically increases the frequency of unprotected sex [ 39 ].

In Malawi, for example, consent to sex is assumed within a marriage and therefore marital rape does not exist [ 31 , 36 ]. Many African countries condone polygamy [ 38 ], which means that an adolescent bride is likely to be a second or third wife [ 39 ]. In the last two decades, nearly all SSA countries have faced slowing economic growth which has influenced spending on social services [ 32 ].

This has further impoverished African populations, with increases in unemployment rates and the decrease in provision of social services, including education and health services. The deterioration of education, health, and other social services implies a loss of opportunities for HIV prevention [ 32 ], particularly in women.

Poverty is another driving force of HIV transmission in women [ 33 ]. Low economic status has been associated with earlier sexual experience, lower condom use at last sex act, having multiple sex partners, increased chances that the first sex act is non-consensual, and a greater likelihood of having had transactional sex or physically forced sex [ 15 ].

Many women resort to transactional sex to sustain their livelihoods and young girls are often coerced into sexual activities with older men to survive [ 32 , 33 ]. Cash transfers among secondary school-aged young women in Malawi showed that such transfers can encourage women to reduce their risky sexual behaviour, and resulted in decreased teenage pregnancy, in addition to lower self-reported sexual activity [ 33 ].

Young people growing up in poor conditions have little access to schooling and therefore few prospects for their future. Sex becomes a way to pass time due to a lack of recreational facilities [ 32 ]. Transactional sex sex for money is common in SSA. Many women engage in sex work which is defined as the provision of sexual services in exchange for money, goods, or other benefits [ 43 ].

An estimated fifteen percent of HIV in the general female adult population is attributable to unsafe female sex work.

The region with the highest attributable fraction is SSA with 98, HIV-related deaths [ 44 ] compared to an estimated , deaths worldwide which are a result of female sex work [ 45 ]. Studies from South Africa and Kenya suggest sex workers engage in high risk behavior such as dry sex [ 46 , 47 ] and anal sex fetching a high price which further increase their risk.

It is well documented that behavioral change can lead to a decrease in HIV acquisition [ 48 ]. These include use of methods such as abstinence or delaying sexual debut, condoms, safe sex, monogamy, reduction in number of partners, voluntary counseling and testing etc. However abstinence is not an option for many women. A South African household survey showed that 7. An association has been shown between early age of sexual debut and ensuing risky sexual behaviors [ 50 ], such as having multiple partners and decreased contraceptive and condom use [ 51 , 52 ].

Studies in Africa demonstrated a correlation between having sex at an early age and the HIV incidence [ 53 , 54 ]. It is thought that the delay of sexual debut may have been one of the crucial changes in behavior which led to a decline in HIV infection in Uganda [ 40 , 55 , 56 ]. Concurrent partnerships are powerful transmitters of HIV in the community [ 57 ]. The vulnerability to HIV infection increases by engaging in unprotected anal sex by 13 fold compared to oral sex [ 59 ]. This is primarily due to the fragility of the rectal mucosa [ 29 ].

However, this practice could be as high as forty per cent in female sex workers [ 59 ]. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. It is however difficult to attract this high risk population group due to the different settings in which the FSWs conduct their business. Regular surveillance, prevention and treatment of HIV among FSWs would benefit this often neglected vulnerable group and the general population as a whole [ 2 ].

Alcohol abuse in much of Africa is characterized by irregular episodes of heavy drinking, frequently in the form of weekend bingeing [ 29 ]. These drinking patterns may have independent effects on sexual decision-making, and on condom-negotiation skills and correct condom use. Many structural vulnerabilities place women at risk including gender inequality and gender based violence GBV [ 63 ], migration and health seeking related stigma [ 64 ]. Gender inequality is created and perpetuated in part by social norms that demand culturally appropriate roles and conduct for men and women [ 65 ].

Hierarchical gender roles such as notions of male sexual entitlement, the low social value and power of women, and ideas of manhood linked to the control of women result in lower levels of education among women; few public roles for women; the lack of family, social and legal support for women; and the lack of economic power for women [ 65 , 66 ].

Sexual negotiation or refusal by a woman may result in suspicions of infidelity and result in intimate partner violence [ 49 ], which is often tolerated by these societies [ 65 ]. Experiences of sexual violence have also been associated with drug and alcohol use, early sexual debut, having multiple sexual partners, trading sex for money and drugs and less contraceptive use [ 66 ].

Women who live in poverty, younger women and uneducated women are especially affected by intimate partner violence [ 70 - 72 ]. Stigma and fear of status disclosure has been a large factor in individuals seeking HIV testing and subsequent treatment and care [ 33 , 75 ]. Stigma can occur at different levels, including community, interpersonal, legislative and institutional e. Women often suffer the heaviest burden of HIV stigma and discrimination, as they are often expected to uphold the moral traditions of their societies; being HIV infected is considered evidence that they have failed in this regard [ 33 , 74 ].

HIV positive women experience discrimination, stigma and other human rights violations within families and communities, by legal and social services, in health-care settings, and in their work environment. Health-care settings often refuse to provide information or provide the wrong information on HIV prevention and treatment, sexual and reproductive health, and family planning [ 33 ].

HIV positive women have also experienced the denial of services, lack of confidentiality, harsh and judgmental treatment, and lack of informed consent [ 33 ]. As a result of stigma, women are often reluctant to seek HIV testing and are not empowered to enact HIV prevention [ 74 ]. Migration trends in Africa vary in terms of their spatial, temporal and social characteristics.

Many individuals migrate due to better job prospects or are forced to migrate due to political instability, war and famine [ 32 ]. Worldwide, mobile populations have higher HIV infection rates than non-mobile populations irrespective of HIV prevalence in the origin or destination location [ 74 ]. However in many cases, lack of education often restricts them to unskilled jobs such as informal trading, commercial sex work and domestic work among others.

Migrant women were 1. Urbanization has also fuelled the rapid spread of HIV. Urbanization replaces the traditional village norms for an urban modern culture with fewer restrictions on sexual behaviour and marriage. Additionally, the loss of culture and social networks are related to social problems such as drug abuse, which fosters high-risk behaviour [ 32 ].

Military conflict can cause changes in risk behavior, and war or civil strife often cause massive displacements of people [ 74 ], interrupt social cohesion and relationships, and encourages promiscuity and commercial sex; forced migration of people from low HIV prevalence areas to areas of high HIV prevalence [ 32 ]. Although female condoms are available, the use still requires negotiation. Thus female-initiated prevention methods have been investigated.

By the age of 27, I estimate that I had had 2, different sex partners. A recent report of survival of HIV in bedbugs supports this hypothesis [ 72 ]. Tasty Movie However, it is difficult to generalize about any cultural trait in Africa since cultural differences differ widely from tribe to tribe. Another practice that is correlated with the acquisition of AIDS in Western societies is anal intercourse. London, The Panos Institute, This was related to me by none other than John Lauritsen.

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Women and HIV in Sub-Saharan Africa

Metrics details. Female anal sex is a receptive type of sexual practice among heterosexual couples where the penis is inserted into the anus of a female partner. In the Western world, a number of studies and interventions have been carried out on anal sex among men due to its potential risks to HIV transmission. In African countries, including Tanzania, there is dearth of information on the risks inherent in practices associated with female anal sex in the general population.

The objective of this study was to determine the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in selected districts of Tanzania. Both quantitative and qualitative methods i. Study participants included community members of aged 15 and above such as heads of the household, adolescents, bar workers and commercial sex workers.

A total of individuals were interviewed, When respondents were asked to indicate whether they had ever been tempted to practise FAS, Of these, 44 In this population, the frequency of FAS practice was rather low. As such, there is a need for further exploratory studies to determine and document drivers of FAS.

In addition, public health education should be provided with regard to the risks of contracting HIV associated with FAS practices. Anal sex has been identified as a predictor of HIV infections among women [ 1 ] as it was also revealed among the men who had sex with men MSM [ 2 , 3 ]. There is a need to investigate the prevalence of female anal sex practices and the associated risk factors to HIV infection in order to inform policy makers to take appropriate action.

A study in South Africa revealed that among female commercial sex workers, Despite anal sex generally being acknowledged as the riskiest factor for HIV infection, it is its associated practices that heighten the inherent risk of HIV infection even further.

These practices include unprotected receptive anal intercourse, multiple sex partners, inconsistent condom use, lack of knowledge about HIV risk, and negative or complacent attitudes toward safer sex [ 15 ].

Socio-cultural factors, social stigma and discrimination, may also lead to increased risk of HIV infection in females practising anal sex as it was also found among MSM [ 17 ].

This study was, therefore, carried out to determine the prevalence and risk factors associated with female anal sex in the context of HIV transmission in selected districts of Tanzania. Kinondoni district is located in the northern part of Dar es Salaam City with a population of 2,, The Kinondoni Municipal Council medical care coverage plan comprises 33 public and private health facilities.

Tanga district is the headquarters for Tanga region province and one of the major ports in Tanzania. The town has a great potential of attracting immigrants from rural areas as it has employment.

It has the estimated population of , Tanga has 52 health facilities both public and private. Kinondoni and Tanga are located in the coastal area where anal sex among men is believed to be practised to a larger extent with the highest HIV prevalence than that of the general population [ 18 ]. The two coastal districts were selected due to the proximity with regions previously documented to have high rate of MSM [ 19 , 20 ].

Therefore, there was a possibility to observe similar trend of FAS in the selected sites. Makete district, on the other hand, is one of the five districts of Njombe region of Tanzania. The district has an estimated population of 97, It has 30 health facilities both private and public. Siha district is one of the seven districts of Kilimanjaro region. The district has a population of , Tanzania Census report, This was a descriptive cross-sectional study that employed both qualitative and quantitative methods.

A total of four districts were sampled purposively using the criteria of HIV-prevalence and existence of anal sex practices. Makete and Siha were selected from inland regions with high and low HIV-prevalence, respectively.

Kinondoni and Tanga were selected from regions along the coastal belt and known to have anal sex practices among men. Two wards were randomly selected from each district. Finally, two villages were selected from each ward. To maintain gender balance, researchers conducted interviews by alternating between females and males, and youths and adults, throughout the survey.

Individuals who had a short stay and those who were found to be sick on the day of the interview were not interviewed. Commercial sex workers CSWs and bar-maids, and some adults males, females, pregnant mothers and youths were conveniently recruited for the qualitative component of the study.

Face-to-face interviews were held with the selected members of the households using a structured questionnaire. The interviews were conducted in the household premises of the respondents. Quiet places were chosen by the respondent within the household premises to ensure enough privacy and freedom of expression because of the sensitive nature of the topic.

The study elicited information on the magnitude of heterosexual anal sex practices among females of different population groups, community awareness about female anal sex practices, common practices involved in female anal sex, perceived risk factors to FAS associated with HIV infection, and drivers for female anal sex practices in the community. A total of 20 focus group discussions FGDs for different age groups and sex—adult females, adult males, female youths, male youths, bar-maids and pregnant mothers from each district—were held.

Discussions were held separately for each group without mixing the sexes or age groups as categorised above to enhance freedom of expression. Participants in each group ranged from 8 to 12 and each discussion was facilitated by an experienced social scientist.

The venues for the discussions were in school premises or village offices as there were enough spaces to enhance privacy, confidentiality and freedom of expression. The discussions were tape-recorded after obtaining consent from the participants. The FGDs facilitated the generation of Additional file 1 to complement household survey data and gain a detailed understanding of issues that were difficult to capture in the interviews.

Each FGD lasted for about 1. Since both the household survey and FGDs were conducted concurrently, there was little chance for participants to participate in both activities. Qualitative data transcriptions was done verbatim and thereafter analysed manually to detect relevant themes and develop sub-themes. Consequently, texts with similar meanings were placed in the respective sub-themes and quotation that reflected informants own words were taken, some of which were presented verbatim to strengthen the qualitative narrative presentation.

Eventually, the quantitative and qualitative data were triangulated to boost the trustworthiness and validity of the data generated and analysed. A total of respondents were interviewed from four study districts, from both rural and urban settings. Males accounted for About Out of the respondents, Out of these, 44 Binomial probability test was used to compare the proportion of respondents who were tempted and actually practised anal sex between coastal and inland districts. There was a significantly high difference between Siha and Makete and less significance difference between Kinondoni and Makete and no difference between Tanga and Makete.

However, when the analysis was done within districts by comparing those who were tempted and those agreed to go ahead and engage in female anal sex, Makete district had the largest proportion of individuals who accepted to practise anal sex. The male partner will never leave you.

Conversely, two males reported to have been forced by their casual female partners and guardians to engage in anal sex with them. In other words, the source of inducement could come from either gender. Out of 44 respondents who practised FAS, Out of those who had ever been persuaded to practise anal sex, A notable proportion of the respondents However, there was no significant difference in condom use among respondents practising FAS between the districts p value 0.

Several factors were mentioned to contribute to non-use of condoms. Reduction of sexual pleasure was mentioned by the majority in the qualitative study. Other reasons included unavailability of condoms nearby, inconveniences when inserting the penis into the anus, and some did not use a condom to as a gesture of loyalty to the partner or as a sign of fidelity.

In fact, many of the FGD discussants said that many of the people who practised anal sex did not use any form protective measures against HIV. Otherwise a person should be well experienced in doing FAS. Those who practised anal sex were asked about the perceived risk of acquiring HIV infection during anal sex in heterosexual intercourse. Over half Of those who reported to be at risk, 10 A good number rated moderate risks and one of the respondent reported to be already HIV infected.

FGD participants in all the groups said that when individuals engaged in anal sex there is a likelihood of getting physical injuries due to severe friction attributed to the tightness and dryness of the anus. Few participants from Siha district reported there being no direct relationship between anal sex and HIV transmission. The reasons given were: first HIV virus stays in vaginal fluids, hence making it difficult for the virus to stay in dry places like anus; second anal sex is practised only by a small proportion of the population and so there is a lower risk to acquire infection than during vaginal intercourse which is practised by the majority of heterosexual partners.

A larger proportion of individuals tested following the death of the partner Other reasons for testing included its being a requirement for marriage, following advice from care providers and being forced to undertake one due to an elongated period of sickness.

Out of respondents, K-Y jelly was described as rather too expensive for many of the respondents to afford and hence was mainly accessible to the high income group. In the household survey, several ways were used for lubrication of the anus before intercourse. The study was aimed at determining the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in heterosexual liaisons.

The study findings have revealed that although the reported magnitude of FAS remained low The practice seems to be widely practised especially in coastal belt districts as reflected in qualitative findings. The low prevalence of anal sex was also revealed in a study conducted in Ethiopia where only 4.

Despite the small magnitude of anal sexual intercourse, it is equally important to make a follow up as this practice is the riskiest sexual practices in HIV transmission. In fact, many individuals in the study reported being convinced to engage in FAS but the receptive rate was higher in Makete than in the three other districts under review.

The acceptance rate in Makete can be well correlated with their lower level of education, compared to other districts as the study findings revealed. This finding attests to the consistency with the data obtained from the qualitative section. To our knowledge this is the first study in Tanzania that has explored specifically female anal sex in heterosexual relationships and its associated practices in the general population.

U n aids anul sex africa

U n aids anul sex africa