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Women more likely to get infected?
Jul 30, 2001

HI. I know that unprotected sex is high-risk behavior on the part of both men and women but, is it true that women are much more likely to get infected over men when having unprotected sex?

Response from Mr. Kull

Your question is not a simple one to answer since there are so many variables that are involved in transmission. In general, the receptive partner in vaginal or anal sex is considered to be at greater risk for infection with HIV than the insertive partner. This does not mean that women are biologically more prone to infection than men. This has more to do with the areas of the body that are exposed to fluids. The vagina and rectum are both warm cavities in the body in which fluids can be deposited (increasing the time of exposure to infected fluids) and may be prone to microscopic tears that can increase the risk for infection. The man's urethra (the tube he pees out of) is the primary location for infection during penetrative sex. There is a much larger surface area for exposure in the vagina and rectum when compared to the small opening at the head of the penis. This transmission dynamic is supported by statisitcs of transmission in the United States. The main modes of sexual transmission are through receptive vaginal and anal sex.

Studies of transmission in Africa seem to contradict this long-held assumption. For many years, reseachers have identified that men were much more likely to be infected thorough insertive sex than men in the United States. Recent studies confirm that the likelihood of male-female transmission is about the same as female-male. It is believed that certain factors, such as the man being uncircumcised, may put him at higher risk for infection than his circumcised counterparts. The presence of genital STD's among men in Africa may also increase their risk for infection. There is also the obvious fact that heterosexual men in Africa are much more likely to have sexual contact with an HIV infected woman than heterosexual men in the United States, increasing their odds for exposure significantly.

All of these factors have some influence in HIV transmission. More needs to be and will be learned about the biology of transmission in the near future.

RMK



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