The Context of HIV Risk Among Drug Users and Their Sexual Partners

during that time, and the possibility of female-to-male transmission was
small.
Because the majority of AIDS cases occurring today reflect infections
that were acquired during the early years of the epidemic, most
heterosexually acquired infections among men still may be in the
asymptomatic or latent stage (Friedland and Klein 1987; Osmond 1990).
The infectivity of an HIV carrier increases over time, suggesting that this
additional factor in the natural history of HIV infection may magnify the
effects alluded to above. Following this line of reasoning, it has been
argued that virus concentration in genital secretions also may increase
over the course of the infection (Burke and Redfield 1988). On the other
hand, Haverkos and Battjes (1992) recently have argued that the relative
frequency of female-to-male transmission has been underestimated
(primarily as the result of the way that cases are classified), suggesting
that it represents a more significant public health concern than is
generally believed.
COFACTORS IN FEMALE-TO-MALE TRANSMISSION OF HIV
Of additional significance here are the relationships among prostitution,
untreated STDs, condom use, and HIV infection. In 1988, Cohen and
colleagues argued that:
If prostitutes [in the United States] are effectively
transmitting the AIDS virus to their customers, there
would be far more cases of white, heterosexual males
diagnosed with AIDS than are reflected in the current
statistics, because some IVDUs in New York, including
some prostitutes, have been infected with the AIDS virus
since at least 1978. The average street prostitute sees
1,500 customers a year. If even five percent of female
street prostitutes in New York City were infected by
1981, the year AIDS was first identified, even
moderately efficient transmission of the virus from
prostitutes to clients would have resulted in the diagnosis
of at least 100,000 white, heterosexual men by now.
(p. 18)
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