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Thursday
Nov142013

“We Don’t Have Anal Sex in Malawi” and Other Tales

Michelle Kaufman is a researcher who focuses on sexual behavior in the developing world. She globetrots regularly, engaging in ethnographic work along the way in order to inform the quantitative and qualitative research she conducts. Recently, Michelle visited Malawi to start a research study on condom use and accessibility.

I recently returned from a research trip to Malawi where I was training a data collection team on the procedures and questionnaires for two small studies, one focused on condom use and accessibility, and the other on male circumcision. The team with which I work—from the Johns Hopkins Center for Communication Programs, Malawi—is in the midst of conducting a 10-year-long program called BRIDGE, which focuses on HIV prevention through the provision of services such as voluntary male medical circumcision (VMMC), getting pregnant women to enroll in treatment for prevention of mother-to-child-transmission (PMTCT) of HIV, and, most relevant to this article, condom distribution.  

The condom distributors are volunteers from various communities who are trained condom advocates in their villages. Each advocate gets a bicycle and thousands of condoms to bring to the rural areas, where they train people how to use the condoms properly.

The data collection included street-intercept surveys, which involve stopping people on the road as they walk by and asking them to participate in a short survey. I spent my visit training about 35 field workers how to effectively recruit participants in well-populated areas (such as market places) and properly administer the survey. As you can imagine, the survey includes several questions about where the villagers get their condoms, as well as their sexual behaviors. I created a little bit of a controversy among our team in Malawi as I was designing the survey, including questions asking not just about sex in general, but types of sex—vaginal or anal—and how often one uses condoms for both types. Our own staff, the research agency director with whom we were working, and the fieldworkers all had concerns:

“But Michelle, to ask such questions in Chichewa [the local language] is very difficult and sensitive.”

“People in Malawi do not have anal sex.”

“People will not feel comfortable answering these questions.”

But guess what? The team figured out a way to ask such questions in Chichewa, people answered the questions readily, and in our pretesting of the questionnaire, we found that about 20% of participants admitted to having anal sex. Many people on the research team were shocked, especially when some participants went on to describe their anal sexual encounters in detail. For instance, a few men surveyed said they see people having anal sex in porn (which is illegal in Malawi) and so they wanted to try it for themselves. One woman told the fieldworker that she has anal sex with her husband because if she does not, another woman will. This created quite a discussion among our field team during our debrief session. Clearly, the assumption among my team was that no one in Malawi has anal sex, but in really, a sizeable percentage does. Without a systematic inquiry, we may have never known the reality.

Reported rates of anal sex vary depending on the sample being studied, how questions about the behavior are asked, and how comfortable respondents feel in answering questions honestly. In the US, one national survey found that 44% of men and 36% of women ages 25-44 reported having anal sex during their lifetime.1

We conducted these street-intercept surveys with about 1,800 people all over rural Malawi with a sample of 75% men and 25% women. Traditional gender roles in Malawian culture make men responsible for condom acquisition, which is why we had the gender discrepancy in the sample. It will be interesting to see what the full data set shows—how many people admit to having anal sex, and how many people learn how to properly use condoms from our bicycling condom advocates. But one thing is for sure: like most places in the world, people enjoy having various types of sex and are also willing to talk about it when asked.

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Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth. National Health Statistics Reports, no 36. Hyattsville, MD: National Center for Health Statistics.

Dr. Michelle Kaufman - Science of Relationships articles
Michelle conducts research on sexual health and how power in heterosexual relationships influences sexual risk and family planning. She has conducted research in South Africa, Nepal, Tanzania, and Indonesia, and teaches a course on Qualitative Research Methods at Jimma University in Ethiopia.

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