Study calculates HIV risk from one sex encounter in Africa: 1 in 588

By Daniel Q. Haney, The Philadelphia Inquirer, 02/09/01

CHICAGO - A study of heterosexual couples in Africa concludes that the chance of catching the AIDS virus from a single sexual encounter with an infected person is one in 588.

This risk is calculated for people who do not use condoms and who have sex regularly with one infected partner.

Earlier estimates from North America and Europe vary but have generally placed the risk at about one in 1,000 for heterosexuals. In this study, researchers followed 174 monogamous couples in Rakai, Uganda, in which one partner had HIV and the other did not. They were given condoms but usually did not use them. Typically the couples had sex nine or 10 times a month. Over time, 38 people became infected.

Earlier data from the same research team showed that the risk of people transmitting HIV was slight if the amount of virus in their bloodstream was low. Those findings have encouraged the belief that the wide use of AIDS-drug combinations, which make virus levels fall dramatically, will slow the spread of the disease.

The latest figures were presented by Dr. Ronald H. Gray of Johns Hopkins University at the eighth annual Retrovirus Conference in Chicago, which concluded yesterday.

Among the findings:
Infected teenagers are three times more likely than people over 40 to spread HIV to others during each sexual encounter. This difference cannot be explained by the fact that young people are more sexually active.

The risk that an HIV-infected woman will transmit the virus to an uninfected man is one in 454. For an infected man to an uninfected woman, it is one in 769. This difference is not large enough to be statistically meaningful, and many have assumed that HIV spreads more readily from men to women than vice versa.

The risk of spread depends greatly on how much virus people carry. In those whose level of virus is less than 1,700 copies per milliliter of blood, the risk is one in 10,000. When levels are more than 38,500, risk is one in 294.

The risk of transmission appears to be the same for different subtypes of virus. Some have speculated that AIDS is much more prevalent in Africa because a different variety of the virus dominates there.

None of the circumcised men in the study contracted HIV. Some experts have raised the possibility of promoting circumcision as a way to control the epidemic.

Whether the transmission risk is the same among couples outside Africa is unclear, especially since virus levels may be higher in Africa, where so few infected people get treated. However, Dr. Helene Gayle, AIDS chief at the U.S. Centers for Disease Control and Prevention, said the latest data at least offered a general estimate of this risk.