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Risk Factors Related to Sexual Behavior, Man's Infectiousness, and Woman's Susceptibility

Adriano Lazzarin, MD; Alberto Saracco, MD; Massimo Musicco, MD; Alfredo Nicolosi, MD, phd

Arch Intern Med. 1991;151(12):2411-2416.

Abstract
To investigate the risk factors for man-to-woman sexual transmission of the human immunodeficiency virus (HIV), we carried out a cross-sectional study of 368 women who were steady partners of HIV-infected men attending 16 Italian clinical centers. Information was collected from the medical records of the infected men and by direct interviews with the women. In a logistic regression analysis, the woman's awareness of her partner's seropositivity (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.0 to 1.1), use of condoms (OR, 0.3; 95% CI, 0.1 to 1), and oral contraceptive use (OR, 0.5; 95% CI, 0.3 to 1.0) were negatively associated with transmission of the HIV infection. An increased risk was found in women having sexual intercourse more than twice a week (OR, 2.4; 95% CI, 1.2 to 4.9) and in women who had been sexually exposed to HIV for between 2 and 5 years (OR, 3.5; 95% CI, 1.8 to 6.7). The transmission rate was higher in couples who engaged in anal sex (OR, 2.8; 95% CI, 1.3 to 6.3); in women reporting vaginitis (OR, 4.9; 95% CI, 2.4 to 10.2) or genital warts (OR, 33.3; 95% CI, 4.5 to 244.1); and in those using intrauterine devices (OR, 3.1; 95% CI, 1.4 to 7.1). The risk for women was also associated with a C D4 cell count lower than 400/mm³ in their partners. Knowledge of the HIV status of the partner led to increased condom use but did not induce a lower frequency of sexual intercourse or an avoidance of anal sex.

(Arch Intern Med. 1991;151:2411-2416)

Author Affiliations
Italian Study Group on HIV Heterosexual Transmission

From the Institute of Infectious Diseases, University of Milan (Italy) Faculty of Medicine (Drs Lazzarin and Saracco); National Research Council, Institute of Advanced Biomedical Technologies, Department of Epidemiology and Medical Informatics, Milan (Drs Musicco and Nicolosi); Gertrude H. Sergievsky Center, Columbia University, New York, NY (Dr Nicolosi); and National Institute of Health, AIDS Operational Center, Rome, Italy (Dr Saracco).

Footnotes
Accepted for publication June 19, 1991.

Reprint requests to IRCCS-Ospedale San Raffaele, Clinica Malattie Infettive, Via Stamira d'Ancona, 20 20127 Milano, Italy (Dr Lazzarin).

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