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Data-driven coding was completed by the first author and reviewed by a co-author. Participants commonly described these experiences as painful. See other articles in PMC that cite the published article. Descriptions of personal experience with painful RAI therefore come primarily from gay-identified MSM in this study, as the straight-identified MSM and the majority with either a bisexual self-identification or bisexual attractions preferred insertive AI only. Yet the fact that many participants in this study recognized their same-sex attractions well before engaging in any same-sex sexual behavior suggests that there is an opportunity to deliver the relevant information before men first engage in anal intercourse. Was it something that you felt needed to be reported?

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Heterosexual anal intercourse among community and clinical settings in Cape Town, South Africa.

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This can be a smart strategy in any new sexual situation. RAI was painful to some participants when they were sober, and was less painful when they were drunk. As Dingani explained, in describing how sex differed whether he was sober or drunk:. In the African context, factors that are unique vulnerabilities for MSM elevate the issue of painful RAI from one of individual to public health significance. Although not originally an a priori focus of our research, many research participants made reference to painful RAI in their discussions of their sexual experiences with men.

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