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INSERTIVE ANAL SEX / HIV TRANSMISSION redux
Feb 19, 2006

Hello, Dr. Bob! Surfing just now to answer my query, I was googled your/our way, as I am an electronic What's New at the Body subscriber. You have addressed this issue at least twice, and I excerpt below. Pardon, but could you clarify a/o confirm my understanding, as below. TIA. You have written: "... I can say your overall per episode risk of contracting the virus is less than .1-.3 per-cent. " and "1. Condom failure places you at some degree of risk for STDs, including HIV.

The estimated per-act risk of acquiring HIV from unprotected insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures.... Q: Dr. Frascino, in the foregoing, second sentence, The estimated per-act risk etc., this meanS the estimated per-act risk to the SERO-NEGATIVE, UNPROTECTED INSERTING PARTNER, i.e., the top, right? Does this 6.5% per 10k exposures thus break down to your 2002 per-episode statistical response to a similar inquiry of ".1 - .3 percent"? Mathematically challenged, anxious to accurately assess risk inherent to inserting partner (were a monogamous, late 50-ish couple eschweing condoms) and Thanks, Dr. Frascino, for your clarification. I know unprotected sex, whenever, is attended by risk, that its playing Russian roulette and in no way do I promote such practices. As a couple, however, we have the question. Thanks again. Dana Oakland, CA

Response from Dr. Frascino

Hello Dana,

Being that you're mathematically challenged, let me keep this simple. You want to know the risk of an HIV-negative top barebacking an HIV-positive bottom, correct?

The best I can do is offer you an estimated statistical risk, emphasizing this is only a general estimate. There are a wide array of variables, such as viral load and concurrent STDs, which can affect any one person's individual degree of risk. That said, the estimated per-act risk for an HIV-negative top acquiring HIV from having unprotected insertive anal sex with an HIV-positive bottom is 6.5 per 10,000 exposures.

I, too, cannot and do not promote unsafe sexual practices; however, I can offer you information that HIV-transmission risk is significantly decreased when the positive partner's HIV viral load is reduced to undetectable levels.

Stay safe. Stay well.

Dr. Bob



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