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Why male-to-female not 100%?

Mar 3, 1997

Rick, In the situation where an HIV+ male ejaculates inside an HIV- lady, why isn't the risk of transmission 100%? Doesn't the semen in this case always go to the bloodstream (otherwise, how are babies made)? If not, what would prevent the semen in this case from not getting directly into the bloodstream? Thanks.

Response from Mr. Sowadsky

Hi. Thank you for your question.

Transmission of HIV is never a 100% certainty. In order for HIV to infect a person, HIV must get into their bloodstream. There is an element of chance that HIV will get directly into the bloodstream. Like anything else that has an element of chance, it's never a guarantee that infection will occur. A person can become infected after having sex just one time. Or, a person can have sex 100 times and still not get infected. But the more times that a person is exposed to the virus, the greater the chance that transmission will occur. Semen does not always have a direct access to the bloodstream. There would have to be some sort of open cut, abrasion, or lesion, in order for HIV to have access to the bloodstream. The more of these cuts, abrasions, and lesions that there are, and the larger these openings are, the greater the chance for infection to occur. But if the HIV virus is not directly at the site of an opening to the bloodstream, it will not enter the bloodstream. Unlike sperm cells, HIV itself doesn't move or "swim". It only goes where the fluid around it goes. So if HIV is not directly in the vicinity of an opening to the bloodstream, it won't get directly into that opening.

Regarding the statement, "Doesn't the semen in this case always go to the bloodstream (otherwise, how are babies made)":

Sperm cells do not go into the bloodstream in order for pregnancy to occur. Sperm cells must penetrate an egg in the uterus in order for pregnancy to occur. Even pregnancy has an element of chance to it. A man can have vaginal intercourse with a woman one time and get her pregnant. Or, he can have vaginal intercourse with her 100 times, and she still doesn't get pregnant. But the more times they have sex, the greater the chance for pregnancy to occur.

For both HIV infection and pregnancy, there is an element of chance that the woman will get infected, or get pregnant. But the more times that they have unprotected vaginal intercourse, the greater the chance that she will get HIV (assuming the man's infected), and the greater the chance that she will get pregnant.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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