[Dash of SAS] Unprotected anal sex drives HIV infection rate

Ana P. Santos

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(UPDATED) Safe anal sex awareness is important because unprotected anal sex has a higher rate of transmission of HIV and STIs

ANA P. SANTOS(UPDATED) Unprotected. Anal. Sex.                                                                    

That is what is driving the rate of human immunodeficiency virus (HIV) infection in the Philippines.

It is not “gay sex” that is driving the HIV epidemic because anal sex is not synonymous to gay sex. 

To use the term gay sex as a euphemism, substitute or synonym implies that only gay men have anal sex and by correlation, only gay men are vulnerable to being infected by HIV.

Both are not true.  Let’s break this down into smaller parts.


According to the Journal of the International AIDS Society, the Philippines has the lowest condom use in South East Asia, at 20-30% among high-risk groups. The study goes on to say that a 2003 national survey showed that 63 percent of male respondents said they had never used a condom and that condom use in extramarital partners was rare.

Average age of sexual debut is 15, but even before that we are overly exposed to the ubiquity of sexual innuendo — from the green jokes and all sorts of insinuations in everyday conversation, the billboards along EDSA, the motels for every budget and vehicle type that are close to rivaling a major department store chain in their coverage.

It is ironic that we have such an aversion to using condoms. But it is not surprising that the Philippines has the highest teen pregnancy rate in the region and is among one of the seven countries in the world where HIV infection continues to rise. (Other countries have already been able to manage their epidemic; some have even been able to drive down the rate of infection.)

If we had a database or a medical repository to record sexually transmitted infections (STIs), indicators would most likely show a growing number as well.

Condoms are the only barrier method scientifically proven to protect against STIs, sexually transmitted infections, and untimed pregnancy. When you have low condom use, you see high rates of STIs, including HIV and teen pregnancy.


Both gay and heterosexual couples engage in anal sex.

A thread in an online women’s forum entitled, “Backdoor…how was it?” reveals a lengthy discussion on anal sex. Some girls are curious about it because either they or their boyfriends are interested to try it. Some girls have done it and are more than willing to give out some sisterly advice; other girls swear by it.

Yes, these are Filipinas.

Yes, they are engaging or have engaged in anal sex with their partners as part of their sexual repertoire and not because they are prostitutes. [I must include the latter clarification because some believe that anal sex is a sex act best reserved for those that require an exchange of cash apart from bodily fluids.]

By equating anal sex only to gay sex, we are depriving women of information about how to engage in it safely.

Safe anal sex awareness is important because unprotected anal sex has a higher rate of transmission of HIV/STIs due to the fact that the anus does not self-lubricate unlike the vagina, making it more prone to tears and lesions where an infection may enter into the body.

CATIE, Canada’s source for HIV and hepatitis C information, rates HIV transmission via receptive anal sex (receiving the penis into the anus, also known as bottoming) at 1.4%. This means that an average of one transmission occurred for every 71 exposures. This risk was similar regardless of whether the receptive partner was a man or woman.

In comparison, CATIE estimated the risk of HIV transmission through receptive vaginal sex (receiving the penis in the vagina) to be 0.08%, equivalent to 1 transmission per 1,250 exposures.

HIV transmission for insertive vaginal sex (inserting the penis into the vagina) was estimated to be 0.04%, equivalent to 1 transmission per 2,500 exposures.


Risk of HIV transmission from different types of unprotected sex

  Number of individual studies Range of estimates Meta-analysis estimate
Receptive anal 4 0.4%-3.38% 1.4%
Insertive anal 2 0.06%-0.62%
Receptive vaginal 10 0.018%-0.150% 0.08%
Insertive vaginal 3 0.03%-0.09% 0.04%



In the parlance of HIV intervention programs, the term MSM or Men who have Sex with Men is used to define a certain behavior rather than a sexual orientation.

The UNAIDS Action Framework defines the term ‘MSM’ to describe those males who have sex with other males, regardless of whether or not they have sex with women or have a personal or social identity associated with that behavior, such as being ‘gay’ or ‘bisexual’.

So, MSM is be a male who identifies as either straight, bisexual or gay but has sex with other men.

He could identify as straight and thus, have a wife/girlfriend/female partner (some have permutations of all three) but also have sex with another man who could also identify as either straight, bisexual or gay.

He could identify as bisexual and have both a wife/girlfriend or a boyfriend/male partner and have sexual relations with both of them.

Or he could identify as gay and have sex only with other men.

Bottom line, MSM is a term used to describe a sexual behavior, and by recognizing that such behavior exists, HIV interventions are developed for other groups that are not usually seen as high-risk for HIV infection such as married women.

If that sounds complicated, that’s because it is. That’s also why it is inaccurate and unfair to limit the driver of HIV infection to simply gay sex (It’s actually kind of archaic; much like the early days of HIV when it was called ‘the gay plague’).

It is unprotected anal sex that drives HIV infection, regardless of who is having it with whom.

Instead of stigmatizing a certain behavior, what we should be doing is creating more awareness for the risks involved.

The sooner we can say unprotected anal sex without flinching, the sooner we can acknowledge it as the driver of HIV. If we address the source of the problem, we can arrive at its solution. – Rappler.com

Once upon her life, Ana P. Santos was once a banker. She decided to retire early and is now a journalist reporting on women’s  sexual health rights. Follow her on Twitter at @iamAnaSantos and on www.sexandsensibilities.com

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