Receptive Anal Intercourse and HIV Infection
- 1 Medical Institute for Sexual Health, Austin, Texas, USA
- 2 Department of Infectious Disease, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
Abstract
Objective : Inform the public that receptive anal intercourse (RAI) is a key transmission route of the human immunodeficiency virus (HIV) epidemic in the United States. Method : The role of receptive anal intercourse (RAI) in this epidemic will be examined using the following approach: 1) Risk comparison of HIV transmission via RAI to the other major routes of transmission. 2) HIV transmission risks of RAI using some of the present risk reduction techniques. 3) HIV infection via anal intercourse among male youth. 4) HIV infection via anal intercourse among women. Results : Of the major transmission routes of HIV, receptive anal intercourse has the highest transmission risk for acquiring HIV infection. RAI is 2 times the risk of needle-sharing during injection drug use (IDU) and 17 times the risk of receptive vaginal intercourse. The estimated per act probability of acquiring HIV from an infected source by the exposure route of RAI is high in most circumstances: 1) Condoms alone only partially reduce the high risk of RAI. With the addition of pre-exposure prophylaxis (PrEP), the risk is further reduced. 2) When one or both partners are infected with a sexually transmitted disease (STD), even with condom use, the risks are very high. With the addition of PrEP the risks are reduced, but RAI still carries significant risks. 3) With exposure to acute HIV (high viral load) the risks of RAI are very high and remain significant even with condom use and PrEP. Anal intercourse often begins in adolescence; both genders are at risk. Conclusion : Public knowledge of the high transmission risks of receptive anal intercourse may likely result in a downward trend of new HIV infections and contribute to ending the epidemic.
- Centers for Disease Control and Prevention (2014) HIV Risk Behaviors. http://www.cdc.gov/hiv/policies/law/risk.html
- Patel, P., Borkowf, C.B., Brooks, J.T., Lasry, A., Lansky, A. and Mermin, J. (2014) Estimating Per-Act HIV Transmission Risk: A Systematic Review. AIDS, 28, 1509-1519. https://doi.org/10.1097/QAD.0000000000000298
- Centers for Disease Control and Prevention (2006) Human Immunodeficiency Virus (HIV) Risk, Prevention, and Testing Behaviors—United States, National HIV Behavioral Surveillance System: Men Who Have Sex with Men, November 2003-April 2005. MMWR Surveillance Summaries, 55, 1-16.
- Finlayson, T.J., Le, B., Smith, A., et al. (2011) HIV Risk, Prevention, and Testing Behaviors among Men Who Have Sex with Men—National HIV Behavioral Surveillance System, 21 U.S. Cities, United States, 2008. MMWR Surveillance Summaries, 60, 1-34.
- Buchbinder, S.P., Vittinghoff, E., Heagerty, P.J., et al. (2005) Sexual Risk, Nitrite Inhalant Use, and Lack of Circumcision Associated with HIV Seroconversion in Men Who Have Sex with Men in the United States. Journal of Acquired Immune Deficiency Syndromes, 39, 82-89. https://doi.org/10.1097/01.qai.0000134740.41585.f4
- Mosher, W.D., Chandra, A. and Jones, J. (2005) Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age, United States, 2002. Advance Data, No. 362, 1-55.
- Copen, C.E., Chandra, A. and Febo-Vazquez. I. (2016) Sexual Behavior, Sexual Attraction, and Sexual Orientation Among Adults Aged 18-44 in the United States: Data From the 2011-2013 National Survey of Family Growth. National Health Statistics Report, No. 88, 1-14.
- Centers for Disease C, Prevention (2008) Trends in HIV/AIDS Diagnoses among Men Who Have Sex with Men—33 States, 2001-2006. MMWR Morbidity and Mortality Weekly Report, 57, 681-686.
- Centers for Disease Control and Prevention (2012) Diagnoses of HIV Infection and AIDS among Adolescents and Young Adults in the United States and 5 U.S. Dependent Areas, 2006-2009. HIV Surveillance Supplemental Report, 17, No. 2.
- Centers for Disease Control and Prevention (2016) Diagnoses of HIV Infection among Adolescents and Young Adults in the United States and 6 U.S. Dependent Areas, 2010-2014. HIV Surveillance Supplemental Report, 21, No. 3.
- The White House Office of National AIDS Policy (2015) National HIV/AIDS Strategy for the United States. The White House Office of National AIDS Policy, Washington DC.