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Potential for Transmission

The earliest safer sex advice rightly categorized penile-vaginal intercourse as "high risk."

All of the conditions for efficient viral transmission are in place during this activity.

Penile-vaginal intercourse is a high-risk activity. The majority of documented cases of HIV transmission throughout the world are the result of unprotected penile-vaginal intercourse. The risk of transmission can be reduced through the proper use of condoms with lubricant.

A widespread misconception is that the risk for the receptive partner will be reduced if unprotected penile-vaginal intercourse is stopped before ejaculation occurs. This action carries a significant potential for transmission, given the efficiency of transmission through penile-vaginal intercourse and the impossibility of determining how much pre-ejaculatory fluid may be deposited in the vagina. Interrupted penile-vaginal intercourse without a condom is still high risk.

Evidence of Transmission

There is ample documented evidence of HIV transmission through unprotected insertive and receptive penile-vaginal intercourse.

Assessment of Risk of HIV Transmission

Insertive Vaginal Intercourse (Giving)

With properly used condom: Low Risk

Without condom: High risk

Receptive Vaginal Intercourse (Receiving)

With properly used condom: Low Risk

Without condom: High risk

Potential for Transmission

The earliest safer sex advice rightly classified penile-anal intercourse as high risk. All of the conditions for efficient viral transmission are in place during this activity. The risk can be reduced through the proper use of condoms with lubricant. In case the condom was to break, the risk is reduced further still if the insertive partner pulls out before ejaculation.

Although more cases of transmission have been attributed to receptive penile-anal intercourse, the number of infections among insertive partners is significant enough to make this a high-risk activity.

Evidence of Transmission

There is ample documented evidence of HIV transmission through unprotected insertive and receptive penile-anal intercourse. The proper use of condoms with lubricant has been shown to greatly reduce incidence of transmission during anal intercourse. There is evidence of transmission due to condom failure, however, so receptive penile-anal intercourse with a condom is considered to be low risk.

Assessment of Risk of HIV Transmission

Insertive Anal Intercourse (Giving)

With properly used Condom: Low risk

Without Condom: High risk

Receptive Anal Intercourse (Receiving)

With properly used Condom: Low risk

Without Condom: High risk