Resumen
ANTECEDENTES: Sexually transmitted infections can be spread through anal and oral sex between heterosexual and same-sex couples. There are few data on these sexual practices in Africa. We aimed to analyze the prevalence of anal and oral sexual practices among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa. Sociodemographic and behavioral factors associated with these practices were analyzed. METODOS: OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study evaluates the impact of the VCT on changes in HIV knowledge and sexual behaviors after 6 and 12-months. Since April 2016 until February 2018 655 persons aged 15-59 were HIV tested (19 HIV+) and replied to the baseline interview, that includes information about anal and oral sexual practices (fellatio and cunnilingus). Follow-up has not finished yet. Descriptive and multivariate logistic regressions have been carried out with baseline data (Stata 12.0). RESULTADOS: At baseline 22.1% of sexually active participants reported anal sex (20.3% of men and 24.4% of women, p=0.22; 15.8% of 15-24 year olds and 24.5% of adults, p=0.02). Same-sex relations were reported by 1.6% of participants. Oral sex was reported by 60.3% of participants (58.8% of women and 62.2% of men, p=0.39; 61.6% among young and 59.9% of adults, p=0.70). Nineteen percent of the participants had had both anal and oral sex (13.4% among young and 20.6% among adults, p=0.04). For both women and men, we found an association between anal sex and having had forced sex (OR=1.7; 95% CI: 1.1-2.7) and paid sex (OR=2.5; 95% CI: 1.4-4.6). Additionally, for women, anal sex was associated with being an adult (OR=2.0; 95% CI: 1.0-3.7), a sexual debut before 18 (OR=2.4;95% CI: 1.3-4.4) and reporting condom use (OR=2.1; 95% CI: 1.2-3.7). For men, reporting multiple sexual partners in the previous 6 months (OR=2.6;95%CI:1.2-5.3) and a low religiosity (OR=2.2; 95% CI: 1.0-4.9) were associated with anal intercourse. Oral sex was associated with condom use (OR=2.0; 95% CI: 1.6-2.6) and forced sex (OR=1.9; 95% CI: 1.3-2.8), for both sexes. For women, oral sex was associated with a higher economic level (OR=2.1; 95% CI: 1.1-4.1) and alcohol consumption (OR=10.9; 95% CI: 1.1-106.0). For men, paid sex (OR=2.8; 95% CI: 1.3-6.2) was associated to oral sex, while being married was inversely associated (OR=0.5; 95% CI: 0.3-0.9). CONCLUSIONES: Anal and oral sex were prevalent among men and women attending VCT in Kinshasa. Both practices were significantly associated with forced sex. Considering the high risk of STIs associated with these sexual practices, specific information about anal and oral sex should be included in HIV counseling sessions as well as in other preventive strategies promoted in Congo