Human Immunodeficiency Virus/Acquired immune deficiency (HIV/AIDS) syndrome is a range of condition caused by the infection of HIV virus. The virus, after entering into the body via different routes, affects the immune system of the individual. No specific symptoms are seen immediately with minor flu-like condition appears at first followed by long period of apparent wellness. As time goes on, the immune system of the person deteriorates and various co-infections are seen along with symptoms like drastic loss of weight, loss of appetite, longer time for wound healing, etc. HIV/AIDS can be transmitted through various routes. Most common are sexual intercourse (both vaginal and anal), blood transfusion, use of infected needles, vertical transmission i.e. transmission from mother to foetus, etc. Among these, the highest risk of infection is through blood transfusion. Equally risky is the practice of sexual intercourse. However, studies suggest that the risk of acquiring HIV virus is eighteen times more during anal intercourse than vaginal intercourse. The risk of transmission ranges from 1.2% – 1.4% per act of intercourse, be it between homosexuals or heterosexuals. Whereas, there is only 0.3% – 0.4% risk per act of vaginal intercourse. Thus, if either partner is HIV positive, anal sex which involves inserting penis into anus possess the highest risk. There is variation insertive and receptive anal sex as well. The risk for the HIV negative receptive person when having anal sex with an HIV positive is higher as compared to the condition when the insertive person is the HIV negative and receptive is the one with the virus. Why is there such variation in the risk? And how Anal sex and HIV/AIDS are interrelated?
Let’s look into these points to fully understand and support the fact mentioned above:
- The mucous membrane, as it contains a lot of immune cells (the most than any other parts of the body), can contain a lot HIV virus which is also supported by the fact that the process of replication also takes place to a great extent in these membranes.
- Rectal fluid is the mucus produced by the membranes of the rectum. The majority of immune cells of human body, the major targets of HIV virus, are located in the membranes of the gastrointestinal tract of which rectum is a part.
- Similarly, the G.I tract may contain a large amount of these viruses due to its large surface area.
- The pressure and friction produced during sexual intercourse may rupture the delicate membranes of the rectal area. Thus, when an HIV positive person (insertive) has anal intercourse with an HIV negative, the virus may get into the circulation system of the receptive one through the rupture. Conversely, if the receptive is the HIV positive, the blood from his partner may come contact with the foreskin and the urethra and therefore contribute to HIV infection.
Anal intercourse is most common in men who have sex with men. It is seen is the heterosexuals as well but to a lesser extent. The increase in the risk of HIV infection does not necessarily mean that anal intercourse must not be practiced at all. What about the men who have sex with men right?
There are ways of preventing the infection. Some of them are:
- Use of condoms during intercourse.
- The practice of sex with multiple partners should be avoided.
- Use of lubricants and other gels to reduce the friction during the intercourse
- Pre-exposure prophylaxis and post-exposure prophylaxis with anti-retroviral drugs may help reduce the risk to some extent.
- Avoid anal intercourse, if possible.
- Penile circumcision is found to reduce the risk of HIV infection and thus be helpful to the insertive HIV negative gay men.
- Use of anti-viral drugs to lower a load of virus in the blood and rectal fluid may also be beneficial.
Some people, in absence of condom, practice anal intercourse thinking it is safer than vaginal intercourse. But, all the facts and their justification suggest otherwise. People need to know these facts, especially the men who have sex with men as they are hesitant to open about their sexuality in fear of social stigmatization and hatred which acts a barrier to their access of sexual and reproductive health services provided rendering them more at risk.