AIDS - 'Low-risk' Homosexual
Activity May Be Driving
HIV Spread

NEW YORK (Reuters Health) - Only a small percentage of new HIV infections among homosexual men are linked to 'high-risk' unprotected anal sex, researchers report. This suggests that 'lower-risk' practices, such as unprotected oral sex, may now be driving the epidemic.
"It is important to communicate clearly that these practices are not without risk,'' according to investigators led by Dr. Eric Vittinghoff of the University of California, San Francisco, and the San Francisco Department of Public Health. Their findings are published in the August 1st issue of the American Journal of Epidemiology.
More than 10,000 new HIV infections continue to be recorded among US gay and bisexual men every year. Previous studies have identified unprotected receptive anal intercourse as posing the highest risk for HIV transmission among gay and bisexual men. Other practices, such as protected receptive anal sex and unprotected receptive oral sex, are assumed to be of lower " but not zero " risk.
Vittinghoff's team examined the sexual histories of 1,583 sexually active homosexual and bisexual men living in San Francisco, Denver, or Chicago in 1992-1994. All of these men regularly provided the investigators with detailed reports on the nature and frequency of their sexual contacts.
Forty-nine of the men seroconverted (became infected with HIV) over the course of the study period.
According to the researchers, "unprotected receptive anal intercourse accounted for only 15% of all reported sexual activity'' among newly infected men. "Providing that subject reporting was accurate, this implies that a majority of new infections took place via other types of contact.''
Unprotected receptive anal sex remained the riskiest of sexual contacts among homosexual men, with a per-contact risk for HIV infection of 0.82% when performed with partners infected with HIV.
The investigators point out that this risk is double that of being stuck with a needle used previously by a person infected with HIV. Furthermore, cumulative risks of infection linked to unprotected anal sex can increase to very high levels as the number of contacts rise. "Prevention messages must continue to emphasize the importance of avoiding this type of contact,'' the authors conclude.
Other sexual acts carry a lower - but still significant - risk, according to the researchers. Risks for condom failure mean that the use of a condom during receptive anal sex reduces per-contact infection risks to 0.18%, not zero. Unprotected receptive oral sex, as well as protected and unprotected insertive anal sex, were each associated with a 0.06% per-contact risk of HIV infection, according to the authors.
Vittinghoff and colleagues speculate that "as (these) lower-risk practices become more common, they may play a larger role in propagating the epidemic.''
SOURCE: American Journal of Epidemiology 1999;150:306-311.
From Gordon Tibbles < 8-4-99
The question not being asked, nor being reported upon is the related medical treatment for parasitic and fungi infestations spread during anal and oral sex. Which are subsequently treated with antibiotics to the extent that these infestations no longer respond to the prescriptions. Many of these individuals also have immune systems ravaged by drug and alcohol abuse. It is not HIV that causes AIDS. AIDS is the end result of opportunistic diseases attacking an already weakened system. AIDS is not a disease, but rather a catchall for a number of debilitating afflictions arising from the aforementioned activities and treatments.