In the February 1st issue of the Journal of Infectious Diseases, scientists from the University of Washington published a study that further illustrates the potential importance of antiretroviral therapy in preventing HIV. The study of discordant couples found that one of the most important factors in predicting the likelihood of HIV transmission was viral load. As the amount of HIV in the blood increased, so did the risk of transmission during any sexual act. This explains how, and why, antiretroviral treatment could reduce a person's infectivity - the "treatment as prevention" paradigm.
The study also confirmed several other factors that are important for prevention. The scientists found that condom use was highly effective at preventing HIV. They found that genital ulcer diseases such as genital herpes increased the likelihood of transmission. They also confirmed the protective role of circumcision.
Interestingly, one unexpected result of the study was that the increased risk of transmission from men to women, as opposed to vice versa, could largely be explained by other factors - such as viral load. This flies in the face of the historical understanding that the widely observed difference was primarily due to the mechanics of exposure during sex. Men deliver a large load of potentially infected material (semen) into the vagina, where women have a large area of cells which are susceptible to infection. In contrast, women's vaginal secretions are primarily infectious to men through a much smaller surface area on the penis, and they are more easily removed after sex. It will be interesting to see if that result is borne out in further studies or if it turns out to be a fluke.
Source: http://std.about.com/b/2012/01/25/lighten-your-load.htm
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