AIDS and Heterosexual Anal Intercourse

To the Editor.— In their valuable report on acquired immunodeficiency syndrome (AIDS) in women, Guinan and Hardy¹infer that heterosexual anal intercourse plays little part in the sexual spread of the AIDS virus (the human immunodeficiency virus [HIV]), a viewpoint editorially echoed in the same issue ofJAMA.²However, inasmuch asreceptiveanal intercourse carries the highest relative risk by far for homosexual men, we underestimate the practice among heterosexuals at some peril. Sex researchers, unlike most physicians, are familiar with data indicating that about one fourth of American women occasionally engage in anal intercourse and about 10% do so regularly for pleasure.³,⁴We find that such information is obtained from most women only after repeated personal interviews and development of strong trust in the interviewer.⁵Thus, standard medical or field interviews are unlikely to reveal such activity, reinforcing the mistaken impression that anal intercourse is