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December 1991

Man-to-Woman Sexual Transmission of the Human Immunodeficiency Virus: Risk Factors Related to Sexual Behavior, Man's Infectiousness, and Woman's Susceptibility

Author Affiliations

Italian Study Group on HIV Heterosexual Transmission

From the Institute of Infectious Diseases, University of Milan (Italy) Faculty of Medicine (Drs Lazzarin and Saracco); National Research Council, Institute of Advanced Biomedical Technologies, Department of Epidemiology and Medical Informatics, Milan (Drs Musicco and Nicolosi); Gertrude H. Sergievsky Center, Columbia University, New York, NY (Dr Nicolosi); and National Institute of Health, AIDS Operational Center, Rome, Italy (Dr Saracco).

Arch Intern Med. 1991;151(12):2411-2416. doi:10.1001/archinte.1991.00400120055009

To investigate the risk factors for man-to-woman sexual transmission of the human immunodeficiency virus (HIV), we carried out a cross-sectional study of 368 women who were steady partners of HIV-infected men attending 16 Italian clinical centers. Information was collected from the medical records of the infected men and by direct interviews with the women. In a logistic regression analysis, the woman's awareness of her partner's seropositivity (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.0 to 1.1), use of condoms (OR, 0.3; 95% CI, 0.1 to 1), and oral contraceptive use (OR, 0.5; 95% CI, 0.3 to 1.0) were negatively associated with transmission of the HIV infection. An increased risk was found in women having sexual intercourse more than twice a week (OR, 2.4; 95% CI, 1.2 to 4.9) and in women who had been sexually exposed to HIV for between 2 and 5 years (OR, 3.5; 95% CI, 1.8 to 6.7). The transmission rate was higher in couples who engaged in anal sex (OR, 2.8; 95% CI, 1.3 to 6.3); in women reporting vaginitis (OR, 4.9; 95% CI, 2.4 to 10.2) or genital warts (OR, 33.3; 95% CI, 4.5 to 244.1); and in those using intrauterine devices (OR, 3.1; 95% CI, 1.4 to 7.1). The risk for women was also associated with a C D4 cell count lower than 400/mm3 in their partners. Knowledge of the HIV status of the partner led to increased condom use but did not induce a lower frequency of sexual intercourse or an avoidance of anal sex.

(Arch Intern Med. 1991;151:2411-2416)

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