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safe vaginal sex???
Nov 1, 2002

I am a man living with an HIV infected woman. She heard you say that there is very little chance that I could be infected by unprotected vaginal sex. What is the risk of infection for unprotected vaginal sex or unprotected oral sex woman to man?

Response from Dr. Frascino


I guess it's how you define "very little chance." Some folks think that if the condom breaks, or if they have sex with someone who is HIV-positive, they will absolutely become positive as well. That's actually not the case. Of course, there are no absolute statistics, but I can give you our best "guess-timates," OK?

Let me put things in perspective by saying that HIV can be transmitted efficiently through blood transfusions: an estimated 95% of recipients become infected from transfusion of a single unit of infected whole blood. The per-contact probability of transmission from an HIV-infected source is much lower for injection drug use and sexual exposures. The risk of HIV transmission per episode of intravenous needle or syringe exposure is estimated to be 0.67%. The risk per episode of needle stick exposure to HIV-infected blood is estimated to be 0.4%. The risk for HIV transmission per episode of receptive penile-anal sexual exposure is estimated to be 0.1% - 3%. The risk per episode of receptive vaginal exposure is estimated to be 0.1% - 0.2%. The risk of being the insertive partner is always less than the receptive partner's risk. There are no published estimates of risk from receptive oral sex. There are scattered reports of this occurring in the medical literature. Many of the cases have extenuating circumstances, such as open sores in the mouth, recent dental work, etc. Again, the risk for the insertive partner is lower than for the receptive partner.

Only you and your partner can decide how much risk you are willing or not willing to take. This is called negotiated risk. I hope that helps clarify the situation for you and your partner. My life partner is HIV-negative, and we still enjoy a very healthy and satisfying sexual relationship. Good luck.

Dr. Bob


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