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We share Dr Harder's general concern about the loss of objectivity in scientific research. However, we firmly believe this concern is not applicable to the public health conclusions drawn in our article. Our article concludes, in essence, that the sexual transmission efficiency of hepatitis B virus (HBV) is 8.6-fold that for human immunodeficiency virus among homosexual men studied and that insertive anal intercourse was the major risk factor identified for HBV seroconversion. Our suggestions for HBV prevention among homosexual men, as stated in our article, include both immunization and use of condoms during sexual intercourse. Dr Harder has taken issue with our statement that condoms used during homosexual anal intercourse would be of benefit for prevention of HBV infection because we did not specifically test this hypothesis. His suggested conclusion is for the proscription of all anal intercourse. Since unprotected heterosexual vaginal intercourse is a well-known risk
Kingsley LA, Rinaldo CR, Ho M. HBV, HIV, and the Proscription of Intercourse-Reply. JAMA. 1990;264(20):2625. doi:10.1001/jama.1990.03450200033019