AIDS and Behavior. We assessed the influence of participant and study characteristics on AI prevalence e. Of 15, identified studies, were included. Pooled prevalences varied little by recall period lifetime: Across all study participants, between 2. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics.
Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
HIV is very effectively transmitted during anal intercourse unprotected by condoms UAI , with a meta-analysis finding that women may have an fold greater HIV acquisition risk during UAI compared to vaginal intercourse unprotected by condoms UVI [ 1 ].
Thus, even a small proportion of intercourse acts being AI may therefore substantially contribute to HIV transmission [ 2 , 3 ]. However, the role of anal intercourse AI within heterosexual epidemics has not been sufficiently examined and is frequently overlooked [ 4 ]. For example, recent reviews on HIV risk behaviour among female sex workers FSW in China [ 5 ] and among young people in Africa [ 6 ] examined multiple measures of sexual risk-taking but neither included AI practice.
For example, none of the studies included in two systematic reviews on HIV prevention interventions among African FSW reported whether or not messaging on safe AI was included in the interventions [ 7 , 8 ].
