Duby, Z., Hartmann, M., Montgomery, E.T., et al. AIDS and Behavior (July 2015), doi: 10.1007/s10461-015-1120-0.
This study investigated condom and lubricant use, rectal cleansing, and rectal gel use for penile-anal intercourse (PAI) during in-depth interviews with 88 women from four sites in South Africa, Uganda, and Zimbabwe who formerly participated in VOICE, a five-arm HIV prevention trial of two antiretroviral tablets and a vaginal gel. The study found that the majority of Zimbabwean participants (65 percent) and South African participants (73 percent) believed that condoms could be used for PAI. In Uganda, however, the majority (59 percent) of participants did not think it was possible to use condoms for anal sex, for reasons including the anus being too tight and that the condom would tear or get stuck. Some participants in all three countries believed that it was not necessary to use condoms for PAI, suggesting that some men and women choose to engage in PAI for HIV prevention, as PAI is seen as a safer alternative to penile-vaginal intercourse. When asked about
vaginal gel use, some participants suggested that if the gel provided protection from HIV, women might use it vaginally or rectally. The authors concluded that results of this first study related to practices associated with PAI among heterosexual women show that women need to be included in rectal microbicide trials in Africa.