Background Worldwide, the predominant mode of human immunodeficiencyvirus (HIV) transmission is heterosexual intercourse, but therisk of heterosexual transmission and the effectiveness of measuresto prevent it are not well defined.
Methods We conducted a prospective study of HIV-negative subjectswhose only risk of HIV infection was a stable heterosexual relationshipwith an HIV-infected partner. Every six months the subjectswere interviewed, tested for HIV, and counseled about safe sexualpractices.
Results A total of 304 HIV-negative subjects (196 women and108 men) were followed for an average of 20 months. During thestudy, 130 couples (42.8 percent) ended their sexual relationships,most often because of the HIV-infected partner's illness ordeath. Of the 256 couples who continued to have sexual relationsfor more than three months after enrollment in the study, only124 (48.4 percent) used condoms consistently for vaginal andanal intercourse. Among these couples, none of the seronegativepartners became infected with HIV, despite a total of about15,000 episodes of intercourse. Among the 121 couples who usedcondoms inconsistently, the rate of seroconversion was 4.8 per100 person-years (95 percent confidence interval, 2.5 to 8.4).Eleven couples refused to answer questions about condom use.The risk of transmission increased with advanced stages of HIVinfection in the index partners (P<0.02) and with genitalinfection in the HIV-negative partners (P<0.04). Withdrawalto avoid ejaculation in the vagina had a protective effect inuninfected women (P<0.02).
Conclusions Consistent use of condoms for heterosexual intercourseis highly effective in preventing the transmission of HIV. Amongcouples not using condoms regularly, the risk of HIV transmissionvaries widely. .
Source Information
The members of the European Study Group on Heterosexual Transmission of HIV are listed in the Appendix.
From the European Centre for the Epidemiological Monitoring of AIDS, Hopital National de Saint-Maurice, 14 rue du Val d'Osne, 94410 Saint-Maurice, France, where reprint requests should be addressed to Dr. de Vincenzi.
Heterosexual Transmission of HIV
Ambati J., Ambati B. K., Rao A. M., Morrison E., Brody S., Padian N. S., Vittinghoff E., Shiboski S., de Vincenzi I.
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N Engl J Med 1994;
331:1717-1719, Dec 22, 1994.
Correspondence
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