Individual, Partner, and Partnership Level Correlates of Anal Sex Among Youth in Baltimore City

Anal sex is an efficient mode of STI transmission and studies indicate that anal sex is common among heterosexuals, including adolescents. We examined the association between individual, partner, and sexual partnership-level characteristics with anal sex among a household survey of 263 individuals aged 15–24 years in Baltimore City, Maryland. We used weighted multiple logistic regression to examine correlates of anal sex in a heterosexual partnership by gender. Twenty-nine percent of males and 15 % of females reported anal sex in a partnership in the past 6 months. For males, anal sex was associated with having two or more partners in the past 3 months (AOR = 13.93, 95 % CI 3.87–50.12), having been tested for HIV (AOR = 0.30, 95 % CI 0.12–0.72), and oral sex with a partner (AOR = 8.79, 95 % CI 1.94–39.78). For females, anal sex was associated with reporting having a main partner (AOR = 6.74, 95 % CI 1.74–23.65), partner meeting place (AOR = 3.03, 95 % CI 1.04–8.82), partner history of STI (AOR = 0.20, 95 % CI 0.05–0.85), and oral sex with a partner (AOR = 8.47, 95 % CI 1.08–66.25). Anal sex was associated with inconsistent condom use for both males (OR = 5.77, 95 % CI 1.68–19.79) and females (OR = 5.16, 95 % CI 1.46–18.30). We conclude that anal sex is a prevalent risk behavior among heterosexual youth and is associated with a range of factors at the individual and partnership levels. These findings provide support for comprehensive sex education that includes information about anal sex; findings from this study can inform public health campaigns targeting youth at risk for STIs.