Evidence map›Paper›PMID 28364565›Full record

SynthesisJournal of the International AIDS Society2017

How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis.

Branwen N Owen, Jocelyn Elmes, Romain Silhol, Que Dang, Ian McGowan, Barbara Shacklett, Edith M Swann, Ariane van der Straten, Rebecca F Baggaley, Marie-Claude Boily

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the International AIDS Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Branwen N OwenDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Jocelyn ElmesDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Romain SilholDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Que DangVaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
Ian McGowanDepartment of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, UK.
Barbara ShacklettDepartment of Medical Microbiology and Immunology, University of California, Davis, CA, USA.
Edith M SwannVaccine Clinical Research Branch, Division of AIDS, National Institutes of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA.
Ariane van der StratenWomen's Global Health Imperative Program, RTI International, San Francisco, CA, USA.
Rebecca F BaggaleyDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Marie-Claude BoilyDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.

Funding

HIV-Specific T Cell Responses in Rectal MucosaR01AI057020 · NIAID · UNIVERSITY OF CALIFORNIA DAVIS · PI SHACKLETT, BARBARA L. · 2003 to 2016
$6.2M
National Institute of Allergy and Infectious Diseases of the National Institutes of Health R01AI057020NIAID NIH HHS R01 AI057020
6 · The paper itself

Abstract

backgroundHIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa.

methodsWe searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by sub-groups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI.

resultsOf 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts.

conclusionReported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic.

Indexed as

HeterosexualitySexual BehaviorAdultAnal CanalBlack PeopleCondomsFemaleHIV InfectionsHumansMalePrevalenceSafe SexSex WorkersSouth AfricaUnsafe SexAnal intercourseheterosexualsexual behaviourSouth Africa

Identifiers

PMID28364565
PMCPMC5461120

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.