Sexual

The majority of HIV infections are acquired through unprotected sexual relations. Sexual transmission can occur when infected sexual secretions of one partner come into contact with thegenital, oral, or rectal mucous membranes of another. In high-income countries, the risk of female-to-male transmission is 0.04% per act and male-to-female transmission is 0.08% per act. For various reasons, these rates are 4 to 10 times higher in low-income countries.^[34]

The correct and consistent use of latex condoms reduces the risk of sexual transmission of HIV by about 85%.^[35] However, spermicide may actually increase the male to female transmission rate due to inflammation of the vagina.^[36]

A meta-analysis of 27 observational studies conducted prior to 1999 in sub-Saharan Africa indicated that male circumcision reduces the risk of HIV infection.^[37] However, a subsequent review indicated that the correlation between circumcision and HIV in these observational studies may have been due to confounding factors.^[38] Later trials, in which uncircumcised men were randomly assigned to be medically circumcised in sterile conditions and given counseling and other men were not circumcised, have been conducted in South Africa,^[39] Kenya^[40] andUganda^[41] showing reductions in HIV transmission for heterosexual sex of 60 percent, 53 percent, and 51 percent respectively. As a result, a panel of experts convened by WHO and theUNAIDS Secretariat has "recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men."^[42] Research is clarifying whether there is a historical relationship between rates of male circumcision and rates of HIV in differing social and cultural contexts.^{[citation needed]}

On the other hand, some South African medical experts have expressed concern that the repeated use of unsterilized blades in the traditional circumcision of adolescent boys may actually be spreading HIV.^[43]

Bugchasing and giftgiving is the active pursuit to contract and transmit HIV, respectively.