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A medical question. I've often heard it said that one is far more likely to contract HIV as a result of gay sex than straight sex. Is this statement true purely as a result of the incidence of HIV infections in the gay male community (i.e. the proportion of gay men who have HIV is vastly higher than the proportion of straight people) - or is there also a mechanical component that makes the virus more likely to spread via certain sexual activities than others? That is to say, supposing Alice and Bob both have HIV, and they've both had it for the same duration, neither are taking PReP. Is Carl more likely to contract HIV as a result of having anal sex with Bob than as a result of having vaginal sex with Alice? Moreover, if Carl had anal sex with Alice, would he have the same risk of contracting HIV as he would if he had anal sex with Bob? Lastly, does it make a difference who the receptive partner is - is Carl more or less likely to contract HIV from Bob if he's the bottom than if he's the top, or does it make a difference?
Yes, tops rarely contract HIV through performing anal sex on bottoms (though it is thought to be marginally more common in uncircumcised men than circumsised ones.) Bottoming is the main cause of contracting HIV among men who have sex with men.
I don't know if there is any research on whether a woman receiving anal sex is more, less or the same riskiness as a man receiving anal sex in terms of HIV transmission rates but I'm curious to know the answer.
Unfortunately, most studies specifically looking at heterosexual anal intercourse are either explicitly or implicitly about Vulnerable Populations, which leaves little reason to trust it can be meaningfully compared with the typical study of gay intercourse. Or they just use gay numbers directly for estimates.
There's mechanical and social reasons that it could be riskier for bottoming men (guys on average like it rougher, the prostate exists) or women (less likely to stretch themselves recreationally, selection effects on partners), but it's probably not a knowable number, and my gut check is that it's probably not an orders of magnitude difference.
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