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After couple-years of follow-up and 77, acts of unprotected anal intercourse, no HIV transmission from HIV-positive partners took place and the researchers concluded that the risk of HIV transmission in these circumstances was effectively zero Rodger. If viral load is detectable, condomless anal intercourse is a highly efficient way of transmitting HIV, and it is considered a high-risk activity for both partners, although the exact degree of risk can depend on many factors.

For each condomless act with an untreated HIV-positive partner, the risk of infection has been estimated at 1.

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However, it may be 10 to 25 times higher if the positive partner is recently infected. Studies have identified several other factors that further increase the risk of transmission. It is true that HIV infection occurs less frequently in men who solely take the insertive role than in men who engage in both roles, or men who practise receptive anal intercourse only Jin.

However, being the insertive partner in condomless sex remains a high-risk activity. The per-act risk for the insertive partner in anal sex is comparable to the per-act risk for the male insertive partner in vaginal sex. Rectal tissue is delicate and easily damaged, which can give the virus direct access to the bloodstream. However, such tissue damage is not necessary for infection to occur: the rectal tissue itself is rich in cells which are directly susceptible to infection.

This creates a risk of transmission to the insertive partner through the tissue in the urethra and on the head of the penis — particularly underneath the foreskin. Several systematic reviews of studies have calculated that condomless receptive anal intercourse posed approximately ten to twelve times greater risk of infection than insertive anal intercourse. Insertive anal intercourse refers to the act of penetration during anal intercourse. Measurement of the amount of virus in a blood sample, reported as of HIV RNA copies per milliliter of blood plasma.

Viral load is an important indicator of HIV progression and of how well treatment is working. Although HIV can be sexually transmitted, the term is most often used to refer to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc. Receptive anal intercourse refers to the act of being penetrated during anal intercourse. The most recent review of the evidence estimated that for each condomless act with an HIV-positive partner, the risk of infection was 1. Nonetheless, many of the studies were carried out before antiretroviral treatment after diagnosis became the Women only bareback anal dating site and so are likely to over-estimate the risk of infection.

Anal intercourse between men and women has generally not received as much attention as anal intercourse between men. However, there is evidence that anal sex is practised by large s of sexually active adults. Unprotected heterosexual anal sex probably plays an important role in HIV transmission among heterosexuals, although reliable estimates are lacking Baggaley. Viral load is the term used to describe the amount of HIV circulating in the body. As viral load rises, so does infectiousness. On the other hand, when viral load is so low as to be undetectable, there is no risk at all of HIV transmission.

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For example, a study of heterosexual couples in Rakai, Ugandawhere one partner was HIV positive and the other HIV negative at the start of the study, showed that the likelihood of HIV transmission is highest in the first two and a half months following initial infection with HIV, and that this correlated with higher viral load levels in early HIV infection. The researchers estimated that relative to chronic infection, infectiousness during primary infection was enhanced fold Hollingsworth.

As people are usually unaware of their infection at this stage, they are not taking treatment and may inadvertently expose sexual partners to HIV. People who have HIV without realising it are much more likely to be involved in HIV transmission than people who know they have HIV, as the latter can receive treatment. Firstly, many although not all STIs can cause ulcers, sores or lesions. They provide a direct physical route of entry for HIV in an uninfected person. Secondly, immune cells that are, themselves, prone to HIV infection — such as activated T-cells and dendritic cells — are prone to be present in greater s at the site of an infection.

The strongest evidence is for herpes simplex virus type 2 HSV Human papillomavirus HPVthe cause of genital warts, is associated with an increased risk of HIV infection in women regardless of whether it is an HPV type that causes genital warts or a type associated with cervical cancer Houlihan. The presence of HPV in cells in the penis also increases the risk of acquisition in men Rositch. Poppers are nitrite-based inhalants, widely used as a recreational drug by gay men in many countries. Especially popular for use during receptive anal intercourse, sniffing poppers relaxes the anal sphincter muscles, making intercourse easier and intensifying pleasure.

However, using poppers during unprotected, receptive anal intercourse more than doubles the risk of HIV infection Macdonald. This may be because poppers increase blood flow to the rectal tissues, heightening their susceptibility to infection. Poppers do not affect the insertive partner's risk of infection. Rectal douching is the insertion of a liquid, such as tap water or soapsuds, into the rectum via a tool, to cleanse the rectum before or after anal sex and is a common activity among gay and bisexual men.

However, it may damage the rectal lining and remove protective naturally occurring bacteria. If the same douching bulb, showerhead or other tool is used Women only bareback anal dating site different people, infections could also be transmitted that way.

A synthesis of 24 studies showed that rectal douching was associated with an almost threefold increased odds of infection with HIV and a more than twofold increase in the risk of a sexually transmitted infection other than HIV Li. While it is possible that this result could simply be due to behavioural differences, most of the studies performed multiple analyses to take into potential confounders such as frequency of sex and partner s.

Rectal bleeding also raises the risk of infection, and could be caused by haemorrhoids, certain STIs such as anal warts, herpes lesions, the prior use of sex toys, or by fingering and fisting. There are some data from low and middle-income countries to suggest that circumcision may be protective, but only for men who exclusively take the insertive role Yuan.

Rodger AJ et al. The Lancet You can about this study in our news report. Jin F et al. Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men.

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AIDS Zuckerman R A et al. Higher concentrations of HIV RNA in rectal mucosa secretions than in blood and seminal plasma, among men who have sex with men, independent of antiretroviral therapy. J Infect Dis Patel P et al. Estimating per-act HIV transmission risk: a systematic review. AIDS, Mercer CH et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles Natsal.

Baggaley R et al. Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis. American Journal of Reproductive Immunology, e, Hollingsworth TD et al. Journal of Infectious Diseases 5 Looker KJ et al.

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Lancet Infectious Diseases Laga M Non-ulcerative sexually transmitted diseases as factors for HIV-1 transmission in women: from a cohort study. AIDS 7 1 Masha S et al. Trichomonas vaginalis and HIV infection acquisition: a systematic review and meta-analysis. Sexually Transmitted Infections Houlihan C et al. A systematic review and meta-analysis.

Rositch AF et al. Macdonald N et al. Factors associated with HIV seroconversion in gay men in England at the start of the 21st century. Li P et al. Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. Sexually Transmitted Infections, online ahead of print, Yuan T et al.

Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data.

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Lancet Global Health, 7: e, Sexual transmission. Primary tabs View active tab Preview. A research briefing. Roger Pebody. July Key points For unprotected anal intercourse with an HIV-positive partner with a fully suppressed viral load, the estimated risk of infection is zero.

If HIV is not fully suppressed by effective treatment, anal intercourse without condoms is a high-risk route of sexual HIV transmission for both the insertive and receptive partner. Sexually transmitted infections and the HIV-positive partner being recently infected increase the risk of transmission. The latest news and research on sexual transmission. Glossary insertive Insertive anal intercourse refers to the act of penetration during anal intercourse. Next review date. This was last reviewed in July It is due for review in July Related topics.

Men who have sex with men MSM. Sexually transmitted infections epidemiology. The biology of HIV transmission.

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