Background: Sexual acquisition of HIV is influenced by choice of partner, sex act, and condom use. However, current risk-reduction strategies focus mainly on condom use.
Goal: To estimate the contribution of choice of partner, sex act, and condom use on the per-act relative and absolute risks for HIV infection.
Study Design: Per-act relative risk for HIV infection was calculated with use of estimates of HIV prevalence, risk of condom failure, HIV test accuracy, and per-act risk of HIV transmission for different sex acts. Absolute risks were calculated on the basis of these relative risk estimates.
Results: Choosing a partner who tested negative instead of an untested partner reduced the relative risk of HIV infection 47-fold; using condoms, 20-fold; and choosing insertive fellatio rather than insertive anal sex, 13-fold. Choosing one risk-reduction behavior substantially reduces absolute risk of HIV infection for heterosexuals but not for men who have sex with men.
Conclusion: Clarifying the magnitude of risk associated with different choices may help people make effective and sustainable changes in behavior.
Ensuring that a partner is HIV-negative can be one of the most effective strategies for prevention of HIV infection.
From the Division of HIV/AIDS Prevention–Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Dr. Maher is now with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
Correspondence and reprints: Beena Varghese, PhD, Mail Stop E-46, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333. E-mail: firstname.lastname@example.org
Received for publication February 27, 2001,
revised May 16, 2001, and accepted May 18, 2001.