Heterosexual transmission of HIV: a view of the future

Article Abstract:

AIDS is the most severe disease associated with human immunodeficiency virus (HIV) infection. When the AIDS epidemic was identified more than 10 years ago, the most common risk factors were identified, but the subtle differences of HIV transmission in different areas was not appreciated. The United States has been slow to accept the reality of that HIV is transmitted between heterosexual partners. In the past year, heterosexual transmission of HIV accounted for 3.1 percent of the cases reported in men and 34.8 percent of the cases reported in women. In the September 25, 1991 issue of The Journal of the American Medical Association, two articles address the issue of HIV transmission. Allen and associates report a study of a female population in Rwanda. Most of these women were in stable long-term monogamous relationships, and would generally be considered a low-risk group for HIV infection, yet the infection rate of these women was 32 percent. An article by Padian and associates studied transmission in heterosexual couples who received HIV testing and counselling. This study showed that there was a 20 percent risk of infection for long-term female partners of HIV-infected men; this compared with a 1.4 percent risk of infection for long-term male partners of infected women. These two studies show that the risk factors for HIV infection are similar for men and women. These two studies demonstrate that susceptibility to HIV is found in all ages, religious groups, racial and ethnic groups, income groups and at all educational levels. The findings in the Allen and Padian studies also indicate that heterosexual transmission of HIV is likely to continue. To better deal with the AIDS epidemic, more information regarding behavior is needed; more must be learned about the choices that people make. We need to identify what information HIV-infected people had and what types of education could have been effective in preventing infection. Information from these studies should be used to develop more effective prevention programs, based not only on understanding transmission of the virus, but on understanding current social and sexual standards and practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, HIV patients, editorial

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Female-to-male transmission of human immunodeficiency virus

Article Abstract:

AIDS is the most severe disease caused by infection with the human immunodeficiency virus (HIV). Heterosexual contact with a high-risk or infected partner is responsible for 4 percent of the reported AIDS cases in the United States; 70 percent of these cases occur in women and 30 percent occur in men. (That is, in 70 percent of the cases of heterosexual transmission of HIV, a woman is infected by a man.) A study was undertaken to examine the rate of transmission of HIV as a result of heterosexual contact, and determine the risk factors and efficiency of heterosexual transmission. A total of 379 couples participated in the study. Infected individuals (index cases) were recruited from HIV counseling and testing centers in California, where they were advised to refer their partners for counseling and HIV testing. The study focused on the 72 male partners of HIV-infected women and the 307 female partners of HIV-infected men. Most couples were white and in their 30s, and 70 percent reported having only one sexual partner since 1978. In 75 percent of the couples, the partner of the index case did not know whether he or she had HIV infection. Testing revealed that 61 (20 percent) of the female partners of HIV-positive men were infected with HIV as was one (1 percent) male partner of an HIV-positive woman. The single case of female-to-male transmission was unusual in that the woman was aware of prior contacts with high-risk men and the couple had observed bleeding from the vagina and penis during intercourse. Forty percent of the female index cases had been infected by other men who had the disease; these women subsequently went on to have other sexual partners before being diagnosed with HIV infection. Among the index cases, it was found that men who infected women were more likely to have disease symptoms than women who infected men. These findings indicate that the risk of male-to-female transmission is significantly greater than the risk of female-to-male transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Women, Women's health

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Risk factors for hepatitis C virus seropositivity in heterosexual couples

Article Abstract:

Heterosexual transmission of the hepatitis C virus (HCV) appears to be infrequent, but HCV seropositivity is strongly associated with intravenous drug use and hemophilia. Of 170 heterosexual couples tested for HCV, 31 of 170 women (18%) and 56 of the 170 men (33%) were positive. Overall, 64% of the injection drug users were HCV positive, and all four hemophiliacs also tested positive. Of 12 women who had undergone blood transfusions, four (33%) were seropositive, and three of 18 men (17%) who had undergone transfusions were seropositive. Two of 31 women who had no other HCV infection risk factors but whose long-term partners were HCV-positive were also HCV-positive compared with none of 81 women whose partners were HCV-negative. HCV seropositivity was not linked with sexual practices, number of sexual partners, history of sexually transmitted disease or HIV seropositivity.

Hepatitis C, Hepatitis C virus

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