Prevalence of and Factors Associated with Oral Sex Among Rural and Urban Malawian Men

ABSTRACT

Objectives: Despite medical evidence that female-to-male oral sex (fellatio) carries a lower risk for HIV transmission than unprotected vaginal intercourse, little research exists on the practice of fellatio in Africa. The objective of this study was to document the prevalence of oral sex in Malawi, and to provide the first evidence on factors associated with the practice in sub-Saharan Africa. Methods: We used two samples of men from Malawi—one rural and one urban—to examine the prevalence of oral sex, as well as factors that were associated with the knowledge and practice of oral sex. Results: While 97% of the rural sample and 87% of the urban sample reported having had vaginal sex, just 2% and 12%, respectively, said they had ever received oral sex. Only half of the rural sample, and less than three quarters of the urban sample, reported having heard of oral sex. Education, exposure to newspapers and television, and condom use significantly predicted oral sex knowledge after controlling for other confounding factors, while exposure to radio did not. Conclusions: The large gap between sexual activity and oral sex prevalence suggests that fellatio should be taken into consideration as a potential component of an HIV prevention strategy, but further quantitative and qualitative research that includes women as well as men is needed to understand potential benefits and drawbacks.

KEYWORDS:

• HIV prevention
• sexual behavior
• oral sex
• sub-Saharan Africa
• Malawi

ACKNOWLEDGEMENTS

Many thanks to Susan Godlonton for input on the processing and analysis of the data. Three anonymous referees provided invaluable comments. We are grateful for research assistance from Jessica Kraft, Arija Jarvenpaa, and Jennifer Hesse.

Notes

Measures of sexual activity included whether the respondent has ever had sex, years of sexual activity, lifetime sex partners, whether he has ever used a condom, condom use at last sex, sex partners in the past month, and sexual encounters in the past month.

This analysis collapses the underlying variables, which recorded media use as “daily or almost daily,” “one to three times per week,” “one to three times per month,” “less than once per month,” and “not at all.” The results were qualitatively similar when using the fine categories instead of the collapsed versions: Newspaper and television use were significantly associated with knowledge of oral sex at the .01 level, while the radio use relationship was significant at the .1 level.

Although the practice is fairly uncommon across Malawi as a whole, the prevalence of circumcision varies greatly not only with ethnic background and religion, but also by region. The same ethnic and religious groups often differ in whether they practice male circumcision depending on their specific location. See Godlonton et al. (2012) for a more detailed discussion.