Rectal intercourse therefore the threat of HIV transmission

Key points

  • For unprotected rectal intercourse by having an HIV-positive partner with a completely suppressed viral load, the projected risk of disease is zero.
  • If HIV is certainly not completely suppressed by effective therapy, rectal intercourse without condoms is just a high-risk path of intimate HIV transmission for both the insertive and partner that is receptive.
  • Intimately sent infections while the partner that is HIV-positive recently contaminated boost the threat of transmission.

In the event that partner that is HIV-positive using antiretroviral therapy and it has a completely suppressed viral load (‘undetectable’), the possibility of HIV transmission through anal sex is zero.

The PARTNER-2 research used 783 male partners where the HIV-positive partner had an invisible viral load with no condoms were utilized in anal sex. 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) after 1596 couple-years of follow-up and 77,000 acts of unprotected anal intercourse.

If viral load is detectable, condomless intercourse that is anal a very efficient method of transmitting HIV, and it’s also considered a high-risk task for both lovers, even though the precise amount of danger can rely on numerous facets.

For every condomless work having an untreated HIV-positive partner, the possibility of disease happens to be predicted at 1.38percent (one in 72 possibility) and 0.11per cent (one out of 909 possibility) for the receptive and insertive lovers correspondingly.

Nonetheless, it might be 10 to 25 times greater in the event that partner that is positive recently contaminated. Research reports have identified some other factors that further boost the chance of transmission.

Dangers to insertive and receptive lovers

There clearly was a extensive belief among homosexual guys that the insertive partner (‘top’) are at really low threat of HIV disease. It is a fact that HIV illness does occur less often in males whom entirely use the role that is insertive in males whom participate in both roles, or males who practise receptive rectal intercourse only (Jin).

Nonetheless, being the insertive partner in condomless intercourse remains an activity that is high-risk. The risk that is per-act the insertive partner in anal intercourse is related to the per-act danger for the male (insertive) partner in genital intercourse.

The receptive partner (‘bottom’) are at danger of illness from HIV into the semen and pre-seminal liquids (‘pre-cum’) associated with contaminated partner. Rectal muscle is delicate and simply damaged, that may supply the virus immediate access to the bloodstream. Nonetheless, such damaged tissues is certainly not required for disease to happen: the rectal muscle it self is full of cells that are directly prone to disease.

The insertive partner (‘top’) can also be prone to illness, as you will find high quantities of HIV in rectal secretions, in addition to blood through the rectal tissues (Zuckerman). This produces a danger of transmission to your insertive partner through the muscle into the urethra as well as on the pinnacle associated with the penis – particularly underneath the foreskin.

A few systematic reviews of research reports have determined that condomless receptive anal sex posed about ten to twelve times greater threat of disease than insertive anal sex.

Insertive anal sex refers towards the work of penetration during anal sex. The insertive partner is the ‘top’.

The past area of the intestine that is large over the rectum.

viral load

Dimension for the level of virus in a bloodstream sample, reported as wide range of HIV RNA copies per milliliter of bloodstream plasma. The VL is a essential indicator of hiv progression and of exactly how well treatment solutions are working.

intimately sent infections (STIs)

Although HIV could be intimately sent, the expression is frequently utilized to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc.

Receptive intercourse that is anal towards the work to be penetrated during anal sex. The partner that is receptive the ‘bottom’.

The most up-to-date post on the proof estimated that for every condomless work with an HIV-positive partner, the possibility of illness ended up being 1.38percent ( one out of 72 opportunity) for the receptive partner and 0.11% ( one in 909 opportunity) for the insertive partner (Patel).

However, most of the scholarly studies were completed before antiretroviral therapy after diagnosis became the norm and are also prone to over-estimate the possibility of illness.

Anal sex between women and men

Anal sex between women and men has generally speaking not gotten just as much attention as anal sex between males. Nevertheless, there clearly was proof that anal intercourse is practised by more and more intimately active grownups. This year, 11percent of females and 13% of males in britain report having rectal intercourse in days gone by 12 months, with younger generations being almost certainly going to report it (Mercer).

Unprotected heterosexual rectal intercourse probably plays a crucial role in HIV transmission among heterosexuals, although dependable quotes miss (Baggaley).

Current disease

The initial couple weeks or months after HIV has entered a person’s human body, their viral load is generally exceedingly high and they’re really infectious.

Viral load may be the term utilized to explain the actual quantity of HIV circulating within the body. As viral load rises, therefore does infectiousness. Having said that, whenever viral load is therefore low as to be invisible, there’s absolutely no danger after each of HIV transmission.

For instance, a report of heterosexual partners in Rakai, Uganda, where one partner had been HIV good plus the other HIV negative in the very beginning of the research, revealed that the chances of HIV transmission is highest in the 1st two . 5 months following initial disease with HIV, and that this correlated with higher viral load amounts in very early HIV infection. The scientists estimated that relative to chronic disease, infectiousness during main infection ended up being improved 26-fold (Hollingsworth).

As folks are often unacquainted with their illness at this time, they’re not using therapy and may accidentally expose intimate lovers to HIV. Those who have HIV without realising it are much more likely to be concerned in HIV transmission than those who understand they’ve HIV, since the latter can get treatment.

Intimately sent infections

Many sexually transmitted infections, specially those that result ulceration, including herpes simplex 2 (HSV-2), syphilis, gonorrhoea, and chlamydia, increase HIV-negative partners’ risk of acquiring HIV during genital sexual intercourse. HIV-negative people who have recurrent STIs are at increased ongoing danger of HIV disease.

In individuals managing HIV that are perhaps not using HIV therapy, STIs additionally trigger increased vaginal shedding of HIV, which escalates the threat of transmitting HIV to other people. Nevertheless, STIs usually do not raise the threat of HIV transmission from those who are using effective HIV therapy and possess an invisible viral load. When you look at the PARTNER study, there clearly was maybe perhaps not just a solitary hiv transmission even though numerous research individuals had STIs.

There are 2 major causes for the effect of STIs on HIV transmission. Firstly, many (but not all) STIs could cause ulcers, sores or lesions. They supply a primary real path of entry for HIV in a person that is uninfected. Next, resistant cells which are, by themselves, prone to HIV infection – such as activated T-cells and dendritic cells – are vulnerable to be there in greater numbers in the web web site of an illness.

“Being the insertive partner in condomless intercourse remains a high-risk task.”

The strongest proof is for herpes virus kind 2 (HSV-2). A meta-analysis discovered that having HSV-2 ended up being connected with an elevated danger of acquiring HIV both in the basic populace (a growth of 270%) and in greater risk teams such as for example intercourse workers and males that have intercourse with males (170%). Having A hsv-2 that is recent had been connected with an nearly fivefold (470%) increased danger of acquiring HIV, most likely because vaginal ulceration, viral shedding and infection into the vaginal tract are most unfortunate in brand new HSV-2 infections and tend to decrease with time (Looker).

Peoples papillomavirus (HPV), the explanation for genital warts, is related to a heightened danger of HIV disease in females no matter whether it’s an HPV kind that triggers vaginal warts or a kind related to cervical cancer tumors (Houlihan). The clear presence of HPV in cells within the penis also boosts the threat of purchase in guys (Rositch).


Poppers are nitrite-based inhalants, trusted as a drug that is recreational homosexual males in lots of nations. specially popular to be used during receptive rectal intercourse, sniffing poppers relaxes the sphincter muscles, making sex easier and pleasure that is intensifying.

Nevertheless, utilizing poppers during unprotected, receptive anal sex more than doubles the possibility of HIV infection (Macdonald). This might be because poppers enhance circulation to your tissues that are rectal heightening their susceptibility to illness. Poppers don’t influence the partner that is insertive threat of disease.

Rectal douching

Rectal douching may be the insertion of the fluid, such as for example regular water or soapsuds, in to the rectum via an instrument, to clean the anus before or after rectal intercourse and it is an activity that is common gay and bisexual guys. Nevertheless, it could harm the lining that is rectal remove protective obviously occurring germs. If the exact same douching light bulb, showerhead or other device can be used by each person, infections is also transmitted in that way.

A synthesis of 24 studies revealed that rectal douching had been related to an almost threefold increased likelihood of illness with HIV and a far more than twofold rise in the possibility of an infection that is sexually transmitted than HIV (Li).

Whilst it is feasible that this outcome could just be due to behavioural distinctions, the majority of the studies done multiple analyses take into consideration prospective confounders such as for instance regularity of intercourse and partner figures.

Rectal blood

Anal bleeding additionally raises the possibility of illness, and might be brought on by haemorrhoids, specific STIs such as for instance anal warts, herpes lesions, the use that is prior of toys, or by fingering and fisting.

Male circumcision

There are information from low and middle-income nations to claim that circumcision can be protective, but limited to males who solely use the role that is insertiveYuan).