Research studies on adolescent women's HIV risk behaviors have begun to trace rates of anal sex (AI) (Houston, Fang, Husman, & Peralta, 2007). Among adolescents, heterosexual anal intercourse (HAI) has become a comparatively common sexual behavior (Carter, Henry-Moss, Hock-Long, Bergdall, & Andes, 2010; Hensel, Fortenberry, & Orr, 2010; Roye, Krauss, & Silverman, 2010), with a prevalence starting from Sixteen Personality Factor Questionnaire to thirty fifth (Carter et al., 2010; Koblin et al., 2010; Roye et al., 2010). The National Survey of Family Growth according that forty three.5% of males and twelve months of females aged twenty five to forty four had engaged in HAI (Chandra, Mosher & Copen, 2011). Receptive AI is that the sexual behavior that the majority dependably predicts HIV seroconversion (Boily et al., 2009; Halperin, 1999; Karim & Ramjee, 1998; Poles, Elliott, Taing, Anton, & Chen, 2001; Royce, Sena, Cates, & Cohen, 1997). Receptive AI is calculable to be five to twenty times riskier for girls than penile-vaginal intercourse (PVI) (Laumann, Gagnon, Michael, & Michaels, 1994). Like adults, young heterosexual couples area unit less probably to use condoms throughout HAI than throughout PVI (Exner et al., 2008; Houston et al., 2007; Roye et al., 2010), indicating that overall lack of birth control device use might not justify unprotected HAI and suggesting that the context of HAI and HAI risk taking might disagree from that of PVI,
The context of HAI isn't well understood. Investigators have ascribed adolescent HAI to a want to forestall physiological state or maintain status (Halperin, 1999). However, in a very study of 244 Black and Latina feminine adolescents, all of whom had a history of PVI, thirty fifth had engaged in HAI even supposing seventy three of these United Nations agency according HAI within the previous 2 months were mistreatment secretion family planning at the time of HAI (Roye et al., 2010), suggesting that HAI might not be explained only by a want to forestall physiological state or maintain status.
Sexual scripts offer a elementary organizing roadmap or guide in determinative and understanding sexual behaviors and risk-reduction activities (Gagnon & Simon, 1973). throughout adolescence, teens learn and take a look at out sexual scripts (Gagnon & Simon, 1973). ancient scripts for a spread of heterosexual behaviors, like PVI (Burns, Futch, & Tolman, 2011; Gagnon & Simon, 1973), area unit predicated on beliefs regarding normative male (active) and feminine (passive) sex (Vannier & O'Sullivan, 2010; Wingood & DiClemente, 2000). Among adolescents, these scripts are found to breed gender-based power arrangements in heterosexual sexual practices (Kim et al., 2007). The physical property of HAI has precluded development of specific scripts for the way this behavior is negotiated (Maynard, Carballo-Dieguez, Ventuneac, Exner, & Mayer, 2009), although as a heterosexual sexual behavior it appears probably that it might be almost like alternative behaviors. Moreover, the literature on sexual scripts describes ladies passively partaking in sexual intercourse, together with unwanted sexual intercourse (Sanchez, Fetterolf, & Rudman, 2012). HAI has usually been viewed as a behavior that's desired by men however not by ladies (Halperin, 1999). Thus, in step with sexual script theory, another theorized rationalization for girls partaking in HAI is that they will be following this script to please their partners; but, few studies might be found that self-addressed sexual scripts specifically for HAI. One study, Maynard, Simon, and Gagnon (1986) did utilize sexual script theory to guide their analyses.
Sexual relationship power (SRP) might play a task in young women's choices to have interaction in HAI and the way they negociate this alternative and operationalize ancient sexual scripts (Billy, Grady, & Sill, 2009; Roye et al., 2010). One study found that heterosexual couples aged twenty to thirty five (N= 335) within which men create the selections regarding sex area unit additional probably than alternative couples to have interaction in HAI (Billy et al., 2009). The literature on this issue is thin.
Two qualitative studies examined HAI, one in adults and one in young adults (Carter et al., 2010; Maynard et al., 2009) In Maynard and colleagues' (2009) study, twenty eight adult ladies United Nations agency were partners of HIV-positive men or men at high risk for HIV infection overpoweringly according that their partners initiated HAI, and 7 ladies according a minimum of one episode of nonconsensual HAI. They additionally cited the role of "intimacy" in their choices to possess HAI, that was perceived as AN exceptional act that was reserved for a special partner. the opposite study, by Carter and colleagues (2010), examined seventy Black and American men and ladies ages eighteen to twenty five. Some ladies in each studies according that HAI was painful, whereas others according pleasure. Some adults according that the pain increased their pleasure (Maynard et al., 2009). Some ladies within the younger cohort additionally felt that HAI increased intimacy or would possibly keep their partners from turning to a different girl United Nations agency was willing to have interaction in HAI (Carter et al., 2010). birth control device use was sporadic in many studies of HAI (Carter et al., 2010; Exner et al., 2008; Maynard et al., 2009). whereas these studies begin to explicate the context of HAI, few up to now have examined HAI and gender dynamics in any people. the present study was designed to get young people's own narratives regarding their experiences with HAI, each the selection to possess HAI and HAI refusals, to produce AN age-specific and additional fleshed-out understanding of this dynamic, and alternative key dimensions of this more and more frequent risky behavior, so a fuller image of HAI among tykes will begin to emerge.
Methods
Recruitment. The study was approved by the institutional review board at an oversized, public, urban faculty before accomplishment began. accomplishment sites enclosed the faculty, wherever flyers regarding the study were denote, ANd an adolescent clinic wherever a analysis assistant (RA) recruited participants. The RA was an experienced social worker from a background similar to the participants. faculty students United Nations agency responded to the flyers received AN e-mail survey to verify eligibility (including ages fifteen to 22; self-identifying as African yank, Caribbean Black, African, or Latino; and history of epithelial duct, anal, or oral intercourse). If eligible, they organized to fulfill with the RA. Those recruited within the clinic completed the survey in a very personal area before or when being seen by their suppliers. All participants signed consent before participation.
Measures. The sexual behavior form, a modification of the form utilized in previous studies conducted by the primary author (Kamb et al., 1998; Roye, Perlmutter Silverman, & Krauss, 2007), asks careful questions about sorts and frequencies of sexual behaviors and partners (main and/or casual).
Sexual Relationship Power Scale (SRPS). The SRPS could be a 23-item scale (Pulerwitz, Gortmaker, & DeJong, 2000). It had sensible internal responsibleness (Cronbach's [alpha] = .84) in a very comparable study of 388 young minority ladies (Pulerwitz et al., 2000). it's 2 subscales, Relationship management and Decision-Making Dominance. Decision-Making Dominance is conceptualized because the ability to have interaction in behaviors against a partner's needs. Relationship management entails the flexibility to regulate a partner's actions (Pulerwitz et al., 2000). every subscale had adequate internal responsibleness in this study ([alpha] = .86 for Relationship Control; [alpha] =.62 for Decision-Making Dominance). Subsequent validation studies found that SRPS scores were positively related to a history of condom use during PVI (p < .01) and reciprocally related to history of relationship violence (p = .01) (Pulerwitz, Amaro, DeJong, Gortmaker, & Rudd, 2002).
Interview protocol. A semistructured open-ended interview was used (Roye et al., 2010). Interviews began with general questions about family, friends, and whom the respondents speak to regarding sex. in line with a phenomenological narrative inquiry (Riessman, 2008), customary sets of queries designed to elicit narratives regarding adolescents' sexual experiences (Tolman, 2002; Tolman, Hirschman, & Impett, 2006) were used so revised to elicit specific narratives regarding HAI, together with their most up-to-date or unforgettable experiences, and birth control device negotiation and use.
Procedure
The form was administered via audio computer-assisted self-interview (ACASI), that reduces recall issues and social desirability biases; participants will browse the queries or hear them through headphones (Kelley, Borawski, Flocke, & Keen, 2003; Kurth et al., 2004; Macalino, Celentano, Latkin, Strathdee, & Vlahov, 2002). supported participants' temperament to be interviewed, people who had full-fledged HAI or HAI refusal created a rendezvous to come for AN interview. To preserve confidentiality, all distinguishing data was faraway from the interview. Interviews were digitally recorded and transcribed.
Results
Quantitative knowledge
A total of sixty one participants completed the survey, fifty three females and eight males, age vary fifteen to twenty two (M = 18), with fifty eight of the sample distinguishing as Black (including African yank, Caribbean Black, and African), fifty seven Hispanic, and V-day mixed Black and Hispanic heritage. In all, twelve participants (20%) according a history of HAI, ten females and a couple of males. Age initially HAI ranged from thirteen to twenty (refer to Table one.) people who according a history of HAI used condoms less often for HAI than for PVI and were additional probably to report ne'er mistreatment condoms for PVI than people who had ne'er had HAI, although the distinction wasn't statistically important (refer to Table 2).
Half the sample (N = 31; twenty eight of whom were female) according ever having refused HAI. However, 2 of the young ladies United Nations agency according HAI refusal had engaged in HAI however according refusal owing to incomplete penetration. the explanations given for refusing AI were "I did not want having anal sex" (N = 29) and "Worried regarding infection" (N = 2); alternative reasons for refusal were "Didn't have a condom" and "Didn't trust my partner."
Analysis. every scale of the SRPS incontestable acceptable internal responsibleness, [alpha] = .88 for Relationship management and a less sturdy however adequate [alpha] = .63 for deciding Dominance. (Two things from the choice creating Dominance scale were born to boost internal consistency.)
To explore variables related to HAI, a series of correlations were obtained. important correlates of HAI enclosed history of physical abuse by a partner, pregnancy, and frequency of birth control device use for epithelial duct sex (inverse correlation) (refer to Table 3).
Relationship management scores yielded a considerable (inverse) correlation with HAI (r = -.44; p<.001), in alternative words, people who perceived having a high level of management in their relationships were less probably to report a history of HAI. owing to this inverse association, correlates of Relationship management were obtained. important correlates of Relationship management, all of that were inverse correlations, enclosed history of a sexually transmitted illness (STD) and physical abuse (refer to Table 3). However, there was no correlation between the connection management score and birth control device use for PVI.
Decision Making Dominance scores yielded a trend toward a big (inverse) correlation with HAI (r = -.24; p = .07). the sole important correlate of deciding Dominance was frequency of birth control device use for PVI (r = .36; p = .009) (refer to Table 3). That is, people who were ready to have interaction in behaviors against their partners' needs were additional probably to report birth control device use for PVI.
Qualitative knowledge
Twelve females and 3 males were interviewed; 2 of the young ladies had refused HAI; and one young man was turned down by his partner. A grounded theory approach (Charmaz, 2000) was wont to establish themes, that were then applied across all of the interviews in a very systematic thematic analysis (Braun & Clarke, 2006). All instances of every theme were known and sorted into meaning classes that applied across the transcripts (Patton, 1990). Development of themes and knowledge secret writing were conducted by the third author, with the primary and second authors confirming the appropriateness of themes known and match of themes into the higher-order classes. The themes were determined to be credible and valid (Maxwell, 1996), utilizing the constant comparison approach (Patton, 1990).
Physical dimensions of the HAI experience: Pain and pleasure. HAI was according as a physically painful expertise by half the females: "It was the worst feeling ever" (22-year-old Black woman). A 22-year-old Negroid according that HAI was painful as a result of the birth control device was tight: "It got higher towards the tip, then again i spotted the sole reason it got higher is as a result of the birth control device ripped." Some females represented HAI as being each pleasant and at the same time painful: "I truly liked it over it [hurt]" (22-year-old Black woman); "It feels sensible, however it is a very little painful at a similar time. however it's sort of sort of a sensible pain" (20-year-old Hispanic woman). One 22-year-old Negro specifically mentioned mistreatment material.
Evaluations and beliefs regarding HAI. once asked what tykes, in general, deem HAI, the comments enclosed that it absolutely was unclean and painful: "It's--it's simply nasty to me" (16-year-old Black woman); "She refused my invite for perversion as a result of she thought it might be painful" (mixed-race 22-year-old man).
Context of HAI.
Intoxication. many ladies mentioned the requirement to be intoxicated before partaking in HAI. "To be honest, that is one thing that you simply would do once you are beneath the influence ... [because] the liquor quite causes you to numb down there.... you will feel sensible and you will not feel the pain" (20-year-old Hispanic female).
Coercion and rape. Some ladies acquiesced to their partners' recurrent requests for HAI: "He wont to inquire from me, 'How come back you do not wanna attempt it?' ... And this only once ... I was like, 'Okay, we'll see if it works'" (22-year-old Negro, United Nations agency according being drunk at the time). 2 young ladies told stories of anal rape, with one 16-year-old Negro describing a resultant pleasant expertise with HAI with a unique partner: "At initial, it absolutely was pain a trifle bit, thus} when a short time like he did not do no rough things or nothing so it absolutely was feeling sensible."
Knowledge of HIV and use of protection. once asked regarding the risks related to HAI, solely 2 participants, one male and one feminine, indicated that they were conscious of the association between HAI and infections. "I did not recognize you'll be able to catch HIV from having like perversion. I learned that in sex ed" (22-year-old Black woman).
Four tykes narrated birth control device use. AN 18-year-old Negroid said: "I tried, however it's too tight.... once it feels too tight, you sort of get involved that the birth control device is gonna break." However, there was an absence of concern from some: "To tell you the reality, no one uses protection today.... i do not suppose it even crossed any of our minds" (20-year-old Hispanic woman).
For some tykes, the failure to use condoms for HAI ushered in discontinuance of use of condoms for PVI as well: "After the anal, we have a tendency to did not use protection when that" (22-year-old Black woman). For others, failure to use condoms for an additional form of intercourse was a reason to not use condoms for HAI. One 16-year-old Negro, in narrating AN HAI expertise that occurred when oral intercourse (OI), represented this development. They usually had used condoms for OI, however now they didn't. once she asked him to place a birth control device on before HAI, he said, "[Because] you simply gave Maine head, you simply sucked my, you know, therefore if I do have one thing, no matter I actually have, it's in your mouth." They didn't use a birth control device for HAI.
Sexual scripts for HAI: ancient and untraditional. feminine gatekeeping to regulate male want in stories of refusing HAI were almost like well-known scripts for PVI (O'Sullivan, Cheng, Harris, & Brooks-Gunn, 2007; Sanchez et al., 2012; Tolman, 2002). Seven young ladies recounted such stories, even supposing four of them gave in to requests for HAI at a later date, together with one feminine United Nations agency was drunk. A typical comment: "He was like, 'When you gonna let Maine fuck ya butt?' and that i was like, 'Never'" (16-year-old Black female). In one case, a young woman described how her partner had tried to trick her into having anal sex, however she was ready to stop him: "I turned ... and he tried to place it in my butt. i used to be like no, i am not gonna do this, like, stop" (16-year-old Black female). Another girl tried to persuade her partner that HAI was a nasty plan, therefore she created up a reason not to--not realizing that this was a true issue: "So i am such as you will get a bunch of ... infections [if we've anal sex].... i used to be attempting to induce him to merely not wanna [have anal sex]" (22-year-old Black woman). in line with a standard belief that if a girl is raped she is command responsible instead of the young man, one 16-year-old Black feminine United Nations agency had been anally raped partially everlasting herself: "I felt like essentially was taken advantage of, but ... I mean, i am unable to absolutely blame them, as a result of i am my very own person. I may have went home or not cut college."
The traditional sexual script wasn't systematically evident in however HAI was represented. In contrast to being proactive only to counteract male desire for penetrative sex, some young ladies told stories of feminine self-assertiveness, initiation, and desire. as an example, one miss described having a concept that included safety and luxury precautions and also the active choice of a selected male: "There was only once that I had planned right before, like I had brought the lubricant and everything. and that i had chosen the guy for it, cause he wasn't that huge.... He was attempting to sleep, I was like, 'Oh no, it isn't over nonetheless.'... I started kissing him" (20-year-old Hispanic woman). Another miss expressed her own desire for perversion once her boyfriend asked, "So he was like, 'Can I place my erectile organ in your butt?' and that i was like, 'Yeah.' I needed some" (16-year-old Black female).
Another steered that her partner had professionalvide|to supply|to produce} her with pleasance as a form of quid pro quo for agreeing to anal sex: "I created him work for it" (22-year-old African American). In another contradiction of a standard sexual script within which actions unfold instead of get mentioned, one miss according shared call making: "Because, well, I mean the primary time we have a tendency to tried it, you know, I enjoyed it, he enjoyed it, therefore we have a tendency to patterned that will be the simplest means for U.S. to go" (22-year-old Black female).
Other reasons for partaking in HAI. additionally to the explanations mentioned, alternative reasons for HAI emerged, together with relationship management, menstruum (one male and one female), physiological state bar, and curiosity that in some cases was galvanized by smut. One miss alluded to a myth: "If you are doing it, your butt can grow.... i am attempting to induce my butt trying like yo[urs]" (16-year-old African yank woman). for a few young ladies during this study longevity of relationship was the determinant for whether or not to possess HAI. They talked regarding having HAI not specifically as a path to intimacy (with one exception) however as a result of they'd been along for a "long" time--one year in one case and 5 years in another. just one miss mentioned intimacy and did therefore within the context of worry of pregnancy: "I needed to require [our relationship] to a different level. I needed to be near him, I needed to pair with him [without the chance of pregnancy]" (22-year-old African yank woman). smut stirred interest in HAI for 2 of the males United Nations agency were interviewed. One (22-year-old mixed-race) male aforementioned, "I simply needed to do it as a result of I actually have seen it in pornos, [so] why not attempt it and see what it seems like."
Silence around HAI. once asked United Nations agency they talk over with regarding sex, most respondents aforementioned that they talk over with their friends however sent discussions regarding PVI and protection for PVI; none mentioned discussing HAI with friends or anyone else. One 16-year-old Negro, United Nations agency indicated that she spoke to friends regarding PVI and condoms, once asked regarding HAI said: "Well, she [her confidante] does not extremely state it. She ne'er talked regarding perversion. I mean, i do not extremely get laid to possess to raise her regarding it." Some giggled once asked whether or not they talked regarding birth control device use for HAI.
Discussion
This study provides AN rising image of HAI for Black and Latino adolescents and young adults. the image is complicated, and even during this little sample, HAI isn't a standardized or monolithic expertise. each the quantitative and qualitative findings shed lightweight on some dimensions of this quality. This study reflects recent findings that HAI is a component of the sexual repertoire for a minimum of some tykes which our operating assumptions regarding this risky behavior among tykes might not be correct. what is more, the same old sexual scripts for PVI might not apply to HAI. The findings highlight necessary areas for future study. for instance, whereas HAI has been understood as a way to preserve status or stop physiological state (Halperin, 1999), this study provides proof of an extra motivation: Some young ladies realize it pleasant, even some United Nations agency additionally expertise it as painful. in line with alternative studies (Pulerwitz et al., 2002; Roye et al., 2010), the quantitative chemical analysis suggests that young ladies United Nations agency feel they need decision-making power at intervals their relationships will and do raise their partners to use condoms for PVI. However, proof that they're mistreatment such capability to request birth control device use for HAI didn't emerge during this study. There additionally seems to be an absence of information regarding HAI risk, which can part justify the discrepancy between birth control device use for epithelial duct and anal sex, though that is still to be verified. additionally, it's potential that issues regarding physiological state might play a neighborhood in birth control device use for PVI however not for HAI; a study that examined young ladies United Nations agency were hormonally protected against physiological state equally found less birth control device use for HAI than for PVI (Roye et al., 2010).
Other findings from the combined quantitative and qualitative analyses that advantage additional exploration embody (a) HAI is also turning into a additional consistent a part of adolescents' and young people's sexual repertoire, usually co-occurring with PVI or oral intercourse; (b) typical gendered power might not to be a unitary construct for all sexual behaviors; (c) sexual scripts for HAI might disagree from those for PVI; and (d) various factors is also related to sexual risk reduction for PVI and HAl--in alternative words, factors that promote birth control device use for PVI might disagree from those that promote birth control device use for HAI or HAI refusal. However, as a result of it seems that the majority tykes don't perceive that HAI is AN HIV-risk behavior, by refusing HA1 young ladies with high relationship power scores might merely are expressing their preference to not have interaction in HAI instead of creating a thought-about risk-reduction alternative. additional analysis is required to grasp the connection between gender power and HAI.
Another necessary finding is that some couples, when crossing the road and not employing a birth control device for HAI, stopped mistreatment condoms for PVI in addition, and the other way around, probably explaining lower levels of birth control device use for PVI by people who have had HAI (Roye et al., 2010). on these lines, one study of adolescent HAI found that having used a birth control device on a similar day for a unique sexual behavior or recent birth control device use for HAI was related to birth control device use for HAI (Hensel et al., 2010). whereas additional analysis can verify however necessary this finding is for HIV risk-reduction education, this study raises a crucial question regarding however HAI informs birth control device use across risk behaviors.
While a previous study of adults (Maynard et al., 2009) found that ladies usually thought-about HAI AN exceptional act reserved for a special partner as the simplest way to precise and convey intimacy, that didn't seem to be the case during this study. HAI is more and more a part of the sexual landscape among adolescents (Carter et al., 2010; Roye et al., 2010); during this study, the bulk of respondents had restricted HAI: simple fraction of the participants according HAI refusal, and an extra two hundredth according partaking in it. The growing proof that HA1 is turning into a normative sexual behavior among heterosexual tykes suggests the requirement to create education regarding HAI risk a typical a part of sex education.
Limitations
This study is AN initial exploration of the development of HAI, with attention on gender power and sexual scripts among tykes. As such, it's restricted by many factors. The sample size was small; therefore, the findings primarily serve to produce intriguing steering for future studies. whereas important associations within the quantitative knowledge were found even with this little sample, in addition as patterns within the qualitative knowledge, inferences should be drawn cautiously. The participants were primarily feminine, all participants were of African or Hispanic descent, and every one were either in faculty or attending a young adult clinic. Larger studies with this population and alternative populations area unit required before implications are often drawn.
Conclusions
This study suggests that the doctrine of HAI among adolescents is distinct from PVI and includes risk behaviors and complexities that haven't been known up to now. These findings counsel areas for future analysis, together with assessment of adolescents' data regarding HAI risk; the context of birth control device use for HAI, notably as a part of a sexual repertoire that features PVI and/or OI; the connection of substance use to HAI; the role of gendered power in HAI; and young women's wishes for and management of HAI, that runs counter to ancient sexual scripts. These understandings can pave the means for higher risk-reduction education for adolescents.
