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[68] [69] Rough sex can be a factor associated with an increased risk of transmission. [70] Sexual assault is also believed to carry an increased risk of HIV transmission, as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections. [71]
In July 2010, the White House announced a major change in its HIV/AIDS policy; the "National HIV/AIDS Strategy for the United States" stated that "the continued existence and enforcement of these types of laws [that criminalize HIV infection] run counter to scientific evidence about routes of HIV transmission and may undermine the public health goals of promoting HIV screening and treatment."
Studies conducted in sub-Saharan Africa have found that circumcision reduces the risk of HIV infection in heterosexual men between 38 and 66% over two years. [27] Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007. [28]
HIV-1 is more virulent and more infective than HIV-2, [20] and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2, compared to HIV-1, implies that fewer of those exposed to HIV-2 will be infected per exposure. Due to its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa. [21]
The main route of transmission for women is through unprotected heterosexual sex. African American women are 19 times more likely to contract HIV than other women. [89] By 2008, there was increased awareness that young African-American women in particular were at high risk for HIV infection. [90]
In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin; therefore, properly shielding the penis with a properly worn condom from the vagina or anus effectively stops HIV transmission.
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