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Risk factors
Oct 26, 2003

Hi Dr. Bob.

In my search for information on the risks of unprotestected anal sex, I find that there is a lot of information saying that the person on the recieving end it at a very high risk, but there is nothing ever said about the risk to the person on the "giving" end.

If I am HIV+ and my partener HIV-, what is the risk to him if he is the "giver"?

Is there someone that has done studies on this?

Of course I know to always use condoms, no matter what, but my curiosity is killing me. I have heard that it is very difficult for men who are "always tops" to catch HIV.

Thanks for your time.

Response from Dr. Frascino

Hello,

To actually conduct a study on this would, of course, be unethical.

What we are talking about are degrees of risk. Unprotected anal sex has the highest probability of HIV transmission. That said, there are factors that can modify any risk somewhat. Regarding anal sex, the only statistical estimate we have is for the unprotected receptive partner of a confirmed HIV-positive insertive partner that being 0.1 to 3 percent risk per episode. We know that risk is always greater for the receptive partner whether it be vaginal or anal sex. How much greater is difficult to quantify and, of course, must be put in the context of anal sex being the "riskiest" sexual activity. Other variables that can influence the level of risk include whether ejaculation occurs, the level of the HIV-positive partner's viral load, the occurrence of local trauma due to aggressiveness of the sexual activity, etc., etc., etc . . . the list goes on and on.

As for what you heard "it is very difficult for men who are always tops to catch HIV" that is not true. It's a fallacy that some folks would like very much to believe, but it just isn't true. All we can say is that relatively speaking, it's less risky than being the receptive partner. However, unprotected anal sex (insertive or receptive) is still much riskier, in general, than other sexual activities. So the bottom line on your bottom is, as you say "always use condoms, no matter what!" I couldn't agree more!

Dr. Bob



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