National Center for Training Support and Technical Assistance

Anal Health Toolkit
"A tool to help start the conversation on anal health" -
Daniel Worrall, MSN, ANP-BC, Adult Nurse Practitioner 
"Anal health is a component of sexual health. It involves asking a patient about anal symptoms, asking about anal practices, and examining the anus."
(Walker, et al, 2016)
The National Center for Training, Support and Technical Assistance presents this toolkit to link HIV service providers and consumers to resources on anal health:
  • The first section is for health providers. It includes anal health tips to discuss with clients, a glossary, and links to two peer-reviewed articles.
  • The second section is intended for consumers and includes links to a brochure and websites on anal health.
Health Providers
Although anal cancer is rare in the general population, the incidence in people living with HIV (PLWH) is 70 times higher than in the general population. However, only 36% of PLWH discussed anal health with their HIV primary care providers in the last year. 
(Rose-Cunha et al, 2010)

This reference guide was developed to help providers discuss anal health with   women, men and transgender persons in non-clinical health care settings.

This glossary was developed to familiarize providers with medical terminology and slang that may be used with or by clients during a discussion on HIV and STD prevention as it relates to anal sex.

This 2010 article from AIDS Patient Care STDs discusses the importance and challenges of addressing the topic of anal health in health care settings.

This 2016 article from Journal of the Association of Nurses in AIDS Care looks at the factors that impede and promote addressing anal health in HIV primary care from the provider perspective.
Health Consumers
"36% of women aged 25 - 44 have had anal sex."  
National Health Statistics Reports, Number 36. March 3, 2011.

This brochure, developed by PROCEED Inc., informs consumers about anal health. It includes a section on Frequently Asked Questions (FAQs), glossary of terms, and links to additional resources. 

**It is recommended that health care providers use this brochure when having conversations about anal health with their clients, and as an educational tool to further reinforce the messages on anal health care.

This website, sponsored by the LGBT Center of Raleigh, NC, includes health information for men who have sex with men, with a focus on sexual health. This website also includes information on sexual orientation. 
Rosa-Cunha I Cardenas GA Dickinson G Metsch LR. "Addressing anal health in the HIV primary care setting: a disappointing reality."  National Center for Biotechnology Information. Sept 24, 2010.

Anjani Chandra, Ph.D., William D. Mosher, Ph.D., and Casey Copen, Ph.D., Division of Vital Statistics, National Center for Health Statistics; and Catlainn Sionean, Ph.D., Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "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. March 3, 2011.

Crystal Martin Walker, PhD, MSN-CNL Wendy Likes , PhD, DNSc, APRN-Bc Marye Bernard , DNP, APRN Satish Kedia , PhD Elizabeth Tolley , PhD. "Risk of anal cancer in people living with HIV: Addressing anal health in the HIV primary care setting". Journal of the Association of Nurses in AIDS Care. February 17, 2016.

Contact Us

Contact PROCEED, Inc. - NCTSTA for Capacity Building Assistance (CBA).  
To request CBA through the CDC web-based CBA Request Information System (CRIS), organizations must enter an access code or contact their Project Officer at the Centers for Disease Control and Prevention (CDC) or Department of Health Monitoring Officer. For all other capacity building services or assistance accessing CRIS contact PROCEED, Inc. at 1-908-351-7727, or email us at
PROCEED, Inc. | 1122 E. Grand Street Elizabeth, NJ 07201 |  908-351-7727  |
  For On Demand Technical Assistance call (317) 7NCTSTA

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This toolkit was supported by the Grant or Cooperative Agreement Number, U65PS004459, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility
of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention 
or the Department of Health and Human Services.