•HIV and the Acquired Immunodeficiency Syndrom• •Prevention of HIV infection•Jan 25, 2006
HIV infection is a sexually transmitted disease (STD). Like other STDs, HIV spreads bidirectionally and appears to be transmitted from male to female and female to male with greater efficiency (up to three-fold) from male to female. Although the majority of sexually transmitted cases reported in the United States occur via male homosexual activity, heterosexual transmission is one of the fastest growing modes of transmission reported in the United States and is the primary mode of disease acquisition in many African countries, where male-to-female prevalence ratios are approximately 1.1:1. Certain cofactors are associated with an increased risk of acquiring HIV infection. Among homosexual men, receptive anal intercourse and contact with a large number of different sexual partners are the most important risk factors. Activities that may lead to damage of the rectal mucosa, such as rectal douching, manual penetration of the rectum ("fisting"), and concomitant ulcerative STDs, increase the likelihood of disease acquisition.
Insertive rectal intercourse, fellatio, and ingestion of semen are associated with HIV transmission to a lesser degree. The likelihood of heterosexual acquired disease increases with a higher number of sexual partners, contact with intravenous drug users (IVDUs), prostitution, sexual practices that damage vaginal or rectal mucosa, and a previous history of other STDs. Female-to-female transmission has been reported via orogenital contact. Prevention
Abstinence is the only absolute way of preventing sexual acquisition of HIV infection. Persons who have been engaged in a mutually monogamous relationship since the mid-1970s are at extremely low risk of acquiring disease; however, the assurance that both partners have remained “faithful” is sometimes difficult to confirm. For the majority...