Lack of evidence for transmission of human immunodeficiency virus through vaginal intercourse

Abstract

Research in determining risks for human immunodeficiency virus (HIV) transmission is confounded by many issues. They include lack of clarity or specificity in terminology used, respondents misunderstanding of questions, and lying. The base rate of lying (or social desirability responding) by itself is sufficient to account for the small percentage of Americans and Europeans claiming "heterosexual" transmission from partners not known to be intravenous drug users. This study integrates the physiological and epidemiological data on risk factors for HIV transmission with the psychological literature on the frequency of anal intercourse and of lying (in this case to researchers and clinicians about risk factors). When these factors are considered, intravenous and anal activities remain the only clear vectors for HIV transmission. Research suggesting that spermicidals are more effective at inactivating HIV than condoms are at physically containing HIV is also noted.

PIP: The purpose was to demonstrate that the notion that HIV is transmitted with little impediment during vaginal intercourse by healthy adults was likely to be confounded because of various forms of unreliability including deception on the part of the respondents in epidemiological and clinical studies. The topics examined covered risk groups and behaviors, respondent reports, animal models, and lying and other sources of unreliability. The safety of condoms and spermicides was also compared in regard to protection against HIV. Regarding risk groups and behaviors, anal intercourse and unsterile iv activity were found to be potent vectors for HIV transmission and appeared to be the behaviors associated with primary risk group membership. The frequency of heterosexual anal intercourse was 18.6% among North American college women according to a 1990 study, providing a potent vector for HIV transmission. Patient reports indicated that even to inquire about activities known to spread HIV (iv activity and anal intercourse) had resulted in incorrect attribution of such spread to vaginal intercourse. Animal models could not be taken as a model for HIV transmission. 1993 Centers for Disease Control tabulations based on 94% of all AIDS cases recorded in the US through September 1993 indicated that 1.0% of male AIDS patients (2899 of 281,168) and 10.1% of female AIDS patients (3773 of 37,314) denied being in such groups. Another 1.3% (3715 of 281,168) of male AIDS patients attributed their AIDS to heterosexual contact with iv drug users, transfusees, or sub-Saharan Africans. The total liar rate was 5% among AIDS patients. Lying by respondents, their inability to recollect the details of sexual activity, and the intellectual limitations of some respondents resulted in seropositive subjects failing to report anal intercourse or iv activity. Such failure often resulted in attributing HIV spread to vaginal intercourse.