Prevalence and Correlates of Heterosexual Anal Intercourse Among Clients Attending Public Sexually Transmitted Disease Clinics in Los Angeles County

Objective: To identify demographic and behavioral correlates of heterosexual anal intercourse (AI), as well as associations with sexually transmitted infections (STI) among clients attending public sexually transmitted disease (STD) clinics. Methods: We conducted a cross-sectional study of clients attending 13 public STD clinics in Los Angeles County, CA. Data collected included information on demographics, types of sexual contact, substance use, other risk behaviors, and STI results. Results: Overall, 10% of heterosexual men (n = 1,978) and 10% of women (n = 1,364) reported AI with an opposite sex partner in the 90 days preceding their clinic visit. Women who engaged in AI were more likely to report exchange of drugs or money for sex (adjusted odds ratio [AOR] = 2.80; 95% confidence interval [CI]: 1.95-4.02], substance use (AOR = 1.35; 95% CI: 1.17-1.55), and less likely to be African American (AOR = 0.53; 95% CI: 0.43-0.65). Among men, African American men were less likely to report heterosexual AI (AOR = 0.70; 95% CI: 0.60-0.82), while Hispanic men (AOR = 1.50; 95% CI: 1.29-1.76) were more likely to report heterosexual AI when compared to white men. Other factors associated with AI among men included exchange of drugs/money for sex, anonymous sex, and sex with an injection drug user. Among both men and women factors associated with AI varied by race/ethnicity. Conclusions: Recent heterosexual AI was reported by a nontrivial proportion of clients seen at public STD clinics. Those who reported AI were also more likely to report risk behaviors that place them at high-risk for transmitting or acquiring STIs/HIV.