Mtenga, Sally

Digital Library of the Tanzania Health Community

  
 
 
 
REASONS FOR AND PROTECTION USE DURING 
Heterosexual Anal Sex in Selected Populations in 
Tanzania 
 
 
 
Sally Mtenga (Social Scientist) 
 
 
 
ICASA CONFERENCE 
CAPETOWN-SOUTH AFRICA 
7-10 DECEMBER, 2013 
 
 
Co-Investigators 
 Dr. Saidi Kapiga – Principle Investigator 
 Dr. Eveline Geubbles  
 Dr. Deodatus Kakoko 
 Dr. Swibert Kamazima 
 Dr. Joyce Wamoyi 
 Donati Shamba 
 Aika Mongi 
2 
OUTLINE 
Background 
 
 Study methods 
 
 Results   
 
 Conclusions and Implications 
3 
Definitions 
 
Sexual act between men and women 
 
 Penetration of penis in the anus of a female 
(receptive) partner (i.e. penile-anal intercourse) 
 
Can be classified as heterosexual receptive anal 
intercourse or heterosexual penetrative anal 
intercourse 
 
4 
BACKGROUND 
5 
The risk of HIV-1 transmission per heterosexual contact in low-income  
countries for male-to-female is 0.30% per act (95% CI 0.14-0.63) 
 
 Unprotected receptive anal intercourse per act estimates are substantially higher 
(~5-6 times higher) than for male-to-female vaginal intercourse 
 
 There is high risk of transmission for male-to-female heterosexual couples 
practicing anal intercourse, even if only occasionally 
 
 
Boily M-C et al (Lancet Infect Dis 2009;9:118-29)                                          Baggaley RF et al (Int J Epidemiol 2010;39:1048-63) 
 
 
BACKGROUND CONT.. 
 
 Comprehensive information about HAS is lacking in Tanzania 
despite anecdotal evidence about its existence.  
    
 Larger study required to investigate HAS in a range of 
populations  
 
 Before implementing a larger study, formative research  
     is needed to understand the perceptions and attitudes about 
HAS 
6 
Specific objectives 
 To explore meanings, perceptions and beliefs about HAS 
 
 To investigate the context within which HAS is practiced 
Reasons for HAS 
HAS initiation 
 
 To explore perceived health risks associated with HAS 
 
 To understand about the link between HAS and HIV 
 
 To assess protection use during HAS 
 
7 
Methodology 
Study design 
 The study was exploratory and involved qualitative methods.  
Study sites: 
  Ifakara rural & Morogoro urban 
  Mwanza urban & fishing camp   
  Dar es salaam urban 
Tanga urban  
Study population: 
    Women & men aged between 15-49 years were purposively 
recruited from 
General population (married & unmarried) 
High-risk groups (Female sexual workers(FSW),  fishermen, 
truck drivers, women working in recreational facilities) 
 
8 
Recruitment process 
 Truck drivers were recruited through a head driver of a 
company running a fleet of trucks 
• 4 major truck stops in Morogoro region were identified 
• At each stop, 2-3 truck drivers were contacted & rapport 
built with them and they were used to identify other 
drivers.  
 
 FSWs were recruited at their work places in the brothels & 
streets 
• researchers contacted establishment owners to seek 
permission to talk to sex workers at their convenient 
time. 
 
 
9 
Recruitment process 
 Fishermen groups were organised through owners of 
fishing camps/leaders of the group along Lake Victoria 
• visited the fishing communities in selected sites 
• approach to building rapport was similar to that of truck 
drivers.  
 
Women working in bars 
• Meet with facility owners/managers to inform them about 
the study & seek permission to meet with the women 
working at the facility 
• Similar to brothel-based FSW, rapport was built, detailed 
information about the study was provided & permission 
to participate sought 
 
10 
Methods cont… 
Data collection methods 
 Focus group discussions (FGDs) [24 FGDs] 
 In-depth interviews (IDIs) [81 IDIs] 
 
Data processing and analysis: 
 Transcription,  frequent review of the narratives, 
identification of relevant themes from the narratives,  
constant comparison, coding and interconnectedness.  
 NVIVO 8 software was used as an aid to facilitate viewing of 
participant's narratives and subsequent analysis. 
 
 
 
 
11 
  
 
 
                                 RESULTS 
12 
REASONS FOR HAS PRACTICE  
 Provide insights on perceptions, believes linked to the practice.  
 Provide an entry point to relevant interventions for HIV and STI  
prevention. 
 
Findings 
 Highly recognized and reported to be a common practice 
among young people, un-married and prostitutes. 
 
 Reported to be rarely practiced among the married individuals.  
  
 Multiple drivers influence HAS practice for men and women 
 
 Men from rural and those from urban had common reasons for 
HAS practice. The same with women.  
 
 
 
13 
Findings cont…… 
 Reasons for HAS as manifested within gender construct… 
 
 
14 
 
Watching 
pornography 
 
Proof of love 
 
 
 
 
 
•Sexual pleasure 
 
Tightness and Dryness of 
the anus 
 
Fasten ejaculation 
 
•Proving Masculinity 
 
•Exploring sexuality 
 
•Value for money 
 
•Belief that HAS is    
safer 
 
 
MEN 
 
 
 
•   Earning high income 
Economic hardships 
 
•Keeping a 
husband/partner 
 
•Preventing pregnancy 
 
• Alternative  during   
menstruation 
 
•Fatten female buttocks 
 
•Keep with modernity 
 
•Preserving virginity 
 
 
Women 
Reasons for HAS, excerpts….. 
 
 Access to income by the students, sexual workers and other women 
 
 
    
 
 
 
 
 
15 
 
 “it pays more than 
penis vagina 
penetration [between 
Tshs 50,000 and 
100,000]”  [IDI, FSW, 25 
years, Dar es Salaam] 
“Students know that if they 
do sex (anal sex) with a man 
they will get much money 
which will help them in  
school. This is especially 
with secondary school 
students, ‘shule za kata’  
ward secondary schools)” 
[FGD, Male participant, 24-49 
years, Community] 
Reasons for HAS, excerpts….. 
     Anus is viewed as most pleasurable sex [dry, resistant, warmth and  
cool] as compared to vagina 
 
    R2: “That if you enter to eat from the back [anus] it is really cool...you 
see...you experience pleasure, it is sticky/has more resistance” R3: 
“The benefits are when you insert; you feel the warmth in the first 
instance..” [FGD, fishermen, 15-24 years].  
 
     Anal Sex for pleasure and vagina for pregnant... 
 
     “You find a woman and you ask her “do you want pregnancy or you want 
pleasure? “and she says that Aah I want pleasure” then you tell her “okay if you 
want pleasure give me anal sex and if you want pregnancy give me vagina sex” 
because in the vagina is where you get pregnant and in the anus that is where 
you get pleasure [P4, #15, FGD, Truck Driver, 25-49] 
 
 
16 
Reasons for HAS, excerpts……… 
 
 HAS is driven by curiosity to imitate what is being shown in the movies    
 
 
 
 
 
 
 
    
             
17 
“I saw from the video and felt that people were 
benefiting a lot and that when I was doing vaginal 
sex with my wife, was not groaning then I thought 
that may be in the anus she will complain and so I 
decided to do in the anus for sure it is sweet, that 
aha, aha, aha attracts me” [IDI, Male participants, 
26, years, general  population]. 
Reasons for HAS Participant’s Quotations 
 A belief that ‘there is no diseases in the anus, the disease is only found in the 
vagina.. 
 
 
 
 
 
 
 A belief that HAS is helping in keeping husbands/partners in the 
marriage/relations 
 
 
 
 
 
18 
“…a big percent of us we know that 
diseases are only acquired from the vagina  
and people think there is no diseases in the 
anus, that is why you see people decide to 
do anal sex .. [FGD, Male participant, 25-
49, General population] 
 
 “Most of  girls and women in this area 
believe that engaging in HAS facilitates 
maintaining sexual relationship or 
marriage”  [FGD, Female participant 15-
24 years. General population] 
Protection use during HAS 
 Both participants oppose the issue of wearing condom during 
HAS. However, men strongly disfavoured condom during HAS.   
 
lower use of protection during HAS  
   “in that other place (anus) I do not use (condom) but in the vagina 
I use condom” [IDI, Male participant, 46 years, general 
population].  
 
Condom was perceived as inappropriate for HAS BUT appropriate for 
vagina sex only 
    “I am saying that, there is no wearing of condom during anal sex 
so that I sex a woman, that exercise (wearing of condom) is very 
difficult because that place is not conducive for wearing condom, if 
it is to wear condom it is only for vagina” [IDI, Male participant, 
25years, general population]. 
 
19 
Protection use during HAS 
    Condom use during HAS is only to protect one from feaces and 
not HIV  
    
   “First, they protect themselves from faeces and not HIV, because 
during the insertion of the penis much faeces is coming out and 
when pulling out the penis you may see the faeces pour down” 
[FGD, Female participant,15-24 years, general population]. 
 
    
     Use of lubricant during HAS was meant  to facilitate easy 
penetration of the penis  
 
     “The man usually applies the jelly to his penis and around the 
anus so that when he enters his penis does not get any difficult 
because that place is dry” [IDI, Female participant, 35 years, 
general population].  
 
 
20 
Specific reasons for not using condom during 
HAS 
 Perception that diseases are only acquired during vaginal sex 
 
  Abelief that condom would easily tear 
 
 A belief that condom may stick inside the anus 
 
   “Mostly in the vagina that is where we like to use condom. 
Because it is easy in the vagina. But difficult in the anus because 
the condom may stick inside the anus…. and provide problems 
[FGD, Female participant, 15-24 years, general population].  
 
 A belief that condom during HAS would delay ejaculation or interfere 
with sexual pleasure  
 
 
 
21 
Conclusion 
 HAS is widely recognized and perceived to be common in the 
study regions.  
 Discourses, believes and social value placed on HAS could be 
driving the practice among different social groups.  
 Men and Women differently share common drivers for HAS 
 Transactional sex is the key driver for HAS among women 
 Desire to experience pleasure is the key driver for HAS among 
men 
 Protection use during HAS is not widely accepted  
 Condom use is almost non-existence during HAS due to beliefs 
about condoms.  
 
22 
Study Implications 
 HAS being a common sexual art, call for it’s integration in the 
health care prevention programmes and advocacy for safer anal 
sex.  
 
 Social construction of sexuality is likely to contribute to HAS 
practice and subsequent negative health outcome if protection 
use is not widely recognized.  
A need to address structural constructs that drives women 
and men to HAS practice.          
 
 Desire to practice HAS for pregnancy prevention  
Call for intensified integrated HIV and reproduction health 
services.  
 A need to clarify myths and misconceptions that drive people 
to HAS practice 
 
 
23 
Acknowledgement 
• Our study participants 
 
• Research and administrative teams at 
 National Institute of Medical Research (NIMR) 
 Muhimbili Health and Allied Science (MUHAS) 
 Mwanza Clinical Trial Unit (MITU) 
 Ifakara Health Institute (IHI) 
 
• Tanzania Commission for AIDS (TACAIDS) for funding and 
commissioning us to do this work 
 
24 
  
 
 
 
THANK YOU FOR LISTENING  
25 


Reasons for and Protection use During Heterosexual Anal Sex in Selected Populations in Tanzania

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Reasons for and Protection use During Heterosexual Anal Sex in Selected Populations in Tanzania

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