Human Sexuality and AIDS - Essay Example

Human Sexuality In working to address the AIDS problem in Africa as well as the rest of the world, many studies have been conducted into the sexual practices of homosexual and bisexual individuals, with the assumption that the majority of heterosexual cases are caused by penile/vaginal penetration of one infected individual to an uninfected individual. However, more and more evidence is coming to light indicating that this is perhaps not the case. For various reasons, the question has been asked if the majority of heterosexual AIDS transmission is actually the result of vaginal penetration or if the risk of disease transmission comes from a more exotic source. Much of the literature avoids the issue of heterosexual anal sex as if it were an abnormal behavior, but studies are increasingly indicating that this is not the case and that anal sex may present a much greater risk for disease transmission than many people realize. By looking at four recent studies into the special issues that confront heterosexual couples who engage in anal sex, it will be understood why more studies and public education efforts must be made if the spread of AIDS is to be curtailed. Barry Schoub (1999) illustrates the various ways in which HIV is transmitted from one human being to another, highlighting the need for the virus to be transferred intravenously, i.e. through the bloodstream. The primary bodily fluids in which the virus is transferred, though, are reported to be blood, vaginal fluid and semen (Schoub, 1999: 92). In discussing the transmission types, particularly as it applies to the virus in vaginal fluid and semen, Schoub highlights the presence of greater numbers of CD4 receptor sites, which improve the chances of the HIV virus finding a new home in the uninfected partner. Because of this, he indicates transmission of the virus can occur after only one exposure with very little secretions exchanged (Schoub, 1999). While a great deal of his study focuses on the susceptibility of the CD4 cells in the male and female genitalia, Schoub also points to the problem of M-cells located in the rectum as these cells could be especially vulnerable to infection during such activities as anal sex (Schoub, 1999). This connection to anal sex brings several concerns to the forefront as this particular practice has been a rather taboo subject in most studies regarding the spread of AIDS and HIV. In “Assessing the Role of Anal Intercourse in the Epidemiology of AIDS in Africa” (2003), researchers Stuart Brody and John Potterat review published literature that addresses the specific issue of anal sex in sub-Saharan Africa in an effort to illustrate how important it is for further study to be conducted in this area. The authors note a profound lack of information regarding homosexual behaviors among anthropologists as well as in other fields when it came to reporting on African tribes throughout the 19th century. This is in spite of a long list of native terms that were used by African tribes to refer to same-sex partnerships (Brody & Potterat, 2003). “Anthropologists were aware, for example, of homosexual marriages which entailed ‘brideprice’ paid to the boy-bride’s parents, but remained silent about such unorthodox practices” (Brody & Potterat, 2003: 431). The concept that anal sex is prevalent among African cultures is further supported by a great many other examples such as this. In addition, the researchers found supportive evidence of anal sex in pathology reports in which a string of infectious and non-infectious conditions were reported as ‘gay bowel syndrome’ but that also managed to appear in heterosexual women. These conditions included anal warts and other symptoms that are difficult to manifest without participating in anal sex. The presence of these conditions in heterosexual women, therefore, point to the prevalence of anal sex practices among heterosexual couples (Brody & Potterat, 2003). Although self-reported anal sex practices remain lower in sub-Saharan Africa than in other parts of the world, the study’s authors indicate that this practice is against the law in many of these communities, causing many individuals to underreport or misreport their sexual behaviors (Brody & Potterat, 2003). However, comparisons of more open cultures as well as using the available reports from Africa, the authors conclude that the practice of anal sex, both homosexual and heterosexual, is much more prevalent than previously believed, warranting further study and education if AIDS distribution is to be curtailed. The need for further research is supported by Bruce Voeller (1991), who indicates that the prevalence of anal sex among heterosexual couples is actually far greater than most people might expect, including doctors, posing significant health risks to a greater number of people than imagined. With his study indicating that as many as 10-30 percent of married couples participate in anal sex, Voeller is able to conclude that there are more heterosexuals participating in anal sex than homosexuals or bisexuals (Voeller, 1991). A similar study by Daniel Halperin (1999) found that as many of seven times more women than men engage in unprotected receptive anal intercourse, greatly increasing their risks of developing one of the many infectious and non-infectious pathologies that are prevalent among those who participate in anal sex without the benefit of any warnings. Voeller’s research also indicates that there is very little discussion held regarding heterosexual practice of anal sex, either because it is assumed to be an activity not often practiced or because of a sense of embarrassment on the part of the doctor or the couple. Halperin (1999) found this same lack of information regarding the increased risks of disease transmission when participating in anal sex, whether that penetration is conducted in a homosexual or heterosexual relationship. “The health risks of anal sex appear to be severely underestimated by a substantial proporation of sexually active women and men in North and Latin America as well as parts of South Asia, Africa and other regions” (Halperin, 1999: 717). This lack of recognition of risks can prove dangerous, however, as anal sex presents several health risks that anyone who engages in it should be aware of. Voeller (1991) supports his claim that anal sex introduces a greater risk for HIV transmission (the virus that leads to the development of AIDS), with studies conducted regarding other Sexually Transmitted Diseases (STDs) and with biological facts regarding differences between the rectum and the vagina as far as disease transmission is concerned. Because of a correlation noticed between anal sex and the occurrence of cytomegalovirus, a herpes family virus, the greater risk of disease transmission in this area were studied revealing that the anus is indeed more susceptible to infection when anal sex is introduced than the vagina (Voeller, 1991). The biological reasons for this are given as well, including the fact that the tissue around the anus and within the rectum are not as elastic as the tissue around the vagina. This leads to the development of small fissures and cracks that provide direct access to the bloodstream for any carried diseases. In addition, the rectum does not produce any lubricant during the sex act, which further exacerbates the risk of injury as well as reduces the body’s ability to form a protective layer of liquid over these areas (Voeller, 1991). Finally, material in the rectum can cause infections in the urethra of the penis or the vagina should it be introduced to these areas. Halperin (1999) points to the fact that many individuals engaging in anal sex do not bother to take the precaution of using a condom, given the increased tendency of this device to break during this practice. Ironically, it is during anal sex that such a device is most needed. While the exact causes and types of virus transmission are continually being studied and attempts are made to educate the public regarding the true risks in HIV/AIDS avoidance, the problem remains as great as it ever was. In Africa, the spread of the virus has remained at epidemic proportions for years, yet there remains little understood about how to address the issue. The studies looked at above indicate that a significant problem in addressing the issue of AIDS transmission remains the social taboo regarding discussion of anal sex, regardless of whether it is considered homosexual or if it occurs between a heterosexual couple. While studies conducted by Halperin (1999) and Voeller (1991) indicate that heterosexual couples in the Western world participate in anal sex much more frequently than previously believed, Brody and Potterat (2003) indicate that these practices are at least equally widespread in Africa despite the lack of reporting. However, as was shown by Schoub (1999), Voeller (1991) and Halperin (1999), the specific characteristics involved in anal sex, including the body’s lack of production of lubricant, the reduced elasticity leading to small tears and fissures leading into the bloodstream, the tendency of condoms to break more frequently and the presence of M-cells which may prove more susceptible to HIV infection, indicates that the lack of education in this area could be deadly. While all of the above studies indicate more investigation is needed, they also make it clear that more public education throughout the world is required, breaking open the taboo subject as a means of saving lives, reducing the spread of the disease and finding solutions that work. References Brody, Stuart & Potterat, John J. (2003). “Assessing the Role of Anal Intercourse in the Epidemiology of AIDS in Africa.” International Journal of STD & AIDS. Vol. 14, pp. 431-436. Halperin, Daniel T. (1999). “Heterosexual Anal Intercourse: Prevalence, Cultural Factors, and HIV Infection and Other Health Risks, Part I.” AIDS Patient Care and STDs. Vol. 13, N. 12, pp. 717-729. Schoub, Barry D. (1999). AIDS and HIV in Perspective. (2nd Ed.). Cambridge: Cambridge University Press. Voeller, Bruce. (1991). “AIDS and Heterosexual Anal Intercourse.” Archives of Sexual Behavior. Vol. 20, N. 3, pp. 233-276. Read More