Abstract
Heffron and colleagues1 showed that risk of HIV-1 transmission was doubled in African couples if the female partner used hormonal contraceptives. An alternative explanation for this association is residual confounding due to substantial under-reporting of sexual behaviour. This under-reporting specifically includes the number of unprotected sex acts during follow-up. A meta-analysis2 showed that in low-income countries, the probability of HIV-1 transmission ranged between 0·30% (male to female) and 0·4% (female to male) per non-commercial sex act.
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