To the Editor.
—The study by Padian et al1 of female-to-male transmission of human immunodeficiency virus (HIV) unfortunately did not consider specific sexual behavioral practices among the comparative cases of male-to-female transmission, even though examination of associated risk factors was said to be an objective. The only mention of anal intercourse was with regard to the one possible case of female-to-male transmission reported. The reader was left with the inference that all the comparative cases of male-to-female transmission occurred through vaginal intercourse because it was not stated otherwise.However, Dr Padian herself was the lead author in an earlier report2 in JAMA on male-to-female transmission of HIV in which anal intercourse specifically was considered and was found to discriminate significantly between seronegative and seropositive women to the extent that women who engaged in this practice were 2.3 times more likely to acquire infection than women who did not.
Godfrey SE. Heterosexual Transmission of HIV. JAMA. 1992;267(14):1917. doi:10.1001/jama.1992.03480140043015