Receptive Anal Intercourse and HIV Infection

John F. Fisher,Gilbert R. Lavoie

doi:10.4236/wja.2017.74023

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.

Highlights

2) human immunodeficiency virus (HIV) transmission risks of receptive anal intercourse (RAI) using some of the present risk reduction techniques
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
In 2005 the Centers for Disease Control and Prevention (CDC) published an estimated per act probability of acquiring HIV from an infected source by exposure route based on studies from published medical journals [17]

Summary

Introduction

Receptive anal intercourse (RAI) carries the highest risk for the transmission of HIV compared to all other major HIV transmission behaviors including needle-sharing during injection drug use (IDU) [1] [2]. It is well established that anal intercourse (AI) is the main route of HIV transmission among men who have sex with men (MSM) [3] [4] [5]. As stated in The White House Office of National AIDS Policy of July 2015, “Educating young people about HIV before they begin engaging in behaviors that place them at risk for HIV infection should be a priority” [11]. The purpose of this study is to compile and organize available data from the medical literature and the Centers for Disease Control and Prevention (CDC) on the high risk of HIV transmission via RAI so as to place into perspective the significance of this high-risk behavior

Background

Methods

Results

Discussion