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Nancy Padian, MS, MPH
School of Public Health University of California Berkeley

John Pickering, PhD
University of Georgia Athens

JAMA. 1986;256(5):590.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The heterosexual transmission of acquired immunodeficiency syndrome (AIDS) from males to females is well documented in studies of female partners of hemophiliacs, ¹ intravenous drug users, ² and bisexual men (N.P. and W. Winkelstein, unpublished data). Sexual transmission from females to males is less well documented. Although we do not doubt that this phenomenon occurs, ³ we question whether the ratio of male-to-female cases in Africa necessarily supports the hypothesis that AIDS is primarily spread in Africa by bidirectional heterosexual transmission.

The ratio of male-to-female AIDS cases varies geographically. In the United States, this ratio has been 13:1 since the beginning of the epidemic.⁴ In Africa, the ratio is closer to unity, although not necessarily 1:1, eg, 1.1:1, ⁵ 2:1.⁶ An explanation that may account for some of this discrepancy is that data across continents are not always comparable, and that conditions such as medical . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Senior Contributing Editor; Sharon Iverson, Assistant Editor.

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